New Jersey Family: How do I know my child needs a retainer?
Dr. David Caggiano: Your teeth are actually the most unstable and prone to movement immediately after they’ve been straightened or when you finish orthodontic treatment. The first nine months or so after tooth movement is the most important time to be wear your retainer as prescribed because the bone surrounding the teeth is not as dense or as strong as it eventually will be. In order for your teeth to move, the bone is softened and the teeth actually loosen. That happens when forces are applied by the braces. Then, when the teeth reach their new position and stop moving, the bone strengthens and the teeth retighten and become stable. In that new position, the gum tissue surrounding the teeth must also regenerate. That’s the role of the retainer.
NJF: How does a retainer work?
Dr. Caggiano: A retainer is an appliance that retains the position of your teeth—it keeps your teeth from moving. Retainers do not move teeth like braces do, that is a common misconception. Retainers are typically used at the end of an orthodontic treatment to keep your teeth straight and to prevent them from shifting back to where they were before treatment.
NJF: Are there different types of retainers?
Dr. Caggiano: There are three common types of retainers: the Hawley, the Essix and Bonded. The Hawley and Essix each have advantages and disadvantages. One advantage of both of these is that they are removable.
The Hawley retainer consists of a thin layer of plastic that fits to the roof of the mouth or inside the gums near the tongue, depending on whether it is worn on the upper or lower teeth. The plastic has a small, metal wire attached. The wire is visible on the outside of the front six teeth and helps hold the retainer in place.
One of the advantages of this type of retainer is that the plastic comes in different colors and designs. Kids have fun with them even though the plastic is invisible when the retainer is inside the mouth. Another advantage is that the retainer does not cover the biting surface of the teeth. As a result, Hawleys last a little longer in patients that grind their teeth.
The biggest disadvantage of the Hawley is that it’s uncomfortable to wear due to how large the plastic is on the inside of the mouth. If a patient has upper and lower Hawleys, they really feel like they have a mouthful of plastic. Another big disadvantage is that the metal wire that keeps the front six teeth straight doesn’t always do its job. And some people don’t like the look of the metal wire running across the front of their six teeth. It’s really not aesthetic.
The Essix retainer is a clear plastic retainer that snaps onto the teeth and fits over the entire surface of each tooth.
A big advantage of the Essix retainer is that it’s virtually invisible when worn. Some people call it the Invisalign retainer because it looks like Invisalign. It’s much more comfortable than the Hawley retainer, so compliance is much better. In fact, the advent of the Essix retainer has made compliance with retainers much easier.
Another advantage of the Essix retainer is that it does a much better job of keeping the teeth straight after the orthodontic treatment. Your teeth simply cannot move if you wear an Essix retainer.
A disadvantage of the Essix retainer is that it may crack or may wear through if you grind your teeth. In the latter of these instances, it serves double duty by protecting your teeth. However, instead of using the Essix retainer as a night guard, it may be best to talk with your dentist about creating an appliance to help protect your teeth from grinding.
A Bonded or a fixed retainer is a small metal wire that is glued to the inside surface of the teeth and cannot be removed by the patient. The biggest advantage of the bonded retainer is that it’s in the mouth all the time. That means the patient doesn’t have to remember to wear it.
However, it requires a little more diligence to keep it clean since it makes flossing in the area of the bonded retainer more difficult. Before choosing this retainer, be sure you understand how to clean around it, and more importantly, how to floss around it.
To be a candidate for a bonded retainer, patients must have excellent oral hygiene habits. A bonded retainer should not be placed by an orthodontist if there is any plaque buildup behind the lower front teeth or any signs of gingivitis.
With proper home care and regular visits to your general dentist for cleanings and exams, your bonded or fixed retainer can be left in place until the lower jaw growth is completed in early adulthood. Or perhaps even forever.
NJF: What does my kid need to know about taking care of her retainer? How do you clean a retainer and do you remove it when eating or sleeping?
Dr. Caggiano: Caring for removable retainers is simple. It only takes a few minutes.
It’s recommended that you clean your retainers daily, otherwise, they can get pretty funky. Since most patients wear their retainers nightly, it’s important to clean them in the morning when you wake up and remove them.
The best way to clean a retainer is simply with a toothbrush and water. I do not recommend using toothpaste, since toothpaste usually has an abrasive in it that will microscopically scratch the retainer. That can result in buildup accumulating over time in the scratches.
Without cleaning the retainers regularly, they can develop a white film that is basically minerals from saliva. That film can also have bacteria in it. Removing that white film is easy enough: Just soak the retainer in a mixture of equal parts water and white vinegar for around 30 minutes. Then brush the retainer with the mixture prior to rinsing it off. White vinegar will dissolve the minerals, leaving the retainer spotless.
There is also a sure-fire plan for cleaning retainers (especially ideal for germaphobes). Go to Amazon.com and search for “ultraviolet light retainer cleaner and retainer cleaning tablets.” An ultrasonic UV cleaning unit costs about $50. Such a machine uses ultraviolet light to kill bacteria and the ultrasonic portion vibrates the water, cleaning tablets and retainer. The cleaning tablets also kill off bacteria to help clean the retainers. Some of them even have a refreshing mint flavor. The unit also cleans itself in the process, so it is basically the gold standard, super-duper way to clean your retainer.
Keeping your retainer clean is important. If your retainer gets funky, you’re less likely to wear it. Too much funk buildup is the most common reason patients stop wearing retainers. So, if it’s kept clean, then there is no excuse for not wearing it.
NJF: How long does a child typically need to wear a retainer?
Dr. Caggiano: I recommend wearing retainers every night until the jaws are finished growing, which is about age 23. At age 23, retainers can be worn every other night for the first month. When worn every other night, the retainer should still feel familiar when placed on the teeth. If it does, then that means the teeth are not moving. After the second month, the retainer can be worn every second night. Again, if the retainer feels the same way it always has, then the third month the retainer can be worn every third night. At any point during this gradual weaning process, if the retainer feels tight, it means the teeth are moving and you need to go back to wearing the retainer every night.
Dr. David Caggiano is a nationally well-known orthodontist who is proud to practice in the Parsippany area and serve the community close to where he grew up. Raised in Fairfield, and son of an engineer, he attended NJIT, where he graduated top of his class with a Master’s of Science degree in biomedical engineering.
A 2001 graduate of the University of Medicine and Dentistry of New Jersey (now Rutgers University), Dr. Caggiano practiced as a general dentist for seven years before becoming an orthodontist. Combining his background in biomedical engineering with his extensive training and experience in general dentistry, Dr. Caggiano can create innovative and exciting approaches to solve even the toughest orthodontic situation, in a manner that is as efficient as possible.
Because of this unique training, passion, and experience, other dentists voted him as a top Orthodontist every year since 2009 (as published in NJ Monthly). Moms appreciate his comforting chairside manner and acknowledge his dedication to customer service by perennially voting him a top doc in New Jersey Family Magazine. Other prestigious awards include Orthodontic Products Best of 2011 & 2012 (a national recognition), Best of Morris County, NJ Top Docs, and Consumer Research Council’s America’s Top Orthodontists.
Dr. Caggiano is the author of “A Parent’s Guide to Understanding Orthodontics: How to Confidently Choose the Best Orthodontist for Your Family,” “Perfectly Clear: Everything You Need to Know About Invisalign” and is currently working on his third book, “The Art of Orthodontics: A Consumers Handbook to the Most Common Orthodontic Questions.”