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.

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.