Q. What is the biggest misconception about orthodontic
treatment?
A. If I could just tell people one thing about orthodontics
it would be this: Teeth are NOT like fence post that are set in concrete. With a fence post, you place it where you
want it, pour concrete around the base, hold it in place (retain) and, when the
concrete sets up, the fence post is stable and should never move. Now this is NOT what happens with teeth! Teeth are never fixed to the jaw bones. They always have the capability to move. So why don’t they…why do crooked teeth stay
crooked until the orthodontist moves them…why do straight teeth stay straight
if a patient is blessed with straight teeth and never needed orthodontic
treatment? The answer is that, in both
cases, the teeth still can move…they just don’t “want” to move, at least not right
then. In both cases, the teeth are stable
(crooked and straight) in their respective positions because the forces on them
from the bite, tongue, lips and cheeks balance out (for you science types: static
equilibrium). Change the forces with
braces, or with just normal aging, and the teeth will move. This is why we
never tell a patient to stop wearing their retainers. Even if the teeth might stay straight for
years, forces change over time, and the teeth will move. Retainers will hold
teeth in position because they can overcome any unbalanced forces that might affect
the teeth.
Now all of this is not to say that in makes NO difference
where the orthodontist puts the teeth.
Ideally, we try and find the most stable position possible for each
patient. If we do this, then the teeth
will tend to stay straight, with or without retainers (not that we recommend
not wearing retainers). And this is
where diagnosis comes in. Let’s say a
patient has extremely crowded teeth due to very large teeth and a small mouth.
The teeth are stable in their crooked position, but if we just expand the
arches to make room for all the teeth, are we not moving them out to an
unstable position? But if we extract
some teeth (so we can leave the remaining teeth in the arch, but straight),
then the final result should be much more stable.
My wife had orthodontic treatment 50 years ago and, like
many people, she stopped wearing her retainers after a few years. Yet, because she had teeth taken out for
crowding, her final result was stable and, even 50 years latter, her teeth look
great. Now this doesn’t happen for
everybody, but this is what we try to achieve, and this is the reason why we
try so hard to get everything perfect and why we reluctantly are forced to
extract teeth in some patients. Now some people will say that treating people
without extractions is a more “conservative” way of doing orthodontics. But is getting a stable result with
extractions more radical than leaving someone with an unstable result that will
collapse the second they stop wearing their retainers?
Bottom line: want to keep your teeth as perfect as the day
the braces came off? Then wear your
retainers!
