Spring is in the air, Let's keep our teeth for a lifetime

 

Spring is in the air (the snow is starting to melt). Soon all the seedlings will sprout and new plants will crop up everywhere.  If only it were so easy with teeth.  We only get two sets.  Most of the time, if everything is normal, we grow a total of 20 primary teeth.  These baby teeth are replaced between the ages of five and twelve (on average) with adult teeth.  New adult teeth also erupt distal to (further towards the back of the mouth than) the full set of primary teeth. The total number of permanent teeth, including wisdom teeth which erupt in adulthood, is 32.  We do not get replacements for the “second set.”  Despite the fact that we call adult teeth “the permanent dentition”, if we don’t take care of these adult teeth they do not last for a lifetime. Neglect can lead to a lifetime of restoring the damage with fillings, gum grafts, and replacement teeth (bridges, implant crowns, and dentures.)

In my recent agricultural volunteer experiences, I have learned that growing plants is not effort-free. It is not simply waiting for new plants to crop up everywhere. In addition to planting seeds in containers, clearing and fertilizing the fields and planting the seedlings in the ground, keeping the plants well-watered, and weeding out the unwanted vegetation, the plants need pruning (removing extra leaves that are sapping nutrients and removing extra fruits that are too heavy for the plant), pests have to be kept away from the plants, the plants need to be protected from the weather, and the fruits need to be harvested, boxed, and sent to market. (Did you know that cauliflower gets sunburned [i.e. it turns brown] if it gets too much sun?  The farmers need to bent the leaves over the head of the cauliflower daily to keep the cauliflower white.) Farmers don’t just plant the seeds and harvest the fruit.

People have to take care of their oral health with just as much effort.  We need to properly brush and floss to remove bacteria from our teeth daily in order to prevent cavities and gum disease.  We can also use other aids for cleaning our teeth like the Waterpik Dental Irrigator and ultrasonic electric toothbrushes like the Philips Sonicare toothbrush. Many of us need to use fluoride rinse daily to strengthen the enamel to resist decay and discoloration. We can use special rinses to keep the gums healthy (examples are The Natural Dentist Healthy Gums rinse, StellaLife VEGA rinse, warm salt water, or a combination of hydrogen peroxide and water.) We need to visit our dentist every 6 months to make sure that we are keeping the disease processes at bay.  If we are having issues, like cleaning the crooked teeth, or having enough space for the adult teeth to erupt properly, we need to visit the orthodontist to make the teeth easier to clean.  The orthodontist also puts the teeth into their best positions to withstand the functional forces of chewing and talking.  If we have parafunctional habits that put excessive forces on our teeth, we need to have the orthodontist make acrylic devices to wear on our teeth at night to protect our teeth from habits like grinding our teeth, leaning our tongue on our teeth. We also need to break habits like chewing our shirtsleeves, sucking our fingers, or biting our pens. Keeping teeth for a life-time is a lot of work!

 

Valentine’s Day is coming and millions of Americans are planning to take their loved ones out to eat, buy them flowers, and buy them jewelry.  Relationships take effort and time to maintain, even relationships with family members, friends and co-workers.

Teeth also take effort and time to maintain. We need to clean them effectively (brushing and flossing daily (https://www.okunortho.com/brushing-and-flossing) is the number one priority, because all diseases of the mouth are caused by the bad bacteria which build up when you don’t clean effectively. Eating fewer sugary things, keeping the time that the sugar is bathing your teeth to a minimum, and rinsing the sugar off your teeth after eating, will all help to minimize dental decay.  Eating fewer acidic things, and rinsing after having acidic beverages (like carbonated beverages, fruit smoothies and sports drinks) will help to keep decay and erosion to a minimum. 

Teeth that are well aligned are easier to clean than teeth that are crowded. Dr. Okun will happily show you how to clean difficult areas, but she will also recommend orthodontic treatment (braces) when it is indicated for the longevity of your teeth. Properly aligned teeth are in positions and angulations that help them to function at their best, and to hold up to the functional forces of chewing and speaking. But even well aligned teeth have trouble holding up to excessive forces that are generated by clenching and grinding your teeth (bruxism) and generated by leaning your tongue on your teeth at rest or when swallowing (tongue thrust).  Obviously, it’s best to eliminate these damaging habits, but it’s impossible to monitor habits when you are sleeping.  Therefore, if Dr. Okun diagnoses you with one of these habits, she will recommend that you wear acrylic appliances (such as a hard full occlusal coverage maxillary guard, or a Hawley retainer) at night (indefinitely) to protect your teeth and their supporting structures from these damaging habits.

(NOTE: This blog was written in January, and  did not post on it's scheduled post date. Sorry it's late.)

Help your teeth celebrate the New Year

 

New Years 2026 blog

How did you celebrate New Year’s? Did you curl up with a book, watch a movie on TV with your family, or go out with friends?

Human beings are social creatures.  We often share our special occasions with other people.  Too much “alone time” often leads to depression. Teeth are not too different.  One tooth that stands alone does not do very well; it has too many forces applied to it from chewing, speech, and swallowing.  But if that tooth has “friends” nearby, they can share the functional forces, and each one “suffers” less. When orthodontists rearrange teeth to a more ideal alignment, each tooth gets less abuse. The front teeth, with narrow edges, incise or cut the food. The corner more pointy teeth guide the chewing forces. The back teeth, with a wide biting surface, support the vertical forces of chewing.  The back teeth also support the vertical height of the face, while the front teeth help the tongue and lips to enunciate (speak more clearly).

The teeth are only one component of the chewing process.  The chewing muscles, tongue, and saliva also play a role.  The muscles help the jaws open, close, and move sideways in order to cut and crush food.  The tongue helps push food onto the chewing surfaces so the teeth can crush the food. The saliva helps by moisturizing the chewed food and filling it with digestive enzymes before swallowing.

There are also some “bad players” that live in the mouth's neighborhood.  Anaerobic bacteria (the ones that live without oxygen) cause cavities and gum disease.  It is our job to help our teeth by effectively removing the bacterial build-up daily with proper home care. If we don’t remove the bacteria effectively, within 24 hours the plaque layer gets thick enough to provide a place for the bad bacteria to live.

If you are not sure how to clean your teeth properly, please view our hygiene videos at https://www.okunortho.com/brushing-and-flossing.

Pain management with the Electro-Accuscope (e-stim energy medicine)- letter from a patient

 

 

 Dear Dr. Okun,

I am writing to thank you for suggesting that I bring my children to you for “electric medicine” treatments following their wisdom tooth extractions.  It clearly worked like a charm to alleviate a great deal of the swelling, pain and discomfort that they had to endure.  Although my oldest two children had all four teeth extracted at the same time, they came directly to your office for treatment and experienced minimal swelling and discomfort for a few days.

 

I was still a little skeptical that the treatments actually worked until my youngest daughter had her teeth pulled recently.  The first tooth was pulled in August and I was unable to bring her to your office from the surgeon’s.  The swelling and pain from this one tooth was extreme and lasted more than a week.  After the other three teeth were pulled this past December we took no chances and came directly to your office.  She used the “electric medicine” for the prescribed time and had no swelling on one side and minimal swelling on the other.  Within a few days she was completely comfortable with no signs of the surgery.    

 

We are all now firm believers in this method that noticeably speeds the healing process.  My children used it whenever you adjusted their braces over the years and I can confirm that this “medicine” really worked.  They never complained about pressure from their braces and the treatments definitely healed cuts in their mouths right before our eyes. 

 

I am no longer skeptical in the least because this last success was not one that could be explained away by the power of suggestion.  We saw and felt the results.  I cannot thank you enough for all your wonderful work and sage advice.

 

Sincerely, J.T.                                                                                    

Why did my teeth shift after the braces came off: part 4- The Finish

Reasons for Relapse Part 4: Reasons for relapse: Finishing a case properly to minimize relapse

 

Why did my teeth shift after the braces came off?

I often hear from patients that their teeth moved after their braces came off and they want to know why.  There are basically 3 reasons for a failed case (that was treated well.)

1. The patient did not wear their retainers properly. This is patient error.

2. The patient did not eliminate mouth habits, and did not wear appliances to protect them from their mouth habits. This is a combination of patient and dentist error (if the dentist did not make the patient aware of their habits, and/or did not make appliances that could protect the patient from these habits.)

3. The patient grew unfavorably. No one had control over this one. 

(4. If the teeth were not aligned in the middle of the bone ridge, they will relapse to be centered in the ridge again. The treating dentist had control over this reason.)

The next few blogs will address these errors. Today we will address #4. How ideally the case was finished.

 

In an ideal world, teeth have certain angulations (tips) in order to function properly.  Upper front teeth and lower front teeth should tip slightly forward toward the lips.  Upper back teeth should be vertical, or have very slight tip toward the cheeks.  Lower back teeth should be vertical or have very slight tip towards the tongue. All of these angulations are dependent on the position of the underlying bone.

 

In a front to back direction, the top jaw should be very slightly in front of the lower jaw (Class I skeletal relationship) in order to achieve the proper anterior tooth tips.  If, however, the jaws are not aligned ideally the angulation of the front teeth can be adjusted to achieve the scissor like relationship of the top to bottom front teeth. These adjustments are called dental compensations.  Now suppose the upper jaw is too far forward for the lower jaw (Class II).  If the teeth are angled properly to their supporting bone, the top front teeth will stick out too far for the lower front teeth.  The angulation of the teeth can be changed so that the roots can remain in the bone, but the crowns (the visible part of the teeth) can still meet like a scissor in the front.  The top front teeth can be tipped more toward the tongue, and the lower front teeth can be tipped more toward the lip. These dental compensations often occur naturally, but can also be applied by the treating orthodontist in order to achieve proper function. Now suppose the lower jaw is too far forward for the upper jaw (Class III). If the teeth are angled properly to their supporting bone, the top front teeth will be behind the lower front teeth.   In order to get the top teeth in front of the lower teeth, the top teeth can be tipped more toward the lip, and the lower front teeth can be angled more toward the tongue. Although small amounts of dental compensation are very acceptable, large amounts of dental compensation create an unstable bite. The teeth may try to find more favorable inclinations, and teeth that were tipped towards the lip (creating a larger arch form) will move towards the tongue (creating a smaller arch form) and become crowded.

 

Now let’s discuss the side-to-side direction.  If the upper jaw is too narrow for the lower jaw, in order to get the top teeth outside the bottom teeth (if the skeletal base is not corrected) the upper back teeth have to be tipped towards the cheeks, and the lower back teeth have to be tipped towards the tongue. If the teeth are tipped excessively, the teeth will try to find a more ideal inclination, bringing back the posterior crossbite (the top teeth bite inside the bottom teeth.)

 

Some orthodontists, like Dr. Okun, like to treat orthodontic cases early (age 7 to age 10) in order to influence the jaw bone size and position, so that the inclinations of the teeth can be more favorable.  Changing the bone structure might mean moving the bones of the palate apart (palatal expansion), restraining the growth of the upper jaw (traditional headgear), or advancing the growth of the upper jaw (palatal expansion combined with a protraction headgear.) Once the supporting structures are idealized, the permanent teeth can erupt into straight positions. With Dr. Okun’s technique, it is rare for early treatment cases to need a second phase of treatment.

Some orthodontists like to treat orthodontic cases later (age 11 to 18) in order to have all of the permanent teeth present when the case is finished. The advantage of teen treatment is that you are likely to need only one phase of orthodontic treatment.  The disadvantage is that you need to tip teeth less ideally in order to compensate for growth that has already taken place. You also are more likely to need extraction of permanent teeth in order to align the remainder of the teeth in a crowded case. Relapse potential is much higher in cases that are treated later, i.e. the teeth don’t stay in place after the braces are removed.  The later the case is treated, the more likely it is that the patient will need retainers at night forever in order to maintain their result.

Halloween- reposted from October 31, 2010, and still relevant!

 

Halloween is nearing the end, and all our children will be enjoying their candy tonight. Here are some hints to preserve their teeth:

- Sticky candy will break braces and aggravate TMJ problems. If you are wearing braces or have TMJ/facial pain DO NOT EAT chewing gum, gummy bears, taffy, jelly beans, and other sticky candies. If the candy is hard to bite through, break it into very small pieces before eating it.

- Avoid eating candy that sits on your teeth a long time. A Kit Kat Bar or a Hershey's Kiss will do less damage than a lolly pop or sucking candy.

- Rinsing your mouth with water after eating candy will decrease the risk of white spots and cavities. In addition, spraying your mouth with Carifree spray or sucking a xylitol "candy" will inhibit the bad bacteria (in  your mouth) that have feasted on the sugar you just ate.

- Rinsing with fluoride rinse before bed daily (especially important if candy was eaten that day) will help reverse the damage that candy does to your teeth.

- If there are already white spots (the beginnings of cavities) present, your dentist can use Curodont to help the lesions remineralize (fading the white spots.)

Why did my teeth shift after the braces came off? Part 3: unfavorable growth.

 

Why did my teeth shift after the braces came off?

I often hear from patients that their teeth moved after their braces came off and they want to know why.  There are basically 3 reasons for a failed case (that was treated well.)

1. The patient did not wear their retainers properly. This is patient error.

2. The patient did not eliminate mouth habits, and did not wear appliances to protect them from their mouth habits. This is a combination of patient and dentist error (if the dentist did not make the patient aware of their habits, and/or did not make appliances that could protect the patient from these habits.)

3. The patient grew unfavorably. No one had control over this one. 

(4. If the teeth were not aligned in the middle of the bone ridge, they will relapse to be centered in the ridge again. The treating dentist had control over this reason.)

The next few blogs will address these errors. Today we will address #3: unfavorable growth.

Unfavorable growth is the growth that takes place after the braces are removed which destroys the final bite. One jaw grows more than the other. The teeth in each jaw may stay perfectly aligned, but the bones that support the teeth may not stay in balance with each other. 

We can all see that children look like their parents.  Facial balance is also genetically determined. Parents with “buck teeth” have children with “buck teeth”; Parents with “underbites” have children with “underbites.” Although we can change the skeletal balance and esthetics with orthodontic orthopedics in young patients, the patients continue to grow after their active orthodontic treatment is complete.    A patient who started with their front teeth sticking out “way too far” will relapse in that direction- their top jaw will continue growing and after several years they may have front teeth that stick out farther than when they completed treatment. This relapse growth issue is seen most vividly in “underbite” cases. The bottom jaw will continue growing for many years after the top jaw stops growing, so a patient who started with a prominent lower jaw will continue growing that prominent lower jaw and the lower jaw may “outgrow” the balance that had been achieved with the orthodontic orthopedic treatment. In addition, lower jaw bones rotate internally, although the outside remodels and looks the same.  The lower front teeth  tip forward with this rotation and in order to stay behind the upper teeth, the lower teeth develop "middle age crowding."

The skull, like the rest of the body, shows early growth “high up” and later growth “low down.”  We see this in babies who have large skulls with respect to the rest of the body versus adults who have small skulls with respect to the rest of the body.  The skull stops growing earlier than the legs stop growing.  Within the skull, the top of the face stops growing earlier than the bottom of the face. The midface stops growing earlier than the lower face.  With orthodontic orthopedics (palatal expansion with headgear treatment) we can modify the growth of the maxilla (upper jaw), which is in the mid-face. Palatal expansion is successful in girls until about age 12, and in boys until about age 14, when the midface stops growing.  While creating width of the upper jaw (palatal expansion) forces can be exerted on the jaw to restrain the growth (traditional straight pull headgear to the top of the head and the back of the neck) or to increase the amount of growth in the forward direction (with front pull headgear against the forehead and chin.) These treatments are no longer effective after the midface has finished growing because the sutures (the zippers between the bones) close with physical maturity. The mandible (the lower jaw which is in the lower third of the face) continues to grow for many more years than the maxilla (upper jaw bone), until about age 17 in girls, and until about age 23 in boys.  If the mandible was genetically programmed to be small, we do not notice the forward growth of the mandible after the maxilla stops growing.  If the mandible was genetically programmed to be large, the forward growth of the mandible is obvious and often results in a return of the “underbite.” 

When I treat “underbite” cases I overcorrect the forward correction of the maxilla, leaving the young patients with the opposite problem from which they presented.  They start with the upper teeth and jaw behind the lower teeth and jaw, and I finish them with the upper teeth and jaw too far forward for the lower teeth and jaw. An ideal bite has the upper front teeth one to two millimeters in front of the lower front teeth.  A Class III underbite may have the upper front teeth behind or tip to tip to the lower front teeth.  I overcorrect the jaw position leaving the upper teeth three to four millimeters in front of the lower teeth in order to allow for up to 2mm more lower jaw growth in the future.  I do not aim for a correction of over-jet to 5mm because I do not want to take the risk that the lower jaw does not have a late growth spurt, and the final result (as an adult) remains with excessive over-jet (seen as “buck teeth.”) Anticipating how much relapse growth will take place is an educated guess based on family history and the appearance of the parents.

Another phenomenon, related to unfavorable growth is the relapse of tooth rotations and teeth that grew in to the outside or inside of the arch form.  The longer the teeth “live” in the poor position, the more they have ingrained that “memory” of that position.  If the size of the arch form is corrected early and the teeth grow into a straight position, the teeth are more likely to stay in a straight position.  If the jaw size is corrected and the teeth aligned within a year after the teeth erupt, the teeth are more likely to stay in a straight position.  If the jaw size is corrected as an early teenager, the teeth already have a memory of the crooked position, and are more likely to return to that crooked position after orthodontic treatment has been completed.  If the teeth are aligned in adults, after facial growth is complete, the teeth are much more likely to return to the crooked position.  This is why night time retainer wear is so important in patients whose teeth were aligned later in life.

Why did my teeth shift after the braces came off? Part 2: mouth habits

 

Why did my teeth shift after the braces came off?

I often hear from patients that their teeth moved after their braces came off and they want to know why.  There are basically 3 reasons for a failed case (that was treated well.)

1. The patient did not wear their retainers properly. This is patient error.

2. The patient did not eliminate mouth habits, and did not wear appliances to protect them from their mouth habits. This is a combination of patient and dentist error (if the dentist did not make the patient aware of their habits, and/or did not make appliances that could protect the patient from these habits.)

3. The patient grew unfavorably. No one had control over this one.

4. If the teeth were not aligned in the middle of the bone ridge, they will relapse to be centered in the ridge again. The treating dentist had control over this reason.

The next few blogs will address these errors. Today we will address #2: mouth habits.

A mouth habit is something you do with your mouth other than talking and eating.  Some examples include biting your fingernails, biting your pen/pencil, chewing on your lips or inside of your cheeks, leaning your tongue on your teeth, and grinding/clenching your teeth. Any force that you exert on your teeth, if it is applied for enough time, will move your teeth.  Patients who bite their pencil consistently in the same area of their mouth will either push the bottom tooth toward the tongue, push the top tooth out towards the lip, or a will form a gap vertically between the top and bottom tooth where the pencil sits. Patients who chew on their bottom lip create crowding of the lower front teeth, or spacing between the upper front teeth. 

Tongue habits can occur in different areas of the mouth. If the tongue sits over the tops of the side teeth it can create an open bite which is an area where the top teeth do not touch the bottom teeth when the patient is biting their teeth together. If the tongue is leaning against the front teeth down low, it will create spacing between the lower front teeth, just as if it is leaning against the front teeth up high, it will create spacing between the upper front teeth.  If it is leaning between the top and bottom teeth in the front it will create an anterior open bite, i.e. the top teeth will not overlap the bottom teeth in the front. Sometimes the patient leans their tongue on specific teeth with less force or duration, and instead of moving the teeth, the excessive force generated on the teeth accelerates loss of bone and gum around the teeth. (Periodontal disease is an inflammatory disease of the supporting structures of the teeth- the gums and bones. It is cause by bacteria which live in the mouth.  When the bacteria are removed frequently (by daily brushing and flossing) the inflammation levels are low, and there is no disease.  When the bacteria are not efficiently removed, the “bad” bacteria set up housekeeping and flourish causing inflammation which is seen as red, puffy, bleeding gums.  Over time the bone around the teeth is lost leaving the roots of the teeth visible in the mouth.  When there is excessive force applied to the teeth, from leaning the tongue on the teeth or from clenching/grinding the teeth, the rate of bone loss is accelerated. Then the roots start showing even in cases where the gums are not visibly red, puffy, and bleeding.)

Bruxism is the clenching and grinding of the teeth.  Clenching is when the teeth are tightly closed when there is no reason, like chewing, to be closed.  Grinding is when the patient moves the teeth “side to side” or “front to back” as if they are chewing, but there is no food present to chew. The most common reason for bruxism is stress, but it also occurs from boredom, concentration on a difficult task, or when a young child has pressure in their ears which they are trying to relieve. Bruxism does a lot of damage to the teeth and their supporting structures (which was discussed in the post October 21, 2020.)  Bruxism can also move the teeth.  When clenching, the back teeth which meet vertically, are pushed deeper into the bone, much like a nail can be hammered into a piece of wood.  As the posterior bite support is lost, the front teeth start to overlap more vertically (i.e. the bite deepens), and the front teeth bypass each other (like a scissor.)  In order for the lower teeth to stay behind the wedge shaped upper front teeth, the lower front teeth start to crowd, and the upper front teeth start to develop spaces between them.

Habits can be controlled in the daytime through awareness, but it is impossible to control habits like improper tongue posture and bruxism while one is sleeping.

Retainers and occlusal guards are used in order to prevent the shifting of teeth from mouth habits. Although retainers should be worn full time immediately after braces are removed, they can be continued at night indefinitely to protect teeth from habits.  Mouth habit appliances should be rigid so that they can’t be deformed by the habit-forces. The design of retainers was discussed in the August 2025 blog. Other appliance designs will be discussed in future blogs.