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If you’ve seen advertisements or considered programs where you can straighten your teeth by buying clear aligners on-line or through the mail, think again. The American Association of Orthodontists ("AAO") recently issued a consumer alert for direct-to-consumer orthodontics and has raised serious concerns about this service because there are over 1000 customer complaints and consumer horror stories on the Better Business Bureau's website for SmileDirectClub and other companies that sell options to straighten teeth by ordering clear aligners through the mail.

Consumers are often lured into these programs by the lower cost or convenience, but unfortunately, they don’t often understand how it works and they are unaware that there is no oversight by an orthodontist. In fact, unless you live in an urban area where you can go in and have a tech provide a scan of your teeth, you will most likely take your own impressions of your teeth with a putty at home.  Once you do that and mail it in, they ship you a set of plastic trays that you wear to align your teeth.

There are several problems with this model:

• There is no dental assessment to see if you are a good candidate for clear aligners to straighten the teeth. Some individuals with more complex issues need metal braces to achieve a well-aligned bite and a healthy smile
• There is no exam to assess dental, periodontal, jaw or joint health to determine if you will do well with the treatment. Additionally, there is no oversight of changes that may occur over the course of treatment.
• There is no tracking or monitoring of progress or the movement of the teeth, which means there is not an opportunity to make needed adjustments along the way.
• When the treatment time is up and you have cycled through all the sets of aligners, that’s the result you get, and it is a result that many people are unhappy with.

While people are often unhappy with the end result because their teeth are not straight or they didn’t achieve the result that they had hoped for, it’s important to note that the consequences can be even more serious. When you are moving teeth, if not done correctly, it can lead to potentially irreversible and expensive damage such as tooth and gum loss or a misaligned bite.

Who is the right candidate for straightening teeth with clear aligners?

 When people want straight teeth one of the first things that an orthodontist will do, beyond a dental health assessment, is to determine the best method or technique to use to straighten the teeth. Clear aligners, such as Invisalign, are not always the right option for every person. An underbite or overbite, jaw or joint pain, uneven tooth wear or a misaligned bite are all signs that metal braces may be needed to achieve an optimal result. These individuals with more complex cases or bite-related problems would not be ideal candidates for clear aligners.  Orthodontists would instead recommend regular metal braces, because they can be more aggressive with the treatment, predict the outcome more accurately and achieve a more optimal result.

The right candidate for clear aligners is often someone in their thirties, fourties or fifties who had braces when they were younger and may have had some movement in their teeth.  Sometimes this is because they didn’t wear their retainer or as they have aged the jaw has changed shape which has caused some aesthetic shifting. Clear aligners are ideal for these patients who have a good bite and generally well-aligned teeth.

Benefits of seeing an orthodontist

If you want to achieve the best result, you best see an orthodontist.  Orthodontists attend dental school and then complete another three years of training beyond that specifically in orthodontics, facial development and the biomechanics of the jaw. They are uniquely qualified and dedicated to getting the best possible outcome.  When seeing an orthodontist you can expect:

• That you will have a complete and thorough oral health assessment to determine if you are a good candidate for orthodontic treatment and identify any underlying periodontal concerns.
• To form a relationship with your doctor and create mutually agreed upon goals for straightening your teeth.
• You will receive the right kind of braces for your individual treatment plan – sometimes that is clear aligners, other times it may be metal braces, or some combination of both.
• Your progress will be monitored every step of the way. The doctor will monitor your teeth to ensure they are tracking with the digital treatment plan and a 3D model of what the teeth are supposed to look like at each stage of the process. As they compare the teeth in the mouth and the bite to that digital model, they make necessary adjustments, because sometimes additional techniques or modifications in the treatment plan are needed to achieve the optimal result.

Keep in mind that even though some cosmetic dentists now offer clear aligners, they still do not have the additional years of specific orthodontic training that is critical for treating complex cases and achieving superior results.  An orthodontist is not just focused on the aesthetic look of the smile, but rather the underlying health of the jaw, the bite and the alignment.  It’s proper alignment that helps to maintain a healthy jaw and avoid problems with sore joints and chipped or broken teeth from uneven wear you age. The truth is, good orthodontic care keeps you mouth not only looking great, but feeling great for a lifetime!

While you have braces, it’s important that you brush your teeth regularly. We recommend four times daily to avoid the accumulation of food particles in your teeth and braces.  Ideally, it is best to follow the schedule below: 

• In the morning after breakfast 
• After lunch or right after school 
• After dinner 
• At bedtime

Flossing while Wearing Braces

Flossing takes more time and patience when you are wearing braces, but it is very important to floss your teeth every day. We recommend flossing at night to make sure your teeth are clean before you go to bed.

Use a floss threader to get the floss under your archwire. Pull a small length of floss from the dispenser through the threader and slide it up and down along the front of each tooth. Use care around your archwire, and do not floss too aggressively around it or put too much pressure on it.

Rinsing with an Antibacterial Mouthwash

To reduce inflammation to your gums and cheeks, we suggest using a hydrogen peroxide antiseptic mouth rinse. This rinse will help prevent infection and decrease irritation that may develop from your braces. Rinse your mouth with two teaspoons of the hydrogen peroxide rinse for one minute, and then spit it out. You may use it up to four times daily following brushing. Just like using peroxide for a scrape on your skin, this hydrogen peroxide mouth rinse helps the inside of your mouth heal. It can be used for general irritation caused by your braces or for canker sores, cheek bites and other minor injuries to the gums.

Using an Interdental Toothbrush

An interdental (between the teeth) toothbrush is used to clean underneath and around your archwires and braces. Please use the interdental toothbrush gently to avoid damaging your wires.

Topical Fluoride

We recommend using a sodium fluoride gel to help prevent tooth decay while you are wearing braces. This gel kills bacteria and replaces minerals in the tooth enamel that have been removed by harmful acids. Using a fluoride gel does not replace daily brushing and flossing, but it should be applied following your daily schedule at bedtime. Place a small strip of the gel on a toothbrush and apply it to your teeth for one minute. Then spit it out. Do not eat or drink for 30 minutes afterward. It is important for the active ingredient to stay on your teeth for 30 minutes, so do not wash it away by eating, drinking or rinsing.

Cleaning Your Removable Appliance or Retainer

If you have a removable appliance, brush it every day as a part of your regular brushing and flossing schedule. Because food particles and plaque can accumulate on your appliance just as they do on your teeth, soak it daily in water with a dissolved denture-cleaning tablet at room temperature.

At one time or another, anyone may pick up a bad habit. But there are some situations where a bad habit can actually have a negative impact on their health and influence the development and function of his or her teeth, jaws and mouth. Some examples of these bad habits are:

• Persistent thumb sucking
• Tongue thrusting
• Mouth breathing

The sucking reflex is natural in early childhood and it usually disappears between ages 2 and 4. But if it persists much longer than that, the pressure of the thumb on the front teeth and the upper jaw can actually cause the teeth to move apart and the jaw to change shape. This can lead to the orthodontic problem known as an “open bite,” and may even effect speech. An open bite can also be caused by the force of the tongue pushing forward against the teeth, also known as tongue thrusting.

Mouth breathing — an abnormal breathing pattern in which the mouth always remains open, passing air directly to the lungs — is related to alterations in the muscular function of the tongue and face. It may cause the upper and lower jaw to grow abnormally, which can also lead to serious orthodontic problems. Although mouth breathing may start from a physical difficulty, it can become a habitual action that's hard to break.

Unfortunately, these potential problems aren't always easy to recognize on your own, but your orthodontist will be able to spot them. Fortunately, there are several orthodontic treatments that are available to help correct these bad habits and the sooner they're taken care of, the less damage they may cause.

While you are wearing braces, please avoid eating hard foods, sticky foods and foods high in sugar. Hard foods can break or damage the wires and brackets, and sticky foods can get caught between the wires and brackets. Minimize the amount of sugary foods you eat, as the sugar can cause tooth decay and other related problems.

Examples of Sticky Foods to Avoid:

• Gum (sugar-free or regular)
• Licorice
• Sugar Daddies
• Toffee
• Tootsie Rolls
• Caramels
• Starburst

Examples of Hard Foods to Avoid:

• Ice
• Nuts
• Hard taco shells
• French bread crust/rolls
• Corn on the cob
• Apples and carrots (unless cut into small pieces)
• Bagels
• Chips
• Jolly Ranchers
• Pizza crust
• Uncooked carrots (unless cut)

Minimize Sugary Foods like:

• Cake
• Ice Cream
• Cookies
• Pie
• Candy

Only Once a Day:

• Soda
• Sweetened tea
• Gatorade
• Kool-Aid
• Drinks with sugar

When you have braces it is very important to maintain a good oral hygiene regimen throughout the length of your treatment. Braces, wires, bands and retainers can all trap food particles and make it difficult to brush or floss away plaque. Careful brushing and flossing, preferably after every meal and snack, is the best way to prevent plaque build-up, tooth decay and gum disease.

We encourage patients to quit bad habits, such as fingernail biting, pencil and pen chewing and chewing on ice or other objects, as all of these activities can break or damage your braces. It's also important to regularly check your braces for bent or loose wires and brackets. If you have a loose/broken wire or bracket, please call our office immediately to arrange a time to have it repaired.