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In orthodontics, the quest for a beautiful harmonic smile often involves various intricate techniques and methods. While braces or Invisalign can make the teeth straighter, in most cases, an orthodontic specialist has many variables to consider and a complex diagnosis and treatment planning is done behind the scenes. Some of these considerations involve a patients skeletal pattern, analysis of several radiographs, the patients facial profile and balance, symmetry, as well as the macro and micro esthetics of the teeth.

This post will focus on the last point. The macro esthetics encompass the relationships of the teeth to the face, lips and gums and the micro esthetics involve the individual tooth size, shapes and shades. There are many misconceptions about interproximal reduction, many of which come from General Dentists who have the best intentions, but are ill-informed, as well as social media. It is important to remember that Orthodontists are specialists in tooth movement and what is needed to obtain the best smile and proper bite relationship.

The size and shape of the teeth play as large role in the appearance of the smile as anything that an orthodontist does with braces or Invisalign. If the teeth have irregular size or shape sometimes the teeth themselves need to be altered in order to obtain an ideal bite as well as an optimal esthetic result. Interproximal reduction, or IPR, is a technique that can be utilized in order to obtain the best orthodontic outcome.

Interproximal reduction is a simple procedure in which the size and shape of the teeth are adjusted using precise diamond embedded instruments in which minute amounts of enamel are removed. This is typically done in between the teeth where they touch one another, known as the contact point. There are several reasons why this is done:

• Tooth Size Discrepancy: The set of upper and lower teeth are like a puzzle and the individual teeth have ideal sizes in order to fit together properly. If the upper teeth are too big or the bottom teeth are too narrow in comparison, a patient will present with upper crowding, an excess overbite or spacing of the lower teeth. On the other hand, if the top teeth are too small or the lower teeth are too wide, there will be spaces on the top or crowding on the bottom. Through extensive orthodontic research, it was discovered that there are ideal proportions of the upper and lower teeth. If the upper and lower teeth do not match due to the tooth size, it is known as a "Tooth Size Discrepancy". On occasion, reduction of the upper or lower teeth is a solution.
• This is a quick, safe and pain free procedure. Tooth enamel can be as much as 2.5 millimeters thick and Interproximal reduction typically involves no more than 0.2-0.4 millimeters. After IPR, there is plenty of excess enamel to keep the teeth healthy and strong, which has be shown in countless orthodontic research. IPR does not increase the risk of cavities. Research has shown that dentists are less comfortable performing IPR routinely and orthodontists who are more likely to have researched the long term effects of IPR on the teeth are more comfortable performing the procedure. Because of this, dentists will often inform patients and their families that IPR is unsafe, will damage the teeth or other statements that are incorrect, and not backed by scientific research.

• Anatomy: Sometimes the shape of the teeth is such that an esthetic improve can be made by removing some excess enamel in order to improve the shape of the teeth or how to teeth connect to each other in order to obtain a more esthetic final result.

• Black Triangles: Sometimes due to the shape of the teeth, how they connect to each other or due to gum recession, the appearance of what are known as black triangles occur. It is noticed as triangluar "spaces" close to the gum-line. While there are not actually spaces between the teeth, if the teeth are only touching at the tips and not up to the gums, a dark triangle will apear. On occasion, IPR can reshape these teeth and reduce the size and appearance of the black triangle once the space is closed.

• Crowding: Another reason for using IPR is due to crowding of the teeth. Significant amounts of space can be created by removing very small amounts of enamel in between some of the teeth. If there is crowding between the teeth, but not enough crowding for the removal of permanent teeth, IPR can be used to create enough space for all of the teeth. In addition to create space, IPR also creates flat surfaces between the teeth which helps improve the stability of teeth to keep them straight after orthodontic treatment is completed.
• Conclusion and Considerations: IPR is a safe procedure and extensive research shows that there is no increased decay after IPR, there is improved stability of the orthodontic results after IPR due to the improved contacts, and there is no increase in sensitivity when the amount of enamel removed is within proper limits.

The author, Dr. Eric Strouse DMD MDS is a specialist in orthodontics in the practice of orthodontics in Spring Hill and Lecanto, Florida. He was trained at Muhlenberg College for his Bachelors Degree where he competed on the track and field team. He completed his dental training at the University of Connecticut School of Dental Medicine, earning a Doctorate of Medicine in Dentistry(DMD). He completed a one year General Practice Residency at St. Luke's Hospital in Allentown, PA and his specialty training in Orthodontics and Dentofacial Orthopedics at Rutgers University where he also completed a Masters in Dental Science. Dr. Strouse has been published in several Dental and Orthodontic Journals. Dr. Strouse is an expert in two-phase orthodontic treatment, phase 1 interceptive treatment, extraction and non-extraction treatment, Invisalign clear aligners, and multiple bracket systems(custom braces, self ligating braces, conventional braces). This blog is for informational purposes only.

Brooksville, often hailed as the "Nature Coast," offers a delightful blend of old-world charm and modern amenities with a wonderful community of families we are privileged to serve at Strouse Orthodontics. Steeped in history, this picturesque city invites you to explore its quaint downtown adorned with historic architecture, charming boutiques, and cozy cafes. Take a stroll down its tree-lined streets, and you'll find yourself immersed in the beauty of Southern hospitality and small-town allure.

But Brooksville isn't just about its nostalgic charm – it's also a haven for outdoor enthusiasts and nature lovers. From the breathtaking landscapes of the Withlacoochee State Forest to the crystal-clear waters of Weeki Wachee Springs State Park, there's no shortage of natural wonders to behold. Whether you're kayaking along scenic rivers, hiking through lush forests, enjoying a Historic Walking Tour or simply enjoying a picnic in the park, Brooksville offers endless opportunities for adventure and relaxation.

At Strouse Orthodontics we understand the importance of a healthy, beautiful smile. Led by experienced orthodontist Dr. Eric Strouse, our practice is committed to providing personalized care and innovative treatments that achieve exceptional results. From traditional braces to Invisalign® clear aligners, we offer a comprehensive range of orthodontic services tailored to meet the unique needs of each patient, for both children and adults.

What sets us apart is our dedication to excellence and our genuine passion for enhancing smiles. We combine state-of-the-art technology with a compassionate approach to ensure that every patient receives the highest standard of care in a comfortable and welcoming environment. Whether you're seeking orthodontic treatment for yourself or your family members, you can trust that you're in good hands at Strouse Orthodontics.

Join Our Orthodontic Family in Brooksville

Conveniently located in the heart of Brooksville, our practice is proud to serve patients from Brooksville and the surrounding communities. Whether you're a longtime resident or just passing through, we invite you to experience the difference at Strouse Orthodontics. Our office has convenient locations in Citrus and Hernando County, in Lecanto and Spring Hill. We provide the highest quality orthodontic care, with custom orthodontic braces and Invisalign in a friendly and welcoming environment. Schedule your consultation today and take the first step towards achieving the smile of your dreams in the charming backdrop of Brooksville, Florida.

At Strouse Orthodontics, we're more than just orthodontists – we're your partners in oral health and happiness. Come and discover the beauty of Brooksville, and let us help you achieve a smile to be proud of! Your journey to a confident, radiant smile begins here!

Some very common statements I hear as an orthodontist from patients are "my wisdom teeth got removed and cause my teeth to shift" or "When my wisdom teeth came in my teeth started to shift". While it is a commonly held belief that the wisdom teeth are related to crowding, they are not related. The thought that wisdom teeth cause crowding or make your teeth crooked is somewhat of an old wives tale and is not true. So why do teeth because crowded after braces or Invisalign?

Teeth become crooked after orthodontic treatment for a few reasons. The main reason is lack of retainer wear. Research has shown that orthodontic retainers are the only way to keep the teeth in their new position after treatment and keep tooth movement to a minimum. Without retainers, the teeth will begin to shift and become crooked. Just like anything else in the body, teeth change over time, and maintenance is necessary. Keeping the teeth straight after braces requires wearing retainers for as long as you want them to stay straight.

Another factor that over time can lead to shifting of teeth is what is known as late mandibular growth. Put simply, there is a very small amount of lower jaw growth that happens in the late teens and twenties that puts a slight force on the lower teeth pushing them forward and upward very slightly into the back of the top teeth. Over time, this extra force or pressure can cause crowding of previously straight teeth.

Research at the University of Iowa showed that wisdom teeth can not exert pressure on the front teeth to cause them to become crooked. The way this was discovered was by using sensors that compared the pressure with wisdom teeth and without wisdom teeth. What they found was that there was no difference. Research also compared the amounts of crowding in children after braces with and without their wisdom teeth. There was no difference in the amounts of crowding, suggesting that wisdom teeth do not play any factor in crowding, or shifting of the teeth after orthodontics.

While everything in the body changes over the course of time, when it comes to maintaining the position of the teeth, the most important thing is to continue wearing your retainers for as long as you want the teeth to remain straight. The wisdom teeth do not play a role in cause the teeth to shift.

Our office and the American Association of Orthodontists (AAO) recommends children get their first check-up with an orthodontist either at the first recognition of an orthodontic problem or at age 7. It is important not to rely on your general dentist(the dentist that does your checkups and cleanings) to properly evaluate for orthodontic concerns.

Around that age, children have a mix of baby (primary) and permanent teeth. An examination at this age gives the child orthodontist a wealth of information. If a problem exists, or if one is developing, your orthodontist is able to advise you on which treatment is recommended, when it should begin, and estimate its length. "Waiting for the baby teeth to fall out" without being evaluated and monitored by an orthodontist is a mistake that can lead to serious issues down the road.

If your child is younger than 7, and you notice something that appears “off,” it’s not necessary to wait until your child turns 7 or until you get a recommendation from your dentist. You should take your child to an orthodontist the moment you notice an issue, regardless of age. No referral needed to set up an appointment for an orthodontic evaluation. At Strouse Orthodontics, as well as most orthodontic offices, initial consultations are complimentary. Orthodontists care about the well being and orthodontic health of your family and will be able to advise if any treatment is needed.

What Happens at the First Exam? Generally five questions will be answered

1. Is there an orthodontic problem, and if so, what is it?
2. What are the options to correct the problem?
3. Is there a possibility any teeth need to be removed?
4. How long is the recommended treatment expected to take?
5. How much will the recommended treatment cost?

Frequently Asked Questions

Won't my child's teeth become straighter as they grow?

Unfortunately, a common misconception is that a child's teeth will naturally align as they age. However, the reality is quite different. The space available for permanent front teeth does not expand with growth. In fact, after the eruption of the permanent molars around age 12, there's often less room for the front teeth, potentially resulting in orthodontic issues like protrusion or misalignment. Furthermore, untreated orthodontic problems tend to exacerbate over time and can pose greater challenges as a child matures.

Should I wait for our Dentist to refer my child to an orthodontist?

No. Parents are usually the first to realize something is off about their child's teeth or jaws. If you have any concerns please contact our office to schedule an initial consultation.

Where did my child's orthodontic problems come from?

Most orthodontic problems are genetic. Some are “acquired,” developing over time by sucking the thumb or fingers, mouth breathing, dental disease, abnormal swallowing, poor dental hygiene, or early or late loss of baby teeth, accidents and poor nutrition. Regardless of the cause, an orthodontist will likely be able to treat the condition.