Wearing retainers - How much, how long, how often? / How to clean orthodontic retainers.

- Common instructions and recommendations for retainer wear. | Why relapse occurs. | How to clean different types of retainers.

Wearing retainers is the second phase of your treatment.

Once you've completed the active phase of your orthodontic treatment (the process of wearing braces or Invisalign®), its retention phase will need to begin immediately. And following through with it is just as important as going through the straightening process itself.

Relapse.

That's because if you don't, your teeth will have a tendency to shift back to their original position. In most cases they won't revert fully. But it is common to see some of the features of a person's original malocclusion return.

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Orthodontists term this process "orthodontic relapse," and it's the main issue they fight after the active phase of their patient's treatment has been completed. And if any degree of relapse does occur, it may not be a quick and easy situation to correct.

  • It's been estimated that between 40% to 90% of patients have unacceptable dental alignment 10 years after the completion of their treatment. [Pratt 2011]). [page references]
  • Not wearing their dental retainers as directed is the main reason you hear of people having braces a second, or even third, time later on in life.

How often, and how long, do you need to wear your retainers?

a) Initially.

Immediately after your work with your braces has come to an end, your dentist will give you retainers to wear.

The idea is that the soft tissues that surround and anchor your teeth (fibers and ligaments) need time to adjust and reorganize before they can play their role in stabilizing the new alignment of your teeth.

Studies show that this process takes on the order of 7 months to a year (Pratt 2011). So in the mean time your retainers will keep your teeth from easily relapsing.

Around-the-clock wear, or close to it.

Don't be surprised if at first you're instructed to wear your retainers twenty-four hours a day, seven days a week. And your dentist will probably have you do this for the next several months, and possibly as long as 1 or 2 years.

We found a study (Lai 2014) that polled dentists (orthodontists) to find out what their recommendations generally were for removable retainers.

Essix and Hawley orthodontic retainers.

Essix and Hawley appliances are the most frequently used removable retainers.

  • On average, the initial stage of a patient's retention process involved wearing their retainers for 16 hours per day (the range was from 2 to 24 hours), 7 days a week.
  • The patient was instructed to keep this schedule for a time period ranging anywhere from 1 to 24 months (with a mean value of 7 to 8 months).
  • Only 5% of the dentists ended this retention period within 6 months. 88% of the dentists continued it for more than a year.
How often are check-ups?

More about
retainers.

If you're wondering how many trips you'll make to your dentist's office during this period:

  • 75% of the dentists polled appointed their patients for check-ups 3 or more times during the first year of retention.
  • 13% checked their patient 5 times or more per year.
  • A study by Meade (2013) reported similar findings with over 90% of orthodontists checking their patients' retainers on average 2.9 times during the first year.
 

b) Later on.

At that point when your initial phase of retention (and the tooth stabilization it creates) has been completed, your dentist will give you a second set of instructions. These will be those that you'll need to follow for the next several years, and likely for the remainder of your life.

Yes, studies suggest that orthodontists appear to agree that some type of life-time wear of
retainers is required to reduce the chances of orthodontic relapse. (Meade 2013)

A more relaxed routine.

It's common that the new recommendation will be one where your retainers are just worn at night while you sleep. And at least at first, your dentist will probably want you to do this 7 days a week. Beyond that however, there may be some leeway in what you need to do.

Figuring out your own routine.

There's an event that may happen by accident that can help you to learn how often you must wear your retainers to maintain your current alignment.

  • If you've gone through a period where you haven't been wearing your retainers regularly, you may find that their fit has changed. They may feel extra tight or snug. If so, this is a sign that your teeth have started to shift.
  • This is an important turning point, and one that needs to be corrected immediately. The usual remedy that's needed for slight changes is to wear your retainers religiously (possibly even around the clock) until they've been able to shift your teeth back into place and their passive fit has returned.
  • Once things have returned to normal, you simply need to insure that your retainers are always worn at minimum often enough that a change in their fit never occurs again.

Why does relapse take place?

You may wonder why orthodontic relapse tends to occur. Here are some of the issues known to be involved.

  • The roots of teeth are anchored in their sockets by fibers that become stretched during tooth movement. Once your braces are taken off, their natural reaction is to contract. By wearing a retainer, your teeth are held in place as these fibers instead reorganize and adapt.
  • Moving a tooth creates changes in the bone immediately surrounding it. In general, this "new" bone is less heavily calcified than what previously existed. Wearing a retainer provides stabilization as the bone changes and matures.
  • Teeth are surrounded my muscular tissues (tongue, lips, cheeks). The persistent pressure they exert on teeth can cause them to shift.
  • Many patients who have completed orthodontic treatment are still at a stage in their life when their jawbones are growing. And as changes take place with them, the positioning of the teeth they hold can be affected. Wearing a retainer helps to control these changes.
Other causes.

Beyond the issues above, there are many other factors that help to explain why relapse occurs. One of these is the type of malocclusion that has been corrected. Another is how stable a position in the jawbone that the tooth has been moved to tends to be.

Everyone's teeth shift over time.

Other than just the issue of relapse, it's normal and natural that a person will experience some degree of alignment change with their teeth over the course of their lifetime. This is true whether they've had orthodontic treatment or not. (That implies that all humans could benefit from wearing an orthodontic retainer, which is true.)

How many years do you need to wear your retainers?

For all of the reasons outlined above, if you want to maintain the exact same perfect alignment that your teeth had the day your braces were taken off, over the course of your entire life, some type of long-term retainer wear will be needed.

That's not to say the amount required might not be just minimal (a few nights a week). But the only way to insure that no changes take place at all is to continue your retainer wear over the long term.

This is an important issue. As mentioned at the top of this page, 40% to 90% of patients have unacceptable dental alignment 10 years after the completion of their treatment. And this correlates with the finding that very few patients are still wearing their retainers as instructed 5 years after their braces have been removed. (Pratt 2011)

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How do you clean dental retainers?

Commercial cleaning soak for tooth aligners.

The same plaque and tartar that tends to accumulate on natural teeth will accumulate on removable retainers too.

Add in the fact that you'll be wearing the same set on a long-term basis, it's easy enough to understand why thorough cleaning and disinfecting is important if you expect them to stay clean looking and odor free.

Essix / Vivera®

Due to their identical construction (vacuum-formed, clear plastic appliances), the same cleaning techniques that we describe for use with Invisalign® aligners makes a good choice for Essix retainers too.

A study we saw.

We ran across the abstract of a study (Chang 2014) that evaluated ways to disinfect Essix retainers. It reported that using a toothbrush and fluoride toothpaste removed 99% of (Streptococcus mutans) bacteria from appliances. Thus implying that this is an effective way to clean and disinfect this type of retainer.

We should point out that the page linked to above has a section that discusses how brushing (especially with toothpaste) can scratch plastic surfaces. And in the case where the same appliance is worn over an extended time frame, micro scratches might start to: 1) Affect its appearance (make it look more opaque). 2) At least in theory, provide more locations for microorganisms to inhabit.

We're not saying that brushing doesn't necessarily make a reasonable way to clean Essix retainers, just that these issues should be considered before choosing it.

Hawley

Hawley retainers are a type of removable appliance that has both plastic and metal components.

  • Cleaning a Hawley should start with brushing. This page (which outlines technique for denture brushing) describes acceptable cleaners and brush types to use.
  • Brushing should be followed by chemical disinfection. Commercial soaks made for retainers (or probably even dentures) should be suitable (check their packaging for their recommendations). Make sure the product says it's safe for use with appliances that have metal components.
 

 
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