Get things straight

May 1, 2005
A typical hygiene scenario is when the intraoral camera during a recare visit reveals the same crooked and stained crevices.

A typical hygiene scenario is when the intraoral camera during a recare visit reveals the same crooked and stained crevices. Unsightly stains have accumulated on the misaligned teeth, as well as dingy bacterial deposits. Floss occasionally finds its way around these crowded teeth when the patient flosses, but it takes a lot of effort on the part of the patient to maintain the necessary home care.

When the camera zooms in, a thin fissure (separating calculus) produced from flossing those tight contacts can be seen. Unfortunately, tissue recession is gradually occurring down the root as it migrates. The tissue tries to adhere in an awkward attachment area, which is caused by crowding and traumatic forces. What corrective service can hygienists offer to rectify this situation?

When the hygienist asks the patient, “Is there anything about your smile you would like to improve?” she may immediately think, “Straighter teeth.” When the patient answers, “Straighter teeth,” this becomes a perfect time to discuss a straighter smile.

The patient may then say, “I had straight teeth when I was younger, but I’m not going through braces again.” The hygienist can tell the patient, “There is now another choice to straighten relapsed teeth using clear technology, called Invisalign aligners by Align Technology, Inc.”

The hygiene setting is the perfect place to discuss straightening and disentangling teeth. Teeth position affects much of the treatment provided by hygienists when they work to remove bacterial deposits lodged in uneven crevices. Both home-care recommendations and periodontal health are influenced by teeth arrangement. It is much easier for patients to brush and floss when the teeth are positioned well.

Traditionally, orthodontic procedures to straighten smiles have been performed solely by orthodontists. Now, properly trained and certified Invisalign general dentists can supervise teeth movement. Team members are welcome to accompany doctors to Invisalign certification courses, and hygienists should be part of this team.

During the clinical exam, the doctor will determine if aligners are indicated for a patient. The CAESY educational system on chairside computer allows the hygienist to offer Invisalign information to patients. The patient’s X-rays, photos, and impressions must be completed and submitted to Invisalign. Utilizing the Internet, the case can be reviewed and a virtual treatment plan can be viewed by the doctor and patient. When the records are finalized, clear aligners are fabricated using three-dimensional technologies in the lab. Aligners are created in the lab (laser assisted scans) at the same time and take into consideration future tooth movements.

When patients receive the trays, no adjustments to the aligners are generally needed, and the aligners will be worn in specific sequence. Aligners come labeled in stages, and the first sequence simply snaps into place. If the tissue is uncomfortably impinged when the aligner is seated, the dentist may trim the aligner with scissors or burr.

Blue and red aligner storage is offered for incoming aligners and the previously completed stage. The system is easy to remember - blue (new) and red (dead). During treatment, some teeth may need to be reproximated or slenderized and composite buttons may need to be placed on outer tooth surfaces. Hygienists should not unintentionally scale these tooth-colored nubs, as they are important landmarks for the treatment phases.

When the teeth are being actively treated, tender pressure points may develop as the teeth shift. These slightly uncomfortable areas may make flossing temporarily unpleasant, but it is important for patients to understand how important bacterial removal is to their overall health. Fluoride rinses and gentle antibacterial mouthwashes will help tissues feel better. For freshness and cleanliness, washing away food debris with a power lavage tool set on gentle cleaning mode will offer comfort. Massaging the gums this way will stimulate and soothe tissue.

There are definite advantages to being treated with aligners. Patients can maintain regular home care because there are no metal brackets or wires. Dentists may find that Invisalign patients are motivated to perform better homecare because they can watch their smile evolve. Aligners are to be removed during eating, and this provides a convenient time to take the toothbrush for a spin before re-inserting.

Changing teeth arrangement may become a life altering experience. Smokers who want straighter teeth may have to kick the habit, because smoking is contraindicated for an Invisalign wearer. The aligners may become discolored from the nicotine. It would become difficult for a chain smoker to remove the liners every time he or she craves a cigarette. A straighter smile may be just the incentive a smoker needs to break the habit.

From closing wide spaces to rearranging crowded teeth, a variety of corrective needs can be addressed using Invisalign aligners. Because the aligners are clear, treatment can be done nearly unnoticed. Without the traditional metalwork, there is less likelihood for painful mouth abrasions caused by poking brackets or wires. The hygiene setting is a wonderful arena for patients to get straight answers on smile design and Invisalign.

The author did not receive compensation for product endorsement. For the straight talk on Invisalign visit

Karen Kaiser, RDH, graduated from St. Louis’ Forest Park dental hygiene program in 1994 and currently practices at the Center for Contemporary Dentistry in Columbia, Ill. She has written several articles for RDH and other publications, sits on dental hygiene panels, and is an evaluator for Clinical Research Associates. She can be contacted at [email protected].