Orthodontics/Bite feels off
Hello Dr. Paul,
I have a few questions, but I'm hoping you could help me. I recently started feeling like my bite is off. There are times when it does feel normal, but it's probably once or twice a week. Most of the time, when I bite down I only feel like my back teeth are touching. So most of the day I try not to let my teeth meet and my jaw gets tired. It is a horrible feeling because this has been going on ever since I had a wisdom tooth removed in March.
I will give you a bit of my background and maybe that will help you answer my questions. I am a 22 year old female and I had braces back in sophomore year of high school. They were removed before my senior year and I have a permanent retainer on my bottom teeth. I haven't worn my upper retainers in about 2 years. My wisdom teeth started coming during college. The two on my left side of my mouth are still impacted while the other two on the right side of my mouth did erupt. Well my upper wisdom tooth erupted completely while my lower wisdom tooth partially erupted. I had that one taken out back in March because my gums kept getting inflammed in that area. Well ever since then a whole bunch of problems have been arising.
My first problem is that my two front teeth have shifted a little bit. It isn't really noticeable, but you can tell if you look pretty close. Is that from my wisdom teeth coming in and not wearing my retainer? Can wisdom teeth shift all the molars forward or just the one right in front of it? Is there anyway I can fix this minor shift, for example getting a spring retainer?
My second problem is my bite. Ever since I removed my bottom left wisdom tooth back in March, my bite has never been the same. It also seems that the tooth in front of the wisdom tooth seems to have shifted as well. I think because the wisdom tooth was leaning up against it and when I got it removed, it didn't it didn't really settle down. Sometimes when I press down the gums by the extraction site, I still feel a sharp pain/tingling feeling months after my surgery. When I bite down, I tend to bite down on that one back molar. Is there a way to possibly fix my bite? I am thinking of having the rest of my wisdom teeth removed and I'm hoping that will fix my bite again.
Third, I have been grinding and clenching more than usual. I think its because when I go to sleep my jaw can't seem to rest. My teeth are having a hard time meeting together like they used to. I may need to get a nightguard, but if I get a spring retainer I will need to have both on at the same time. Is it possible to get a nightguard fitted over a spring retainer for the nightime?
Lastly, I have a permanent retainer on my bottom teeth. Ever since I got it, my gums have receeded a little bit. It is barely noticeable, but I hate seeing those gaps in between my teeth. I think its mainly because I can't use regular floss and I need to use a special floss. One my brackets broke a few months ago and I haven't gotten it fixed. I would like to get my permanent retainer removed. I have had it on for about 5 or 6 years now and I think its time for some removeable retainers. Do you think that is a wise decesion? I am just worried about the cement that was put on my teeth to hold the brackets. What if they drill too much off and drill some of my tooth enamel off? When I got my braces off years ago they did just that and you can see where there was some enamel shaved off by mistake.
I apologize for this question being so long. I will understand if you can't answer it since you have real patients to worry about. Thanks for your time and have a great day!
I apologize for the delay, as I have been out of town in Seattle at a conference.
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 changes since completing treatment. You wrote:
My first problem is that my two front teeth have shifted a little bit.
My second problem is my bite. Ever since I removed my bottom left wisdom tooth back in March, my bite has never been the same.
Third, I have been grinding and clenching more than usual.
Lastly, I have a permanent retainer on my bottom teeth. Ever since I got it, my gums have receded a little bit. It is barely noticeable, but I hate seeing those gaps in between my teeth.
The problems which you describe can, in part, be broadly termed "relapse" and it is not unusual to see this happen. Over time, whether one has had orthodontic treatment or not, there will be changes in the dentition, and may include changes n the gum levels, bone recession shifting of teeth, wearing down of the dental enamel, etc. I feel that what you are describing may be quite realistically within the limits of what can be expected, even though I do not have the benefit of photos and other records.
Problem #1 is a slight5 shifting of the upper central incisors. Retainer wear generally will prevent this. at this point, if the movement is extreme enough to be objectionable, there are two possible treatment options, namely to put braces on the anterior teeth for a very short period, or to consider wearing a removable "aligner" to re-align the teeth. This appliance can be either a removable clear plastic aligner or a spring retainer. After this is corrected, you may which to inquire abut having a lingually ( inner tongue side of the teeth) bonded wire placed in addition to a removable retainer to help ensure long term enhanced stability.
Problem #2 concerns your bite. I do not have records, but if this lower third molar was erupted in place, and contacting the opposing upper teeth, it may have played a role in defining your upper vs. lower teeth bite relationship. Upon removal, the bite may have experienced a change. If the extracted third molar was in fact unerupted or impacted, then the sudden change in the bite may be due to other factors. Speaking from personal experience, when I had my third molars removed back in my twenties, the oral surgeons opened my jaw to such an extreme that for two years I had slight jaw pain and a slight difficulty in re establishing my bite. I attribute this to inadvertent excessive opening and stretching of the jaw while the surgeons wrestled to remove the impacted wisdom teeth. Whether some slight damage occurred to the anatomy of my jaw joint is not clear, but the discomfort resolved. The bite also settled down, but this may have been due to slight adjustment in the positioned of the teeth as well. In your case, I just can not tell based on the information you provided. As a solution, I would say wear a night tie only this clear retainer which should help provide comfort for a poor bite at night should you be predisposed to grinding your teeth.
Problem #3 you may have already answered. If you do correct your upper teeth with a clear aligner, this will serve double duty as a temporary night guard so to speak. After the correction is complete a clear retainer may also serve the trick of helping you from experiencing damage to your teeth from night clenching or "bruxism". There are some differences between a custom night guard and a custom retainer. For many individuals a slightly thicker ( .060 inch thick) clear retainer works quite well as a "night guard". Only of you are an extreme clencher and "bite" though the plastic will a thicker more robust night guard be needed. Some clinicians assert that the custom notching of the opposing teeth in a "proper" night guard is important. I have not read evidence based dentistry research to that effect, and in my not so limited anecdotal clinical experience, .060 thick retainers have been very well received by my patients with few complaints. My bottom line advice. Consider a clear retainer to correct the upper incisal shifting, and then get a bonded lingual wire and a .060 inch thick clear retainer to cover it all which can serve double duty as a night guard for your bruxism.
Problem #4 is about the slight recession. hat is a tough call. I have had patients who had worn bonded lingual lower retainers for 20 years with little if any problems. If plaque and tartar (calculus) accumulation is an issue, perhaps better brushing and flossing are a solution. If recession is strong, a consultation with a periodontist may be helpful. I would say that there is a risk benefit situation here. The lingual wire clearly helps to stabilize the incisors, yet there are some concerns for the gums as well. Check with your orthodontist, genera dentist, and/or periodontist for advice.
Daniel, I know this has been a long and winding explanation. I hope it answers some of your questions. Again, I have been in Seattle, Washington for a week, and I apologize for the slightly delayed response.