Musical Instruments and Braces

Are there major problems with wearing braces and playing musical instruments?  The answer is No, and that is Good News!  Over the years, I have been asked this question numerous times and I have always encouraged my patients to go ahead and musically rock their world. 

In the beginning, your ability to play wind and brass instruments will be affected by the new braces, but eventually your lips and the mouthpiece will get used to each other.  Meanwhile, the music may sound a little funny as your embouchure tries to figure this whole thing out.  Once settled in though, your lip muscles will get back to their usual activity and beautiful music will fill the air.  By placing a small amount of orthodontic wax over the braces on the front teeth, any irritations will be kept under control.  Eventually though, your braces will come off and you will have to go through the adaptation process again, but this time with straight teeth.

As an orthodontist, the last thing I want to see is a compounding of an orthodontic problem with a musical instrument, but frequently, this is unavoidable.  For example, someone with a large overjet (protruding upper front teeth) should probably not play the clarinet or saxophone while undergoing orthodontic correction, but the mouthpiece fits very nicely into this type of mouth and is literally perfect for this musician!  Professionally speaking, for these types of bites I would suggest an instrument such as the oboe, flute or a brass instrument. :(

And once in awhile, we run into people who can't get used to anything, much less braces.  If you are one of those musicians, remember you can always find something in the lowly strings or percussion sections.

J. Staples DDS (First Chair-First Trombone)

Invisalign Problems

"Nobody knows I'm wearing Invisalign"

Despite its popularity, Invisalign treatment has had a mixed track record of not only producing beautiful success stories, but also of being associated with horrendous failures.  This orthodontic appliance system requires a number of critical steps to be accomplished before the finished result can become the desired result.

Problems can be attributed to the aligners themselves, the treating doctor and the patient.  These problems include:
    Patient cooperation - not wearing the aligners the proper amount of time
    The presence of crooked teeth at the end of treatment
    The presence of height discrepancies between adjacent teeth
    The presence of "open bites" or even wrong bites on the back teeth
    Teeth that lean the wrong way
    The inability of the orthodontist to do subtle finishing details

Orthodontists struggle with overcoming these Invisalign problems and will use traditional braces as a fail safe mechanism to produce a properly finished orthodontic result.  In the hands of a general dentist that has no formal orthodontic training, patients are many times left with an unsatisfactory result and the parting remark of "Well, that's the best Invisalign can do".

In order to finish their orthodontic problems properly, about 50% of my Invisalign cases required traditional braces after the aligners.  These patients were understandably frustrated with the progress and effectiveness of Invisalign.  Only after a short period of braces were they finally satisfied with their smiles.

Personally, I don't like working with any orthodontic appliance system that only provides me with a 50% chance of success.  Add to this the patient frustration and you begin to see the point.  I do realize though, that many patients are sold on this system despite the problems.  On mild crowding or spaced teeth, maybe this is the right tool to use, or maybe not.

As a side note, Invisalign is constantly working to overcome or minimize the short-comings of their orthodontic appliance system.  Nevertheless, there is no fix for problems associated with poor patient cooperation or seeking Invisalign services from a dentist that is not an orthodontic specialist.  On the bright side, I do look forward to using an improved version at some time in the future.

J. Staples DDS

Critical Timing for Orthodontic Examinations

Even though the American Association of Orthodontists recommends that a child's first orthodontic exam should take place at age 7, a very critical time for a more detailed look is at age 9.  We all know what crooked teeth look like after they have come into the mouth, but before they erupt, when they are working their way into the mouth, big trouble can be present.

Very often, unerupted permanent teeth want to come in the mouth in surprisingly odd positions. Of particular concern are the canine teeth in the top jaw, often called eye teeth. They are notorious for not only erupting in odd positions, but for the damage they can do. If left unattended, they can literally wipe out the roots of other permanent teeth or possibly erupt in such a bad way that permanent gum tissue damage occurrs.

For the 9 year old child, an orthodontist can take a panorex xray to evaluate the eruption paths of all of the developing permanent teeth and to critically look at the upper eye teeth. Are they erupting in the right direction and is there the proper amount of space for them to come in?  If things don't look good, early orthodontic treatment may be necessary to keep them out of trouble.