Are Retainers Really That Important?

importance of retainers
Naomi, the patient
Dear Dr. Stosich,
I wear my retainer every night like I’m supposed to, but when I wake up in the morning, I find it somewhere in my bed and not in my mouth. I think my teeth have started moving because the retainer isn’t staying in. Help!

Sincerely,
Naomi

Dr. Michael Stosich
Dear Naomi,

You aren’t the first patient to ask this question. This can sometimes happen in the beginning of retainer wear because you aren’t used to wearing the retainer yet. There could be a couple of reasons why the retainer is coming out.

First, you haven’t placed it in properly before going to sleep. If you are in a hurry and don’t make sure the retainer is placed properly, it may not be as far up as it should be, allowing it to become loose and fall out while you sleep. A more common answer, though, is that you may be removing it in your sleep. This can be the case in the beginning of retainer treatment because you aren’t used to it yet, and it may be slightly uncomfortable so you simply remove it during your sleep.

Another reason may be that the retainer itself has become too loose due to damage. If you take the retainer in and out of your mouth improperly, you can cause the wire to loosen, which will not only make it easier to fall out of your mouth, it will make it less effective.

If you are a new retainer wearer, I would give it a week or two and see if this lessens at all. Your body may just need to get used to having the retainer in. If you have been wearing a retainer for a while, I would suggest making an appointment with your orthodontist to check the fit of the retainer.

Sincerely,
Dr. S.


Ed, the patient
Dear Dr. Stosich,
I wore braces for two years, but wasn’t very good about wearing my retainer after. Now, my teeth are drifting back and my retainer doesn’t fit anymore. What can I do? A friend says I’ll have to have braces again to move the teeth back into the right position, but I don’t want another two years in braces!

Sincerely,
Ed

Dr. Michael Stosich
Dear Ed,
Wearing your retainer exactly as your orthodontist recommended immediately following braces treatment is crucial to maintaining your new smile. The solution that will work best to move your teeth back to their ideal positions will depend on how much your teeth have shifted.

My recommendation is to schedule an appointment with your orthodontist to determine the extent of your relapse, and to discover what treatment he or she recommends is best. At my office, we offer a special program for patients, where, for a nominal fee, we will use braces or aligners to again guide the teeth to their proper locations. A retainer will not move your teeth back to where they should be, but will only retain their locations.

Sincerely,
Dr. S.


Anisah, the patient
Dear Dr. Stosich,
My braces were recently removed and my orthodontist gave me a removable retainer but also placed a permanent retainer. How long will I have to have the permanent retainer in?

Sincerely,
Anisah

Dr. Michael Stosich
Dear Anisah,
Permanent, or bonded, retainers, are used on teeth that an orthodontist feels have a higher likelihood to relapse. They aren’t really permanent at all, but are actually just fixed retainers that are bonded with a special dental glue. They are most often affixed to the lower six teeth, but a bonded retainer can also be used on the top teeth. This is sometimes seen if a patient had a very large gap that needed to be closed.

There isn’t a magic formula as to how long your bonded retainer will have to stay in place, but one factor that will come into play is your age. If you are a teenager, your retainer will likely stay in place until your wisdom teeth have come in. This will ensure that these new teeth don’t have the ability to shift your smile.

If you are over the age of 25, you may need to wear your bonded retainer longer than a teenager might. This is because the teeth of adults tend to shift naturally over time, due to biological factors, as well as other issues such as gum disease.

Personally, I do not recommend bonded retainers. They can break easily, and can become traps for food particles, especially in people who do not have ideal oral hygiene. But, in certain cases, especially those with a very high possibility of relapse or for a patient that may not be great at remembering to wear a retainer, they may be a fine option.

Sincerely,
Dr. S.


Jennifer, the patient
Dear Dr. S.
It recently came to my attention that my son has not been wearing his retainer. He finished Invisalign treatment a while ago, but admitted he hasn’t worn his retainer for at least two weeks. I’m worried his teeth are going to shift. He says the retainer hurts too much to put back in, but he has an older set of aligners left that fit. Can’t he just put those back in until his next appointment with his orthodontist?

Sincerely,
Jennifer G.

Dr. Michael Stosich
Dear Jennifer,

It’s good that you have noticed your son isn’t wearing his retainer before the situation gets too out of hand. Wearing your retainer after the braces come off or at the end of Invisalign treatment is crucial to ensuring that beautiful new smile stays that way.

His retainer is probably a touch tight and uncomfortable because the teeth have shifted slightly. This can be the case even if a retainer isn’t worn for just a couple of days. My recommendation is for your son to put the retainer back in, and give it a few days so he can re-adjust to wearing it. It may be slightly uncomfortable, but he can take an over-the-counter pain reliever to help.

Using a previous set of aligners that were used during Invisalign treatment is not a good idea, because they will not be calibrated for the retention portion of the treatment. Each aligner was designed to meet a specific goal in the tooth movement process. If the retainer is too uncomfortable, schedule an appointment with your orthodontist as soon as possible.

Retainer wear is a very important part of orthodontic treatment, so be sure your son understands that all the hard work he put in while he was in Invisalign can be undone if he fails to wear the retainer exactly as his orthodontist recommends.

Sincerely,
Dr. S.


Dajonae, the patient
Dear Dr. Stosich,
I lost my retainer. I don’t really want to have to go to the hassle of replacing it, and I wore it for about six months anyway. What are the chances my teeth will shift?

Sincerely,
Dajonae

Dr. Michael Stosich
Dear Dajonae,
It isn’t just a chance, but a guarantee that without wearing your retainer your teeth will shift. Wearing your retainer as prescribed is a crucial part of your orthodontic treatment. It’s not only your teeth that have to get used to their new locations, but the ligaments and tissues that hold them in place, too. Because they are kind of elastic, they’ll have a tendency to want to pull your teeth back to where they were before. A retainer doesn’t just hold the teeth in their new locations, it trains all of the tissues of the mouth so they will be able to hold the teeth in their new spots, too.

If you’ve lost your retainer, call your orthodontist right away. Many offices have a special smile for life program that can provide a new retainer. Typically, these programs involve a one-time fee to be enrolled in the program, but after that, if you ever lose or damage a retainer, you’ll be able to get a new one in no time.

If you want to keep the beautiful new smile you got once your braces were removed, you have to wear your retainer. Call your orthodontist today to see about getting a replacement.

Sincerely,
Dr. S.


Meilin, the patient
Dear Dr. Stosich,
When my braces were removed two years ago, my orthodontist put in a permanent retainer because he thought my bottom teeth might be likely to relapse. But, the retainer has broken twice in the two years, and it’s starting to get frustrating. Do I need to have it replaced with another permanent retainer, or can I switch to a removable one?

Sincerely,
Meilin

Dr. Michael Stosich
Dear Meilin,
We refer to these types of retainers as permanent, but that’s not the case – they don’t last forever, but rather as long as the bonding material holds. For some patients that can be many years, and for others not.

If you wear a bonded retainer, it does mean you have to pay close attention to things you eat and how you care for your teeth. Just like with braces, anything too hard, crunchy, chewy or sticky can cause damage to the retainer.

But sometimes, a particular patient simply isn’t the best candidate for a bonded retainer. Depending on your bite, you may cause damage to the retainer just by biting down regularly. This can be the case for patients who had a pretty severe overbite. If you’re retainer is on the top, the bottom teeth may be biting into it without you even realizing it, causing the bonding to loosen.

I would schedule an appointment with your orthodontist, or schedule a consultation with a new one, to determine what could be the cause of the issue and determine a new way to correct it. You may benefit from switching to a removable retainer, as long as you wear it as directed by your orthodontist.

Sincerely,
Dr. S.

AUTHOR: Michael Stosich

Michael S. Stosich, DMD, MS, MS, is a specialist orthodontist for children and adults with subspecialty expertise in robotically assisted orthodontics. Dr. Stosich serves as the orthodontic director at the University of Chicago's cleft lip and palate clinic and craniofacial anomalies clinic, which treats complex pediatric craniofacial anomalies.