Orthodontics/retainers

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QUESTION: Do i need to keep my retainer in water ALL THE TIME?
so i have retainers when i'm travelling i don't wear them all the time so i'm suppose to keep them in water? How will i put it in my bag if i keep them in water'?
My retainers box is not air and water tight .so water wil definitely come out .

so can I put my retainers in case without water .
is there a need to add water in it ??
Plz help

Clear Essix Style Retainer in a Case (dry)
Clear Essix Style Reta  
Upper Hawley Style Removable Retainer
Upper Hawley Style Rem  
ANSWER: Hello Yash,

You asked:

Do i need to keep my retainer in water ALL THE TIME?
//snip//
so can I put my retainers in case without water .
is there a need to add water in it ??
Plz help


Dear Yash,

Thank you for your question. I spoke with two other dentists about your question.  Since it is 2015, I was curious if they recommended putting night guards, full or partial dentures, Orthodontic retainers, etc. into water. They do not.

Retainers in 2015 are generally made of an acrylic and metal.  Others are vacuum formed and made of clear plastic (see Image). Unlike certain contact lenses which perhaps need to be kept moist, retainers are more or less rugged enough and do not require immersion in water.

Yash,  I have a background in infection control, and it is actually my opinion that maintaining a removable oral appliance in a medium such as water might in fact promote the growth of pathogens such as colonizing bacteria, funguses, etc. For example, certain hot tubs and even gymnasium equipment have been cited as a source of transmission for certain human papilloma viruses (HPV). Bacterial growth in a retainer case that is constantly kept moist can not be ruled out. I would be cautious of keeping a retainer case constantly moist. Dry is better.

Let me also say that many years ago older materials were used in dentistry, such as vulcanite. It was often customary to place dentures made of vulcanite into a glass of water when a person retired to be for the night. In my 35+ years of experience as a dentist, I have seen vulcanite prosthetic appliances, but never an Orthodontic retainer made of this older generation material.

This has been my experience in the United States and Germany. I cannot speak for places such as India. I also do not which to go against the instructions of your local Dentist or Orthodontist. If he or she is insisting that the retainer be stored in water, do ask why and do kindly resubmit your question with this additional information.

Now I would also like to briefly mention that there are reasons to sometimes place retainers into a medium such as water or mouthwash in order to keep the appliance clean.
In the United States, and in India as well, one can buy denture cleaning tablets and solutions. Some of my patients will put a denture cleaning tablet into a cup or glass of water and let the cleansing tablet clean and freshen up the retainer.

My point is Yash, that while such an immersion will not hurt a retainer, in my experience, it is NOT NECESSARY to keep an Orthodontic retainer in a fluid solution when it is not being worn.  Is it perhaps possible that you misunderstood the instruction you received, or that the Dentist may have accidentally misspoken and offered you the wrong instruction in the maintenance and care of your retainer?  

My recommendations for you at this point Yash include:  

1. Please check with your Dentist or Orthodontist to make sure he/she has given you the correct instructions.

2. Regardless of whether you have a clear Essix style clear retainer, or a traditional Hawley style with acrylic and metal clasps and bows, do use a retainer case when the appliance is not in the mouth.

3. My recommendation is to keep the retainer clean, but dry in the case when you are not wearing it.  

4. Rinsing the appliance with water and cleaning it with a tooth brush, as well as soaking it in water with a denture cleanser will keep it clean and free of debris.

5. Some doctors also recommend soaking the retainer for short periods in mouth wash to reduce or kill the bacteria . Some mouth rinses contain high amounts of alcohol which may affect the plastic part of a retainer, so check with your doctor for exact instructions.  

6. Some people employ Ultra Violet (UV) light to help kill bacteria on a denture or retainer. Again, ask your doctor for guidance.

Yash, I hope that this has helped. Your question asked about an unusual topic. Please resubmit your question with images if you have any further concerns.

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. I also will sometimes consult with other doctors on complex questions. This of course takes time.  Your understanding is appreciated.



---------- FOLLOW-UP ----------

QUESTION: Can u tell me the minimum time in a DAY(24 hr),for which I should wear my retainers (hawley)?

I know retainers is to prevent the natural shifting of teeth .
but what should I do ..its just that when I remove my retainers to eat something or for having meals , then I get engaged in other things so much that I forget to wear those retainers again for atlest  1-2 hrs.
so plz suggest me the minimum time in a day for which I must wear it .
Or
can I wear it only at night ??
Is that not okay ??
Wearing it before going to bed and then remove it during morning.
Plz help doc..

Answer
Patient wearing clear upper retainer
Patient wearing clear  

From braces.com Clear and Hawley Retainers
From braces.com Clear  
Dear Yash,

Thank you for your follow up question. I have been traveling so pardon the slight delay. I do try to get an answer back always < 7 days.  I actually was looking through some images I had in my clinical records to also assist in explaining my response to you. I appreciate your inquisitive approach regarding retainers. I believe you are doing anything and everything to help maintain a nice orthodontic result after much effort by you and your Orthodontist.  

Your main question in the follow up was  

Can u tell me the minimum time in a DAY(24 hr),for which I should wear my retainers (hawley)

This may sound like a simple question, but it is not. In fact, in my opinion, there is no single correct answer. Rather the best response is actually a series of responses depending on the specific circumstances of the case. Permit me to break this down into more easily digestible chunks of information. The answer below may be a bit detailed, but it comes together at the end I think to really help explain your situation Yash.

1.  Types of Retainers:

For both upper and lower teeth, these days there are basically three types of retainers which are commonly employed in the US for helping to ensure Orthodontic retention after treatment.

The first type I want to describe is a FIXED bonded lingual wire retainer. It is not intended to be removable by the patient. Basically this is employed along the anterior four (left lateral incisor to the right lateral incisor), or anterior six teeth ( left canine to the right canine). A small wire is custom bent so that it adapts very closely to the inside curves of the teeth, and the shape also courses slightly in between the teeth where one tough touches the next (the proximal contacts to use dental lingo). The wire can be of various types. Some doctors choose to use .040 or .040 solid wire which they will custom bend. Other doctors will use a braided wire that they may find more easily adapts to the curves and bends of the inner aspects of the anterior teeth. Some doctors have even used fibre materials in cases where metal allergies are a concern. Any of these will work, and I am not aware of any Evidence Based scientific studies which have demonstrated the superiority of one type of lingual fixed bonded wire retainer over the other. Once places, a bonded lingual retainer is basically not adjustable, unless removed by the doctor, and then re-bonded again to the teeth.

A second type of retainer is what you already seem to have, namely a Hawley. This is a classic REMOVABLE retainer which can in fact be adjusted as needed.  The retainer is made of acrylic, and an upper Hawley fits onto the roof of the mouth and is kept securely in place by a series of metal clasps that gently encircle the molars or fit in between the contacts of the teeth. A lower Hawley has its acrylic body fitting along the lower inside aspect of the gums between the tongue and the inside (lingual) aspects of the lower teeth.

The Hawley has advantages and disadvantages. Slight movements of the teeth can be achieved if a patient has had some relapse. A hallmark of this style of retainer is a metal labial bow, that is a somewhat thick metal wire or bow that courses along the outside aspect of the teeth. This is in fact a disadvantage for some people, because they have aesthetic objections, and refuse to wear a retainer which can be so readily discerned.  Some patients also complain that they find the Hawley appliances somewhat bulky and cumbersome to wear.

At third type of REMOVABLE retainer is the clear type often referred to as  an “Essix” or “Invisalign” style clear retainer.  This type of retainer is very aesthetic and does not have any metal in case of potential patient allergies to metal. It is basically a removable but non-adjustable retainer “sort of”.  That is, one can somewhat adjust it by using special instruments to thermally cause indentations in the plastic, or perhaps remove certain area of acrylic covering a tooth to permit slight movement. Another advantage of this retainer is that it covers the entire tooth, and more or less  “fits snugly” like a corset and therefore is very good at keeping teeth in place. All this of course assumes patient cooperation in wearing the retainer. Another advantage is that is can act as a night guard to prevent destructive wear due to bruxism or  “grinding” of the teeth while the patient is asleep.

In 2015, at least in my practice, the clear types have become the preferred style. In difficult cases I will often provide the patient with BOTH a bonded lingual wore and a removable clear style retainer. This is analogous to have seat belts and an airbag in the car for back up. If I suspect a patient may likely relapse and be non-compliant regarding retainer wear,  the supplemental use of a FIXED bonded lingual retainer helps to ensure that the teeth will not shift.


2. Pre-Treatment Severity of the malocclusion

Yash, this brings me to the next relevant retainer issue, namely what was the initial condition before treatment. A very severe malocclusion where the teeth are severely crowded may require more robust follow up retention after treatment.  Imagine an overweight  person who perhaps weighs 125 Kg (about 275 pounds) and who then loses 50 Kg (about 110 pounds) to achieve a healthier weight.  Then imagine a second person who is no overweight, but who weighs say 70 Kg and wishes to lose just 5 Kg.  The first person may have a higher tendency to regain a lot more weight and to “relapse” in contrast to the second person where the change in weight was less profound.

Similarly in Orthodontic treatment, more severe cases are often ones which tend to relapse more. Part of this is dependent on the proper diagnosis and treatment by the doctor. A borderline extraction case which is treated non-extraction may be more susceptible to relapse in contrast to an extraction approach. Furthermore, sometimes factors such as personal dysfunctional habits such as nail biting, or in the case of adolescents, additional skeletal growth, can result in relapse. The picture is not completely clear, but overall, a large change can result in a potentially large relapse is what I am saying.

3. Discussion:

So now Yash we come to your specific question regarding wear. And the most accurate answer is …it depends…

There are some Orthodontists who advocate the position that retention is for life. As the body changes, maintaining an ideal bite takes additional effort. Teeth wear down over time, bone support of the teeth decreases, restorations such as crowns and dental fillings due to tooth decay, and many other issues can influence stability of the dentition.

If you have a Hawley, again follow the direct advice of your Doctor. For my patients, I would generally have them wear their retainer of choice full time for 4-6 months. Afterwards I advise them to wear it at night ongoing. Some patients report that they wear it only on week-ends, and they have been able to maintain a good result.

Yash, part of this may depend on the severity of your initial pre-treatment malocclusion. It may also be influenced by your periodontal status. If there has been considerable loss of bone support among certain teeth, more rather than less retainer wear is called for.

A clear style retainer may be better for you if you have aesthetic concerns. As stated earlier, there is the added benefit of a clear style retainer helping to prevent abrasive damage due to grinding of the teeth while you sleep.

Also, let me address the anecdotal reports you will hear from time to time that person X never wore their retainers and their teeth are fine. That may very well be, but it is the exception, not the rule. One hears of people living to 90 + years old who smoked heavily.
Epidemiological studies would suggest that smokers in fact have shorter, not longer, lifespans.  I suppose some cars will never be in an accident and therefore do not need to have seatbelts and airbags.  It is not possible to determine which rare and unusual Orthodontic cases will remain stable without the help of retainers.

5. Summary:  

So Yash, I would recommend the following action steps,  


1.Check with your Orthodontist regarding retainer wear.
2,Inquire if a clear retainer would help out your specific condition.
3,Inquire if a fixed bonded lingual wire would assist in stability
4.Share your concerns with your Orthodontist about your ability to wear or not wear whatever style of retainer you do end up with.
5.Ask if night time only wear using either a Hawley or Clear style retainer will suffice.


I have described some of the various background factors which impact your situation. With this information, I hope the conversation between you and your Orthodontist will allow you to collectively arrive at a good solution to your situation.  Thank you for writing Yash.  Please feel free to send any follow up questions, but be so kind as to submit additional clinical images if you elect to do so.


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. I also will sometimes consult with other doctors on complex questions. This of course takes time.  Your understanding is appreciated.

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Paul Supan, DDS, MA, MPH

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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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