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Will the wisdom teeth “push” my other teeth to become crooked again? This is a common concern amongst orthodontic patients. We get asked about this a lot. Many patients are worried that the wisdom teeth will exert pressure on the front teeth causing the teeth to become crooked.

Studies have shown that patients who do not have wisdom teeth (congenitally missing) or already had the wisdom teeth removed still had teeth which became crooked later¹. This means that the wisdom teeth do not cause the teeth to become crooked after braces.

The reason teeth become crooked again after braces is because of the natural movement of the teeth as the patient grows older. Therefore, retainer wear is especially important to maintain the alignment of the teeth after braces.

When should wisdom teeth be removed then?
You should consider having your wisdom tooth/teeth removed in the following conditions²:

Recurrent pericoronitis. Repeated episodes of gum swelling around the wisdom tooth.

Decay (caries) of the wisdom tooth. If it is difficult to clean the area surrounding the wisdom tooth, it might be preferable to extract the wisdom tooth. (Figure 1)

Decay (caries) of adjacent tooth. If the adjacent tooth is decayed, then removal of the wisdom tooth is necessary to allow filling to be done. (Figure 1)

Infection. Pericoronitis or decayed wisdom tooth can cause infection of the area around the wisdom tooth.

Periodontitis. Gum disease (periodontitis) can occur around wisdom tooth. A study showed that 1 in 4 person with non-problematic wisdom teeth had gum disease around the wisdom teeth area³.

Non-functional wisdom tooth. If the opposing wisdom tooth is missing (either extracted or congenitally missing), then the wisdom tooth may need to be removed. This is to prevent trauma of the gums on the opposing side due to elongation of the tooth (supraeruption). Figure 2.

Denture covering buried (impacted) wisdom tooth. If the buried wisdom tooth is very near the gums, then the tooth might need to be removed to prevent irritation from the denture.

Obstruction of adjacent tooth. If both the wisdom tooth and the adjacent tooth (second molar) are buried, then the wisdom tooth might need to be removed to allow the second molar to be straightened. (Figure 3)

Jaw surgery with braces. If jaw surgery is planned for the lower jaw, then the lower wisdom teeth would need to be removed at least 6 months before surgery to facilitate the jaw surgery procedure.

Figure 1. Decay (caries) of lower right wisdom tooth and adjacent tooth (second molar) (red circle). Decay of lower left wisdom tooth (yellow circle).

Figure 2. Elongation (supraeruption) of upper right wisdom tooth due to missing lower right wisdom tooth (red circle). Possible trauma to gums (red arrow).

Figure 3. Lower left wisdom tooth obstructing impacted adjacent tooth (second molar) (red circle). If the adjacent tooth is going to be uprighted, then the wisdom tooth will need to be removed.

In conclusion, wisdom teeth do not cause the other teeth to become crooked. However, the wisdom teeth can cause some other problems even if you do not experience any pain or discomfort. Therefore, it is important to go for regular check-ups to ensure the wisdom teeth are problem-free.

Don’t worry, you will not lose your “wisdom” after removal of your wisdom teeth. If you are unsure about the condition of your wisdom teeth, contact us to schedule an appointment for a check-up.

Also wondering if something can be done to correct crooked teeth? Do check out our braces related posts by clicking here. Feel free to contact us for a no obligation braces consultation.

References:
1. The role of mandibularl third molars on lower anterior teeth crowding and relapse after orthodontic treatment: A systematic review (The Scientific World Journal)
2. The indications for third-molar extractions (Journal of the American Dental Association)
3. Periodontal pathology associated with asymptomatic third molars (Journal of Oral and Maxillofacial Surgery)

Updated: 21 Sept 2021

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A common question that we get regarding braces is: what is the best type of braces?

Well, the short answer to that is, it depends. The most suitable braces for you would be one which fits your budget, personal preference, job (e.g. some airlines do not allow visible braces for flight attendants), etc.

Below is an overview of different types of braces:

In this blog, we will only be comparing metal and clear braces with clear aligners. Plates (removable and functional appliances) are normally reserved for simpler cases and will be discussed in another blog.

Metal braces

Brackets are braces attachments which are glued to the teeth. Brackets can be made of metal (e.g. stainless steel, titanium) or clear materials (e.g. plastic, ceramic or composite).

Stainless steel is the most common material for metal braces. Titanium brackets can be used for patients who are allergic to stainless steel brackets.

Metal braces can be fitted in front (labial), or behind the teeth (lingual).

Lingual braces are invisible but because they are fitted behind the teeth, they tend to cause more discomfort to the tongue. Lingual braces are technically more challenging to manage for the dentist/ Orthodontist.

Lingual Braces

Clear braces

As the name suggests, clear braces are tooth-coloured which makes them less conspicuous than metal braces. Earliest version (1970s) of clear brackets was made of plastic but had problems like staining, poor strength, poor stability and high friction¹.

Currently, ceramic brackets are the main option for clear braces. However, ceramic brackets are not suitable for patients with deep bite as the brackets can cause wear to the opposing teeth.

Newer clear brackets are made of composite which is the same material used for tooth fillings. These brackets are highly aesthetic.

Clear braces are very popular among patients here at Tan Dental Surgery.

Clear aligners (e.g. Invisalign®)

Clear aligners are transparent plastics which cover the teeth. They are almost invisible when worn and look like vacuum-formed retainers. In fact, the material used to produce clear aligners is almost similar to retainers and the fabrication process is also similar. One could even say clear aligners are “active” forms of retainers which can move teeth.

Invisalign® was the first commercial clear aligner system introduced in 1998 by Align Technology (Santa Clara, California). The idea was to use a series of clear plastics to move teeth little by little. Each aligner has to be worn for 2 weeks and after that, the patient proceeds with the next aligner in sequence.

More affordable brands of clear aligners are starting to become available now. The differences between the different brands are the material used, cost and manufacturing location.

Clear aligners are gaining popularity now due to the invisible appearance and increased comfort compared to metal/clear braces. And because the aligners can be removed, tooth brushing is made easier.

However, disadvantages with clear aligners include possible longer total treatment time than normal braces² and difficulty in moving teeth in certain directions.

Table of comparison between metal braces, clear braces and clear aligners

	Metal braces	Clear braces	Clear aligners
Material	Stainless steel Titanium	Plastic Ceramic Composite	Elastic thermoplastic material
Durability	Very strong	Brittle and bulkier than metal brackets	Aligners can break if not handled well
Appearance	Silver-coloured	Tooth-coloured	Transparent
Comfort	Might cause discomfort	Might cause discomfort	More comfortable
Oral hygiene care	More difficult to clean	More difficult to clean	Easier to clean teeth as aligners are removable
Types of cases	Suitable for all cases	Not suitable for deep bite cases	More suitable for mild to moderate cases
Cost	$ ($$$ for lingual braces)	$$	$$$
Compliance	No compliance with wear required as brackets are fixed	No compliance with wear required as brackets are fixed	Compliance with aligner wear required (20-22 hours per day)

In summary, if you are on a tight budget, then metal braces, specifically labial ones (fitted in front) is the most cost-effective option.

If you do not like the “metal mouth” look and budget is not a concern, then your options are clear braces, lingual braces or clear aligners. Of these 3 options, clear braces are the cheapest. Clear aligners are definitely more comfortable than clear and lingual braces. However, clear aligners might not be suitable for cases that are more complex.

We offer all types of braces at Tan Dental Surgery. In our opinion, the metal and clear braces are still the best options for the majority of patients as they are more affordable and produce predictable results.

If you are thinking of having braces, be sure to check out our other braces related posts here.

Did you know?

Prior to the 1970s, brackets were welded to metal bands/rings. The bands were custom-made and fitted around each tooth individually (see below). The fitting process was arduous, time-consuming and uncomfortable. In fact, the entire process could take an entire day!

Full mouth banding

References:
1. Contemporary Orthodontics (Elsevier)
2. Activation time and material stiffness of sequential removable orthodontic appliances. Part 3: premolar extraction patients (American Journal of Orthodontics and Dentofacial Orthopedics)

Updated: 20 Sept 2021

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Periodontitis is an inflammatory disease that affects both the soft (gum) and hard tissues (bone) that support the teeth. It is caused by the build-up of bacterial plaque, leading to the detachment of your gums from the roots of your teeth. This will result in the formation of a gap between your gums and your teeth, which is known as the periodontal pocket.

The periodontal pocket is an area where your toothbrush cannot access. Therefore, bacterial plaque (from your food debris) will continually deposit below your gum line onto the roots of your teeth. Over time, the build-up will harden and become tartar, and attract even more plaque. Multiple studies have shown that the subgingival plaque (plaque beneath the gums) harbours large amounts of bacteria.

Early stages of periodontitis are often pain-less. As a result, many patients only seek “symptom-driven” care when their disease is at the advanced stage. Once a considerable amount of gum and bone has been lost, tooth migration (change in tooth position), tooth mobility (loose tooth) and tooth loss follow.

Poor chewing function, as the terminal stage of periodontitis, compromises your digestion, as well as your nutrition, often leading to poorer general health.

How Chewing Affects Digestion

Did you know that the food that you eat is digested in your mouth first before it enters your stomach? What?! Your saliva contains digestive enzymes (called amylase) which break down starches into simple sugars. So by chewing for one minute, up to half of the starch may be digested before you even swallow!

Your saliva also contains some fat digesting enzymes (called lipase) that help begin the process of breaking down the fats in your food. The act of chewing food triggers the production of your stomach acid and pancreatic juices further along the digestive tract, so that the system is primed for the whole digestive sequence.

Chewing well also breaks the food down into smaller pieces, so when you swallow the food, it mixes more thoroughly with your stomach acid. The more surface area is exposed to stomach acid, the more effectively it can do its job. Good chewing function also comes in handy further down the digestive tract. Thorough chewing means that less un- or partially-digested food matter enters your colon and that translates into less intestinal gas.

How Chewing Affects Nutrition

If you’re digesting your food better, does that mean that you get more nutrition from it? Yes! Longer chewing has been shown to increase the amount of protein your body can absorb from foods and put to use building muscle. It also makes some vitamins and minerals more available for absorption, especially from fresh fruits and vegetables.

In summary, chewing your food more thoroughly can improve your digestion and nutrition. And in order to chew your food well, you need a healthy set of pearly whites.

How Does Periodontitis Affect Your Overall Health

Over the last 20 years, there has been a large increase in the literature reporting on increasing number & variety of conditions linked with periodontitis:

Cardiovascular disease

Diabetes mellitus

Pre-term/ low birth weight

Pneumonia

Rheumatoid arthritis

Metabolic syndrome

Cancer

Chronic kidney disease etc.

Substantial evidence points to the fact that periodontitis affects the body by haematogenous dissemination (spread via the bloodstream) of both bacteria and bacterial products (from the dental plaque), and inflammatory mediators (from the inflamed gum and bone). Say what?!

An easy way to understand this is to quantify the size of the periodontal wound in your mouth, and compare that to the size of a skin wound, say on your knee. An abrasion wound on your knee (say 30x30mm) would equate to an area of 900mm². One recent study showed that individuals with severe periodontitis have an average periodontal inflamed surface area (PISA) of approximately 2300mm² – 2.5 times wider!

An untreated periodontal wound forms an easy portal of entry for oral bacteria into your circulation, to your heart, lungs, joints etc. Several studies found the presence of oral bacteria in atherosclerotic plaque (the stuff that is responsible for narrowing your blood vessels).

Furthermore, as your body tries to get rid of these bacteria, it releases chemicals (called pro-inflammatory mediators) which may cause collateral damage to your organs. There is strong evidence that individuals with periodontitis have higher levels of C-reactive protein (CRP), a pro-inflammatory mediator (easily measured from a blood sample) compared to periodontally healthy individuals.

Harmful bacteria can enter your bloodstream through the gums (Dentistry and Oral Health)

The Role of Periodontal Therapy

So if periodontitis affects your general health, can treating periodontitis reverse your fate?

There is evidence on the effect of periodontal therapy in lowering the levels of CRP in cardiovascular disease. Periodontal therapy has also been shown to reduce the level of glycated haemoglobin, HbA1c (0.4-0.7%) in diabetic patients, and erythrocyte sedimentation rate, ESR in rheumatoid arthritis patients.

Therefore, periodontal therapy may not only help achieve and maintain a healthy smile into your twilight years, but may also help with the management of other chronic inflammatory conditions.

What Can You Do

Here’s what you can do to improve your periodontal health:

Practice good oral hygiene

Aware of common signs of gum disease

See your dentist regularly

Quit smoking

Healthy diet

Exercise regularly

With proper management, many systemic diseases can be well controlled – even if they can’t be fully cured. Likewise, periodontal disease deserves consistent attention and appropriate care. If you have questions or concerns about periodontal disease, your dentist can be a great source of information and help. You may also click here to find out more about the types of periodontal services available at Tan Dental Surgery.

References:
1. The Effect of Periodontal Therapy on the Composition of the Subgingival Microbiota (Periodontology 2000)
2. Protein Metabolism After a Meat Meal Is Influenced by Chewing Efficiency in Elderly Subjects (American Journal of Clinical Nutrition)
3. Particle size and nutrient bioavailability (Journal of Agricultural and Food Chemistry)
4. Effect of Bite Size and Oral Processing Time of a Semisolid Food on Satiation (American Journal of Clinical Nutrition)
5. Periodontal Inflamed Surface Area: Quantifying Inflammatory Burden (Journal of Clinical Periodontology)
6. Periodontal Inflamed Surface Area and Periodontal Case Definition Classification (Acta Odontologica Scandinavica)
7. Periodontal Pathogens in Atheromatous Plaques Isolated From Patients With Chronic Periodontitis (Journal of Periodontal Research)
8. Harmful bacteria can enter your bloodstream through the gums (Dentistry and Oral Health)
9. A Systematic Review and Meta-Analyses on C-reactive Protein in Relation to Periodontitis (Journal of Clinical Periodontology)

Updated: 2 Aug 2021

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One of the most common questions we get asked about braces is how much do they cost? Some have also asked why does the braces fee vary between clinics. After all, isn’t braces treatment the same at all clinics?

Just like many other products and services, there are multiple reasons why the braces fee is different between clinics. If you are “shopping around” for braces, take a look below at some of the factors that affect the cost of braces before you plonk down your hard-earned cash (or your parents’) :

1. Treatment by General Dentist or Specialist (Orthodontist)

Braces (orthodontic) treatment is provided by general dentists and specialists (Orthodontists).

What is an Orthodontist? A degree in Dentistry is typically 5 years long. However, just like doctors, a dental graduate will need to complete at least 1 year of compulsory service with the government before he or she can become a registered dentist and practise dentistry in Malaysia. After that, there is an option to choose to specialise in fields such as orthodontics, periodontics etc. The process of specialisation is usually 3 years long.

In short, it generally takes about 6 years to be a fully registered dentist and another 3 years to become a specialist!

Education pathway to becoming a dentist and dental specialist (EduAdvisor)

Generally, braces treatment carried out by Orthodontists cost more but there are always exceptions. Here at Tan Dental Surgery, our resident Orthodontist, Dr. Tan Wee Han is registered as a dental specialist with the National Specialist Register as well as the Australian Health Practitioner Regulation Agency (AHPRA)

2. Private, government, university or military (Hospital Angkatan Tentera) dental clinics

The cost of braces is also influenced by where you get the braces done. Naturally, the cost of braces treatment is highest in private clinics compared to government clinics.

Most people assume that braces can only be done in private or government dental clinics. However, there are a number of university and military dental clinics offering braces as well. For a full list, click here.

3. Types of braces

When it comes to braces, there are a few options available to suit your budget and needs. For instance, if your job (e.g. flight attendant) does not permit visible braces on your teeth, then you have the option of either lingual braces (braces behind the teeth) or clear aligners (e.g. Invisalign®). Other types of braces include metal braces as well as clear braces.

In terms of cost, metal braces are the most affordable followed by clear braces. Clear aligners (e.g. Invisalign®) and lingual braces cost the most.

Another subtype of braces known as self-ligating braces (e.g. Damon®) is available in metal or clear form. These cost more than conventional braces. Self-ligating braces are different from conventional braces as they have clips to hold the wires whereas conventional braces require rubber rings to secure the wires.

There are also removable plastic plates. Plates which move teeth are called removable appliances and plates which change the position of the lower jaw (mandible) are called functional appliances. Removable appliances are normally used in children and some adults. Functional appliances are normally used in children.

We offer all types of braces here at Tan Dental Surgery. Do check with our Orthodontist if your choice of braces is right for you.

4. Scaling, X-rays and extractions of teeth

Here at Tan Dental Surgery, we normally advise patients who have signed up for braces to have gum evaluation (periodontal screening) and scaling done first. This is an important first step to ensure the teeth and gums are healthy prior to starting braces. If gum problem (periodontitis) is detected, then gum treatment is necessary before braces.

X-rays are also required before starting braces to assess the general condition of the teeth and jaw bones.

Some patients require extractions of teeth for braces. The reasons for extractions could be to make room to straighten the teeth or maybe because the tooth/teeth are in poor condition.

All of the above procedures are usually not included in the braces fee so do take that into account when calculating the total cost of braces.

5. Braces accessories and retainers

For some patients, additional components like orthodontic miniscrews, expanders, etc. are necessary to help move the teeth and jaws. These extra accessories are normally not included in the total fee for braces.

After completion of braces treatment, you would need to wear retainers to maintain the straight alignment of teeth. Some practices include the cost of retainers in the total fee and some do not. Do make sure you find out first before signing up for treatment (FYI, retainers are included in the fee here at Tan Dental Surgery).

Orthodontic miniscrew

Hopefully the above information has been helpful in providing you with a better idea of the factors determining the braces cost. Feel free to contact us (via WhatsApp, phone or email) if you have any enquiries about braces. We’ll be more than happy to answer them!

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Category: Uncategorized

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1. Treatment by General Dentist or Specialist (Orthodontist)

2. Private, government, university or military (Hospital Angkatan Tentera) dental clinics

3. Types of braces

4. Scaling, X-rays and extractions of teeth

5. Braces accessories and retainers

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