"Invisalign" Retainers forever; a new solution

Multiple conversations with local dentists are coming to the same conclusion: Invisalign may make the front teeth look straight, but it doesn’t create great occlusions.  The smile may look nice, but the bite doesn’t work.

Recently the patient pictured above came in requesting that I order more Invisalign retainers for her. (She was not  returning to the treating orthodontist because she had moved.)  She had been wearing Invisalign retainers for many years and was happy with how her teeth looked.  She knew that she needed to wear retainers the rest of her life to keep her teeth straight. Orthodontically the result was less than satisfactory.  The top teeth overlapped the bottom teeth over 75% in the front (they should only overlap 1-2mm), and unless the patient postured her lower jaw forward, the front teeth could not meet like scissors to cut food. In addition, the gum was “creeping down” on the back teeth so that the roots stuck out.  This loss of periodontal attachment is frequently seen in patients that grind their teeth or wear flexible retainers (like Invisalign and Essex retainers) long term. The loss of attachment is accelerated when there is also a little bit of inflammation in the gums (from not brushing effectively and not flossing every day.) I suggested that we change her retention appliance.  Rigid retainers would minimize the rate that the gum- coverage of the roots would be lost in the future. An occlusal guard would give the patient a comfortable place to bite, at least at night when she was wearing it. We decided to make an occlusal guard for the top teeth (a rigid piece of plastic which fits on the top teeth, but is adjusted to touch all of the bottom teeth when the teeth are closed) and a Hawley retainer for the bottom teeth (an orthodontic retainer with a front wire to keep the front teeth aligned with the hard plastic which sits on the tongue side of the teeth).

The result was astounding.  At the visit that the occlusal guard was delivered the patient commented on how comfortable her bite felt, and that her face felt so much more relaxed than it did without the guard.  The muscles in her face did not have to work so hard when the teeth were closed on the guard because the bite against the plastic was balanced from "right to left" and "front to back".  This never happened when she closed her teeth.  She assured me that she would wear the lower retainer and upper guard every night forever, not only because she wanted to guarantee that the teeth stayed straight, but because they made her face feel so much better.

I know that patients will continue to ask for aligner treatment like invisalign, and I know that the results may not always be satisfactory.  But as the case above demonstrates, there is a long term solution for these patients which will retain tooth alignment, preserve the bones and gums that hold these teeth in the mouth (i.e.  Keep the periodontal attachment), and allow the chewing muscles to relax 1/3 of the rest of their life (i.e. 8 hours out of every 24.) Once again, a patient has left my office happy with her treatment.

Jelly fish, Whales and Dophins

My treatment room ceiling is covered in fish- the beany baby kind- so that patients have something to look at while laying back in the chair. The younger patients like to talk to the the whale hanging over their heads, and several patients have donated new additions to our ceiling aquarium. C.T. has been looking for a rainbow fish for over a year, but settled recently on this pink jellyfish. I was thrilled with her thoughtful gift and promised her I'd hang it over the sink where patients

wash up after treatment. It turns out that I'm not the only one excited by my new addition.  In one day four patients commented on my new jelly fish. Now the kids have a new friend to keep them company.

Okun Orthodontics is a Better Business Bureau Accredited Business

 Dr. Judith A. Okun is honored that the Better Business Bureau has recognized Okun Orthodontics as a business which deals honestly with our patients and colleagues. For over 25 years Dr. Okun has worked to deliver quality patient care, fully explain our treatment goals and expectations, and honor all of our agreements. Congratulations Dr. Okun!

It's intriguing to see how patients entertain themselves in our reception area.  Sometimes they pull out the tablet or phone that Mom keeps in her purse, sometimes their devices travel in their own pockets, Candy Crush at the ready. Often it's our game cube or magazines.  I always smile when I see that they are still intrigued by old fashioned real-life blocks.  Zach was so pleased with his creation that he couldn't wait for his mom to see it, so we preserved it for posterity in this photo.

Giving Back

We at Okun Orthodontics believe in giving back to our local community.  That is why we are one of the proud sponsers of Rye Brook’s 2014 Officer Phil Child Safety Program.  This program will teach students in Kindergarten through Fourth grade safety information such as how to deal with bullies, and what to do if you see someone trying to pull your friend into a car.  The Officer Phil program is part of an ongoing educational process which is modified for each grade level’s capabilities.

Last year Okun Orthodontics also participated in Rye Brook’s Crime in America Community Resource Program which was dedicated to adults.  The educational materials produced covered topics such as domestic abuse, sexual assault, carjacking, shoplifting, home security, teen abuse of prescription drugs, telemarketing scams, consumer and jury duty scams, child identity theft, protecting your credit cards, fire prevention, and senior safety.

Dental Care = Healthcare

Here’s a summary of the most recent continuing education course I have taken.  Dr. Tim Donley (DDS, MSD) spoke about periodontal disease and what we dental professional should be telling our patients:

“Inflammation ls at the root cause of many of the chronic diseases that occur with age.  The mouth is a source of these exact same mediators of inflammation when chronic periodontal disease is present.”  When there is inflammation of the gums (i.e. gums that are red and puffy or gums that bleed), there is ulceration of the epithelium (skin) allowing bacteria, bacterial byproducts, and mediators of inflammation to enter the blood stream, and travel throughout the body, influencing the progression of systemic diseases including heart disease, rheumatoid arthritis, diabetes, and pregnancies which  result in premature low birth weight babies. All diseases in the mouth are caused by bacteria, but the body’s response to the bacteria does vary.  The patient’s most at risk for chronic inflammatory periodontal disease are tobacco users, diabetics, and patients who suffer from obesity. "Brushing and flossing" is good prevention, but won’t solve the problem if there is subgingival inflammation already present, therefore you need to partner with your dental care professional (dentist and hygienist) for minimal oral inflammation over your lifespan. Good dental care is necessary for good healthcare.

When was the last time a dentist or hygienist checked you for gum disease?

February 24

"A beautiful smile can change your self image." I've said it again and again....

NBC is still running their "love your selfie" series. In February , each anchor- person described what they did and did not like about their image now and in the past. 

When describing what they didn't like about themselves, 2 out of 9 "hosts" said that they didn't like their big front teeth that "stuck out". Braces solved this problem for them both. Yes its true, braces can change your self-image!

"Mouth Breathing"

We’re back in Spring- complete with grass and pollen allergens. Along with the sniffling and itchy eyes of Spring Allergy season comes swelling of the inside of the nose which can further block the airway. Poor breathing ability has also been linked to poor sleeping (with symptoms typical of sleep apnea). At Okun Orthodontics we see a lot of mouth breathers during allergy season.  Breathing through one’s mouth creates many issues.  The air one “mouth- breathes” is not warmed in the nose or filtered by nose- hairs.  The soft tissues of the mouth desiccate (dry out) and the muscle balance between the tongue, cheeks and lips is altered.  Mouth breathers, like thumb suckers, have a greater force “pushing in” from the taut position of the cheeks. This force is not balanced by a “pushing out” force from the tongue because the tongue is positioned downward with the lower jaw. Therefore mouth breathers tend to have narrower dental arches.  Narrower arches often have more dental crowding.  In young patients, mouth breathing may also contribute to more vertical growth of the lower jaw creating a longer face.

Orthodontists are in the unique position of being able to alter facial growth in children.  As part of the orthodontic process we can expand the bones of the roof of the mouth creating a wider arch form.  Since the bones which form the roof of the mouth are the same bones which form the floor of the nose, palatal expansion increases nose-breathing ability.  This is because the triangular space of the nose increases in area as the base of the triangle widens.  Even when seasonal allergies cause inflammation of the mucous membranes of the nose, the swollen nose tissues are less likely to fully occlude (block) this wider space.  Thus an orthodontic patient who undergoes palatal expansion to alleviate posterior cross-bites and dental crowding can also benefit from increased airway and better sleep quality.