Specialists In Orthodontics

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October 1, 2014

Teeth Gone Wild – The Impacted Tooth Story, Part I

Heck it has been a long time! Hopefully everyone survived the summer. In Michigan, we had a cooler than normal summer which was great for those of us who like to do physical activity outside but not great for anybody who spends time on one of our amazing lakes. Here are a couple of pictures, including an obligatory family photo, of where my family vacations during the summer in Northern Michigan (we call it “Up north”). When I first told my wife about going “up north” she said: “You mean Michigan isn’t north enough!?” She had no idea how amazing northern Michigan can be.

Hemlock Shores, Walloon LakeGroth family photo

Enough about my summer, let’s talk about impacted teeth. An impaction basically means that a tooth is surrounded by bone and is unable, or unwilling, to erupt into the mouth. Most people are familiar with impacted wisdom teeth, because most jaws do not have enough space to accommodate wisdom teeth so they simply hang out in the bone waiting for two things to happen: 1) they get removed, or 2) they become unruly and begin to misbehave potentially causing damage to perfectly healthy teeth. The photos below show impacted wisdom teeth that were not removed in time causing significant damage to the tooth on the lower right of the picture.

Impacted Wisdom TeethDamage Resulting from Impacted Wisdom Teeth

While we are on the subject of wisdom teeth let’s clear up a common misconception. Eruption wisdom teeth do not cause shifting of the lower front teeth. This has been a heated debate in the dental field for many years and nobody has been able to prove it to be true (despite some very good efforts). The shifting that occurs is generally due to the fact that as we age our lower teeth tend to drift forward more than our upper teeth. Our lower jaw is on an angle, towards the ground, compared to our upper jaw so gravity and chewing forces tend to push lower teeth forward. As they drift forward and begin to contact the upper front teeth they have no choice but to become crowded. For patients who have been treated, the eruption of the wisdom teeth around the age of 16-18 is generally the time when people think that retainers are no longer necessary. So this is truly a case of correlation and NOT causation.

Moral of this story is: get your wisdom teeth removed because an impacted wisdom tooth is NOT harmless, and WEAR YOUR RETAINERS!

Stay tuned for Part II of the Impacted Tooth Story where we will discuss teeth that truly have gone off of the beaten path.

Thanks for reading,

Dr. Groth

June 24, 2014

Retention and Retainer Fatigue


Ask any orthodontist what the hardest part of their job is and there is no doubt, in my mind, that a very popular response will be retention. There are several possible “phases” to orthodontic treatment. Some patients may go through two-phase treatment in which there is a phase I, where we are very focused on fixing a specific problem before all of the adult teeth are in, and a phase II treatment for comprehensive bite correction. I believe we should consider retainer wear as phase III of orthodontics, because it is just as important as any other phase of treatment. I am sure many of you are reading this and thinking, “When I went through braces I was told to wear my retainer for a certain amount of time and then it was no longer necessary.” Let me tell you why this is a bad idea!

Tyler | Dumas | Reyes

Clear Retainers with Typodont

In many regards preventing teeth from moving is the hardest facet of orthodontic treatment. Your teeth are not unlike anything else in your body, they are set in bone and surrounded by tissue and ligaments. Bone is not like cement. Bone can, and will, change and if you don’t actively maintain the final position of your teeth, they will move. What I cannot tell you is how much they will move. A great example of this (many of you may have already heard this from me while in the office) is the difference between my wife, Kelly, and me. Kelly was treated with upper only braces and rarely wore her retainer for the better part of 10 years and her teeth barely moved. I have gone through initial treatment and two rounds of Invisalign because if I don’t wear my retainers I can feel my teeth move throughout the day! My teeth want to move whereas Kelly’s do not. She is lucky! The major problem is that I have no way of identifying who will experience relapse and who will not, but I can say if you are wearing your retainers, you will have less relapse than someone who does not.

Retainer Fatigue

I also want to touch on the importance of replacing your retainers. Clear retainers are our retainer of choice for several reasons: they look better (and hopefully are worn better), and hold the teeth in their position better than the traditional Hawley retainer. However, there is one downside to these retainers – the plastic fatigues. Every time you remove your retainer you are stretching the plastic just a tiny bit. Over time the plastic stretches enough to allow micromovement of your teeth and as these movements get larger and larger the retainer stretches more and more. This is the reason why some people come in after wearing their retainer faithfully still have experienced some minor relapse of their teeth. Believe it or not your teeth are stronger than a thin layer of plastic. Crazy, I know! If you were to take a person who had been wearing their retainers faithfully for a year and gave them a brand new retainer made off of their original models, that new retainer would be much tighter than the old retainer due to plastic fatigue.

Tyler | Dumas | Reyes

Lost Retainers

I can’t tell you how often to replace your retainer because there has never been a long term study on what happens to the retainer plastic over time. Our suggestion at TDR is to replace your retainer every 18-24 months (or sooner if they are getting the funk). If I had the ability to give someone a pill that would eliminate tooth movement (and retainer wear) I would do it in an instant. There is a substance that has been shown to reduce tooth movement when injected around the teeth; however, it has only been used on lab rats and will not reach consumers anytime soon.

The moral of the story? Wear your retainers and replace them regularly for the best chance of keeping your teeth as straight and beautiful as the day your braces were removed.

Thanks for reading!

Dr. Groth

The Important of Losing Baby Teeth

Few things bug us more at TDR than double parking. No, not the double-parking that you are thinking of (although that is very annoying as well). The double-parking that I am talking about is when you have a baby tooth and its adult twin occupying the same space. Not only does this make you look like a character out of a sci-fi movie but it also can have long-term consequences. So why do we want you to get baby teeth out as quickly as you can after they get loose? Read on and you can find out!

Tyler | Dumas | Reyes

Double Parking

First let’s talk briefly about what ages you can expect the baby teeth to exfoliate (our fancy scientific term for the loss of a baby tooth). The first wave of baby teeth is generally lost around 7-8 years of age. These are the 8 upper and lower incisors. After this first wave there is a quiet period where no teeth will be lost. The second wave begins normally around 10 years old and can last 1-2 years. In the second wave the final 12 baby teeth are lost. The last baby teeth to be lost, in general, are the upper canines or lower second primary molars.

There are two main things that we worry about when baby teeth are not lost in time. The first is the redirection of the adult tooth that is supposed to replace it. If an adult tooth does not “hit the runway” perfectly it can head in the wrong direction and begin to erupt ectopically (another of those fancy terms which means that it is erupting in the wrong spot). Ectopic eruption often causes treatment to be prolonged because we need to work harder in order to get the tooth to the correct position. The worst type of ectopic eruption is when a tooth becomes impacted (has gone off track so far that it will not erupt into the mouth without intervention). The upper canines are the most common teeth to become impacted (see the x-ray for an example of an impacted canine). Often if we suspect that this will be an issue we will ask for the baby canines to be removed to help give the permanent canine a better “runway” to land on. If they do not hit the runway we have to go in after them, but that is another subject all together.

Tyler | Dumas | Reyes

Impacted Canine

The second issue with retained baby teeth is that food can get trapped underneath the loose baby tooth and cause problems with the adult tooth that it is covering. It is not unheard of to have a cavity on an adult tooth that has recently erupted because of this. While this does not have any effect on our orthodontic treatment, we never want to have our patients risk cavities due to baby teeth that don’t want to come out.

Why are baby teeth so darn stubborn sometimes? There are a couple of reasons. First, the back baby teeth have several roots on them and if an adult tooth does not dissolve all of the roots that baby tooth will hang on for dear life. Often these require the help of your dentist to kick them out of the party. Second, gum tissue can be very strong. The majority of retained baby teeth are simply being held in the mouth by the tough gum tissue surrounding it. All it takes to remove these is some persistence and willingness to wiggle that thing out of there!

So when you are in the office and we ask you to wiggle out those baby teeth, please do it! We never ask our patients to do things without a reason.

Thanks for reading and go wiggle out those loose teeth!

Dr. Groth

January 3, 2014

New Year’s Resolutions

Happy New Year! Hopefully everyone has enjoyed a bit of rest and relaxation during the holiday break. 2013 was a great year at TDR and we are thankful to all of our great patients and parents who continue to make our offices the premiere orthodontic practice in metro Detroit.

Beckett Majors
Reese Groth

Looking back, a few of the 2013 highlights would have to include the arrival of two new members of the TDR family (babies Reese Groth and Beckett Majors), the acquisition of three iTero scanners allowing us to deliver the most technologically-advanced treatment possible, and Buddy the Elf making his debut at TDR.

One of the greatest achievements from 2013 happened late in the year and that was our recognition as one of the top 1% of Invisalign providers in the country! At TDR we pride ourselves in providing a variety of treatment options for both children and adults, and Invisalign continues to be one of our favorite ways to give people the smile that they deserve. While Invisalign may not be the best treatment for everyone, we do everything we can to offer it to anybody who wants it.

If you have been considering orthodontic treatment why not make it one of your New Year’s resolutions? There have been debates over the long term benefits of orthodontic treatment when it comes to the health of the teeth, prevention of gum disease, and the health of the jaw joint; however, there is no question that orthodontic treatment has a profound positive effect on a person’s quality of life. Many research studies have examined this and here are a few of the results that you should know:

  • The vast majority of people (94%) notice a person’s smile first and it is a key component to their first impression of that person.
  • People with straight teeth are perceived as more successful, smarter, and even get more dates!
  • Crowding in the front of the mouth and having excess overjet were shown to have a negative impact on quality of life.
  • A space between the two front teeth and crowding of the front teeth were rated as less beautiful compared to ideal alignment.
  • Women with crowded teeth were rated as less capable than those with ideal alignment!

So there you have it! A beautiful smile not only can improve your self-esteem but potentially can land a date with your future spouse, or get you your dream job. For everyone who has just started or is in the middle of treatment use this as motivation when you think it will never end, and for those contemplating orthodontic treatment just imagine the doors that may open!

Thanks for reading!

Dr. Groth

November 27, 2013

Thanksgiving Smiles

It is Thanksgiving week which brings up a few things that we always take for granted. The first two are a couple of traditional football games that always occur this time of year: the Detroit Lions playing on Thanksgiving Day and the Michigan/Ohio State matchup, and Florida/Florida State (my wife’s favorite pick). While football has become a four letter word in our household because of how poorly our favorite teams are playing (my Wolverines and Kelly’s Florida Gators have failed to live up to expectations in a big way, Michigan State and Ohio State are on fire and the Detroit Lions seem to be on a slippery slope out of playoff contention), these games will be played and watched by everyone in the house (even Reese).

After watching the Lions, hopefully, win against Green Bay we will all eat too much turkey, stuffing, mashed potatoes and pumpkin pie and let the tryptophan lull us into a post-prandial nap for the ages. It happens every year, I tell myself that I won’t eat too much but the delicious southern spread that is put in front of me is too much to turn down. For those of you who have never tasted deep fried turkey, smoked turkey, or a true pecan pie I will tell you that you are missing out!

Let’s not forget the meaning of this holiday though. It is a time to reflect and give thanks for everything that we have in our lives; even something as simple and fulfilling as a smile. With this in mind, I will end my thoughts with this recent press release from Dr. Reyes and our hope to bring just that, a smile at this time of year, to those who are in great need of something to smile about.

Local Orthodontist Hopes to Send Smiles Across the Miles with Relief Funds for the Philippines

Dr. Brian Reyes

Rochester Hills, Mich., November 26, 2013 — You can read about it over and over, “4 million Philippine children in need of food and water” as the country struggles to get aid to the survivors. No dollar goes unnoticed and no effort is too small when the devastation is this widespread.

Dr. Brian Reyes, of Tyler | Dumas | Reyes Specialists in Orthodontics, knows very well the landscape and the destruction that is possible when a typhoon hits this archipelago. Born and raised in Michigan, he has been back “home” many times over the years, where his extended family resides. “My parents and I have been in touch with the family, and all are safe but the grief and the horrors of this storm are heavy on their hearts. This is far from over. It’s going to take a long time to reach out and start to rebuild/reconnect the country.”

Tyler | Dumas | Reyes has decided to try and send some “some smiles across the miles” and now through the end of the year will donate 50% of all Lasting Impression retainer fees to the relief efforts for Typhoon Haiyan. This along with hygiene supplies from the office will be going out in November and December.

“I hope our patients can really help us get behind this initiative and try to make any impact we can to bring the slightest relief. We are asking that if you need to replace your retainers, you might not want to wait,” says Dr. Reyes. “We would like to send our first donations by the end of next week and then continue through the end of 2013.”

“This feels like a drop in the bucket compared to the multi-million dollar campaigns of larger corporations but being mindful of our local responsibility to the schools and charities we support, we would like to stretch just a bit further and if we can bring a smile to even one hungry child in the Philippines,” continues Reyes, “then I believe any effort is a worthy endeavor.”

Thanks for reading and don’t be like me and eat too much food on Thursday!

Happy Thanksgiving – Dr. Groth

T|D|R proudly providing braces, Invisalign, and orthodontics to Rochester Hills, Birmingham, Novi, Shelby, Lake Orion, Troy, Bloomfield, Royal Oak, Farmington Hills, Northville, Livonia, Walled Lake, and surrounding communities with a long list of straight teeth and happy smiles! An orthodontist receives two to three years of education beyond dental school and are the only ones allowed to call themselves “orthodontists”. Only orthodontists may be members of the American Board of Orthodontists.