Day: November 13, 2021 (page 1 of 1)

Are Permanent Retainers the Right Choice for You?

Retainers are appliances you should wear once you remove your braces. They are either permanent or removable. 

A permanent or fixed retainer is, basically, a piece of metal wire attached to the inner side of your teeth. The metal wire is glued to your teeth to hold them in place so that they don’t move back to their pre-braces position. 

Your orthodontist may advise you to use a removable retainer for the upper teeth and a fixed retainer for the lower. As fixed retainers are more convenient, they are becoming popular, especially among people with a busy lifestyle.

Are you wondering whether permanent retainers are the right choice for you? 

In this article, I discuss how permanent retainers work and describe their benefits and drawbacks.

How Do Permanent Retainers Work?

A permanent retainer is commonly referred to as a lingual wire because it is fixed to the back surfaces of the teeth. 

Since a glue known as bonding material is used to attach the retainer, it is often called a bonded retainer too.

To resolve the issue of crooked or misaligned teeth, orthodontists resort to braces. Braces help move your teeth into the right alignment and correct problems like crowding or spacing.

However, many people discover that once their braces are removed, their teeth begin to shift back to their previous position. To maintain the teeth in their new position, your orthodontist would want to restrict their movement. Otherwise, the entire treatment may end up failing due to relapse. 

This is where permanent retainers come into play. Permanent retainers secure the teeth effectively. You don’t need to take them out and place them back like removable retainers.

How Much Do Permanent Retainers Cost?

The charges of the first permanent retainer are typically covered within the overall charges of the braces. 

However, you can expect the cost to be anywhere between $150 to $500 if you need to get a replacement for a broken or lost permanent retainer. 

What Are The Benefits of Permanent Retainers?

Convenient– You won’t need to take your retainers on and off.Almost no speech interference– You won’t be uneasy while speaking in public.Unnoticeable– No one would notice that you have your retainers in place as the wires are placed on the inner and less visible surfaces of your teeth.No fear of loss or damage– As the retainers are attached to your teeth, there is less chance of losing a retainer.

What Are The Benefits of Removable Retainers?

Removable– You can remove them when you want to eat something.Easy to clean– Maintenance of removable retainers is easy as you can soak them in a cleaning liquid and wash them with water.Better for upper teeth– Fixed retainers on upper teeth are prone to damage as your lower teeth may bite on them.Easy to maintain oral hygiene– You can just take them off before brushing or flossing your teeth.

What Are The Drawbacks of Permanent Retainers? 

If the root cause of misaligned teeth is addressed accurately, there is no reason why the teeth will move to their previous positions, and therefore, there is no need for a permanent retainer.

So if your orthodontist prescribes a fixed retainer, it may mean that your orthodontic issue is still unresolved even after the removal of your braces.

Moreover, permanent retainers may pose some problems as well:

Diminished proprioception- Our teeth are meant to function as individual units while moving about independently within their respective sockets. Binding them together with a fixed retainer can decrease the proprioceptive property of our teeth.Early bone loss- Young and healthy individuals experience bone loss around the teeth that are bound by a permanent retainer. Our teeth move mildly during activities like chewing and clenching. Retainers restrict the normal tooth mobility leading to the decreased blood supply to the periodontal ligament and subsequent crestal bone loss.Potentially invasive procedure– The teeth need to be etched and a composite filling is applied to hold a metal wire or mesh chain. Applying, maintaining, and removing this material over time may lead to some damage to the enamel layer of your teeth. This is mostly dependent on the skills and temperament of your dentist.Difficult to maintain oral hygiene– Brushing and flossing with a piece of wire glued to the inner surfaces of teeth can be quite a challenge! You need extra patience, effort, and time to ensure that the area around your retainers is clean while using floss. You may need to use a floss threader to actually fish the floss through the gaps in between your teeth to accomplish this.Need for caution in your food choices– You will need to be more careful while biting on tough foods like bread crusts as you may bend the wire or cause a detachment between wire and tooth. It may take some time before you or your dentist is aware of this detachment potentially causing a need for additional orthodontic work. Make sure your dentist looks at your fixed retainer closely with dental loupes by pushing on each splinted tooth to see if there is a separation between wire and tooth. It’s easy to miss!Uncomfortable– Some individuals do not like the feel of a metal piece rubbing against their tongue at all times.Replacement expense– You should be prepared to pay an extra fee if your bonded retainer breaks off or gets detached. The detached end can even wear down your tongue.

What To Do If My Retainers Just Snap Off?

If your permanent retainers detach from your teeth or bend at some point, you should not try to fix the issue yourself. Neither should you leave the issue unattended. Here’s what you can do:

Call your dentist or orthodontist right away– A detached end of the retainer can be quite harmful as it may injure your mouth and damage your teeth. Hence, consider an emergency and meet your dentist right away to get it fixed. Also, the detached tooth can accelerate in the movement away from its ideal position (its position relative position to the other teeth).Book an appointment with your orthodontist– If your retainer ends are still at their place but the wire is detached from one or more teeth or bent in the mid-portion somewhere,  you have some grace time to get it fixed. Make an appointment with your orthodontist and get your retainer repaired or replaced before it causes any further damage.

How To Clean and Floss My Permanent Retainers?

Cleaning your teeth with your fixed retainers can be slightly tricky. Here are a few tips that you can incorporate into your oral hygiene regimen:

Brush your teeth just like you do regularly. Make sure that your bristles pass through the gaps between the teeth so that all the areas around the retainer are covered. A sonic toothbrush may be helpful in this area.Flossing in between the teeth can be tedious during those initial days when you are trying to get a hang of it. You will be an expert with a few days of genuine practice. While inserting the floss between the teeth, care should be taken not to jerk it in as that may harm your gums. Instead, maneuver the floss gently on the sides of the teeth so that the interdental surfaces are properly cleaned.

Final Note

Permanent retainers are a convenient option for holding the teeth in their new positions for the rest of your life.

It has a couple of significant drawbacks and is not meant for every case. Discuss your options with your dentist or orthodontist so that you can decide what is best for you.

My take: Short term (a few years maximum) is acceptable if this is an option you want. However, ultimately, use a removable retainer. Or better yet, address why the teeth are shifting if not held in place by any retainer, fixed or removable.

The post Are Permanent Retainers the Right Choice for You? appeared first on Ask the Dentist.

Did you miss our previous article…

Hydroxyapatite Vs. Fluoride: How Do They Compare?

Dentists have recommended fluoride toothpaste for stronger cavity-resistant teeth for decades.1 It is still considered the “gold standard” in dental schools, despite its safety concerns.

But there’s a new ingredient in town proven to be just as effective as fluoride and completely non-toxic.

It’s called hydroxyapatite. Hydroxyapatite toothpaste has replaced fluoride toothpaste as what I recommend to all of my patients. But what is hydroxyapatite toothpaste?

In this blog post, we will learn about hydroxyapatite and take a look at how fluoride compares with it. 

How Does Fluoride Toothpaste Work?

Your teeth have an outer covering called enamel that is made up of calcium and phosphate. Your saliva also contains calcium and phosphate that constantly bathe your teeth. These minerals keep your teeth strong.

Bacteria found in cavities can break down food particles and create an acidic environment in your mouth. This acidic environment is harsh and can strip away these beneficial minerals from the surfaces of your teeth. This process is called demineralization.  

The fluoride in fluoridated toothpaste works by:

Teaming up with the calcium and phosphate in your saliva and teeth to form a compound called fluorapatite. This compound looks like a crystal lattice (apatite crystal lattice).Covering demineralized enamel with the more acid-resistant fluorapatite. This remineralizes the teeth, restores their strength, and protects it from further damage by acid. 

How Does Hydroxyapatite Toothpaste Work?

Hydroxyapatite is a form of calcium that makes up 97% of your tooth enamel and nearly 70% of the dentin of your teeth. 

The rest of your enamel is actually composed of water, collagen, and other proteins.

Hydroxyapatite is absorbed by the teeth and fills the enamel fissures caused by demineralization.

The most widely studied type of hydroxyapatite is nano-hydroxyapatite. Toothpaste that contains nano-hydroxyapatite has particle sizes between 20-80 nanometers (nm). Because of its small size, it can insert into really small spaces, which leads to better benefits. 

Unlike fluoride, hydroxyapatite works by:

Remineralizing enamel from within, reaching the innermost part of a dental cavityBinding to plaque and harmful bacteria in our mouth

How does Hydroxyapatite Compare to Fluoride in Efficacy?

When it comes to which toothpaste is more efficient, there is really no difference between hydroxyapatite and fluoride toothpastes.

One study compared 10% hydroxyapatite with 500 ppm F− (amine fluoride), which dentists typically prescribe.2 The researchers discovered that the 10% hydroxyapatite worked just as well as 500ppm F− for remineralization and lesion depth (LD) reduction.

The conclusion of the study was that hydroxyapatite toothpaste is equal to fluoride toothpaste when it comes to efficacy.

Benefits of Hydroxyapatite over Fluoride Toothpastes

Both fluoride and hydroxyapatite can remineralize tooth structure, but here’s why I prefer to recommend hydroxyapatite over fluoride:

Oral microbiome friendly: Although both have antibacterial properties, fluoride kills decay-causing bacteria and some good bacteria. On the other hand, hydroxyapatite does not kill the bacteria. It prevents harmful bacteria from attaching to the enamel.3Fortifies enamel: Hydroxyapatite can increase the microhardness of enamel.4 The coating of hydroxyapatite reinforces the teeth better than the fluorapatite coating.Non-toxic: Hydroxyapatite is biomimetic.5 There are no side effects with hydroxyapatite—in fact, it’s safe enough to swallow the entire tube of toothpaste! With fluoride, on the other hand, there’s a poison control label on the tube, and overexposure causes dental and skeletal fluorosis.Kid-friendly: At an early age, children don’t have full control over swallowing and can ingest large amounts of toothpaste.6 When this happens, the fluoride in toothpaste can get absorbed into the bloodstream and cause dental fluorosis (a change in the appearance of tooth enamel). Toothpaste that contains hydroxyapatite reduces the risk of fluorosis.Whitens: Hydroxyapatite toothpaste has been shown to lighten the shade of the teeth without the help of any additional abrasives or whitening agents.7

Is Fluorapatite Stronger than Hydroxyapatite?

Fluorapatite is less soluble than hydroxyapatite. This means that in acidic conditions, fluorapatite is stronger and more resistant to demineralization. 

However, this does not mean that fluorapatite toothpaste is better than hydroxyapatite toothpaste. In fact, studies show that hydroxyapatite toothpaste is just as good as fluorapatite toothpaste, with an added benefit — it helps with dental hypersensitivity.8 

Should I Switch to Hydroxyapatite Toothpaste?

To me, this is a no-brainer. If you have a better alternative to fluoride toothpaste and it’s non-toxic, why wouldn’t you? 

To most dentists, this is a no-brainer as well—however, fluoride is still taught as the “gold standard” in dental schools, and there are still some dentists out there who might be leery of hydroxyapatite. If this is your dentist, send them the research!

I recommend everyone talk to their dentist about switching to a hydroxyapatite toothpaste, especially the following categories of people:

Pregnant womenPeople who live in areas with fluoridated water supplyBabies and children, especially if they are below the age of six.People with sensitive teeth, as hydroxyapatite treats the root cause of sensitivity.9

Which Toothpaste Brands Contain Hydroxyapatite?

There are two brands of hydroxyapatite toothpaste brands I recommend to readers because I use them myself and they also have an appropriate concentration of hydroxyapatite to be efficacious. There are many hydroxyapatite toothpastes out there, unfortunately, that don’t contain enough of the ingredient to have an effect—if you’re not sure, email the company and ask for the concentration. It should be 15% or more.

Boka Ela Mint Toothpaste

RiseWell Mineral Toothpaste

RiseWell Kids’ Mineral Toothpaste (birthday cake flavor)

Bottom line

The biggest advantage of using toothpaste with hydroxyapatite is that it remineralizes your teeth without any side effects, unlike fluoride that is toxic in large quantities.

Hydroxyapatite is naturally present within our body and constitutes most of our enamel.

Both fluoride and hydroxyapatite are scientifically proven to reverse dental decay—why not choose the less toxic one? 


1. Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;(1):CD002278. doi:10.1002/14651858.CD002278

2. Amaechi BT, AbdulAzees PA, Alshareif DO, et al. Comparative efficacy of a hydroxyapatite and a fluoride toothpaste for prevention and remineralization of dental caries in children. BDJ Open. 2019;5(1):18. doi:10.1038/s41405-019-0026-8

3. Meyer F, Enax J. Hydroxyapatite in Oral Biofilm Management. Eur J Dent. 2019;13(2):287-290. doi:10.1055/s-0039-1695657

4. Pepla E, Besharat LK, Palaia G, Tenore G, Migliau G. Nano-hydroxyapatite and its applications in preventive, restorative and regenerative dentistry: a review of literature. Ann Stomatol (Roma). 2014;5(3):108-114.

5. Enax J, Epple M. Synthetic Hydroxyapatite as a Biomimetic Oral Care Agent. Oral Health Prev Dent. 2018;16(1):7-19. doi:10.3290/j.ohpd.a39690

6. Bossù M, Saccucci M, Salucci A, et al. Enamel remineralization and repair results of Biomimetic Hydroxyapatite toothpaste on deciduous teeth: an effective option to fluoride toothpaste. J Nanobiotechnology. 2019;17(1):17. doi:10.1186/s12951-019-0454-6

7. Niwa M, Sato T, Li W, Aoki H, Aoki H, Daisaku T. Polishing and whitening properties of toothpaste containing hydroxyapatite. J Mater Sci Mater Med. 2001;12(3):277-281. doi:10.1023/a:1008927502523

8. Pajor K, Pajchel L, Kolmas J. Hydroxyapatite and Fluorapatite in Conservative Dentistry and Oral Implantology-A Review. Materials (Basel). 2019;12(17). doi:10.3390/ma12172683

9. Vano M, Derchi G, Barone A, Covani U. Effectiveness of nano-hydroxyapatite toothpaste in reducing dentin hypersensitivity: a double-blind randomized controlled trial. Quintessence Int. 2014;45(8):703-711. doi:10.3290/j.qi.a32240

The post Hydroxyapatite Vs. Fluoride: How Do They Compare? appeared first on Ask the Dentist.

Did you miss our previous article…