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Orthodontics/Retainers after Braces

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Question
Hi, I have a question regarding retainers and wisdom teeth. I am 24 years old and had braces 6 years ago. My last two wisdom teeth are coming in, and my dentist is positive they will all come through and none will have to be extracted.  I have been wearing my retainer every night since having braces, but have not in the past 6 months. I tried to start back wearing it, but it does not fit anymore. My back molars have shifted due to my wisdom teeth coming in. My molars are crooked, but my front teeth look fine. Should I contact my Orthadonist about getting a new retainer, or wait until my wisdom teeth fully come in? Also, should I ask about getting something some to straighten my molars, or just not worry about them? Thanks!

Answer

Hi Kaycee,

Pardon the delay in getting back to your question. I was at a meeting in Atlanta. I see you are from South Carolina, and I had the pleasure of  also visiting western South Carolina during my latest trip. Walhalla, Seneca, Tacoa Falls and the surrounding are truly beautiful places.

Anyway, getting back to your question. Again Kaycee, as always, 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.  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.

You wrote:

“ My last two wisdom teeth are coming in, and my dentist is positive they will all come through and none will have to be extracted. ”

That is good news Kaycee. In the past there has been a lot of discussion about the prophylactic extraction of wisdom teeth. The lack of more definitive evidence based dentistry has created very active discussions. If your family dentist recommends the extractions, then that is fairly compelling.

You also wrote:

“. I tried to start back wearing it, but it does not fit anymore. My back molars have shifted due to my wisdom teeth coming in. My molars are crooked, but my front teeth look fine.  “

Kaycee, I don’t have the benefit of  photos or X-rays, but usually back molars are fairly stable relative to the front teeth.  Perhaps what you experienced was late eruption of the second molars and subsequent impaction or semi-impaction issues with the third  (wisdom teeth) molars. If they are in fact shifted, the extraction of the wisdom teeth may have an impact on prevent in further shifting, but may not in fact correct the current misalignments.

You asked:

“Should I contact my Orthodontist about getting a new retainer, or wait until my wisdom teeth fully come in? Also, should I ask about getting something some to straighten my molars, or just not worry about them? Thanks!  “

This part Kaycee is a bit complex without the benefit of any diagnostic records. If your dentist feels the wisdom teeth should come out, it may be for several reasons, not just shifting of the teeth.

1) Sometimes a semi-impacted wisdom teeth only half erupt into the mouth. The gum tissue surrounding the molar can become inflamed and because keeping the tooth sufficiently clean is not possible.
2) Sometimes the wisdom teeth are inclined in a manner that is almost horizontal and there is no likelihood of eruption. In cases like this wisdom teeth are sometimes recommended for extraction.
3) The inclination of a wisdom tooth also sometimes is such that the crown of the wisdom tooth collides with the root of a second molar located directly in front. This can cause damage to the root of the second molar. Again third molar extraction might be advised.

In terms of sequencing the various actions. I would have you consider:

1) Have your family dentist send the X-rays to the Orthodontist. Ask the Orthodontist to review the radiographic records independently. Also ask what limited treatment options, if any, exist for treating  the crowding.
2) If extraction is indeed indicated, then consider: A) Extracting the teeth;  B) Getting new removable aligners, if indicated or desired, to correct the molar shifting, and; C) Final retainers to hold everything in place.

If the molars are not that badly shifted, consider the wisdom tooth extraction option and new removable retainers. If you have any follow up questions Kaycee, then please follow up with some questions and include X-rays and photos if possible.

Thank you for writing Kaycee, and please stay in touch and let me know how all this works out.

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health
http://www.braces.com
http://www.leesburgbraces.com

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.

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Paul Supan, DDS, MA, MPH

Expertise

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 braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

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.

Experience

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.

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

Publications
Available upon Request.

Education/Credentials
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.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

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