As soon as the braces come off, many people feel that the hard work in getting a new smile is all done. But wait! There's one critical piece of the process that remains: the orthodontic retainer. What makes this little device so important?

To understand that, let's look at how your teeth are attached, and how they may move. A tooth isn't anchored into the jaw like a screw in wood — it's joined to its bony housing by a unique, hammock-like suspension system called the periodontal (“peri” – around; “odont” – tooth) ligament. The periodontal tissues are living, constantly changing and renewing themselves.

Orthodontic appliances like braces are designed to apply just enough pressure to move the teeth slowly and steadily into new positions. As the teeth are moved, the periodontal tissue gradually re-forms around them, helping to hold them in their new locations.

But tooth, bone and gum tissues also have a “memory” which, if left alone, tends to move the teeth rapidly back to their original places. This unwanted movement gradually lessens, but it can be an issue for a long time after treatment. That's where the retainer comes in.

This little device holds the teeth steady in their new positions until the bones and ligaments have had enough time to re-form — a development that can take several months. It brings the entire process of moving the teeth to a gradual close, helps to prevent trauma and to maintain proper tooth location.

Once, all retainers were made of plastic and wire, and all were removable. These are still popular, and are usually worn 24 hours a day at first, then less often, until (after a period of time) they're only worn at night. Alternatively, in many cases a thin wire can be bonded to the inside surfaces of the front teeth. This type of retainer doesn't show, and it doesn't have to be removed.

How long will you have to wear it? It's hard to say. Teeth are kept in position not only by bone and ligament, but also by a balance of forces between the tongue, lips and cheeks. They aren't permanently fixed in place, but can move over time in a way that's unique to every person. Depending on the type of tooth movement done, we can recommend what type of retainer is right for you, and how often to wear it. Having the right retainer will help ensure you get the best result: a great new smile.

If you would like more information about orthodontic retainers, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Why Orthodontic Retainers?” and “The Importance of Orthodontic Retainers.”

Sometimes, we all need a bit of prompting to do what's good for us. When Serena Girardi, the 10-year-old daughter of New York Yankees manager Joe Girardi, needed to have orthodontic treatment, she was a little nervous. To help lessen her anxiety, Girardi, then 45 years old, made a deal: if she got braces, then he would too.

“What I didn't realize,” said Girardi in an interview with ESPN, “is that she only had to get four on her front teeth and I got the full mouthful.”

But that didn't stop the baseball great from keeping up his end of the bargain. In a separate deal with his son Dante, who also needed braces, Girardi agreed to wear blue rubber bands. “It's a good look,” he said. What will he do if his third child needs braces? Stay tuned...

Whether it starts as a bargain with your kids or as a promise to yourself, orthodontic treatment can offer real benefits at any age. In fact, about one out of five orthodontic patients today is an adult. Studies have shown that up to three-quarters of all adults have some form of orthodontic problem, like drifting or crowding of teeth. And having a great-looking smile not only improves self-confidence, but can also boost an adult's social life, and even enhance his or her career opportunities.

If you or your child may need braces, but you're put off by the dreary metal hardware you remember from back in the day, take heart! Plenty has changed in the field of orthodontics since you were a teenager — and it's not just the color of the rubber bands.

In many cases, clear or colorless ceramic braces can be used instead of metal ones. These stain-resistant orthodontic appliances blend in well with your own teeth, making them much less evident. It may be possible for them to be placed on the lingual (tongue) side of the teeth, where they're even less visible.

Clear aligners offer an alternative to braces that's appropriate for some people. Aligners are a series of precision-made “trays” composed of polyurethane plastic. Worn 20-22 hours per day for a period of months, these appliances gradually move teeth into an improved position. Besides being virtually invisible, another advantage of these trays is that they may be removed for eating and for important occasions. Once recommended only for adults, they have recently become available to teenagers as well.

What's the best way to find out whether you or someone in your family could benefit from orthodontics, and which treatment option best suits your individual needs? Come in to our office for a consultation! After a thorough examination, we would be happy to recommend the most appropriate treatment methods for your particular situation.

If you have questions about orthodontic treatment, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “Orthodontics For The Older Adult” and “Clear Aligners for Teenagers.”

Everyone's heard the jokes about root canals. Now, let's go beyond the myths and get to the “root” of the matter. Here are a few things everyone should know about this relatively painless and beneficial procedure.

1) If you experience discomfort after eating hot or cold foods, sharp pain when biting down, swelling of the gum tissue, or acute tooth pain, you may need root canal treatment.

All of the above are symptoms of disease in the pulp tissue, which lies deep within the roots of teeth, inside tiny canals that go from one end of the root to the other. Pulp tissue can become infected or inflamed for a variety of reasons, such as trauma or deep tooth decay, causing pain and leading to further complications.

2) Diseased pulp tissue in the root canal must be removed to prevent more problems.

The acute pain may go away — but without treatment, the infection in the pulp tissue won't. It will eventually travel through the ends of the tooth's roots and into surrounding areas. This can lead to dental abscesses, and may even cause systemic problems and diseases in other parts of the body.

3) Root canal treatment is effective.

Removing the diseased pulp tissue removes the infection. Pulp tissue itself is a remnant of tooth development which the tooth no longer needs. After the tissue is removed, the root canal is filled with a biocompatible material, and then it is sealed. A crown or other restoration is usually done after root canal treatment to restore the tooth to its full function.

4) Root canal treatment is generally pain-free.

Just like having an ordinary filling, the process begins with an anesthetic administered to numb the tooth and the nearby area. A tiny hole in the tooth's biting surface provides access to the canal, and minute instruments are used for the procedure. Afterwards, over-the-counter pain relievers are typically all thatâ??s needed to relieve the sensitivity that may persist for a day or two following the treatment.

5) A properly done root canal preserves your natural teeth.

A tooth that has had appropriate root canal treatment and restoration can last just as long as a natural tooth. That's important, because the other option — removal of the tooth — can lead to issues like unwanted tooth movement and bite problems. Saving your natural teeth should be the first priority in proper dental care.

If you would like more information about root canals, please contact us to schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine articles “Common Concerns About Root Canal Treatment” and “Signs and Symptoms of a Future Root Canal.”

Being “in the pink” is a good thing; it means you're healthy. Being “in the red” is not so good; it means your health is questionable (financially, anyway). Though they weren't coined for dentistry per se, these colorful expressions are helpful reminders when it comes to taking care of your gums: Pink is their natural, healthy color; that's what you want to see every time you look in the mirror. Red is generally a warning that something's amiss.

If your gums, or “gingiva,” appear slightly swollen and reddened at the margins and/or they bleed when lightly prodded by brushing or flossing, it's likely that you have gingivitis. This is an immune response to the buildup of bacterial plaque (biofilm) at your gum line. It is also an early red flag for periodontal disease (peri – around, odont – tooth), a degenerative process that affects not only the gums, but the periodontal ligament that attaches each tooth in its bony socket, and the underlying supporting bone.

Attentive home dental hygiene practices prevent most plaque buildup from occurring. Brushing correctly at the gum line is a good start. But even a deftly handled brush can't reach everywhere, so it's important to use dental floss or specially designed mini-brushes to get in between teeth and other hard-to-reach areas. Our office can instruct you on optimal home care techniques. We also encourage you to visit at regular intervals for professional cleanings so you are assured of addressing anything home care might miss.

In the absence of good oral hygiene, dental plaque can build and become increasingly difficult to remove as it calcifies, becoming tartar. It becomes a breeding ground for disease-causing microbes that normally wouldn't have the chance to gain a foothold. When caught early, gingivitis can be treated before any harm is done. Sometimes a thorough professional cleaning is sufficient. If the problem is ignored, however, the disease will most certainly progress to destruction of the surrounding, supporting tissues — the periodontal ligament and the underlying bone. If this happens, tooth loss could eventually result.

That said, there can be other causes for bleeding gums. These include:

• Brushing too rigorously or using a toothbrush with bristles that are too firm
• Side effect of a medication
• In women, elevated hormone levels (e.g., birth control pills or pregnancy)
• A systemic (bodily) disease

Whatever the reason, red is not normal when it comes to your gums. The sooner you discover the underlying reason(s) for inflammation or bleeding and take appropriate action, you and your smile will be back in the pink and you'll have no reason to be blue!

If you would like more information about preventing or treating bleeding gums, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bleeding Gums.”

Dental plaque (a film of bacteria that forms on your teeth) is known to be the main cause of periodontal (gum) disease. When the bacteria settle on your teeth they form a whitish film called biofilm. Those that are not removed cause formation of “pockets,” areas of separation between the teeth and their surrounding gums, in which plaque hardens into deposits known as calculus or tartar. The purpose of having your teeth cleaned regularly by a trained professional hygienist is to remove deposits of plaque and calculus. Removal of hard deposits on your teeth is called “scaling.” This can be done either by using hand-held scalers or by newer technology: ultrasonic power scalers.

Let's take a look at the strengths and weaknesses of both types of instruments.

Power Scalers

How they work: These instruments use the energy of ultrasonic vibration to crush and remove hard, calcified deposits of calculus. They also create shockwaves that disrupt bacterial cells. Use of these tools includes washing and flushing the pockets and any exposed root surfaces with water.

Pros: They are as effective as manual instruments for calculus removal in shallow gum pockets and significantly more effective in pockets greater than 4mm. They are very effective in removing calculus from root surfaces and from within periodontal pockets. Their small tips can penetrate deeper into periodontal pockets than manual instruments and are more comfortable to experience, and they are more effective for cleaning difficult nooks and crannies. Coolant sprays flush the area and remove bacteria and their by-products. They require less time than manual instruments.

Cons: A contaminated mist may form so that the hygienist needs to wear protective equipment. The vibration of the ultrasonic instruments may make it difficult to feel if the root surface is completely smooth and free of calculus. Power scalers affect some heart pacemakers.

Conventional Hand-held Scalers

How they work: These depend on the skill and knowledge of the hygienist to manipulate them and scrape away calculus (tartar) from teeth and within pockets.

Pros: They are equally effective for plaque and calculus removal from shallow gum pockets. They do not interfere with electronic equipment like heart pacemakers. They can be used more easily on teeth in which there are areas of demineralization (areas where minerals have been removed from the tooth's enamel, making it more vulnerable to decay). They are easier on the tooth's surface and are thus better for use with porcelain or composite restoration, or sensitive teeth.

Cons: They take longer to complete a cleaning. Sometimes they cause more discomfort than ultrasonic scalers.

In most cases the choice of scalers is not really an either/or situation. Most experts say that the best results come through using both types of instruments. As a result, cleanings can be done with effective and efficient outcomes and greater patient comfort.

Contact us today to schedule an appointment to discuss your questions about dental cleanings. You can also learn more by reading the Dear Doctor magazine article, “Dental Cleanings Using Ultrasonic Scalers.”