My older sister had braces and her enamel ended up deteriorating. When her braces come off there were the white spots and they turned into cavities. I’m about to have braces and I am terrified that I’m going to have the same thing happen. Is there anything that I can do that will keep that from happening to me?

CeeCee

Dear Cee Cee,

I am glad you wrote. The fact that these white spots turned into decay tells me that your sister was not under good dental care. There is a solution when this happens. Either her dentist did not know the solution or did not bother to tell her. Neither of those are good in my book. But first, let’s talk about how you can prevent this.

The white spots are decalcification. this means that your sister wasn’t quite getting the areas around her braces really clean. Granted that is tricky, but it can be done with persistance. You will need to brush your teeth diligently, really getting in the spots around the metal wires and brackets. If you do that, there should not be a problem with white spots.

A second option is to get some aligner based orthodontics, such as Invisalign or Spark Aligners. These use clear aligners instead of metal wires and brackets to clean your teeth. These have the benefit of allowing you to remove the aligners in order to brush and floss your teeth, making it easier to get your teeth completely clean.

Let’s says that you still got metal braces and you ended up with those white spots. The solution would be to see a cosmetic dentist who can use microabrasion on the white spots and then cover that area with dental bonding.

That being said, this is avoidable with careful oral hygiene during your treatment.

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

I need some advice. I paid almost $5k for Invisalign. The purpose was to fix my midline and close up some space between teeth four and five. He worked the computer and said that it should fix in nine months. Nine months came and went. The area closed up but the midline still had problems. We did another nine months, still no result. I got very frustrated because now he is talking about a full set of porcelain veneers. I went to see an orthodontist and he said Invislign never should have been used for this and it needs traditional orthodontics. I feel like I’ve wasted a year and a half and $5,000. Is there a way to get my money back on this?

Karen

Dear Karen,

While fixing a midline is a bit trickier than some other cases, it can sometimes be repaired with Invisalign. I’d be curious to know if this an orthodontist who also does Invisalign or is one of the orthodontists who eschews Invisalign. Some orthodontists see it as a threat and don’t recommend it under any circumstances. My recommendation would be to get a second opinion from an orthodontist who does both procedures. Then, if he or she says that Invisalign was inappropriate in your particular case then you’ll have a better chance of getting a refund.

There have been major advancements with Invisalign and they can do many things that traditional braces can do. However, there are those more complicated situations where you really need a specialist. Your typical dentist may rely too heavily on Invisalign’s advances and hope things will work out.

You should also be aware that there is another type of clear aligner braces, Spark aligners, that are only available through orthodontists. These have some advantages over Invisalign. When you get that second opinion, see if those will work better for you. They may keep you from needing metal braces.

As to how to go about getting that refund,  I would start with just politely asking. This will be easier with that recommendation from an orthodontist who does both procedures. If that doesn’t work, you can threaten to take it to the dental board. You have another practitioner on your side, so this will be a black mark on his record he would not really want. Finally, you can get a lawyer. I don’t think it should come to that if you have someone who does both procedures backing you up, but be prepared for that possibility.

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

My daughter, who is about to go to college had braces for two years and then wore a permanent retainer for close to three years. It was time to remove the permanent retainer. Unfortunately, when the orthodontist did remove it, he ended up damageing one of her teeth. It is now recessed. It has also changed colors and hurts her when she bites down. I’ve taken her to another dentist and he said she needs a root canal treatment. I’m very frustrated about this. Should the orthodontist be responsible for paying for this treatment? This has been a frustrating treatment from the beginning. Not only have we spent a fortune, but the majority of the time we didn’t even see him. He just had one of his assistants do the work. The whole reason we went to an orthodontist was to have someone with extra training. I have a son that is about to need braces and I’m wondering if we would be better off with just taking him to a dentist for something like Invisalign.

Joyce

Dear Joyce,

A fixed retainer is fairly easy to remove. I am interested in hearing more about how this tooth was damaged. Either way, the orthodontist you saw is liable for the damage he did. He should cover the root canal treatment and dental crown. You didn’t say which tooth was damaged, but if it is a front tooth make sure your dentist uses a porcelain crown. Additionally, you should chose the dentist to do the repair work, not the orthodontist. He will either pick a friend or the cheapest dentist he can find to lower his expense in this situation.

It does not sound like this is the best orthodontist for your family. When you are spending all that money for a specialist, you want the specialist to be the major contributor in the treatment. I understand your frustration.

Given your experiences, I would suggest a different orthodontist for your son. You do not have to go to a dentist to get Invisalign. There are orthodontists who will do Invisalign or even Spark aligners. Spark Aligners have some advantages over Invisalign, but can only be done by an orthodontist.

I am sorry this happened to your daughter.

This blog is brought to you by Lake Travis Orthodontist Dr. Alberto Tostado.

I have a question about the possibility of switching dentists. I come for a small city. Very few of our dentists do any of what they call “cosmetic frills,” such as Invisalign. I picked the one closest to my home who does. I am about a 1/3 of the way through tthe treatment. The treatment itself is going very well, and even though I am not very far into the process, I can already see a difference. I like that I can eat what I want and don’t have a mouth full of metal to deal with. One thing I am not thrilled with is the dentist. Obviously, the work itself is fine but he spends every appointment talking about politics. I’m civic minded and am involved in the political spectrum. However, I find some of his ideas offensive. I don’t begruge him having those ideas, we are free to believe what we want. I just don’t want to have to listen to them at every appointment, especially when I’m in a semi vulnerable position as the patient. Is it possible to change dentists while I am in the middle of the procedure or do I need to just suck it up and put up with his diatribes until my treatment is over?

Carol

Dear Carol,

I am glad you wrote. I’m sorry the dentist who has been handling your case doesn’t have the sense to keep his office neutral. The good news is that you are allowed to switch dentists at any point in your treatment.

Your dentist is under an ethical obligation to provide whichever dentist you go to next with all of your dental, as well as procedural, information. This includes x-rays, notes, everything. Your next dentist should be able to pick up right where you left off, with no trouble at all.

If you’ve paid for all of it up front, your dentist can pro-rate the treatment that is left and return the fees for those.

One thing to consider, is that you are not limited to seeing a dentist for your Invisalign case. With the ability for Invisalign to take on more advanced cases these days, you are likely to find an orthodontist who offers the treatment as well. The benefit to this is their additional training in orthodontics. That means if something is not going according to plan, which happens in many treatments, whether Invsiaglign or not, they will have the expertise to come up with a solution and get your procedure right back on track.

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

I’m getting braces and my dentist wants me to have my two upper wisdom teeth removed in order to do it. I am worried about that. Here is some background. I am in my early 20s. I have a missing right incisor that never came in. My canine is taking up the missing space. I’m also missing a left canine for the same reason. If my wisdom teeth are not bothering me, why should they be removed?

Callie

Dear Callie,

I would definitely get the wisdom teeth extracted if that is what your dentist is telling you. It may be that you need the space in order to fill in those areas with replacement teeth. At least, I hope that is what he is planning to do. You do NOT want him moving your canine teeth next to your cental insicors and try to make the canine teeth to look like lateral insicors. This would end up making your smile look really weird. You would need one of the top cosmetic dentists in the country to pull that off, which would cost you a fortune.

Another cosideration is how complicated your orthodontics case is. Unless your dentist has some post doctoral training in orthodontics, and a lot of it, you will be much safer seeing an orthodontist for this one. It is always possible your dentist does have this training, but I would make certain first.

As for the wisdom tooth extractions. You are at the perfect age for that. There is not much cementum accumulation at the roots of your teeth and the bones are still plaible. Getting them extracted now, rather than waiting until there is a problem and the procedure becomes more complicated could end up being a blessing for you.

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

I had braces several years ago and had a retainer that I wore full time for a month and then was supposed to go to just overnight. Then, I stopped wearing it for a while. As a result, I ended up having a relapse of my teeth shifting. My dentist said I could either redo my orthodontics or just go back to wearing my retainer. I ended up wearing my retainer full time again. The problem I’m having is, even after two years of this, when I take the retainer out my teeth begin shifting again within just a few hours. This back and forth cannot be good for my teeth. Am I paranoid? Do I need to wear this retainer full time for the rest of my life?

Elena

Dear Elena,

It is common, in fact required, for patients to wear a retainer after braces. Generally, this is on a short term basis. Your case seems to be a bit more complicated. As far as the movement goes, you are not being paranoid. The back and forth is definitely not good for your teeth. While I do not know why your teeth are shifting after just a few hours, I can tell you it would be better for you to wear a retainer full time to prevent this.

You actually have a couple of options that will allow you to have a beautiful smile without feeling self conscious about wearing a retainer during the day.

Essix Retainers

Your first option is to get an Essix Retainer. This is a clear retainer and allow you to keep it on without anyone even knowing you have a retainer on. They will typically last about two years, but are not very expensive.

Permanent Retainers

Your second option is a permanent retainer. These are bonded to the insides of your teeth. No one will even see them. The downside to these have more to do with your oral health. It will be more challening to keep the area with the retainers clean. You will also need a floss threader to enable you to floss around the retainer.

There is no wrong choice here. It is just your personal preference.

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

I’m an old biddy in my late 60s. However, that doesn’t mean I have stopped caring about my appearance. I do what I can. One thing that has always bothered me was my crooked teeth. I just never had the money to do anything about it. Now I do. I don’t really want a mouth full of metal at my age though. My neighbors teen has something called Invisalign which lets her straighten her teeth without people knowing. If her mother hadn’t told me she had them, I’d have never known she had anything on her teeth. Am I too old for this procedure?

Carol

Dear Carol,

I’m glad you are in a position to fix something that has always bothered you. That’s a great feeling. I have some great news for you. Invisalign has no age restrictions. In fact, there is a group of Invisalign dentists who have a study group. They once took a survey of their members of the age of their Invisalign patients. The oldest from that group was 80. You are just a pup!

You are going to love the convenience of Invisialign. It has a very high patient satisfaction rate too. There is no chance of food getting stuck in any wires or brackets so you can eat whatever you want. Plus, cleaning your teeth is simple. You just remove the aligners and then brush and floss they way you normally do. Just make sure you wear them for the prescribed amount of time and you should see results in no time.

Though general dentists offer this service, it would be ideal if you could find an orthodontist who also does Invisalign. This way you have the benefit of their specialized training in teeth movements.

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

I had braces but the orthodontist didn’t tell me that the gap to my front teeth would come back literally the next day after stopping my retainer. There is a small mass of tissue between my front teeth. I don’t know if that is the cause or not. Either way, because of this shifting I wore my retainer until it broke. I’d recently tried teeth effects bands, but then a friend sent me an article about how dangerous these are and that people are losing their teeth because of them. Is that true? Is there anything I can do about this gap?

Casey

Dear Casey,

First, the most important thing is that you stop using the Teeth Effects Bands. Your friend is right. These can cause serious problems. They are basically just rubber bands worn on the teeth. Here are the two types of complications (thus far) seen with these:

First, because they lack controlled movement by a professional orthodontist, there is no time for the bone to integrate with tooth movement. There have been cases when teeth have come loose or even been pulled out of its socket. In other cases, the bands have worked their way up and under the gums of the person wearing them causing pain, infection, and even teeth falling out.

While some patients can just wear their retainer the prescribed time, after their braces treatment is finished, others need to continue with it their entire lives. Based on what you’ve said, I see a few options for you. Please bear in mind that I haven’t actually examined you or seen where the problem is coming from.

Option 1: Have the small mass of tissue removed, then have another retainer made to wear short term.

Option 2: Have another retainer made and wear it long term.

Option 3: Have a permanent retainer made. These are bonded to your teeth and can even be bonded behind them so no one sees them.

See an orthodontist you trust and get this taken care of. But, please, for the sake of your teeth, stop using those Teeth Effects Bands.

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

I have two dental crowns that are way old and need to be replaced. They look awful. The dentist who did the crowns retired and now I have to go to the person who bought the practice from him. He said before he can replace my crowns, I need full orthodontics. I don’t know if that is true or if it is because he just added an orthodontist to his practice. Either way, I feel I am too old for braces. I will be honest and say that I have teeth that aren’t perfect, they could probably stand to be straightened a little, However, I am not sure why it is necessary when my first dentist was able to put the crowns on just fine. Also, can you even get braces if you have dental crowns?

Nathan

Dear Nathan,

I’ll start with your last question. Can you get braces if you have dental crowns? Yes, that is definitely possible. Do you need them in order to get your crowns replaced? I doubt it. Like you, I am wondering how it was possible for your last dentist to provide you with the crowns without braces, but this dentist insists they are necessary. If I were in your place, I would get a second opinion.

Invisible Braces for Adults

If it turns out you do need braces for some strange reason, or you just decide you want to straighten your teeth regardless of the crowns, you do not have to get those traditional wire and metal braces from years gone by. I have a feeling that is what you meant when you said that you were too old for braces.

These days, you can get your teeth straightened using clear aligners. This will be more efficient for you plus, nothing has to be cemented onto your teeth, which is a big plus when you have dental work, such as dental crowns in your mouth.

Most people have heard of Invisalign, which many dentists offer. Some orthodontists, like Dr. Tostado, offer them as well. He also offers another type, Spark Aligners. These are only offered through orthodontists and have some benefits over Invisalign.

I hope this helps.

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

I went to see an orthodontist hoping to get Invisalign to straighten my teeth.  A couple of my friends did it and you really couldn’t tell that they were wearing braces at all!  At my age, that is encouraging! However, when I went to see the orthodontist he said it doesn’t work for misalignment and I will need to go the traditional braces route. That was a bit disheartening. Plus, I’ll admit a bit confusing. Should I seek a second opinion or am I stuck with braces?

Madison

Dear Madison,

I am glad you wrote. The whole point of Invisalign is to fix misaligned teeth. I definitely recommend a second opinion because I see three different possibilities here. The first is that the orthodontist you saw has not kept up with the advancements in his field. Many still “only do braces” because that is what they were trained in. There are orthodontists, however, that have kept up and received training in Invisalign as well as other invisible braces type of systems. When you get your second opinion, call and find out if the office does Invisalign before going in. Some won’t recommend a service they don’t offer.

A second possibility is that your case has some complicating factors. If so, then the dentist should have mentioned that to you. However, I’m leaning toward that not being the case because you didn’t mention anything unusual about your bite, just basic misalignment.

A third possibility is the orthodontist does not realize how much Invisalign has improved. This also goes along with not keeping up with their field. When Invisalign first came out, it was only useful for the most ideal cases. That is not true any longer. These days, Invisalign can handle all but the most complicated cases.

Barring that, I feel confident you can get Invisalign to straighten your teeth.

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