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Orthodontics/retainer usage/clenching


I had braces for two and a half years and got them off in November of 2012. I have a permanent retainer on my top four teeth and bottom 6 teeth. I also have a removable clear plastic retainer for my top teeth. Is it necessary to wear the removable retainer anymore??? It caused me to clench my teeth at night because of the feeling it has, and now i can't stop clenching at night, with or without it. How can i stop the clenching as well?


Hello A,

Great question.  First of all i think your Orthodontist did a great job to give you double security regarding the retention. having fixed small wires in addition to the removable retainers is like having an airbag as a back up to a seat belt.

What I write here are only my opinions based on very limited information. My comments should not be viewed as any form of diagnosis, definitive or otherwise,  or any form of  treatment recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should  only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Okay… having said  that…  your  questions focused on bruxism and your need to continue to wear the clear retainers at night.

There is a strong feeling in the orthodontic community that retention goes on forever. Now that can be interpreted in different ways. Using another analogy, pretend you have been on a diet and have achieved your weight goal. You may still find yourself stepping on a scale once a week. Does that mean you are dieting....?? Well you are sort of "watching things " I suppose.

Generally stronger retention strategies are called for when a person had an very severe original orthodontic problem. In other words, if the teeth were extremely crooked, they will want to shift back to their old ways much more so than in the case of a person with only slight misalignments.

Sometimes an orthodontic case involves both a skeletal (bone) and dental (teeth) discrepancy. If growth or surgery does not address the skeletal issue (say a weak lower jaw causing the upper teeth to appear protruded), the Orthodontist may wish to address the skeletal issue with a dental compensation. In other word, instead of doing jaw surgery, the teeth are sometimes moved to camouflage a weak jaw profile.  Again in cases where strong dental compensation has been used, robust retention strategies may be needed to keep everything stable.

Here is a link to some thoughts on retention along with photos.

I also would like to comment on the bruxism or clenching. This may or may NOT be related to the appliances. In fact, clear retainers like yours often are used to help address night time bruxism.  Do check the retainer to see if it has perforations. It could be that you naturally have night time clenching and that you are simply seeing manifestations of that as the retainer shows continuing evidence of being worn and abraded.

My take home recommendations to you "A" would be to continue with night time use of the retainers. Check with your orthodontists to see if they are still in good shape, sufficiently functional, and in fact still fitting properly. The Orthodontist may be able to detect\wear patterns or shortcomings in the appliances which you may not be able to recognize.  Also ask if you can alternate wearing only the upper one night while wearing only the lower removable clear retainer the next night.

One last point to ask is if you have had your second and or third molars fully erupt. You did not state your age. In some cases, orthodontics is completed before the second and or third  molars are fully erupted and in occlusion ( contacting upper and lower teeth). In such cases the retainer may not cover these teeth. If they have possibly over erupted relative to the other teeth, some bruxism might arise. Again, the solution is to have your orthodontist have a quick look.

I hope I have answered most of your concerns "A".

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health  


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Paul Supan, DDS, MA, MPH


First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites and are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.


Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Available upon Request.

BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

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Available upon Request Please see my personal websites and for further personal background.

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