Teeth, gums and other treatments

Question 1

Which comes first – periodontal treatment for gum problems or orthodontic treatment?

Accepted Answer

At the first examination, the orthodontist assesses not only the alignment of the teeth but also the condition of the gums. Diseases of the tissues that support the teeth (the gums and bone) can have different stages and symptoms – redness, bleeding when you brush, gum recession and even bad breath. If a patient has gum problems, these must be brought under control before orthodontic treatment begins. A periodontist can give recommendations and arrange maintenance appointments to make sure the gums stay healthy while the teeth are being moved. Once orthodontic treatment is complete, further procedures may be needed – covering areas of gum recession or trimming the gums. Throughout treatment, it is important that there is no active gum inflammation or bone loss.

Question 2

Should I replace a crown (or bridge) first, or start orthodontic treatment?

Accepted Answer

A crown is a protective cap that covers a badly damaged tooth and stops it from breaking. A bridge, on the other hand, joins two or more teeth, often to fill the gap left by a missing tooth. Both can be made from different materials – metal, ceramic or zirconia. It is advisable to replace permanent crowns and bridges with temporary ones, for several reasons: The adhesive used for braces does not bond as well to the material of crowns and bridges as it does to natural tooth enamel, which can mean the brackets keep coming off. If the teeth under the bridge need to be moved, this will not be possible unless the bridge is replaced with individual crowns. When treatment is finished, the teeth will be in a different position, so the old crown or bridge may no longer fit properly. To bond a bracket to a crown, its surface has to be roughened slightly, which spoils its smooth finish. Temporary plastic crowns hold brackets better, and once treatment is complete they are replaced with new permanent ones. The same considerations apply to the attachments (buttons) used with clear aligners.

Question 3

Can a bracket be bonded onto a filling, and will the pressure make the filling come loose?

Accepted Answer

Many patients have fillings (composite or amalgam) in the places where the brackets are bonded. Braces can be bonded onto a filling, but to get a good bond the surface needs to be prepared first – either by roughening it slightly with a dental drill or by applying a special bonding material. Once the braces come off, the filling is polished. If it is sound and functional, there is no need to replace it.

Question 4

Can dead (root-filled) teeth be moved with braces?

Accepted Answer

Dead (devitalised) teeth are teeth whose nerve has been removed because of inflammation and that have had root canal treatment. They are easy to recognise on an X-ray, because their canals are filled with a material that shows up on X-rays. In the mouth, these teeth sometimes look slightly darker than the others. In some cases there may be residual ‘hidden’ inflammation in the root that causes no symptoms, but when the tooth is moved with braces or aligners it can flare up, and the root canal treatment may need to be redone. Moving dead teeth orthodontically is no different from moving any other teeth – they move at the same speed and are not at risk, as long as the roots are healthy and there is no inflammation.

Question 5

Do all cavities have to be treated before orthodontic treatment?

Accepted Answer

All decay must be treated before orthodontic treatment begins, whether you will be having braces or aligners. In certain cases, if a cavity does not interfere with bonding the braces, its treatment can be postponed until the teeth are better aligned. If a cavity is between severely crowded teeth, it may be treated once they have been aligned, so that it is easier for the dentist to reach.

Question 6

My gums bleed when I brush my teeth. Will straightening my teeth help?

Accepted Answer

Bleeding gums are often a sign of inflammation, which needs to be brought under control before orthodontic treatment begins. The cause may be a build-up of tartar or difficulty cleaning the teeth, especially if they are severely crowded. Aligning the teeth orthodontically makes oral hygiene easier and, in the long term, can improve the health of your gums, because it will be easier for you to clean between your teeth.

Question 7

I have gum problems. Can I start orthodontic treatment?

Accepted Answer

Problems such as bleeding gums, gum recession or loose teeth need to be brought under control before orthodontic treatment begins. This is done by a periodontist, who decides when straightening the teeth can begin. The periodontist's work does not end once you are ready for orthodontic treatment – they also need to monitor the health of your gums during treatment to avoid complications.

Question 8

Can braces cause tooth decay?

Accepted Answer

Braces themselves do not damage the teeth, but they create conditions that can increase the risk of decay if oral hygiene is not good enough. Because of their shape, braces trap bits of food, and if they are not cleaned regularly, the plaque that builds up can attack the enamel, especially around the base of each bracket. The first stage of enamel damage, known as demineralisation, shows up as white spots, which can spread over a larger area with time. If action is taken at the first signs of this process, the damage can be stopped and even reversed. To avoid this risk, you need to make an effort to keep up good oral hygiene. Foods high in sugar, such as chocolate and biscuits, and acidic drinks such as fizzy drinks and fruit juices, make decay more likely and should be limited. At every check-up, the orthodontist checks the condition of your teeth and gives advice on improving your hygiene, but keeping it up is also down to you.

Question 9

Are my teeth less likely to decay with aligners?

Accepted Answer

Aligners and braces present different challenges when it comes to hygiene. Braces are fixed to the teeth and trap bits of food, which makes some areas harder to clean. Keeping your teeth clean with braces takes more time and calls for extra types of toothbrush. On the other hand, aligners cover the entire surface of the teeth, and saliva circulates more slowly underneath them, which can encourage plaque to build up. In addition, if you are not able to clean your teeth after eating before putting the aligner back in, plaque can stay on the enamel for longer. According to research, there is no significant difference in how often white spots and decay appear with braces compared with aligners. In both cases, hygiene is crucial. Even so, cleaning your teeth is much easier with aligners.

Question 10

Can cavities be treated while I'm wearing braces?

Accepted Answer

Ideally, all decay should be treated before your braces are fitted. However, a new cavity may develop during treatment, or one may be found in a place that was not accessible before – for example, where two teeth touch. Cavities can be treated during orthodontic treatment with braces too, but the bracket or the archwire may need to be removed to give access. Once the dentist has finished, the orthodontist puts the bracket and archwire back. Removing and refitting brackets and archwires is the orthodontist's job, not the dentist's – in many cases, dentists will not make any changes to orthodontic appliances.

Question 11

Can cavities be treated while I'm wearing aligners?

Accepted Answer

Aligners are made from a digital impression so that they fit the teeth snugly, which is important for the treatment to work. Any change to the shape of a tooth, such as a new filling, can stop the aligners fitting properly and affect the planned tooth movements. If an emergency arises – for example, a piece of tooth breaks off – and a new filling is needed, it can be made smaller so that it does not interfere with the aligners. Another option is to place a temporary filling, which is later replaced with a permanent one before the next planned rescan of the teeth.

Question 12

Can I have tartar removed while I'm wearing braces or aligners?

Accepted Answer

Tartar builds up where the tooth meets the gum. It is hard, mineralised plaque that contains bacteria. If it is not removed, it can cause inflammation and, over time, lead to gum recession. Moving teeth while there is inflammation is not recommended, so tartar should be removed whenever necessary. Dentists have cleaning methods that do not damage braces or cause them to come off. How often cleaning is needed depends on the individual patient. With aligner treatment, once the aligners have been taken out, the dentist has full access to remove the tartar. It is recommended that the aligners are cleaned very thoroughly with disinfecting tablets before they go back in.

Question 13

I have permanent crowns. Do they have to be replaced with temporary ones before treatment starts?

Accepted Answer

A bracket doesn't bond as firmly to a permanent crown as it does to the surface of a natural tooth. When teeth with crowns are moved, the position of the edge of the crown relative to the gum can change, which means the crown has to be replaced after treatment. The contacts between the crown and the neighbouring teeth can also change and may no longer be tight, because the shape of the crown was designed for the position of the tooth before treatment. In general, a bracket bonds better to a temporary crown, and permanent crowns usually have to be replaced after orthodontic treatment anyway, so it's advisable to replace them with temporary ones before treatment starts.

Question 14

I need to have a mini-implant placed. Could my body reject it?

Accepted Answer

Mini-implants, which are placed temporarily in the bone between the roots of the teeth to provide extra anchorage in orthodontics, do not cause allergic reactions in the body. They are made of a biologically inert material. The problems you can expect after having one of these implants placed are: 1. Mild, dull pain for a few hours after the procedure; 2. Possible irritation of the cheek and a sore or mouth ulcer; 3. Inflammation of the gum around the head of the mini-implant; 4. Loosening of the mini-implant, which means it has to be repositioned; 5. Shifting of the mini-implant as a result of it loosening; 6. The mini-implant falling out. None of these unwanted effects causes a lasting problem or major discomfort for the patient. Mini-implants are a completely safe aid for moving teeth.

Question 15

Will straightening my teeth protect them from decay in the future, or will they decay during treatment?

Accepted Answer

Straight teeth have proper contacts with each other, which means less food is expected to get trapped between them. In adults, the most common type of decay is contact decay – that is, decay that starts between two teeth. So if the contacts between the teeth trap less food, we expect less decay. The main factor for healthy teeth, however, remains oral hygiene. If a patient can clean well between their teeth and remove all the plaque, they will not develop cavities. Straight teeth are easier to clean. Crooked teeth are harder to clean, but it can still be done. There is a chance that a tooth may decay during orthodontic treatment, and this again depends on how well you clean your teeth with braces or aligners. The longer treatment lasts, the more likely it is that decay will develop. That is why the best treatment plan is the optimal one – the one that achieves the best result in the shortest time.

Question 16

My gum has swollen between two teeth. Why?

Accepted Answer

The gums can react in different ways while a patient is wearing braces. When the gum is irritated by bacteria, it reacts by swelling, turning red and bleeding easily. In this situation, many patients start avoiding brushing that part of the mouth so as not to make it bleed. This is actually the opposite of what you should do. The gum swells when too many bacteria build up around or under it, or when food gets trapped there. Its defence reaction is to increase its blood supply, because the blood contains many cells that fight inflammation. To calm the gum down, we need to deal with the cause of the inflammation – namely, the bacteria. Thorough brushing, careful flossing with a scraping, sawing motion and an anti-inflammatory mouthwash will calm the gum and make it shrink back within just a few days. Clean the problem area perfectly and don't be afraid that it will bleed – the important thing is to remove the bacteria, plaque, tartar and any other similar irritants.

Question 17

My teeth look more yellow with braces. Why is that?

Accepted Answer

The colour of a tooth isn't the same across its whole surface. If you look closely, you'll notice that a tooth is whitest in its central part, darkest near the gum, and in some people slightly greyish at the biting edge or tip. This is down to the colour and thickness of the enamel. Where the tooth looks more yellow, the enamel is thinner and the inner layer of the tooth – the dentine – shows through; at the biting edge there is mainly enamel, which is semi-translucent, and this gives it that slight grey tinge. Braces are generally placed in the middle of the tooth and cover its whitest part. They also cast a shadow and darken the rest of the visible crown. Even white (ceramic) braces, precisely because they are so white, emphasise the yellowness of the tooth near its neck (by the gum). This is the most common reason teeth look darker with braces. Don't worry – it means that on the day your braces come off, your teeth will immediately look whiter.

Question 18

A filling with a bracket on it has fallen out. Did the bracket pull it off?

Accepted Answer

The bond between a bracket and tooth enamel is the strongest; next comes the bond between a bracket and a light-cured composite filling. The bond between a filling and the tooth is stronger than the bond between the bracket and the filling, so a bracket cannot pull a filling off while it is moving the tooth. If this happens, it simply means the filling hadn't held well to the tooth and needs to be redone.

Question 19

Can a dead (root-filled) tooth start to hurt during orthodontic treatment?

Accepted Answer

Dead (devitalised) teeth are teeth that have had root canal treatment in the past, in which the nerve of the tooth had to be removed. They differ from the other teeth in the mouth in being greyer in colour, and they break more easily. Sometimes these teeth need to be ‘covered’ with a crown to protect them from breaking. Devitalising a tooth involves removing the nerve and cleaning and disinfecting the root canal. Sometimes this procedure is not entirely successful and bacteria remain in the canal, which can be seen on an X-ray even if the patient feels no pain or discomfort in that tooth. Moving teeth with this kind of ‘hidden’ inflammation can make the process flare up and cause symptoms – pain in the tooth. This needs to be distinguished from the normal discomfort that teeth with braces feel while they are moving.

Question 20

Can braces move teeth upwards, towards the gum?

Accepted Answer

Braces can move a tooth in any direction, and the gum follows it, keeping its position relative to the crown of the tooth. This means that if we move a tooth towards the gum (an upper tooth upwards, for example), the gum will move up with the tooth too.

Question 21

Can a tooth die during treatment with braces?

Accepted Answer

A tooth dies when its nerve and blood supply are cut off. When teeth are being moved with braces or aligners, some movements carry more risk to the tooth's vitality – for example, a tooth can die if it is rotated 180 degrees from its starting position. If movements like this are necessary, they must be carried out slowly and with light forces. Another way a tooth can die as a result of orthodontic movement is if the orthodontist applies very heavy forces. In principle this is not acceptable, and it is extremely unlikely.

Question 22

Can my gums recede while I'm wearing braces?

Accepted Answer

Gum recession can be caused by inflammation of the gums (periodontitis) or by traumatic irritation (aggressive tooth brushing, for example). During orthodontic treatment, gum recession can happen if the gum is the thin type (or the type that is prone to recession) and the teeth are moved towards the edge of the jawbone. This kind of tooth movement is not desirable, and the orthodontic plan usually aims to place the teeth in the middle of the bone rather than at its edge.

Question 23

I need a dental implant. Should I have it before or after orthodontic treatment?

Accepted Answer

Of course, this is a question that needs an individual answer depending on the situation. Sometimes the dental implant will be used as anchorage for moving teeth during orthodontic treatment. More often, however, the implant is placed once the orthodontic alignment is finished, so that enough space can be created for it and so that it doesn't restrict the tooth movements we want.

Question 24

Can teeth be moved if I have a bridge or an implant?

Accepted Answer

If you already have an implant before you start orthodontic treatment, you should know that the teeth in that quadrant can only be moved to a limited extent. For example, the implant will prevent movement forwards or backwards, and after orthodontic treatment you may also need to have its crown replaced with one that fits the new contacts between the teeth.

Question 25

Can braces be fitted on teeth that have been built up with bonding?

Accepted Answer

Brackets bond best to tooth enamel, but they also hold securely on other surfaces such as fillings or composite build-ups. To create a strong bond between the two materials, the surface of the build-up has to be roughened (lightly abraded with the dental drill). Once the bracket is removed from that tooth, the composite can be polished with no lasting damage. Bear in mind that bonding is sometimes done to change how teeth look in position (to make them appear straighter). If you decide to straighten your teeth after this kind of work on your smile, the bonding will probably need to be removed so that the braces can straighten the crooked teeth.

Question 26

Can wearing aligners make my gums bleed?

Accepted Answer

Aligners are worn for an average of 22 hours a day, except when you are eating and brushing your teeth. Patients don't always manage to clean their teeth and aligners well enough before putting them back in after eating. This means food particles can get trapped under the aligners and close to the gum. Plaque on the teeth is food for the bacteria in the mouth, and its presence makes them grow and multiply. When a large number of bacteria are in contact with the gum, they trigger an inflammatory reaction, with swelling and gums that bleed easily. If your gums bleed easily while you are in active orthodontic treatment, your first response should be to clean the problem area very thoroughly with all your hygiene tools – and always with floss – to remove the bacteria.

Question 27

Can ‘black triangles’ appear between my teeth during treatment? Why does this happen and how is it corrected?

Accepted Answer

You start orthodontic treatment to straighten your crooked front teeth. Once they are in a proper line after a few months of treatment, you may notice dark, triangular empty spaces appearing between some of the teeth. Some patients call them ‘gaps’, yet they are there even when the two neighbouring teeth are in tight contact with each other. The reasons some patients have this problem are: 1. Thin gums – this is a characteristic of the tissue, and unfortunately patients with this type of gum are prone to gum recession; 2. Large teeth with a wide crown and a narrow base at the gum line (triangular-shaped incisors); 3. Some patients who start with very crowded teeth have less bone in this area. Black triangles can be dealt with by filing down the side surfaces (the contact points) between the teeth concerned and moving the teeth closer together. Sometimes the triangular space is very large and this method cannot eliminate it completely, because too much enamel would have to be filed off the teeth. In these cases it is better to have bonding on the two neighbouring teeth (adding material) to fill the gap.

Question 28

Can the roots of my teeth be pushed out of the bone during orthodontic treatment?

Accepted Answer

Properly planned orthodontic treatment will align the teeth while keeping them surrounded by bone on all sides. In theory, teeth can be moved out of the bone as a result of incorrect treatment. The teeth sit within what is called the alveolar ridge – a horseshoe-shaped ridge of bone made up of soft inner bone and a thin outer shell of hard bone. If the teeth are moved orthodontically within the limits of the soft bone, they will not be pushed out of the bone. If, however, a tooth is pressed until it comes out through the hard bone, there will be no bone around its root in that area, only gum. The gum will not necessarily recede along with the bone, or it may do so years after orthodontic treatment. Widening the bony base is only possible while a person is still growing (in childhood and the teenage years), or with surgical methods in adults. We are limited in how much we can widen the dental arch in adults, because the bone doesn't widen with the teeth.

Question 29

If the root of a tooth has become exposed (gum recession), can this be corrected by moving the tooth?

Accepted Answer

A tooth with recession (a receding gum) can be moved so that the gum sits in a more favourable position and covers part of the recession. This doesn't mean that the bone lost around the root can be restored. Once a tooth has moved outside the boundaries of the hard bone, even partially, it is left with less bone around its root.

Question 30

Can orthodontic tooth movement shorten the roots of my teeth, and is that harmful to them?

Accepted Answer

Root shortening refers to resorption of the tip of the root inside the bone, which can only be seen on an X-ray. There are normal limits within which this kind of shortening affects individual teeth in the mouth – around 1 mm does not affect the health of the teeth. Root shortening occurs in some people who have thin tooth roots and are predisposed to it, and also with certain movements, such as intrusion of the front teeth (moving upper teeth upwards or lower teeth downwards, towards the gum); when excessive forces are applied to the teeth; when elastics and archwires are changed too often (more often than once a month); and in dead (root-filled) teeth, which are additionally predisposed to this process. Within the limits of normal shortening, there will be no harmful consequences for the teeth.

Question 31

Does cleaning off the leftover glue with the drill damage my enamel?

Accepted Answer

The adhesive left on the teeth is removed with a special bur (an attachment for the dental drill) that is designed not to remove any enamel. However, the drill spins the bur at high speed, and when it touches the surface of the tooth you may feel some sensitivity (the bur heats up and the heat irritates the tooth). Once the adhesive has been removed, the teeth are polished until they are smooth. The final, perfectly smooth feel comes after a few weeks, thanks to the polishing action of your toothpaste and toothbrush.

Question 32

Can a tooth fall out when my braces are taken off?

Accepted Answer

I wouldn't say that's possible. If a tooth is at all loose (wobbly because of periodontitis), the bracket has to be removed from it carefully – in other words, the orthodontist will not let a tooth come out when the braces are removed.

Question 33

Can a filling come out when my braces are removed?

Accepted Answer

Sometimes a brace has to be bonded onto a filling. The bond between the brace and the adhesive is weaker than the bond between the adhesive and a tooth-coloured composite filling, so the pressure applied to the brace with the pliers will not make the filling come out. However, if the filling is defective and was not placed properly, it may come off together with the brace. In that case, you should be glad you found out about the faulty filling before the tooth underneath it started to decay.

Question 34

Can I whiten a dead tooth?

Accepted Answer

Dead (root-filled) teeth can change colour over time and look darker, greyish or pinkish. This makes them unsightly and noticeable in the smile, which is why many patients ask about having them whitened. A dead tooth can be whitened by applying whitening gel to its surface, but this is much less effective than whitening the other teeth in the mouth and takes much longer. Internal whitening of such problem teeth is also possible: the active ingredient is placed inside the tooth, in the space left after its filling has been removed. If the dead tooth does not respond well enough to whitening, other options for changing its colour are a veneer or a crown.

Question 35

Can I have bonding on a dead tooth?

Accepted Answer

Bonding is a procedure in which a light-cured composite material is added to the surface of a tooth to change its shape, size or colour. The teeth may be lightly filed before bonding, or the material may be bonded directly onto the tooth. Composite comes in a wide range of shades so that it blends in with the colour of the natural tooth, and it has a slight translucency and a chameleon-like effect that helps it merge with the tooth. If we use bonding to mask the colour of a dead tooth, the composite may improve the tooth’s appearance considerably but may not hide its colour completely, because the material is slightly translucent and is usually applied in a thin layer. If we use bonding on a dead tooth to correct its shape without covering the whole tooth with material, the correction can blend in completely and be invisible.

Question 36

Can I make my teeth bigger with bonding?

Accepted Answer

Bonding can be used to change the size of a tooth. For a slight enlargement, there don’t have to be gaps between the teeth to fill with material – the teeth can be made larger by building up their front surface. Ideally, though, teeth are enlarged when there are gaps between them in the dental arch. Orthodontic treatment before bonding can distribute the spaces in the arch ideally, so that once they are filled with composite material the teeth end up a normal size.

Question 37

Can bonding give my teeth any shape I want?

Accepted Answer

Bonding offers many possibilities for changing the shape, size and colour of the teeth. There are, however, limiting factors that determine the final result. A small jaw cannot be made bigger (i.e. the smile cannot be made wider), large teeth cannot be made smaller, and protruding teeth will not be pulled back with bonding. It isn’t realistic to expect bonding to make your smile look exactly as you imagine it, but it is of course a good idea to come prepared with photos, so that you can more easily explain what you would like to your dentist and they can prepare you for what to expect from the procedure.

Question 38

Can my longer tooth be shortened instead of building up the shorter one?

Accepted Answer

Uneven teeth at the end of alignment are common in adult patients. This is because, while the teeth were out of position before orthodontic treatment, their biting edges became worn and chipped, and sometimes the teeth even fractured. Once these teeth are straightened, the defects in their shape become more noticeable. In such cases, bonding is most often recommended to restore the shape of the affected tooth or teeth. Shortened teeth have usually lost some of their enamel, and adding material to them restores their natural appearance. If the patient wants a solution without bonding or adding material to the teeth, shortening the longer tooth can be considered, although this means artificially wearing down and ageing that tooth, so unless the tooth is unnaturally long, we do not recommend it.

Question 39

Can the points of my canine teeth be filed down? I want them to be even.

Accepted Answer

The four front teeth are called incisors. As their name suggests, they are used for cutting and biting into food, and their shape resembles a spade with a straight lower edge. The first pointed tooth after the incisors is the canine, located symmetrically on either side of the incisors. After it come the premolars and molars. The canine has a pronounced point, and its function is to tear food. Its tip also meets the opposing teeth in a very specific way and takes part in the sideways movements of the jaw. Without the point of the canine, the smile looks unattractive and resembles ‘false teeth’. Many patients don’t like how pointed their canines are, but don’t realise that these teeth contribute to the harmony of the smile and play an important role in chewing.

Question 40

Can I have bonding on my lower teeth?

Accepted Answer

Bonding is a cosmetic procedure that is more often carried out on the upper teeth , but it can also be done on the lower teeth . The difference between the two lies in how the material is built up and how much of the tooth surface is covered. On the upper teeth , it is often enough to restore just the biting edge , without covering the whole surface of the tooth. On the lower teeth , however, it is advisable to add material over a larger part of the tooth to ensure a stronger bond . This is due to the anatomical difference between the two jaws: The upper jaw is fixed , and its front teeth mainly hold the food when you bite. The lower jaw moves , and its front teeth do the main work of cutting through the food . Because the lower teeth take more load during chewing and biting, the build-up on them needs to be more stable and durable than on the upper teeth.

Question 41

When my braces come off, will my teeth have discoloured ‘squares’ where the braces were?

Accepted Answer

Even if treatment with braces has lasted a very long time, there is no visible difference in the colour of the tooth under the base of the brace once it has been removed. You won’t see squares on your teeth. If the patient’s hygiene has been poor, white spots form on the surface of the enamel around the brace, but not underneath it. This enamel is compromised – its structure has been damaged by the bacteria in plaque over a long period – and it needs treatment with a remineralising toothpaste or, if the process is very advanced, with bonding or veneers.

Question 42

How long does it take for swollen gums to go down?

Accepted Answer

Appliances in the mouth – braces, archwires, aligners – as well as the larger number of bacteria that build up because cleaning is more difficult, can make the gums react by becoming swollen and red. Once the orthodontic appliance has been removed and the teeth have been thoroughly cleaned of tartar, stains, deposits and plaque, both on their surfaces and between them, the cause of the swelling has been removed and the gums can return to normal. This process takes a few weeks – at least 3–4. If gum trimming is planned, periodontists advise waiting 6 months after the end of orthodontic treatment.

Question 43

When can I have the tartar removed from my teeth?

Accepted Answer

Built-up tartar can and should be removed before, during and after orthodontic treatment. If a clean is needed before treatment, it is best done at least a few days before the braces or aligners are fitted, to give the gums time to heal. While you are wearing braces or aligners, there is no reason not to have tartar removed and your teeth polished. This can be done by your orthodontist, the advantage being that they can take out the archwires if you have braces and polish the braces themselves more thoroughly. A general dentist or a periodontist can also do the cleaning. After orthodontic treatment, if needed, cleaning can be done straight away when the appliance is removed. Polishing the teeth with bicarbonate of soda (air polishing) is not recommended more than twice a year.

Question 44

How soon after my treatment can I have bonding?

Accepted Answer

Teeth can be built up immediately after braces or aligners are removed, but ideally it is best to wait for the gums to settle and to have the teeth cleaned and polished. This means having bonding after 3–4 weeks. If whitening is planned, you first wait 3–6 weeks for the sensitivity of the teeth and gums to pass, then the teeth are whitened, and after whitening you wait at least 2 weeks before bonding.

Question 45

Which teeth can have bonding?

Accepted Answer

Bonding means attaching a light-cured composite to the surface of a tooth, so it can be done on any tooth. Most often, bonding is done on the front teeth – the front six teeth at the top and bottom.

Question 46

Can my gums recede after a fixed retainer is fitted?

Accepted Answer

There are many different reasons why the gums pull back from the surface of the teeth, and they are studied by the speciality of periodontology. A fixed retainer makes it harder to keep your teeth perfectly clean and can lead to more frequent tartar build-up and gum inflammation. Over time, these factors contribute to gum recession.

Question 47

A stain has appeared in the middle of my tooth some time after my braces/aligners came off. What could it be?

Accepted Answer

If the adhesive from the braces or the aligner attachments was not properly cleaned off the surface of the enamel, over time it can pick up stains and become visible as a brownish spot on the tooth. Another possible cause of staining is white spots that developed during treatment as a result of poor oral hygiene . White spots are caused by demineralisation of the enamel, and if they are left untreated , they darken over time. This happens because of colourings in food and drink (coffee, tea, wine, spices) and the progressive breakdown of the enamel , which makes these spots more noticeable. To prevent these problems, it is important that after braces or attachments are removed , the teeth are professionally cleaned and, if necessary, remineralisation therapy is carried out to restore the enamel.

Question 48

Years after orthodontic treatment, my gum has receded on a tooth held by a fixed retainer. Why is this happening?

Accepted Answer

The causes of gum recession are very varied: aggressive brushing; a traumatic contact on the tooth that overloads it; gum inflammation due to built-up tartar; gum inflammation due to hormonal changes (pregnancy); and disease of the gums and bone – periodontitis. If we cannot find the cause of the recession among these, we may look for it in the fixed retainer. Some types of fixed retainer are made from a material that slowly and uncontrollably moves a tooth or teeth instead of just holding them passively. If the recession comes with a tooth bonded to the fixed retainer having become noticeably crooked, the retainer may need to be removed and the teeth realigned orthodontically. Retainers that carry this risk of shifting are no longer used, but until recently this side effect was not known.

Question 49

Can my tooth enamel get thinner when my braces are removed?

Accepted Answer

The brace adhesive is removed with a high-speed bur. Although this is done carefully and the bur glides over the surface of the enamel, a minimal amount of tooth surface can be lost if it is handled carelessly.

Question 50

Can braces wear down the corners of my teeth?

Accepted Answer

Ceramic and sapphire braces are made of a material whose hardness is comparable to that of enamel. If there is prolonged contact between a tooth and a brace of this kind (most often an upper tooth against a lower brace), you may notice the edge of the tooth wearing down and its shape changing. This kind of contact should not be allowed to happen, and it is eliminated either by filing down the brace or by placing bite-raising material to prop the bite open and limit it. Metal braces don’t cause this kind of wear, because metal is softer than enamel.

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