"Yup, you have one of those old-school retainers," the dentist remarked. "Wow." Her gloved fingers probed the hardware. "Wow" is never what you want to hear from someone who sees thousands of mouths per year. Yes, I answered, explaining that I had the metal wire installed on six of my bottom teeth right after I got my braces off at 17. I'd gotten used to its smooth bulk over the years; I rarely thought about it. And then Sharon Huang, DDS, cosmetic dentist and founder of New York City’s Les Belles NYC Dentistry, hit me with something surprising: not only did she suggest we replace the retainer, but that we remove it that very moment.
Let me back up for a moment: I was visiting Les Belles Park Sixty, a luxe Upper East Side dentistry practice with an office decked out in gilded mirrors and white, faux fur furniture. Not five minutes after checking in, I was introduced to Oliver, the team's Chief Anxiety Officer. It's important to note that, in addition to his official job title, Oliver is a football-sized Maltipoo in a sweater. Once I was settled into my chair in a private room and realized there was a plasma screen TV on the ceiling with Netflix queued up for midprocedure entertainment, I knew that this was a far cry from the hometown practice I'd grown up at. With Oliver now snoozing peacefully in my lap, his owner Dr. Huang tipped me back to take some imaging of my teeth before a standard cleaning and the practice's bespoke, painless whitening process. (No, really — painless, but that's a story for another day.) alloy roller crusher parts
Despite the beautiful setting and the C-suite pup, I soon found myself very nervous and facing the prospect of making a big change to a small metal wire that I’d long assumed was unchangeable: my fixed retainer.
"I thought it was…well, permanent," I objected, thinking back to the hundreds of hours I'd spent at the orthodontist growing up in pursuit of straight teeth. I'd faced myriad dental issues — impacted teeth, resorption, canines I wasn't even born with, and a generally crooked smile — and this permanent retainer had marked the end of a long and costly (and, frankly, traumatic) journey. Dr. Huang showed me a photo of what my retainer looked like to the naked eye, and while not pristine, it was typical: just a thin metal bar covered with a milky layer of glue. Then, she showed me the zoomed-in image she had just taken with her office's state-of-the-art camera that can capture what lies beneath the glue.
In short: the retainer was fucking gross. There was yellow and green buildup between my teeth and a subtle shadow of black at the very base of their backs. My gums were inflamed, the metal caked in what looked like plaque. (Oliver continued to nap during this crisis.) I couldn't believe this was what my mouth looked like, but Dr. Huang assured me it wasn't, at least not to anyone except her camera. She assured me this is a common issue for people who, like me, had worn their fixed retainer for years, but couldn't see or feel the damage that was being done. We agreed to remove and replace the retainer at my follow-up appointment, and I left the office with my tail between my legs and headed to the office.
My coworkers were horrified when I told them about what I'd seen — not for me, but for themselves, because they, too, had those metal bars on their own pearly whites. It turns out that nearly everyone I know apparently has a fixed retainer, and judging from their reactions, none of them knew they might need to replace them. And so my investigation into the not-so-permanent retainer began.
For the record, you don’t need straight teeth in order to have a beautiful smile. However, if you’re in the process of looking into treatment options for orthodontic retainers, or if you already have this type of retainer, here’s what you need to know, including proper care, the cost of replacements, and how long they actually last.
It's important to note that this kind of retainer — the correct terminology actually being bonded retainers or fixed retainers — doesn't always mess with your dental hygiene. When installed and maintenanced correctly, they're a safe and useful orthodontic tool that can keep your teeth and bite in line for decades at a time.
"Retainers are prescribed for two reasons: first, to allow the bone that holds teeth to rebuild after teeth have moved, and second, to keep the healthy new positions of teeth after active orthodontic treatment ends. Your body changes your whole life, and your teeth change, too," explains Norman Nagel, DDS, MS, orthodontist and president of the American Associations of Orthodontists based in Simi Valley, California. These can be bonded retainers, like mine, or removable retainers that are typically worn at night. Your orthodontist (or your dentist, depending where you are in your dental journey) can help you decide if a bonded or removable retainer is right for you.
"It really depends on the lifestyle," says Dr. Huang, who says she herself uses a removable retainer she uses every single night. "If you're someone who's very, very disciplined and you have a list of A to Z the things that you do before you go to bed, the removable retainer is [likely] fine. If you're someone [who is] going to forget to put in the removable one, fall asleep [without it], or you travel a lot, or you leave it everywhere, or you just fall asleep and you can't put anything in your mouth, then you [may] need a fixed retainer." These bonded retainers, which many of us refer to as permanent retainers, are meant to last for decades at a time.
"Bonding means it's glued to the back of the teeth. If you use the word permanent, you have an implication of time, that's going to be there forever," explains Daniel Grauer, DDS PhD, orthodontist at Grauer Orthodontics in Santa Monica, California. “And nothing lasts forever in the human mouth.”
Bonded retainers are common for a reason. "Retention is a very important part of the orthodontic treatment," says Dr. Grauer. Aside from maintaining the position of the teeth that was corrected through prior orthodontic methods like braces, bonded retainers can help maintain the health of your teeth, gums, and bones.
"The mouth works like a machine. There are the top teeth and the bottom teeth and the saliva acts like a lubricant," explains Dr. Grauer. "The mouth is composed of three things: teeth, gums, and bones. When everything fits well, there is no friction, and there's no wear on the teeth. The teeth can work forever. The moment you have things that don't fit well, you can end up having dental, gum, or joint problems. Teeth can get decay, gums can [recess or swell], you can reduce your bone." In short: Retainers help keep all this stable by keeping the teeth steady. And with orthodontics evolving constantly, it's becoming easier to do so.
"Now, we [also] look at the teeth, the lips, the eyes, the position of the chin, and we align the teeth with the frame of reference that's the face," Dr. Grauer continues. “We can get much better aging process. We can put the braces behind the teeth; we have Invisalign. There are so many things that we can do today that we couldn't do before."
That said, they're not a blanket fix for anyone who needs their teeth retained. "It doesn't work for everyone. There are people who can't tolerate having something in their mouth. I've taken them out for people because they're so fixated," says Dr. Huang.
It's usually not apparent when it's time to reconsider the retainer you've got. Even patients who brush and floss diligently often have no idea there's invisible damage being done. "You didn't know it looked like that," Dr. Huang points out, referring to my own flawed set-up. "Most people don't know. I mean, even dentists [may not], unless [they have] the tools to magnify it by that much."
According to Dr. Grauer, there can be more than one cause for a retainer failing to look out for, including the efficiency they're installed with, damage that can happen from wear and tear, and the materials they're made from. He lays out the three materials bonded retainers are typically made from: twisted wire, rigid wire, and CAD/CAM [or computer-designed] wire.
"We used [twisted wire] retainers for 40 years, so now, we are changing. The problem with the twisted wires, which is the most [common] one that people have, is that you can eat something [hard] and you can impact the retainer and bend it," he explains. "When you bend the retainer, nothing happens right away, but long-term, the retainer stores this energy from your bite. Then that energy's released back to your teeth, and that can move your teeth in the long-term." That's why he recommends seeing an orthodontist "every three to four years" to check that your retainer is still correctly in place, as you may not notice the shift when it happens.
CAD/CAM wires, though, which are made using more advanced computer tech, "are made of a wire that has shape memory. The fabrication process involves milling the 'wire' to a digital scan of the teeth, so its adaptation is excellent and the profile is very flat. If you bite on something, the wire is going to go back to its normal shape, and it's not going to move your teeth in the long run," Dr. Grauer adds.
Placement is also key, which means your orthodontist installing your retainer with both retention and hygiene in mind. "Sometimes, they place it with too much glue, and it makes it very difficult to clean," Dr. Grauer says. This was my exact issue, which I had no idea wasn't normal for over a decade, but Dr. Huang reassured me this is common among patients who have had bonded retainers for a long time.
"It's so hard. There's nothing you could do at home that could make this better," she says, noting that large amounts of glue make it near impossible to keep your gums and teeth clean and prevent negative health effects.
"If you can't floss your retainer, there's a problem," she explains. "You should be able to floss in between every single tooth to get into the gum to clean the bacteria. So, if you're not able to do that because of the retainer, then you need to swap it out."
That's one reason an open narrative with a dentist you trust is so important for maintaining your long-term oral health. "Especially as cosmetic dentists, we're really focused on prevention and educating our patients. We're big on having patients be our teammates. With the technology that we have, we're able to capture the small spaces and blow this [image] up so that you can understand [the issue], not just [feel like] the dentist talking at you,” says Dr. Huang.
Hygiene is the most important factor when it comes to maintaining bonded retainers. Dr. Huang lists cavities and periodontal disease as two major effects from retainers that are unable to be cleaned properly.
"Because there's so much debris in the area, the bacteria tunnels into the gum and starts feeding away at the bone, so you get a lot of bone loss in these teeth," explains Dr. Huang. “That accumulates a lot of bacteria, which spreads through your entire mouth and could cause periodontal disease. It's a bone-eating bacteria," she says. Eek! "The bacteria that [may be] living in this gum also travels through your entire body… it can even land in heart and cause heart disease," she adds. Michael Apa MD, aesthetic dentist and founder of Apa Aesthetic, also notes that the gums are high-risk if the retainer isn't placed well.
"If a wire is incorrectly positioned on or too close to gum tissue, there can be a domino effect of issues, starting with gum inflammation. Prolonged gum inflammation can lead to bone loss, which then leads to tooth mobility," he says. Dr. Huang, though, adds that intervention can make all the difference if your dental situation is going south. "Prevention is really important to us because we want to catch [the issue] before it happens. There are so many opportunities to do something before something becomes a cavity, or before something becomes gum disease."
Dr. Apa confirms that your retainer should allow for consistent cleaning, even if it requires a little extra effort. "The most obvious thing to consider with permanent lingual wires is oral hygiene. Some wires, depending on how they’re made, are not easily cleanable," he explains. "You have to treat them almost like a dental bridge, where you're using a floss-threader to run floss underneath the wire and get into the gum area. I always recommend a water pick to patients with bonded wires because it’s easy [to use], and that means they’re more likely to make it part of their daily routine, which is critical for avoiding cavities and decay."
Dr. Nagel says it's also recommended to switch to an electric toothbrush, which has been shown to remove more plaque than manual toothbrushes and rinse with a mouthwash containing flouride to strengthen the enamel and decrease the bacteria in the mouth.
Dr. Huang says that lingual retainers for upper teeth or lower teeth, "usually run about $850 an arch," and that there's typically a fee to remove the retainer. Pricy, absolutely, but it may end up saving you the extra money that intervention would require later.
"Let's say it's a $1,000 retainer, but that can save you from a very complicated orthodontic treatment 20 years down the road," adds Dr. Grauer.
When I returned to Les Belles, I was genuinely terrified of what Dr. Huang might uncover once the glue had been chiseled off. With Oliver dozing off on my lap once again, she got started. For context, it normally takes about ten minutes to remove a bonded retainer. I ended up spending almost 45 minutes in the chair because there was so much glue for Dr. Huang to file and pick away from my teeth and gums. Afterward, I checked out the tiny monster that had been wreaking havoc on my bottom teeth. It was totally unassuming, and I was relieved to see it tossed in the trash.
Top: What remained after chiseling away the retainer glue. Bottom: Once the retainer was fully removed.
Insert middle finger emoji here
For the first time in almost a decade, I could feel the backs of my bottom teeth: slippery, devoid of a massive hunk of glue, and most of all, clean! After that, to get fitted for my new retainer, I was expecting to withstand the same gross process of taking molds the old-fashioned way I'd spent hours of my life dreading as a kid — my mouth stuffed with two trays full of bland goop. Thankfully, that's not how this goes down at Les Belles in 2022: Dr. Huang's assistant took a 360-degree scan of my teeth with a tiny camera at the end of what looked like an electric tooth brush while Oliver snoozed in my lap. I watched the scan hit 100 percent visibility on the screen as it captured every cranny of every tooth, and I was sent on my way.
My fancy, custom bonded retainer.
Two weeks later, my personalized retainer arrived at the office and I returned for its installation. In under 15 minutes, Dr. Huang had replaced my junked-up twisted wire with the Mazzeratti of retainers. Shaped into an S-wave, the proprietary new model allows for effortless flossing and brushing, and most importantly, I couldn't feel any glue whatsoever. As I was aggressively thanking Dr. Huang, I realized that all that now-defunct glue had probably been affecting my speech for over a decade. It was a huge step towards better health — and until now, I had no idea it was a step I even needed to take.
In conclusion, maybe it's time to call your orthodonist.
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