Retainers

At the completion of the active phase of your orthodontic treatment, the braces will be removed and you will wear removable appliances called retainers. To retain means to hold. Your teeth must be retained or held in their new positions while the tissues, meaning the bone, elastic membranes around the roots, the gums, tongue and lips have adapted themselves to the new tooth positions. Teeth can move if they are not retained. Your final orthodontic result depends on your retainers, so follow through with the hard work you've put in so far. Initially you will wear retainers all times for a minimum of 12 months. For the next 6 months you will wear your retainer during sleeping hours every night. Retainer wear will gradually be decreased after that. The schedule the doctor puts you on with your retainers is to prevent tooth movement. Keep in mind when you wear your retainer at night and teeth are tender, more wear is needed. It is extremely important to wear your retainers as directed!

Now that your treatment has been completed and appliances have been removed, you should make an appointment with your dentist immediately to have your teeth cleaned and checked.

Care And Use Of Your Retainer(s)

Retainers support the teeth in their corrected position and guide the teeth into the established occlusion. Failure to wear the retainers as directed, even for a short time, may result in rapid change; therefore, to help you get the best results observe the following instructions:

1. You will have to wear the retainer for 24 hours per day for several months. The appliance is to be worn at all times except when eating, brushing your teeth and during athletic activity unless otherwise instructed. The retainer may make it difficult to speak initially. Do not become discouraged in the first few days. Speaking and eating will become less difficult shortly. Leave the retainer in and your tongue will adapt to the retainer in a few days. It helps to read aloud from a book or try singing to learn to speak clearly with your new retainers. You’ll be surprised how quickly you will master it.
2. Remove and insert your retainers carefully to avoid breaking the plastic or deforming the wires. Do not bite the appliance into place. Gently place it up in the roof of your mouth, making sure the wire is around your front teeth, and snap it into place with your fingers. Always use both hands to remove the retainer. You may pull down very gently-on the loops over the “eye teeth”.
3. Your retainers will lose their “plastic” taste within a few days. Soaking your retainer in mouthwash may help.
4. Your retainer may be left in when drinking cool liquids but do not eat with retainer in place. And always remember to put retainers in their case! (Most appliances are lost in school lunch rooms or restaurants.)
5. If there is a prolonged irritation of the gums, lips, cheeks or tongue, make no attempt to adjust your retainer yourself. Phone for an adjustment appointment.
6. Remember when you brush your teeth after every meal to remove your retainer first. Then after you brush your teeth, brush your retainer with your toothbrush and toothpaste before placing it back in your mouth. Cleansers intended for dentures will aid in preventing hard deposit build-up. Soaking it in mouthwash for a few minutes will also help remove plaque build up and eliminates odors from your retainer. Avoid using very hot water when cleaning the appliance as it may distort or warp the plastic. Use cold or warm water to clean your retainers.
7. A rough edge can be carefully smoothed with the fine side of an emery board.
8. After a several months, retainer wear will be reduced to part-time. You will be informed of this change at a check-up appointment. When retainers are not in your mouth they should ALWAYS be in a retainer case. This prevents bending, breaking or loss. A special place should be set aside for your retainer and its case. It should not be left haphazardly around the house. Pets love to chew on them! Keep retainers away from hot water, hot car dashboards, pockets, the washing machine, and napkins. Always make sure your name, address and telephone number are written on your case. Keep the retainer out of the reach of younger children and pets. Be careful with your retainer in restaurants or cafeterias. Dogs and cafeteria trays are the #1 and #2 causes of lost or broken retainers.
9. Take care of your retainer(s)! Retainers are breakable, so treat them with care. To make a new one requires considerable time. If the retainer is lost or broken through carelessness, there is a replacement charge. If you lose or break your retainer, contact our office as soon as possible so a replacement can be made. Retainer replacement is expensive... with proper care they will last for years! If you do not wear your retainers according to instructions given, relapse (shifting) of your teeth CAN BE EXPECTED. Additional charges are made for re-treatment when retainers have not been properly worn.
10. If the lower retainer comes loose on either end, it must be removed from the mouth immediately. If it is not removed from the mouth, it could be swallowed should the other end pop loose. If possible, come in to see us immediately. If this is impossible, you may remove the retainer my manipulating it back and forth until the other end comes loose. Before doing this, tie dental floss or string to the retainer so that it cannot be swallowed. As long as the retainer is fastened at both ends, the eventuality of swallowing it is remote.

Never wrap your retainer in a napkin when eating. It will be forgotten when you leave the table and will be thrown away.

Never place your retainer in your pocket without the retainer in its case - it will get broken. Always make sure your name, address and telephone number are written on your case.

Never leave your retainer out of its case where a pet or small child can find it. Pets love to chew on the plastic, which, to them, smells like you.

Always store your retainer in its proper case when it’s not in your mouth.

Always bring your retainer to every appointment so the Doctor can adjust it.

THE SAFEST PLACE FOR YOUR RETAINER IS IN YOUR MOUTH!!

Rapid Palatal Expansion Appliance

A Palatal Expander is designed to widen your upper jaw (maxilla). This widening may be necessary to correct crossbite or to help create enough space for your teeth. Your upper jaw is made up of two bones, right and left, separated by a suture down the middle of the palate. This suture is pliable and allows the upper jaw to widen.

ADJUSTMENT PERIOD

1. Increased salivation expected to last 1-2 days.
2. Difficulty with swallowing expected to last 1-2 days.
3. Difficulty with eating expected to last about 1-2 days.
4. Difficulty with speech expected to last about 1 week.

Diet-Hygiene

1. Eat soft foods for first couple of days.
2. There are certain types of foods you must AVOID such as gum, caramel, Gummy Bears, Starburst, popcorn, ice, and taffy. etc. Stay away from anything sticky or hard to chew. It is very important to avoid dislodging the expansion appliance. It is not easily recemented and expansion can be lost if the appliance is loosened. Long, stringy foods such as spaghetti or roast beef will need to be cut into shorter lengths. Also cut up fresh fruits and vegetables into bite size pieces.
3. Minimize intake of sweets and pop.
4. Brush teeth five times daily. Brush the front and back of the teeth, as well as the top surfaces of the teeth. Also, make sure you brush the appliance.
5. Rinse with mouthwash to help clean the appliance. Certain foods will tend to get stuck between the palate and the plastic (bread especially). Do not try to get the food out with a fork or toothpick! You may scratch the roof of your mouth.

Activations

How to adjust the appliance properly:

1. Follow the activation schedule given to you by your doctor.
2. If you should have to change your first appointment after receiving your expander, it is very important that you stop turning your expander and call the office. This will help prevent the chance that the upper jaw is widened too much. If you miss your next appointment, stop turning on the date of that appointment.
3. Please keep track of the number of times that the appliance has been activated.
4. The patient may want to take an analgesic (such as Tylenol) prior to activation. Usually, this is not necessary.
5. You will give the appliance two turns daily – usually before bedtime. A space may develop between your two front teeth as your upper jaw is expanded. When your upper jaw has been expanded wide enough, the appliance will be sealed, and the space between your two front teeth will close up a bit.
6. The patient will feel some pressure and tightness against the teeth as the expander is activated. There may also be pressure sensations in the area of the cheekbones and the bridge of the nose. This is very normal. Most of the pressure will be relieved during the first few hours. If the appliance begins to hurt or feel “too tight”, it may be turned backwards to relieve the pressure.
7. If any activation is unusually painful in the palate, stop that activation and wait until the next day to try again. If still painful, please call the office because it may indicate that a pressure sore has developed. This is not unusual. Call for an appointment to have the appliance checked.
8. The appliance is usually turned every day for approximately 2 to 3 weeks before it is sealed. After about 10-12 activations, you should start to see a space develop between the upper front teeth or the maxillary incisors. This is normal and is a good sign that the palatal bones are widening and opening. Some people only experience a small space, while others notice a significant space. Do not be alarmed. Once you have completed your expansion, this space will begin closing naturally.
9. After the appliance is sealed, it will remain in your mouth for 3 months to allow new bone to form in the palate. This also decreases the chance that the upper jaw will lose some of its expansion.
10. Then, the appliance will be removed and the braces will be placed.
11. If the expander ever feels loose, please call the office.
12. Patient will need to be seen weekly until appliance is no longer being activated.

As always, please feel free to contact our office with any concerns you may have.

Information About Your Headgear

Headgear is a removable appliance that is worn is to move the upper teeth farther back in the mouth in order to reduce an overbite. There are several types of headgear. The one prescribed for you depends upon the treatment needed to correct your malocclusion. The following instructions are to be followed when starting and/or wearing headgear during orthodontic treatment. These instructions are to be followed exactly, or expected tooth movement from the headgear will not be observed, and necessary treatment progress will be delayed.

1. It is essential that your headgear be worn EVERY DAY for 10-12 hours per day.
2. In order to be successful with the nighttime headgear wear, you must learn to sleep on your back or only slightly on your side. Try not to take the headgear off while sleeping. You should strive to wear the headgear every night, all night! If you leave it off for just one night, you may have to wear it many extra nights and extend your treatment time unnecessarily.
3. Use the “Headgear Chart” provided to record the total number of hours the headgear is worn each day and night.
4. Some temporary discomfort and soreness is normal when first starting your headgear. The molar teeth may become tender and even a little loose. Take a Tylenol or an aspirin as you would for a routine headache. Do not skip nights. It is important to NOT remove the appliance. If you remove the headgear to “rest” your teeth, you have done exactly the wrong thing; removing the headgear does not allow the teeth to adjust to the pressure. The discomfort is temporary; if you wear the headgear continually for three to six nights, the soreness should go away and not return. However, if the pain appears to be unusually severe or persistent, call the office.
5. Never go a complete 24-hour period without wearing the headgear at least some period of time. For each day or wearing period that is completely missed, the progress of moving teeth is delayed by four days!
6. Care should be exercised when inserting and removing the headgear to prevent the possibility of injury to the mouth and face or breaking the appliance. To remove properly, first unhook the safety strap and the elastic strap which is attached to the outer bow and then pull the facebow straight out. If this is difficult, pull gently on one side of the facebow. Never try to wiggle the facebow up and down, this can result in breakage. Always handle the headgear carefully, and never force your appliance on or off.
7. Never attempt to adjust your headgear yourself. If you find it is difficult to place or move your headgear, please call for an appointment.
8. PLEASE DO NOT WEAR YOUR HEADGEAR DURING ROUGH PLAY, SPORTS OR WHEN AT SCHOOL. THIS COULD RESULT IN INJURY TO YOU. WEAR THE HEADGEAR ONLY DURING QUIET TIMES.
9. Protect the headgear when not in use by keeping it in the plastic case provided. If the headgear is lost or distorted, call us immediately. There will be an additional charge for replacing the appliance if it is lost or damaged.
10. If a band which is cemented to a tooth becomes loosened or the headgear breaks or needs an adjustment, call for an EXTRA appointment. Do NOT wait for your regular scheduled appointment to have your appliance repaired or adjusted. Bring the band and all other material with you.
11. ALWAYS bring ALL parts of your appliance with you to ALL appointments. It may be necessary to check or adjust your headgear even if you come to the office for an appointment that you believe will not involve your headgear.

Rubber band Instructions

Purpose: Sometimes it is not possible to adjust only the wires in order to cause the teeth to move as they should. Small elastics or rubber bands are used to provide a gentle but continuous force to help individual tooth movement or the aligning of one arch to the other. Elastic bands are placed specifically to move teeth in a planned direction. Wearing elastics as instructed will help you finish your orthodontic treatment as soon as possible.

You will be given a special size of elastic bands to be placed as you have been shown in the office. Attempt to place your own elastic bands before leaving the office in case you are confused about the wearing location of the elastics.

In order to accomplish the most efficient tooth movement with the rubber bands, please follow these directions:

1. Rubber bands are to be worn 24 hours a day except when eating or brushing your teeth. Wearing your elastic bands 24 hours per day will be necessary for tooth movement to occur unless you are specifically otherwise instructed. It is also helpful to eat with the elastics in place. Sometimes, however, this is not possible. If removing the elastics to eat, please remember to replace them as soon as possible. NEVER switch sizes of elastic bands or wear more than you have been instructed to wear. This could cause your teeth to move the wrong way and set back your orthodontic progress. Remember when rubber bands are worn inconsistently, the tooth movement with the rubber bands is greatly reduced or stopped. Good elastic wear is a major key to the removal of your braces. It is up to you!
2. The rubber bands should be changed two or three times a day since they lose their elasticity after being worn awhile. Plan ahead. Take elastics to school, work or trips. Ask for an extra package if needed. If you start to run low on rubber bands, stop by the office for more or call, and we will mail some to you. Do not allow yourself to run out of elastics!!
3. Wearing elastic bands will make you teeth SORE as they cause the teeth to move. Leave them in and the soreness will go away within a few days. Some teeth may become a little bit loose. Take a Tylenol or an aspirin as you would for a routine headache. Continue wearing the rubber bands.
4. If a hook breaks or comes loose, call us immediately so we can fix the problem. Waiting until your next appointment will delay treatment completion.

Our number one goal is to give you the best smile possible and shorten the time you must wear your braces. Cooperation in wearing your elastics as instructed will help you and us achieve this goal!

Sports and Instruments

If you play an instrument, be assured that wearing braces will not interfere with your music. You may find it easier to limit playing your instrument for the first few days after braces are placed in order to allow your lips and teeth to adjust to the new braces.

If you play sports, it's important that you consult us for special precautions. A protective mouthguard is recommended for playing contact sports. Our office will provide you with a special type of mouthguard just for orthodontic patients. It is important that you do not use the “boil and bite” kind of mouthguard, as this can get stuck around the braces and pull them loose.

In case of any accident involving the face, check your mouth and the appliances immediately. If teeth are loosened or the appliances damaged, phone at once for an appointment. In the meantime, treat your discomfort as you would treat any general soreness.