Magician Michael Grandinetti mystifies and astonishes audiences with his sleight of hand and mastery of illusion. But when he initially steps onto the stage, it’s his smile that grabs the attention. “The first thing… that an audience notices is your smile; it’s what really connects you as a person to them,” Michael told an interviewer.

He attributes his audience-pleasing smile to several years of orthodontic treatment as a teenager to straighten misaligned teeth, plus a lifetime of good oral care. “I’m so thankful that I did it,” he said about wearing orthodontic braces. “It was so beneficial. And… looking at the path I’ve chosen, it was life-changing.”

Orthodontics — the dental subspecialty focused on treating malocclusions (literally “bad bites”) — can indeed make life-changing improvements. Properly positioned teeth are integral to the aesthetics of any smile, and a smile that’s pleasing to look at boosts confidence and self-esteem and makes a terrific first impression. Studies have even linked having an attractive smile with greater professional success.

There can also be functional benefits such as improved biting/chewing and speech, and reduced strain on jaw muscles and joints. Additionally, well-aligned teeth are easier to clean and less likely to trap food particles that can lead to decay.

The Science Behind the Magic

There are more options than ever for correcting bites, but all capitalize on the fact that teeth are suspended in individual jawbone sockets by elastic periodontal ligaments that enable them to move. Orthodontic appliances (commonly called braces or clear aligners) place light, controlled forces on teeth in a calculated fashion to move them into their new desired alignment.

The “gold standard” in orthodontic treatment remains the orthodontic band for posterior (back) teeth and the bonded bracket for front teeth. Thin, flexible wires threaded through the brackets create the light forces needed for repositioning. Traditionally the brackets have been made of metal, but for those concerned about the aesthetics, they can also be made out of a clear material. Lingual braces, which are bonded to the back of teeth instead of the front, are another less visible option. The most discrete appliance is the removable clear aligner, which consists of a progression of custom-made clear trays that reposition teeth incrementally.

How’s that for a disappearing act?!

If you would like more information about orthodontic treatment please contact us or schedule an appointment for a consultation. You can also learn more about the subject by reading the Dear Doctor magazine article “The Magic of Orthodontics.”

Fans of the primetime TV show The Middle were delighted to see that high school senior Sue, played by Eden Sher, finally got her braces off at the start of Season 6. But since this popular sitcom wouldn’t be complete without some slapstick comedy, this happy event is not without its trials and tribulations: The episode ends with Sue’s whole family diving into a dumpster in search of the teen’s lost retainer. Sue finds it in the garbage and immediately pops it in her mouth. But wait — it doesn’t fit, it’s not even hers!

If you think this scenario is far-fetched, guess again. OK, maybe the part about Sue not washing the retainer upon reclaiming it was just a gag (literally and figuratively), but lost retainers are all too common. Unfortunately, they’re also expensive to replace — so they need to be handled with care. What’s the best way to do that? Retainers should be brushed daily with a soft toothbrush and liquid soap (dish soap works well), and then placed immediately back in your mouth or into the case that came with the retainer. When you are eating a meal at a restaurant, do not wrap your retainer in a napkin and leave it on the table — this is a great way to lose it! Instead, take the case with you, and keep the retainer in it while you’re eating. When you get home, brush your teeth and then put the retainer back in your mouth.

If you do lose your retainer though, let us know right away. Retention is the last step of your orthodontic treatment, and it’s extremely important. You’ve worked hard to get a beautiful smile, and no one wants to see that effort wasted. Yet if you neglect to wear your retainer as instructed, your teeth are likely to shift out of position. Why does this happen?

As you’ve seen firsthand, teeth aren’t rigidly fixed in the jaw — they can be moved in response to light and continuous force. That’s what orthodontic appliances do: apply the right amount of force in a carefully controlled manner. But there are other forces at work on your teeth that can move them in less predictable ways. For example, normal biting and chewing can, over time, cause your teeth to shift position. To get teeth to stay where they’ve been moved orthodontically, new bone needs to form around them and anchor them where they are. That will happen over time, but only if they are held in place with a retainer. That’s why it is so important to wear yours as directed — and notify us immediately if it gets lost.

And if ever you do have to dig your retainer out of a dumpster… be sure to wash it before putting in in your mouth!

If you would like more information on retainers, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor magazine articles “The Importance of Orthodontic Retainers” and “Why Orthodontic Retainers?”

We all know Madonna, Seal, David Letterman, Anna Paquin and Michael Strahan (of the talk show Kelly and Michael). What do all of these celebrities have in common? Each has a “signature gap” between their front teeth. Given that they have been in the public eye for quite some time, it's not likely that these famous faces will choose to change their well-known smile. In fact, Michael Strahan has publically stated that he will never close his gap.

However, it is not uncommon for people to desire to fix a small gap in their teeth, particularly in advance of important events, such as weddings. Often times, fixing this small gap requires relatively simple orthodontic movements or tooth straightening. Since the teeth don't have to be moved very far, we can usually use simple appliances to correct the issue within a few months.

In order for us to determine your course of treatment, you'll need to make an appointment with our office for a thorough examination. When we examine you, we'll be looking for a number of items that will affect our treatment recommendation:

• Is there enough room to close the space without creating other bite problems?
• Are the roots of the teeth in reasonably good position to allow for minor tooth movement to close the space? X-rays will be required to make a proper assessment.
• Is there an involuntary tongue habit that has pushed the teeth forward and created the gap? If so, this could be difficult to fix quickly.
• Are the surrounding gum tissues and bone healthy?

Based on our assessment and your individual needs, we may recommend one of the following options:

• Clear retainers, a computer-generated series of clear retainers customized for your bite to move the teeth
• Removable orthodontic retainers to which we will attach small springs or elastics to facilitate the minor tooth movement
• Traditional fixed orthodontic appliances (most commonly known as braces), small metal or clear brackets bonded to your teeth through which tiny wires are used to move the teeth

Regardless of the method we choose, once your teeth have moved into the new position, it is important for you to remember that they must be kept in this position until the bone stabilizes around the teeth. We may therefore advise you to wear a retainer for a few months to a few years, depending on your situation.

If you would like more information about orthodontic treatments, please contact us or schedule an appointment for a consultation. You can also learn more by reading the Dear Doctor magazine article “Minor Tooth Movement.”

Normally, teeth erupt and grow in a symmetrical alignment: on the top palate, for example, the two central incisors take center stage; on either side are the lateral incisors, and then beside these the canines (cuspids).

But what happens when teeth don’t grow in? The result can be a smile that just doesn’t quite look right; more importantly, normal function is impaired because the person can’t grasp and chew food correctly.

These missing teeth are the result of a congenital (“from birth”) defect. It’s estimated that almost a quarter of all people are missing one or more wisdom teeth, and more than 5% are missing one or more second premolars or upper lateral incisors.

In a normal arch (the upper or lower set of teeth), each tooth type performs a particular role during eating. A missing tooth causes the remaining teeth to compensate, but beyond their capacity. The remaining teeth also tend to move to fill in any gaps left by the missing teeth, as when the eye teeth move toward the central incisors in the absence of the lateral incisors. This puts them out of position, so they can’t cover (“occlude”) their counterparts on the other arch and grasp food properly.

To improve the smile and restore proper chewing function it’s necessary to first move these “out of position” teeth to their correct position through orthodontics. We would then fill the gaps that result with life-like restorations (preferably dental implants with crowns) that resemble the type of tooth that should be there.

The restoration needs to be timed carefully, especially for young patients whose jaw structure has not fully developed. If implants are installed before the jaw’s full maturity (usually late teens or early twenties), the implant crowns may not appear to be the right length as the jawbone continues to grow. Since bone growth depends on the normal pressures exerted by the teeth, there may also be insufficient bone mass in the gap area to support a dental implant. Growing bone with bone-grafting material may be necessary before installing implants.

The total process could take many months or even years, depending on age and other conditions. In the end, though, the results can be astounding — better function and a vibrant, new smile.

If you would like more information on developmental problems with teeth, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “When Permanent Teeth Don’t Grow.”

If you are considering having your teeth straightened, for cosmetic or other reasons, the idea of using clear aligners rather than traditional braces may be appealing.

Here are the answers to some frequently asked questions about clear aligners.

What are clear aligners?
Clear aligners are clear removable custom fitted “trays” that gradually straighten teeth. Used sequentially, each individual tray is slightly different from the one before and is worn every day for two weeks before going on to the next one in the series. This slowly moves your teeth to a new position.

How are they made?
The trays are computer-generated, based on impressions and models of your mouth combined with the knowledge of growth, development of teeth and jaws, and most importantly how and why teeth move.

How long does this treatment take?
By wearing clear aligners for at least 20 hours per day for two weeks before changing to the next tray in the sequence, treatment time can range from six months to two years depending on your individual situation.

Can children wear clear aligners?
Clear aligners are generally used for adults who have all their teeth and when jaw growth is complete, but can be used for younger people depending upon the extent and severity of their situation.

What situations can clear aligners be used for?
Clear aligners can realign or straighten teeth, close mild spaces, treat elongated teeth and tip teeth into better position. They are usually recommended for correcting mild to moderate crowding of teeth, particularly if your back teeth already fit together properly.

When are clear aligners probably not the right choice?
If you have a bad bite (your back teeth do not fit together well), or if you have a severe overbite or underbite, traditional braces are probably a better choice for treatment. If your teeth are severely crowded, or if your situation is complex, clear aligners will probably not be the right treatment choice.

How do you decide whether clear aligners are right for you?
An orthodontic assessment of your individual situation must be performed by our office.

What is considered in the assessment?
The assessment includes specialized x-rays of your teeth, jaws and skull, along with photos, impressions, and models of your bite.

For more information about clear aligners vs. traditional braces, make an appointment with us for a consultation and an examination of your own situation. You can learn more by reading the Dear Doctor magazine article “Clear Orthodontic Aligners: An Alternative for Adult Orthodontics.”