An Ounce of Prevention

Dr. Pfister demonstrates the retaining power of Invisalign®.

“An ounce of prevention is worth a pound of cure.”

These words were spoken by Ben Franklin in 1736, as a starting point solution to fire-threatened Philadelphians, who faced losing their homes and worldly possessions to a recent surge in fires in the Philadelphia area.

In essence, we have all heard and learned that it is easier to stop something from happening in the first place, than to have to repair the damages after it has occurred.

Anybody over 21 years of age would have to agree that this is not just a nice saying or proverb, but should be a guideline or mantra for life itself!

Medically speaking, my parents (or anyone over 75 years of age) grew up in an age where you ate what grandma and grandpa ate, caloric or fat content were never discussed, smoking was just a way to unwind even at the dinner table, and exercise was getting the mail. And then, when our parents got cancer or had a heart attack and died (as my dad did when I was 15), we were always shocked!

Prevention should not be a random act, but a way of life!

As important as prevention is in medicine, equally is its importance in dentistry. As oral health education has improved over the decades, we all know if we want to keep our natural teeth, routine checkups at the dentist (along with regular daily brushing and flossing) are a must.

The American Dental Association has seen a distinct reduction in those individuals needing dentures with each passing decade. And with the use of fluoride toothpaste and reducing sugar consumption, especially at bedtime, our children are exhibiting less decay in many areas.

Recently, I’ve been asked about two areas in Orthodontics that I feel would fall into the “prevention department”…

The first question is, “How long do I have to wear my retainers?” and the second is “Do I really have to get my wisdom teeth out?”

As you will see, both questions are related to each other and to the longevity of your great smile.

Let’s look at retention first (i.e., the use of retainers).

As an orthodontist, I use the laws of physics and geometry with just the right amount of pressure to stimulate or inhibit natural bone deposition or remodeling, to move teeth through the bone, to properly align them. Once properly aligned and your amazing smile is created, keeping it there is a balance between inner bone stability and outward lip, cheek, and various other external forces intent on moving them out of alignment. This is in a healthy bone state. Throw in hormone imbalance, pregnancy, or improper calcium utilization, osteoporosis, and it’s a wonder how the poor little retainer can be so successful. But to be successful, it has to be worn! One of the favorite quotes young orthodontic residents learn early on to say in orthodontic school is, “Wear your retainers for as long as you want to keep your smile intact.”

After a few years in practice, I learned this statement may not be practical for everyone and that there were systems and routines that patients could utilize to preserve their smile. Bonding in a lower retainer helped with cooperation and many of these style retainers have gone 10-15 years without breakage, but oral hygiene is tough.

Enter Invisalign®…

The dawn of the clear retainer, fitting tightly to the entire lower arch and worn only at night or twelve hours during the day, has greatly reduced the post-treatment movement of teeth; and oral hygiene is back to normal!

There is another collateral benefit to this aligner retainer — it also functions as a night guard to protect the enamel on your crowns, especially the posterior teeth, from clenching and grinding.

The American Dental Association has shown (from surveying its members) a definite increase in night and day clenching, with TMJ soreness and tooth sensitivity, during and after Covid. We humans build up life’s stresses within our bodies and then try to find ways to channel it out. Clenching and grinding seems to be an ideal way to release the lactic acid build up from our TMJs and chewing muscles.

My protocol for retention is to wear your retainers every night for the first five years after treatment and then at least three times a week after that to hold the teeth in place; or, continue every night if clenching and grinding is an issue.

Women need to be vigilant during pregnancy. Many of my female adult patients have actually shown me which teeth moved with each child. Once morning sickness hits, the retainer takes up residency in the bathroom drawer, not to be used again. I have always tried to instruct my moms-to-be to at least wear the retainer during the day for several hours, if nighttime has its challenges.

Finally, one of the biggest challenges to post-treatment stability in either gender… the dreaded wisdom teeth.

Now, let’s see why there’s no wisdom in keeping wisdom teeth (and why it’s a good preventive measure to have them removed)…

Archeologists and paleoanthropologists have shown over the years that our jaws have gotten smaller with successive generations. There was a time when we chewed tough meat that contained lots of silicate that wore down our teeth, making room for a third set of molars, the wisdom teeth.

But today, due in-part to Wolf’s law, form follows function. We do not place significant workloads on our jaws by eating fast food, thereby we have smaller jaws. A human can have from zero to eight wisdom teeth, each one can have a twin, but four is the most popular. Wisdom teeth usually try to erupt from 17 years of age… after the person is usually out of orthodontic treatment and supposed to be wearing their retainers.

Many of my adult patients coming in for Invisalign still have their wisdom teeth present or remark that they were recently removed but their teeth have already crowded up, especially in the anterior. Some wisdom teeth only erupt half way and then stay soft tissue impacted. These form a pita pocket in the gums, usually leading to periodontal disease, due to the inability of the patient to clean and remove bacteria from the pocket.

Some wisdom teeth dissolve the root of the twelve-year molar in front of them, as they try to erupt, leading to a root canal or loss of the molar. Still more exciting is the wisdom tooth that falls over horizontally and forms a cyst as it dissolves all of the neighboring bone in a failed attempt to erupt, leading to the jaw fracturing at the angle of the jaw.

Invisalign currently won’t print trays back to the wisdom teeth, due to usually not enough space to move them into proper occlusion.

And last, but definitely not least, is the abundant research between chronic inflammation from gum tissue found around partly erupted wisdom teeth, with increased accumulation of cholesterol plaque deposits in blood tissue… the long-term effect being increased incidence of heart attacks and stroke.

After all the proof that is out there on the need to remove wisdom teeth at the appropriate time, I still get monthly push back from patients and parents who want to “watch them.”

You can stand on a railroad track watching an approaching train, but at some point you need to make a decision to move (or you may not like the outcome).

As you can see, there is no magic or secret formula to keeping your smile amazing after orthodontic treatment…

It really comes down to 2 key things:

1) a routine determination to be vigilant in wearing your retainers (and observant to dental movements in your mouth that are the result of outside forces overriding your retention program); and

2) above all, getting an intellectual evaluation of your wisdom teeth.

An ounce of prevention is worth a pound of cure.

Now, you know how to prevent that beautiful smile from slipping off track.

Happy Friday,

Dr. Pfister