Dental Health: Braces and Wisdom Teeth

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girl brushing teethIf you’ve been told by your dentist that your teeth are not aligned correctly or your teeth are too crowded, you may need braces. Braces are the most common way to fix crooked and/or crowded teeth and help align the jaw (keep it in the right position).Your dentist will likely have you make an appointment with an orthodontist (a dentist who specializes in braces) to find out if braces are right for you.

What are braces?

Braces are bands, wires, and brackets that hold the teeth in place. The good news is that braces and bands can be stylish. They now come in different colors and some are almost invisible. Movement of your teeth can also be done with clear, removable plastic aligners as well. Your dentist or orthodontist can help decide if these are right for you.

How do braces work?

Braces work by slowly moving and straightening your teeth so they have enough space and they are aligned properly. The wires apply pressure to your teeth to cause them to move in the right direction and the rubber bands help line up your teeth to make them straighter. Braces usually need to be adjusted about once a month.

How long will I have braces?

Since everybody’s teeth are different, it may take a few months to years to correct teeth that are not straight.

What do I do when I get my new braces?

Your mouth will likely be sore for 1-2 days after you get your new braces. Chewing hard foods may be uncomfortable, so it’s best to stick with soft foods for 24-48 hours. It’s also a good idea to eat soft foods on the days that you have your braces adjusted or tightened. For example: macaroni and cheese, soups, oatmeal, mashed potatoes.

Foods to stay away from in general, when you have braces:

  • Hard foods—nuts or hard candy
  • Sticky foods—gum, candy, and chewy fruit snacks
  • Chewy or crunchy food—bagels or apples or licorice

Ways to relieve soreness of your mouth:

  • Rinse your mouth with warm water and ½ teaspoon of salt and spit out (do not swallow).
  • Ask your orthodontist if it’s okay to take Acetaminophen (Tylenol®) for pain
  • Talk to your orthodontist about using special dental “wax” over areas of your braces that cause irritation to your lips, cheeks, tongue, or gums

How often will I need to see my orthodontist?

When you meet with your orthodontist, he/she will tell you how often you should come back for follow-up visits. You will need to have regular check-ups to see how the braces are working and to adjust or tighten them. Tightening your braces keeps your teeth straight and moving in the right direction.

Do I still need to floss my teeth?

Yes! It is extra important for you to take good care of your teeth when you have braces because food and bacteria can get stuck. Brushing and flossing will help prevent cavities, and keep your gums healthy. Your orthodontist or assistant will show you how to brush and floss your teeth.

What is life like after braces?

After you get your braces taken off, you will probably need to wear a retainer. A retainer is a “dental appliance” that helps your teeth stay in place and prevents them from moving. Your orthodontist will let you know how long you will need to wear your retainer because it can be different with each person.

Here are some tips to remember when you are wearing a retainer:

  1. Take the retainer out when you eat.
  2. Use your toothbrush, toothpaste and warm water to clean your retainer once a day. This gets rid of trapped food, bacteria and any odors.
  3. When you are not wearing your retainer, keep it in a retainer case.
  4. Don’t wrap your retainer in tissue or a napkin, as you are apt to throw it away by mistake.
  5. Take your retainer out when you swim.
  6. Keep your retainer away from hot water and hot temperatures- it’s made of a plastic material and could melt.
  7. Wear a mouth guard over your braces, if you play sports.
  8. Bring your retainer to every orthodontist appointment.

How much do braces cost?

Braces can be pricey depending on whether you have dental insurance or not. It’s a good idea to ask your parent(s) or guardian if you have dental insurance. If you do, you can find an orthodontist on your plan. You should also ask your dental insurance provider how much they will pay for braces. Most orthodontists will set up a payment plan to help with expenses.

Wisdom Teeth

If you go to your dentist for regular check-ups, you’ll likely know if your wisdom teeth have come in or if they’re impacted. If your dentist thinks you need to have your wisdom teeth removed, you will probably need to make an appointment with an oral surgeon (a doctor who is trained to do surgery that involves gums and teeth) for an evaluation. Some people never have any problems with their wisdom teeth, and some people never even form wisdom teeth.

What are wisdom teeth?

Wisdom teeth are the last molars to develop. They are located on each side of the jaw in the very back. By the time you are between 16-19 years old, you should be able to see them. If you can’t, they may be impacted, meaning they haven’t broken through the gums yet, or they may be completely absent. Wisdom teeth are the last permanent teeth to come in so there is often not enough room for them to grow into your mouth completely. These trapped or impacted wisdom teeth will sometimes need to be removed by an oral surgeon.

How can I tell if I have wisdom teeth?

You may not even realize that you have wisdom teeth or that they may even be impacted.
During a regular check-up, your dentist will take an x-ray to find out where your wisdom teeth are located and if they are impacted.

Be sure to tell your dentist if you have any of the following symptoms:

  • Trouble opening your jaw
  • Pain when you bite or chew
  • Swollen gums at the back of your mouth or near the side of your jaw
  • Irritation or pain when you open your mouth

Why are wisdom teeth removed?

Wisdom teeth are usually removed if they become impacted or if they are crowding other teeth. This means your wisdom teeth either don’t break through your gums or they only partially break through. Impacted or trapped wisdom teeth can cause problems such as:

  • Pain on one or both sides of your mouth—with or without eating
  • Infection—food and bacteria can get stuck in the partial opening or flap around the trapped wisdom tooth and can cause swelling of the gums
  • Movement of teeth and change in bite
  • Benign (harmless) cysts or tumors of the jaw

What should I expect if I find out that my wisdom teeth are a problem?

Your dentist and/or oral surgeon will give you specific instructions to follow. Below is a summary of what you might expect to happen if you need to have your wisdom teeth removed.

  • Your dentist will likely have you make an appointment with an oral surgeon to have your wisdom teeth removed.
  • Your oral surgeon will talk to you about the procedure and what anesthesia or sedatives (medication that make you relaxed and put you to sleep) will be used.
  • An x-ray will be taken so that the oral surgeon can remove your tooth/teeth the best way. A panoramic x-ray (an x-ray of your whole mouth) will be taken of all of your wisdom teeth as well as the teeth around them. Some people get all of their wisdom teeth removed to prevent any future problems.
  • Some oral surgeons prescribe antibiotics before or after surgery. For example; if you have an infection, or a weak immune system.
  • It is best to wear a short sleeve top or one with sleeves you can roll up easily as you will likely have an IV (intravenous- small tube in your arm that will give your body medicine and fluids when you are asleep).
  • You will not be able to eat or drink for 6 hours before your procedure.

How are wisdom teeth removed?

Simple extraction- If your wisdom tooth or teeth are not impacted but you need to still need to have them removed, you may be able to have them taken out with a local anesthetic (a numbing medicine often called “Novocaine”). Using a very small needle, your dentist will inject numbing medicine into the gum area around the tooth/ teeth that need to be removed. The wisdom tooth/teeth are then removed using a special dental instrument.

Surgical extraction- This procedure is used if your wisdom tooth/teeth are impacted (completely covered by the gum and bone of your jaw) or partially impacted (partly covered) Before the procedure your dentist or oral surgeon will inject a local anesthetic into the gum area around the tooth/teeth that will be removed, Next you may be given IV medicine or general anesthesia in a hospital operating room (medicine that will put you to sleep so you won’t be awake during the procedure). Your oral surgeon may need to make a small cut into your gum to remove your tooth/teeth.

What is recovery like?

You will likely be mild to moderately uncomfortable after you have your wisdom teeth removed, but the pain or discomfort should only last for a couple of days. It is important to follow the specific instructions that your dentist or oral surgeon give you. The information below is an example of what your recovery might be like.

  • After the incision is made and the wisdom tooth or teeth are taken out, you will be given a piece of gauze to bite down on. You will need to bite down on the gauze for 20-30 minutes so that a blood clot can form. You will be given gauze pads to take home so you can change the pads as they become wet with blood. It is common for the area to bleed on and off for the next 24 hours.
  • If your oral surgeon had to cut your gum to get your tooth/teeth out, you may have “stitches”. Depending on the kind of stitches you have you may or may not have to have them removed. Some stitches need to be removed by your oral surgeon when the gum has healed and some dissolve on their own.

Do:

  1. Prop your head up with pillows instead of lying flat.
  2. Use an icepack on your face to help with pain or any swelling.
  3. Continue to brush and floss your teeth carefully, but stay clear of the extraction areas.
  4. Take the medicine prescribed by your oral surgeon for pain.
  5. Talk to your oral surgeon about replacing your pain prescription with over-the- counter pain relievers, such as acetaminophen (Tylenol®), or ibuprofen (Motrin®) as your pain improves.
  6. Eat “soft” foods such as yogurt, gelatin, pudding, and macaroni & cheese.
  7. Rinse your mouth every couple of hours with about 1 cup of warm water and ½ teaspoon of salt. Try not to spit out or swallow the rinse. Just let it drain from your mouth over the sink. This will help prevent infections.
  8. Follow the directions your dentist and/or oral surgeon give you so that you can lower the chance of any pain or future problems. Full healing takes about 1-2 weeks.
  9. Call your oral surgeon if you have a fever or if the pain doesn’t lessen in a few days.
  10. Avoid strenuous exercise for 24 hours.

Don’t:

  1. Don’t smoke for at least 24 hours after an extraction. A good time to stop forever!
  2. Don’t use a straw to drink.
  3. Don’t drink very hot liquids.
  4. Don’t eat foods with little seeds (sesame seeds, poppy seeds) or small grains (rice) that may get stuck in the tooth sockets.

Are there any risks involved when having my wisdom teeth removed?

Having wisdom teeth removed rarely causes big problems, but with any surgery, there are possible risks involved.

Pain and Dry Socket- About 5% of extractions result in “dry socket” (when a blood clot does not form in the hole where the tooth was removed and the bone underneath becomes exposed to air and/or food). A dry socket can be very painful and may need to be treated with a special dressing so that the area can heal. Avoiding drinking hot liquids, smoking, the use of straws, and spitting out immediately after an extraction can make a dry socket less likely to occur.

Bleeding that is heavy or that lasts longer than 24 hours- some bleeding is normal during the first 24 hours but it should not be heavy and it should stop within a day.

Numbness- It is normal for your mouth, chin and possibly your lips to feel numb until the anesthesia or local anesthetic (numbing medicine) wears off. If your lower lip and chin continue to feel numb, there may have been some irritation to a nerve in your jaw. This is more common when your lower wisdom teeth are removed. It may take 3-6 months for a nerve to heal and in rare cases it can be permanent. You should call your oral surgeon if you have numbness that lasts for more than a week.

Damage to teeth next to or near your wisdom teeth- It doesn’t happen very often, but occasionally a nearby tooth/teeth can get damaged.

Damage to existing dental work (crowns, etc.) close to your wisdom teeth.

If you have any of these symptoms after you have your wisdom teeth removed, it is very important for you to tell your oral surgeon!

How much does it cost to have wisdom teeth removed?

If you have dental insurance, the cost of having your wisdom teeth removed will either be partially or completely covered. General health insurance sometimes will cover dental procedures as well. Depending on what type of general health insurance you have, it may cover all or part of the procedure. Be sure you talk to your dental and or Health Insurance Company BEFORE your oral surgery to find out about the kind of coverage you have and how much you will have to pay out of pocket!

It’s more common for problems with wisdom teeth to develop during the teen and early adult years, but you may never have any problems with your wisdom teeth. The most important thing to remember is to take care of your teeth (brush and floss regularly) and see your dentist for regular checkups.