All posts by Camilleri Dr.

Children’s teeth

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Why do I need retainers?

Why do I need retainers after braces?

Retainers are provided after nearly every type of orthodontic treatment except the simplest type in very young patients. This is because the bone and gums need time to adjust to the new positions of the teeth. Failure to provide (or wear) retainers may mean that the teeth will relapse, that is, move either partly or wholly back to their original position.

How have they evolved?

In the late 1960’s a scientist called Reitan found that the reorganisation process takes roughly a year. The first few months of the retention phase is the time that the teeth are most prone to rapid relapse. Some movements of teeth are more prone to relapse than others. For example, rotated or twisted teeth are very prone to relapse and the gaps between previously spaced teeth are even more likely to re-open unless retained. This is because the elastic fibres in the gums take a long time to adjust. Even after the first year is over, your teeth may still move. This is because your teeth respond to pressure (otherwise your brace wouldn’t have worked). Once the brace is off, your teeth come under the influence of your lips, which apply inward pressure on your teeth and your tongue, which pushes the other way. The stable position of your teeth is the balance zone between the two pressures and this is where your orthodontist will have aimed to put them. However this balance zone moves throughout your life as your face matures and changes with age.

Some of the more recent findings

Scientists in the UK and the USA have found that the front part of your mouth actually narrows by a millimetre or two after the age of thirteen. A Swedish scientist named Bjork looked at serial xrays of children and adolescents and found that the lower jaw keeps growing for longer than the top, possibly leading to movement of the teeth as they try to keep contact.  Furthermore, your face keeps lengthening, albeit again by a millimetre or two, into middle age. This does not sound like much but millmetres make quite a difference to the appearance of teeth.

Why do teeth move?

The most common time for teeth to move after having had braces is when you are in your late teens or early twenties. Many people notice that their lower front teeth have crowded. Traditionally the wisdom teeth have been blamed for this, but an Irish researcher, Margaret Richardson, looked into this subject and found that wisdom teeth do not make a significant contribution to crowding of the lower incisors, so please do not have your wisdom teeth out to prevent or treat this problem. In summary, nobody knows exactly why the teeth tend to move at this age, however the most likely explanation is that your face is always changing and your teeth change also. Therefore, even though you have had a course of bracework and your teeth are perfectly aligned, the only way to guarantee that your teeth will stay straight is to keep wearing a retainer, at least on a part-time basis – for as long as you want to keep them straight! I will discuss the different types of retainer in a subsequent post.

What types of retainer are there?

There are two basic types of retainers, removable or fixed and both have their pros and cons. Removable retainers are usually worn full-time for the first three to four crucial months after removal of the brace but are removed for eating and cleaning. Afterwards they may be worn at night only. They are very effective and reliable, but obviously this depends on their being worn as instructed.

There are two categories of removable retainers:

Vacuum formed retainers are the most common. These are made of polyethylene or polypropylene sheets which are vaccum formed to a mould of your teeth. They are light and transparent, virtually invisible and as they only cover the teeth, there is rarely and interference with speech apart from the first day or so. However they may be damaged if the instructions for wear and cleaning are not followed and being almost invisible, are easily lost! 

The other type are made of acrylic and wire, the commonest being known as a Hawley retainer. These retainers are more robust but heavier and cover at least part of the palate, therefore are more prone to affect speech. There is often a wire crossing the front teeth and so are more noticeable. These retainers are used in certain cases where a vacuum formed retainer is not suitable, e.g. when the upper jaw has been expanded or after major jaw surgery.

Advantages of removable retainers

The major advantage of a removable retainer is that the wearer can control and supervise the retention of the teeth. Removable retainers need only occasional checks by the orthodontist as damage is easily spotted by the wearer. Furthermore, if the retainer is not worn for a time and the teeth move slightly, the situation may often be saved by pushing the retainer in until the teeth move back into place. Being removable, there is nothing to hinder cleaning of the teeth. Your local dentist will be able to tell you more about this.

Fixed retainers are fine wires glued to the backs of the teeth and are usually preferred by patients as they eliminate the need to remember to wear a retainer. They also do not interfere with speech. However they do have several disadvantages. They cannot be placed in every situation as they may interfere with the way the teeth meet. This will either cause discomfort or will break under the force of the bite. Being fixed they tend to accumulate debris. This may be difficult to remove, even by a dentist and may cause disease. They may also become detached and need urgent repair. Should a fixed retainer become partly detached and the wearer does not notice, the detached teeth may drift. These may be very difficult to bring back into line without a further course of bracework. Occasionally, if the fine wire is damaged or bent, it may act as a spring and move the teeth itself. Again, the wearer may not notice until significant movement has occurred and considerable re-treatment will be necessary to straighten the teeth once again. So, while fixed retainers are useful in certain cases, they are certainly not ‘fit and forget’ as most people would like them to be. A fixed retainer needs regular, lifelong supervision and maintenance, either by a general dentist who has some extra training and knows what to look for, or by an orthodontist.

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crooked teeth and orthodontics

Why do teeth get crooked with age?

Lots of people have crooked teeth. Scientists think that this is chiefly because our jaws and teeth are getting smaller, but the jaws are shrinking faster than the teeth. Crowding can start from a very early age. Many parents are shocked when their child, who had perfectly straight baby teeth, develops crowding once the teeth start to change. This is because the permanent teeth are much larger than the baby teeth and unless the baby teeth were well spaced out, crowding is almost inevitable.

Some theories of why teeth crowd

Some people’s teeth come up straight, then become crowded later on. Based on his observations of Aboriginal teeth, the Australian researcher Raymond Begg put forward the theory that as our diet is so refined, the teeth do not wear down and therefore become crowded, but this idea is not accepted by many scientists. So what is the reason that crowding gets worse with time? The answer is that the shape of your mouth changes with age and this has an effect on the position of your teeth. The front part of the mouth gets wider up to the age of 10, in order to accommodate the larger permanent teeth.

An English academic called Robert Lee, found that the mouth starts to narrow after the age of 13, reducing the amount of space available.  The mouth does grow in depth after that age; however the space is not made available to the front teeth as the 14 year molars and then the wisdom teeth take up the room. Furthermore, a Swedish scholar, Arne Bjork, found that the upper and lower jaws keep growing even into the late teens and twenties, but at different rates.  This difference in growth may cause the teeth to tip towards each other to maintain the correct contact. A side effect of this is crowding, especially of the lower front teeth. The wisdom teeth come through at this age and are blamed for the crowding where in fact, they are innocent!

An Irish researcher, Margaret Richardson from Belfast, has shown that there is no connection between wisdom teeth erupting and the occurrence of tooth crowding. As you go through your twenties and early thirties, your face changes and so do the pressures on your teeth, this may push them towards each other and cause dental crowding.

Can I prevent crowding?

So, your teeth are at the risk of crowding from a very early age and the risk increases as you get older. Can anything be done to prevent crowding? If the jaws are significantly crowded then extraction of teeth together with the appropriate brace is the current answer. Unfortunately we do not understand enough about the variability between persons in order to be able to predict the amount and type of crowding a person may develop. The only guaranteed way of keeping your teeth kept straight, whether or not you have had braces, is to wear a retainer for as long as you wish to keep your teeth straight, or in other words, lifelong. The advantages and disadvantages of the different types of retainer will be dealt with in a subsequent post.

Concerned about your teeth crowding?

Camilleri Clinic is a leading dental clinic in Malta offering orthodontic treatment by fully qualified orthodontists. Contact us for more details about treatment options available.

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Brushing teeth too hard

Tooth Myths Debunked – you have probably been doing it wrong!

You might have heard or learned a lot about brushing your teeth and how best to look after them – but the things we often learn or hear or even what we teach our kids about oral hygiene is not always factually correct.

Myth: you should Wet your toothbrush

You do not actually need to wet your toothbrush before you add tooth paste to it. If you wet your toothbrush for softer bristles, then you should just opt for a soft bristled toothbrush. If you wet your toothbrush to better lather the toothbrush, you should have enough saliva in your mouth to do this – there is no need to wet the toothbrush. Wetting your toothbrush can dilute the fluoride content in the toothpaste. If you really feel you must wet your toothbrush, use a minimal amount of water.

Myth: add a nice slug of toothpaste

Adverts are very misleading – when toothpaste is being applied to the toothbrush, the TV ad usually shows toothpaste being pushed out the tube and the length of the toothbrush, from end to end – the toothpaste worm. It is in the interest of marketers that we consume as much toothpaste as possible so that we end up needing to buy tooth paste more often. The truth is, we only need a pea sized amount to brush our teeth. Any more toothpaste than this, will not give you better results. It will only waste more money.

Myth: Cleaner teeth mean hard brushing

You should not apply too much pressure when brushing your teeth. Brushing too hard and vigorously will not get the teeth any cleaner then using a lighter stroke. Hard brushing could damage the teeth by eroding the enamel over time. By brushing hard, you may be increasing your chances of cavities because the enamel protects the inner part of the tooth and hard brushing wears the enamel away. Also, try to opt for soft to medium bristled toothbrushes. Very hard bristles can also damage the tooth enamel.

Myth: flossing is important

This has been debated in the recent years by dentists and professionals in the area. In the USA, flossing has been removed from the Dietary Guidelines issued by the ADA (American Dental Association). Public Health England also started reviewing their recommendations back in2016. The British Dental Association doesn’t particularly champion flossing or discourage it. It does however, recommend small single tuft tooth brushes which can help reach areas in between the teeth that conventional tooth brushes may not. Although strong evidence in favour of flossing is lacking, with no major study concluding it is important, it does not mean flossing is useless or that you shouldn’t floss.

Myth: chewing gum cleans your mouth

Not a replacement for brushing your teeth – chewing [sugar free] gum can have a protective effect on the teeth, but it does not actually clean them anywhere close to the way a good brushing would. The benefits of chewing gum are in the production of saliva. Gums stimulates more saliva to be produced which means your mouth can wash away acids from food and drinks that can erode the tooth enamel. If the gum Xylitol, it can help redouble the effects of saliva.

Myth: If I cut out sugar, I will avoid cavities

Sugar is bad for your teeth- we all know this. But crisps and crackers can also be bad for teeth, in fact they may be even worse. The starch content in these foods is high. Carbohydrates contain sugars and the sugars found in the carbs you take in when eating crisps, can damage the teeth.

Myth: avoid brushing gums if they bleed

This is a difficult one to explain. Bleeding is a sign of infection in the gum but sometimes actually getting your gums to bleed can help with the heeling process. If you notice your gums bleeding, don’t be afraid to brush them – you should always brush your gums along with your teeth anyway. In fact, brushing will help your gums heal, even if it means more bleeding. However, we do suggest you visit your dentist to see what the cause of the gum bleed is.

If you already new all this, hats off to you. We hope all our patients learn all there is to learn to help them maximise their oral health.

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Whitening teeth

A handful of quick and useful tips for whiter and brighter teeth

Professional whitening is a great way of enhancing the whiteness of our teeth, lightening stains and getting a nice, even tone. The results of a professional whitening of course are not always the same; they depend very much on how well we have looked after our teeth as well as the nature of our own teeth (which varies from person to person). The efficacity depends on several factors which can be both external (such as diet, medications etc) as well as genetics, structure etc.

It is important to note that whitening treatments will not keep your teeth permanently white and despite the fact that professional whitenings do no harm to the teeth, they may become less effective as years go by and on older teeth. Keeping away from certain foods and beverages can help keep your teeth white for longer. A dentist will be able to advise you on what type of whitening is best for you and what results you can expect.

Good oral hygiene & regular check-ups

We cannot stress just how important good oral hygiene is – not only for whiter, brighter teeth but also for better oral health. If it’s the pearly whites you have in mind, you may want to consider flossing, whitening tooth pastes or whitening strips. Importantly, keep your check-ups regular to ensure good oral health as well as cleaner teeth and avoid build-up of tartar or plaque. If you are looking for a dentist in Malta, then contact our clinic, let’s set up an appointment and discuss how to maximize your oral health.

Some products can stain your teeth

There are certain products we tend to regularly consume which could stain our teeth. Usually staining is caused by pigment substances in the drinks we consume that can adhere to the enamel or even penetrate the enamel thus staining the teeth.

Wine, coffee and other drinks

A glass of vino never goes amiss – but it is worth bearing in mind that both red and white wine can stain the teeth. If it is red wine, then chromogens are to blame. Chromogens are chemical compounds that can be readily converted into a dyes. The tannins in red wines (as well as other drinks we consume) can aggravate the problems as they actually make it easier for the chromogens to bind to the tooth enamel.

With white wine the issue is a bit different – white wine is often acidic and it is the acidity of the wine which can cause your enamel to erode and reveal what lies beneath it – the rather yellowish looking dentine. The dentine is not only a less visually pleasing yellow but also makes our teeth more sensitive.

Tip: Avoid brushing right after drinking wine as this can actually cause damage to the teeth. Read more about how to achieve the best results when brushing your teeth by clicking here.

You may also [wait for it] want to try drinking wine or any other drink that has the potential to stain with a straw. And finally, the less time the drink is in contact with your teeth, the more we reduce the chances of staining. Hence, if you enjoy sipping your wine, savouring it, swirling it in your mouth etc you are increasing your chances of staining.

The list: foods and drinks to avoid

Here is a non-exhaustive list of foods and drinks that have the potential to stain your teeth:

Coffee, tea, soft drinks, dark juices (such as cranberry, blueberry or grape), eating fruits that dark juices are made of, soy sauce, balsamic vinegar, tomato sauce, beetroot, some hard sweets (usually coloured ones).

Your teeth as they age

As years go by, wear and tear of the teeth causes tiny microscopic fissures and cracks. The cracks mean that any drinks or foods we consume can penetrate the tooth enamel more easily. Typically these deeply inset stains can challenging to remove.

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Medical Doctor

Are my teeth and gums healthy? A few checks you can do yourself

You should be asking yourself this question and take a quick look at the inside of your mouth from time to time. A few checks and you should have a fair idea of whether your teeth and gums are healthy or perhaps whether there may be some underlying condition which may require a visit to the dentist’s.

Look at your gums

We seem to invariably concentrate on looking at our teeth and how straight, clean or white they are, often ignoring our gums. People many times don’t realize just how important the gums, the tongue and our entire mouth actually is.  Healthy gums should not be any other colour but pink. If they appear too red or too white, then there could be a dental issue. You may find yourself wondering if your gums are the right “healthy” pink or not. Running your fingers gently on the surface of your gums should be a good check for you to carry out hand in hand with your gum colour check. If sliding your finger across your gums results in any discomfort, pain or bleeding there could be an underlying problem.

What about my tongue?

You should examine your entire mouth – oral health is called “oral health” because it is concerned with the overall health of all parts of the mouth not just the teeth. Your tongue should be pink (not white or crackled) and you mouth should feel moist which a constant flow of saliva. Saliva is important for a number of reasons – besides carrying out part of the digestive process, it also help flush and clean our mouths. If you suffer from a dry mouth, a condition known as xerostomia, you should definitely get it seem to. A dry mouth can be a side effect of some medications but it can also be a sign of an underlying condition like diabetes or Alzheimer’s. When brushing your teeth remember to also brush your tongue. Plaque build up also happens here and brushing will ensure a healthier mouth, preventing bad breath and a host of other potential issues.

What about my breath?

We may begin by keeping in mind that as nice and fresh as that minty after taste from mouth wash or toothpaste is, our mouths and breaths do not naturally smell minty. This said, a healthy mouth shouldn’t smell good or bad but rather neutral. Mouths that emit foul odours are indicative of something happening either in the mouth (perhaps tooth decay) or the stomach or in both.

Bleeding gums?

Gums can bleed from time to time, so a bit of blood is not usually anything to be concerned about. However, if you see that bleeding is consistent and happens with every brushing it might be time to visit us.  The number one cause of bleeding gums is built up plaque. You can begin by going over your brushing technique; you may not be using the correct motions or perhaps not actually brushing your gums but only your teeth (a common mistake we often hear about when talking to our patients). Brushing too hard can also cause the gums to bleed – keep light-handed, no need to for pressure or vigorous brushing.

Time to visit your dentist?

Now that you’ve read this, are you ready to make sure to keep your mouth healthy? Camilleri clinic is one of Malta’s leading dental clinics. Based in Sliema, we are a team of dentists available to guide you and help you achieve optimal oral health. We believe in long-term relationships with every one of our patients and strive to provide you with the level of treatment that we hope will leave you beaming or at least happy enough to return to your preferred dentist.

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