A tooth gem is a cosmetic accessory applied to the surface of a tooth using a dental-grade adhesive. Retainers maintain alignment after orthodontic treatment, preventing teeth from shifting. Since most retainers are custom-molded to fit the precise contours of the teeth, the addition of a gem can interfere with this exact fit. Determining if a tooth gem is practical depends primarily on the type of retainer you use.
Retainer Compatibility with Tooth Gems
The feasibility of wearing a retainer over a tooth gem depends highly on the orthodontic appliance design. Clear plastic retainers, sometimes called Essix retainers, present the most significant challenge. These vacuum-formed retainers fit tightly over the entire surface of the teeth. A gem creates a small bump that prevents the clear plastic from fully seating, compromising the retainer’s function.
This tight-fitting design means the retainer cannot exert stabilizing pressure evenly across the tooth surface. Forcing a clear retainer over a gem can cause a gap to form between the plastic and the tooth, leading to minor shifting or relapse of the affected teeth. Often, the gem prevents the retainer from being worn at all, rendering the appliance ineffective. The pressure from the plastic may also forcibly remove the gem prematurely, potentially causing trauma to the enamel or damaging the retainer itself.
Wire retainers, such as the traditional Hawley retainer, generally offer better compatibility due to their different design. The Hawley retainer uses an acrylic plate against the palate or floor of the mouth and a metal wire that wraps around the front teeth. If the gem is placed away from the metal wire’s path, the retainer can often be worn without interference. Fixed or bonded wire retainers, which are cemented to the backside of the front teeth, are typically unaffected by a gem placed on the front surface.
A professional may be able to create a customized clear plastic retainer with a small bubble or relief area precisely molded over the gem’s location. This modification allows the retainer to seat fully over the rest of the teeth while accommodating the gem’s bulk. However, even with this customization, the gem introduces a slight discontinuity in the retainer’s stabilizing force, making the fit less precise than on a smooth tooth surface.
Potential Risks and Material Stress
Even if a retainer seems to fit over a tooth gem, the presence of the gem introduces risks related to material stress and orthodontic stability. Clear plastic retainers are particularly susceptible to damage from the concentrated force applied by the gem’s bulk. The plastic material is not designed to accommodate such protrusions, which can lead to stress fractures or cracking around the gem site, especially when the retainer is repeatedly inserted and removed.
The physical pressure exerted by the retainer can also compromise the integrity of the gem’s bond to the tooth. Tooth gems are attached using a dental composite resin. The constant, subtle pressure from the retainer can weaken this adhesive bond over time, increasing the likelihood of the gem becoming dislodged sooner than its expected lifespan. The premature loss of a gem may necessitate a trip to a dental professional for removal of any remaining adhesive.
There is also a risk of minor orthodontic relapse, even if the retainer has been modified to fit. The retainer works by applying a gentle, uniform pressure to the teeth to maintain their position. If a gem creates a space or gap where the retainer cannot contact the tooth surface perfectly, that specific tooth is not being fully stabilized. This incomplete stabilization can potentially lead to shifting of the tooth with the gem or the teeth immediately next to it, compromising the long-term success of previous orthodontic treatment.
Professional Consultation and Hygiene
Before getting a tooth gem, consulting with your orthodontist or a dental professional is a necessary step to ensure the health and stability of your smile. They can assess your specific retainer type and propose the safest course of action, which may include fabricating a new, customized retainer. This professional assessment helps confirm that the gem’s placement will not interfere with the wire of a Hawley retainer or require a custom relief bubble in a clear plastic appliance.
Maintaining excellent oral hygiene becomes more challenging with both a retainer and a tooth gem present. The gem creates additional surfaces and edges where plaque and food debris can accumulate, increasing the risk of localized decay or gum irritation. A specialized cleaning routine is needed to thoroughly brush around the perimeter of the gem, ensuring no bacteria are trapped between the gem and the enamel.
Retainers themselves require specific cleaning, generally involving non-abrasive cleaners and a soft brush to prevent scratching or warping the material. Abrasive cleaners or harsh chemicals should be avoided, as they can damage both the retainer’s plastic and the gem’s adhesive. If the gem is ever removed, a dental professional must use specialized tools to polish the enamel surface and remove all traces of the bonding material. Once the gem is gone, the old modified retainer will no longer fit, necessitating a new, perfectly contoured retainer to maintain alignment.