Now, everyone is looking for ways to save money while making their lives easier with do-it-yourself tutorials. In addition to the home improvement and cooking videos, you will find many dental-related tips online. Among the most popular DIY dentistry information currently trending on social media involves the use of charcoal toothpaste to resolve stubborn tooth discoloration. The results are simply amazing as the black substance provides drastic results without having to visit a dentist. While there are many claims raving about its success, is it really safe for your teeth?
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You’ve spent spend thousands of dollars to straighten your teeth or your kid’s teeth with an orthodontist and the goal is to keep them that way. However, long-term compliance of retainers is an issue. Adults who have had braces tend to be better with retainer compliance. Here is the latest research and my thoughts on keeping your kid’s teeth straight.

Studies show and should not be surprising, that the average patient compliance decreases dramatically the longer a patient is out of treatment. Retainer use is abysmal at five years following treatment.

There are basically three methods used to retain teeth after braces: a clear, vacuum-formed retainer (typically referred to as an Essix retainer), a hard, pink, plastic retainer with a wire in the front (typically referred to as a Hawley-type retainer), and a bonded wire, which is splinted to the back of the teeth. Obviously, the bonded wire has the best compliance because nothing has to be “worn”, but it has its own issues – namely, it only keeps the front teeth straight and flossing compliance is poor because it can be difficult.

The most recent studies I have seen suggest using the clear, vacuum-formed retainers for a year or two and then moving into the Hawley-type retainer. The reasoning is that it is has been shown that kids are more compliant initially with the clear retainers because it is a relief to get rid of all the wires. However, after a while, those types of retainers lose their “memory” and are also difficult to keep clean. Return visits to the orthodontist for retainer checks also decrease as time goes on.

Another great system for long-term retention after orthodontics is a system developed by Invisalign called Vivera. Here’s how it works. You have impressions taken after orthodontics with your teeth in their ideal position. Invisalign creates a digital model of the teeth that stays on file. They send you (4) sets of retainers, which look like the Essix-type retainers, although they are made from the harder type Invisalign material. At the end of the first year you throw out the retainers you have been using and use the second set for another year. This provides excellent retention for four years.

Every year you change the retainers the new retainers feel a little tight because the teeth have moved slightly over that time. However, the “new” retainers were made from the original model, therefore the teeth are moved back to their starting position. After the four years you order another (4) sets of retainers made from that stored digital impression. Guaranteed retention provided there is good compliance. The cost of the (4) sets of Vivera retainers is about $600. That’s $150 per year to guarantee the teeth stay straight.

Of all the choices available, however, my preference is a bonded lower wire on the lower front teeth and a hard plastic custom-made nightguard for the upper. This keeps all the teeth straight and also provides protection of the teeth from grinding and clenching, which is a very common problem. This option also lasts the longest, which is the most cost effective.

I’m sure you have heard the saying “You are what you eat”. This implies that a healthy balanced diet high in vitamins and nutrients and low in junk food is better for you and will help you maintain a healthy body and stave off illness.

Your diet provides your body with the fuel it needs to run at its optimum, so if you are filling your tank with a diet heavy in sugary and fatty foods instead of nutrient-rich vegetables and lean proteins, you’re doing yourself a disservice. A poor diet can lead to weight gain, high blood pressure, digestive problems, increased risk of illness, and can also affect the health of your teeth and gums.

When you eat anything, the bacteria that are already present in your mouth convert the sugar and starch in this food into acids, which attack the enamel on your teeth and can cause tooth decay. The more often you eat foods that contain sugars and starches, and the longer these remain in your mouth before brushing, the greater your risk for decay. That is why it is important to brush and floss after every meal, preferably about a half hour after the meal, to brush away any food particles that may be clinging to or in between your teeth.

Sugar and starch are not just in junk food. Sugar also lurks in things such as milk, yogurt, salad dressing, ketchup, and even some vegetables. Fruit juices, granola bars, and even “nutritional” bars can also be loaded with sugar.

Starchy foods such as bread, cereal, pasta and beans can also wreak havoc on your teeth and gums. Like sugar, starch can also be found in some unexpected places such as bananas, canned soup, prepared spaghetti sauce, potatoes, and some other vegetables like corn and peas.
It’s not just what you eat, it’s when and how frequently you eat. Limit the amount of sugary and starchy foods, especially between meals. Make sure to read nutritional labels so you know what you are consuming. After you do eat any of these things, wait about a half hour for your saliva to naturally neutralize your mouth and then brush with fluoridated toothpaste.

There are several factors other than sugar that can contribute to dental decay. Genetics play a role, in addition to other things such as home care, xerostomia (dry mouth), pH (acidity level), gum recession and age. Decay rates can change throughout life due to these factors. For those who are more prone to decay, a prescription fluoridated toothpaste should be an important consideration. This is something only your dentist can prescribe, so regular dental visits are essential.

Snack on healthier choices such as cheese, vegetables and fruit. These are better for you in general but still require you to cleanse your teeth following consumption. Try to limit your intake of soda and fruit juices and drink plenty of water. Water not only keeps you hydrated but helps with cleansing the mouth.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.stclairdmd.com.

Dentistry has nine recognized specialties. They are listed below with a brief description. As you will notice, cosmetic dentistry is not one of them. Every general dentist does “cosmetic” work – unless they are putting silver fillings in front teeth. There are some general dentists who do more “cosmetic” work than others and some who even limit their practices to esthetic cases. However, a dentist cannot officially be designated as a “cosmetic dentist” or “cosmetic specialist.”

The nine recognized specialties in dentistry are:

Public Health Dentistry – this field of dentistry is involved in the assessment of dental health needs and improving the dental health of a specific population of patients.

Endodontics – this dentist, an endodontist, deals only with the inside of a tooth, the tooth pulp, and the tissues surrounding the tooth. They perform root canal treatments and other procedures only dealing with this specific area.

Oral and Maxillofacial Surgery – these dentists treat a wide spectrum of disease, injuries and defects in the head, neck, face and jaws. Oral surgeons remove teeth, treat oral cancers and other oral diseases, place dental implants and some treat temporomandibular joint (TMJ) problems.

Orthodontics – this area focuses on the straightening of teeth and modification of midface and lower jaw growth. This is the “braces” dentist.

Prosthodontics – this specialty deals with replacing missing or defective teeth using crowns, bridges, implants and removable appliances.

Pediatric Dentistry – specializes in treating dental diseases in children, adolescents and those with special needs.

Periodontics – the periodontist specializes in treating the supporting tissues of the teeth such as the gums and bone that surrounds teeth. Many periodontists also place dental implants.

Oral and Maxillofacial Pathology – this group specializes in the diagnosis of less common dental and head and neck diseases. They work closely with the surgeons.

Cosmetic dentistry isn’t just limited to super expensive fancy stuff. Orthodontics and whitening can give a really dramatic result without any “drilling.” Replacing stained fillings or replacing aging, dark silver fillings can lighten the color of your smile too. Also, most people don’t really think of dentures as “cosmetic dentistry”, but a well-made custom denture can make a huge cosmetic difference as well.

General dentists are allowed to perform procedures within any of the specialties, if they choose to. This includes dental implants, which is also not a recognized specialty.

There are some dentists who refer all specialized treatment out to specialists, and others who do much of it themselves. It really depends on the dentist’s interests and training. Specialists are often relied upon heavily due to their advanced training and focus on one specific discipline.

If you need any specialized care, have a conversation with your dentist about your options. Many patients like to stay within one office to be able to get the care done they need. However, there are times when a specialist’s care is in the best interest of the patient.