Do I have to Wear a Retainer Forever?
Getting straight teeth is only half the battle when receiving orthodontic treatment. Keeping them straight is the other half! Many patients are surprised and disappointed when they hear they’ll need to wear a retainer for the rest of their lives to keep their straight teeth. The fact that our teeth change positions with age should not surprise anyone. Can you name another part of your body that does not sag or wrinkle as you get older? Teeth are no different. What determines the position of our teeth? Why do teeth move after the braces come off? Is it possible to keep the teeth exactly as the day treatment ends?
What determines the position of our teeth?
It is basic physics that if something is not moving, it is because the forces acting on it are at “equilibrium.” The weight of a book sitting on a table is balanced by the force of the table holding it up. The positions of our teeth are also determined by forces that act upon them. These forces include the tongue on the inside, the lips and cheeks on the outside, the bone, ligaments, and gums around the roots, and the biting force of the teeth in the other arch. Before you begin your orthodontic treatment, your teeth are usually at equilibrium. Even though they are not straight, they are relatively stable in their original positions. (Note: Abnormal forces factors, such as thumb sucking, breathing problems, or tongue posturing issues, can also affect the position of the teeth.)
Does orthodontic treatment change the equilibrium?
While some oral conditions can be changed during orthodontic treatment, most cannot. Dentists or orthodontists who say they can retrain your tongue, lips, biting force, etc., are making claims that are mostly wishful thinking. Any treatment that moves the teeth away from where they were at the start changes the forces acting upon them and may make them more likely to move after treatment. For this reason, orthodontic specialists consider the initial position of the teeth as part of their treatment plan and the effect that moving them from that position will have on their stability afterward.
Do teeth that haven’t been moved very much still require retainers to stay straight?
Sadly, no matter where teeth start or end up, all teeth require retainers to remain straight. There are other factors in play besides how far teeth were moved from their original positions. For example, the ligaments around teeth that have been turned or moved up or down have memory that pulls the teeth back toward their original positions. The way the teeth come together (the occlusion) has also been changed, which can cause tooth movement. Additionally, even if none of these things were altered much during treatment, they naturally change with aging. Facial muscles become weaker. The gums, bone, and ligaments also change. Again, the sagging and wrinkling that affects the rest of our body also affects our smiles, even if we never had braces!
Retainers are the only way to minimize tooth movement after treatment
Because your teeth will change positions and shape (through natural wear), retainers are prescribed for all our patients. While retainers cannot prevent all tooth movement, they are the best tool available for minimizing these changes after orthodontic treatment. As you can read elsewhere in my blog, different retainer designs are used for the various kinds of orthodontic problems. Discuss your options with your orthodontist to ensure you have the best choice for you.
What can I do if my teeth move so much that I dislike their appearance?
Sometimes, orthodontic patients need a “tune-up” after their braces have been off for a while. Additional treatment does not come as a surprise to patients who have had Lasix surgery on their eyes. At the first visit, ophthalmologists explain that eyes will change with age, and they almost always need a “revision” about ten years down the road. Maybe orthodontic patients should be told something similar before their treatment begins.
NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist in the private practice of orthodontics in Rio Rancho and Albuquerque, New Mexico. He was trained at BYU, Washington University in St. Louis, and the University of Iowa. Dr. Jorgensen’s 30+ years of specialty practice and 10,000+ finished cases qualify him as an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in New Mexico. He cannot diagnose cases described in comments nor select treatment plans for readers. Copyright laws protect the opinions expressed here and can only be used with the author’s permission.
