I have a son with Down Syndrome. Things are more scary for him than other children. We’ve tried a dentist a few times. None of them have gone well unless we used some type of sedation. His teeth are out of alignment. When I asked my dentist about getting him braces, he said there really wasn’t a point. I’m not sure what he meant by that and I’m trying not to think about the most offensive possibilities. However, I know what it is like to have a bite that is off. When I was a teenager, I had jaw aches and head aches until my teeth were fixed. I don’t want my son to go through the same thing. Is there some type of process for treating a child with Down Syndrome who needs braces?

Cathey

Dear Cathey,

I’m not sure what your dentist meant by there is no point. In fact, a healthy bite is very important. When you have a child that has Down Syndrome, the biggest issue would be sensitivity to his specific needs. Because of that, it is important that you see a dentist and orthodontist who are familiar with special needs care. For instance, some special needs children struggle with certain textures. While some can tolerate traditional braces, others may need a more creative solution or a different type of treatment altogether. There are many options for braces these days.

Special needs dentists will have some useful advice on how to make the transition of using a dentist or orthodontist less scary for your son. I would check out some of the advice that Dr. Tostado gives to patients in a situation like yours. There are some simple things that can be done ahead of time to make for a smoother transition.

This blog is brought to you by Bee Cave Orthodontist Dr. Alberto Tostado.

I am writing a bunch of dentists and a few orthodontists about an issue I have with my smile. I have a HUGE tooth gap. I think the dentist told me about 9mm in width. I am looking for options. I will tell you that the odds are against you as an orthodontist because I really don’t want braces. You’d have to do some convincing about why that is best. I was going to get snap-on smile and had already had all the diagnostics done and my dentist sent it to the company, but they said I am not a good candidate. So, I’m back to square one. My dentist is suggesting Lumineers, but they are pretty expensive so I’m looking for other options. What would you suggest if I came to your office?

Caden

Dear Caden,

Because my specialty is orthodontics, I reached out to a cosmetic dentist I know to make sure you get balanced advice here. He highly suggested you stay away from Lumineers for a couple of reasons. First, they’re usually marketed to inexperienced cosmetic dentists and your case is very advanced. The size of your tooth gap would be enough to fit another tooth in there. That is a very advanced case. One that I would suggest you go to an AACD accredited dentist for and they do not come cheap. They also rarely recommend Lumineers. That brings me to the second reason. Lumineers force dentists to use their lab to do the work, which is not known for producing beautiful results.

My suggestion is for your to close the gap using either Invisalign or Spark Aligners. I know you said you don’t want braces, but these are different. They use clear aligners to straighten your teeth that are invisible even at a conversational distance. You could repair your tooth gap without anyone even knowing you are wearing orthodontics.

I hope this helps. This blog is brought to you by Bee Cave Orthodontist Dr. Tostado.

I had a fall that ended up knocking a tooth backward. The root of the tooth went forward so far that it is now sticking out into my upper lip. While my dentist was able to even out the visible  part of the teeth, the protruding root is still a problem. It hurts my gums and I can feel it in my nose. It is really uncomfortable. Is there a way to get this root back into its original position. My dentist insists that nothing can be done, but this is so uncomfortable, I am hoping you might know something he doesn’t.

Pamela

Dear Pamela,

There is definitely a way to get this root back in place. Truthfully, your dentist could have crunched this all back into its proper place, if he had done it right away. However, you just have to go with what you have to work with now. Yes, this can be dealt with. However, at this point, you have to wait until the area is completely healed. Once that has taken place, then you can go to an orthodontist and they can move the tooth root back.

This can be done by wearing braces on the area temporarily. It would not take as long braces normally would. There are several options for adult orthodontics. Be aware that it is possible that you will need a root canal treatment eventually. Just make sure the dentist does not leave any gutta percha or root canal cement in the crown of your tooth when they do it or your tooth will discolor much more quickly.

This blog is brought to you by Bee Cave Orthodontist Dr. Alberto Tostado.

I ran across this website for dental bands called Teeth Gap. They are designed to close a tooth gap without having to get braces. Are you familiar with these? Do they actually work?

Brad

Dear Brad,

I am glad you wrote before ordering these. First, I see the prices vary from $25 up to $70. Aside from being very expensive for what is, at their essence, fancy rubber bands, they can actually do real damage to your teeth. These do not work like orthodontics do. With braces or other type of orthodontic, such as Invisalign or Spark Aligners, the movement of your teeth is carefully controlled.

This is not the case with these dental band type of treatments. They tip the tooth to move it. This has the potential of creating gaps on the outside of the bands as they move the teeth inward. However, they can also do serious damage to your teeth as well. It can even cause healthy, adult teeth to come loose.

This before and after image is an example of a case by the Teeth Effects Company. While the gap is closed, this patient now has a few problems. The first thing I noticed is how the front tooth on our left looks like it has been pulled out of the socket a bit. I have a strong suspicion that this tooth is now a bit loose.

Whenever you use traditional braces, after each carefully planned movement there is a pause to give the bone time to integrate with the tooth root again. There is no way to do that with the teeth bands. What you don’t want is to have teeth that no longer have a gap, but can fall out of your mouth! In fact, I read of a case where a young woman had her adult teeth come loose as a result of this type of procedure. You can read about it here.

Additionally, you will notice that there are small gaps on either side of the central incisors that were not there previous to treatment. It may even be that the gaps are bigger than they seem here because there is no way to verify this. It looks like the teeth in that area have been photoshopped a bit too because the lateral incisors are a different shape than they were before the treatment.

An Alternative to Traditional Braces

Because you are just talking about tooth gaps, you may be a candidate for Fastbraces. However, if you absolutely don’t want any type of metal braces, there are two aligner treatments that are a good option for you: Invisalign and Spark Aligners. Both of these can straighten your teeth without using metal. No one will even know that you are straightening your teeth.

This blog is brought to you by Bee Cave Orthodontist Dr. Alberto Tostado.

I have a problem with my two front teeth looking way too big and long. They also stick out in front of the rest of my teeth. Everytime I look in the mirror, I feel like I look like a beaver. I don’t know what to do with them. My dentist suggested either braces, which won’t really change how long they are or removing them and putting dental implants in the area. What do you think?

Sandra

Dear Sandra,

Please do not have your teeth taken out. There is a much simpler solution for your situation. Bear in mind that I haven’t actually examined you. Going just on what you described, I would have the teeth shaved down a bit on the biting edges as well as the sides. This can be done with diamond burs and diamond strips.

After that is complete, you can have an Invisalign or Spark Aligners procedure done. Both of these systems use clear aligners to straighten your teeth. These are not visible even at a conversational distance. They will also straighten your teeth in about half the time as traditional braces will.

Combining these two procedures means that you can get rid of the Beaver look without having to get rid of the teeth themselves! Find a great orthodontist who can do an in-person exam you and give you their recommendation.

This blog is brought to you by Bee Cave Orthodontist Dr. Alberto Tostado.

I was never able to get braces as a child. Now that I am more financially independent, I am hoping to get Invisalign, but I am missing a few teeth on my bottom arch. Will Invisalign work in this type of situation? My dentist doesn’t think it will, but I am wondering how much that has to do with the fact that he doesn’t do Invisalign himself.

Janice

Dear Janice,

I am glad you wrote. Invisalign does a fine job working around missing teeth. However, even among dentists who do the Invisalign procedure there are varying levels of comfort in which cases they would feel comfortable handling.

One thing I would suggest is that you talk to an orthodontist who also uses Invisalign. Plus, there is more than one brand of invisible braces. Another one is Spark aligners. This brand can only be done by an orthodontist. Sometimes Invisalign requires buttons to be added which is not the case with the Spark aligners. Plus, their scalloped design reduces irritation.

It is important that you do not try and force a dentist into a procedure they are not comfortable doing even though you are a good candidate. The results rarely work out how you’d like.

You are better off finding a dentist or orthodontist who can do the procedure with training and confidence.

This blog is brought to you by Bee Cave Orthodontist Dr. Alberto Tostado.

I had my invisalign treatment started about three months ago. At first everything was going well, then about four weeks ago my attachments started coming off. First it was the one on my upper right and I had it put back on, then it was one on my lower right the following week. Now another one has come off, and I’m wondering what is going on. Is it something I’m doing or not doing?

Help me.

Candy

Dear Candy,

For those who aren’t sure what these Invisalign attachments are, in some cases,  tooth-colored attachments are bonded directly onto some of your teeth and your clear aligners snap on over these. It’s sometimes necessary to help with the tooth movement.

These attachments aren’t designed to be permanent and will be removed at the completion of your treatment. As such, they do occasionally come off, and this is not a cause for concern. Simply call your orthodontist when one comes off. They may say it’s fine to wait until your next appointment, or they may ask you to come in for an urgent orthodontic appointment.

During the normal course of treatment, there are times that your teeth will be shifting, and this movement can cause pressures that cause the attachments to pop off. This is common, and temporary.

My one concern is the number of them you’ve had come off in this short time period. There are some possibilities of what could be causing this.

1: Your attachments are too “tight”. The clear aligners should fit semi-loosely over the attachments, snug enough to cause retention, but loose enough that the patient can easily snap the trays in and out quickly. If you’re struggling to take them out, that may be putting undue pressure on the attachments. The doctor may simply need to lightly polish the attachment to ever-so-slightly “loosen” the fit.

2: The bonding material may be the cause. If the etching and bonding materials are either expired, compromised, or otherwise weakened in any way, they will not perform to expectations and will easily pop off. I’m sure your doctor or their staff wouldn’t mind double-checking the condition of the materials, just to be on the safe side.

3: Lots of acidic foods or alcohol. If you are someone who takes in a lot of acidic foods and drinks, including alcohol, the acids from these foods may weaken the bond between the attachment and your enamel. Switch to gentler foods/drinks, or rinse immediately after consuming them.

4: Your technique in placing/removing aligners may be in need of adjustment. Some patients lift and “twist” the clear aligners in an improper manner, causing pressures that pull the attachments off. There’s a trick to it, to remove them without causing damage, and you’ll get quick with it very soon–you haven’t had these that long. Ask your doctor or a staff member to go over proper technique with you at your next appointment.

I would talk to your orthodontist about this and he or she can help you determine if there is something unusual going on in your particular case.

This blog is brought to you by Bee Cave Orthodontist Dr. Alberto Tostado.

I am on my final pair of aligners for my Invisalign treatment. I’ve just got a promotion that requires immediate relocation. It’s the job of my dreams so I don’t want to pass on it. Can I just finish these aligners and be done or will I need to find an Invisalign dentist right away for some post procedure treatment? I remember my dentist saying something about needing a retainer.

Paisley

Dear Paisley,

I don’t think you need to rush out and get an Invisalign dentist the day you move. While you will need a retainer to prevent your teeth from shifting back out of alignment, there is a way to use your final aligner as a retainer while you get settled. Then, when things calm down, you can see either an Invisalign dentist or an orthodontist to get a sturdy retainer.

Keep your final aligners on for at least a month, then you can start gradually backing off. This is the procedure I want you to follow for that. After that month or so, start wearing them every other day. If when you’ve been out of them for a day the aligners are a little harder to put it, in means your teeth have shifted and you need to go back to every day longer. If they’re fine, wear them every other day for a month or more.

From there you can try backing off a little more by doing it every three days, always being sure to check that there has been no shifting. Then go to once a week. By then, you will probably be settled and able to get things checked out by a professional. Your old Invisalign dentist is ethically bound to share all his treatment notes and diagnostics with whoever you see next, so make sure you get those transferred.

I hope this helps. Congratulations on the new job and I hope your move goes smoothly.
This blog is brought to you by Bee Cave Orthodontist Dr. Alberto Tostado.

I don’t know what it is called for my daughter whether she has an over bite or something else. Her smile makes it look like she has a receding chin. She’s very embarrassed by her smile. A lot of her friends are getting Invisalign. Will that help her situation?

Karen

Dear Karen,

Whether Invisalign will work for your daughter will depend on how bad her overbite is. It sounds like she has some rather complicating factors. I would not just go to a dentist for this. I would go to an orthodontist who also does either Invisalign or Spark aligners, which are two great brands of clear aligners. While a general dentist can do Invisalign, only an orthodontist can do Spark.

Given your daughter’s complicated situation, I would expect that she will need that additional training in order to receive the proper treatment. Be aware I haven’t seen your daughter’s bite or read any diagnostic notes from your dentist, so it is hard to give you any concrete treatment suggestion.

Based on what you described, her treatment could range anywhere from simple clear aligners, to traditional braces, all the way to the need for surgical orthodontics. This is why it is important she is seen by someone with real expertise.

The good news is, regardless of the situation, her bite CAN be fixed and she can have a smile she is proud to share with the world. Step one is get her to an orthodontist who handles a variety of treatment options.

This blog is brought to you by Bee Cave Orthodontist Dr. Alberto Tostado.

I am supposed to get my braces off in one month. I just realized I have some back teeth coming in. Will that mean I can’t get my braces off? Do I need to call the orthodontist right away so he can get braces on them? Would this be an emergency or do I just wait for my next appointment?

Brandy

Dear Brandy,

The good news is that you are not dealing with an orthodontic emergency. Everything is intact. My guess is that your orthodontist took x-rays before your case was planned. If so, he would have known that you had more teeth coming in and when they could be expected.

As long as your new adult teeth are coming in straight, then you should not have any problems. As long as all your teeth are erupted and straight there should not be any problems with you having your braces removed.

It will be important that you wear a retainer once your braces are removed. Doing that, will help your teeth to stay in their proper position even while the new teeth are coming in.

I would not call the orthodontist to go in early, but just bring it up at your next appointment.

I hope this puts your mind at ease. I’m excited you’ll be getting your braces off soon. It’s always fun to have a brand new smile.

This blog is brought to you by Bee Cave Orthodontist Dr. Alberto Tostado.