Why You Should Wear Retainers;

Even If You’ve Never Had Braces!

Let me explain. You might be thinking… Wait, a retainer is used to hold (or retain) your teeth after they have been moved orthodontically so why would you need a retainer if you never had braces in the first place. I am not suggesting that all teenagers who don’t get braces should get a retainer instead. However, it is my recommendation that almost all adults wear a retainer part-time to prevent unwanted tooth movement.

The reason orthodontic retainers are so important is because of the unique biology of the jawbones. The section of jawbone that hold the teeth (the alveolar bones) are different from all other bones of the body. They behave more like the immature bone found during youth that allow us to grow. The alveolar bone is that unique part of bone that supports the teeth. If the teeth are lost the alveolar bone is lost which is why people without teeth look like their lips have sunken in, they have lost the slip support that comes from teeth and the supporting alveolar bone. Teeth and alveolar bone go together, you can’t have one without the other. The alveolar bones are especially sensitive to mechanically applied forces. Orthodontics applies forces mechanically so this explains why braces and Invisalign are able to move teeth predictably. It is not the actual brackets or braces that move the teeth, it is the forces created utilizing the braces, wires and any other adjunctive orthodontic tool including rubber bands. These forces apply pressure to the ligament surrounding the teeth, which in turn apply pressure to the surrounding alveolar bone. If the alveolar bones did not respond to these types of light pressures orthodontics as we know it would not be possible. 

The relationship between the teeth, the periodontal ligament and the alveolar bone, along with the special properties of the alveolar bone allow braces to apply forces to move teeth through the bone. Due to this special relationship the teeth are never 100% stable.

Orthodontics is not the only thing that applies pressure to the teeth. I am sure you have known a child who has used a binky for too long, or who has sucked their thumb. Did you notice that the teeth in these children often do not overlap properly. This is due to the light regular force applied to the teeth from the pacifier or thumb. Having a pacifier is normal, however ideally it should be taken away by age 2 to avoid long term dental changes. I fully understands how hard this can be see the image below of my daughter with her prized binky collection. 

She sure is cute - but started to get an open bite from her binkys. At age 2 we said goodbye to the pacifier and luckily her teeth corrected on their own.

If a habit persists well into development an open bite and dental cross-bite can occur due to the pressure applied by the thumb (or fingers) during growth. The image below is a patient of mine who had a thumb habit that continued through development into their teethage years resulting in a significant open bite where the front teeth did not touch at all. This pressure actually changes how the jaws develop altering the final shape of the alveolar bone that holds the teeth, which changes the bite. If you would like to read more about oral habit and the impact on the teeth along with how orthodontics can help, stay tuned for the upcoming blog post “Get Rid of the Binky by age 2; Your Child’s Teeth Will Thank You!”. Let’s get back on topic. This post isn’t about pacifiers or thumb habits, I mention these examples to underscore how pressure can impact and move teeth and jaws without braces!

In a normal bite with normal developmental growth, the cheeks, lips and tongue all apply pressure on the teeth resulting in an equilibrium or balance of forces that help keep the teeth stable. We know this because in rare cases of trauma or sickness in which part of the cheeks, lips or tongue change in shape this equilibrium is lost. If this equilibrium changes the pressure applied to the jawbones is no longer balanced resulting in changes in the tooth position, bone shape and bite. You may be asking yourself, if there is a stable equilibrium then why would I need a retainer. Well the answer is simple; the face slowly changes as we age altering this equilibrium slightly. 

It is well understood that as we age our faces gradually change. When these changes occur in the area of the lips and cheeks it can result in movement of the teeth. A normal but notable resorptive area of our face is the boney region between our lip and chin. This means that with age the bone in that area naturally resorbs, or gets smaller. This is the same region of bone that holds the roots for the lower front teeth, which is a contributing reason why the lower incisors (front teeth) are the most common teeth to shift or become crooked with age. People tend to notice an “all of the sudden shift” but that is usually not what actually happens. Typically there is a very slow gradual shift that goes unnoticed until it becomes large enough to become obvious.  

Teeth hold bone. Use a retainer to hold your teeth that will hold your teeth!

Have you ever known someone who always had straight teeth, maybe they never even had braces then one day their lower teeth started to shift? While it can be a natural part of aging it isn’t necessary. Teeth hold bone, retainers hold teeth, ipso facto if you are currently happy with where your teeth are but you do not have a retainer I recommend that you ask about retainer options that may be right for you. Likely you will only need a simple retainer to be worn at night to ensure your teeth do not move. If your bite is stable it doesn’t even need to become part of your routine every night. You may only need to wear a retainer once a week, or even less frequently depending on your teeth. 

There are some cases where a retainer is not indicated. For example, if you have significant bone loss or root damage to teeth a retainer could put unnecessary forces on those teeth. There are also cases in which certain types of retainers may not be a good fit. For example, if you have a very high risk of cavities, and less than ideal oral care habits, certain retainer designs can increase your risk of cavities. It is best to have an orthodontist evaluate your teeth and jawbones before getting any orthodontic appliance. Just like a retainer, I am just here to keep you straight!

This one is for the moms - If Jonathan Taylor Thomas wears a retainer then you can to!

Let’s hope he is still wearing his retainer to sleep.