Retainers after orthodontic treatment: why they matter

The day braces come off or the last aligner is finished can feel like the end of orthodontic treatment. In practice, it marks the start of the stage that protects the result: retention. A retainer is a device that holds the teeth in their new positions and stops them drifting back towards where they started. Orthodontic organisations in the UK and the US are clear that retainers are an essential part of treatment, not an optional extra. This article explains why retainers are needed, the main types, how long they are usually worn, how to look after them and what to do if something goes wrong.

Why straightened teeth tend to move

Teeth are not fixed rigidly in the jaw. They sit in bone that is constantly renewing itself, with new bone forming and old bone being reabsorbed throughout life. The American Association of Orthodontists (AAO) describes this lifelong process, called bone remodelling, as the reason teeth can move: the everyday forces of biting and chewing gradually push them in the direction of that pressure.

After orthodontic treatment, the supporting tissues need time to adapt. The British Orthodontic Society (BOS) notes that it can take at least a year for the jawbone and gums to settle around the new tooth positions. During this time, and beyond, teeth have a tendency to return to where they came from. BOS points out that this is particularly likely when treatment has been very quick.

There is also a longer-term reason. BOS explains that tooth positions continue to change throughout life as part of normal ageing, whether or not someone has had braces. A retainer helps to limit these changes and keep the result you have worked for.

Removable and fixed retainers

BOS advises that all patients need to wear retainers after treatment, and that your orthodontist will recommend the type you need. There are two broad groups.

Removable retainers

These are taken out for eating and cleaning. Common designs include:

• Clear retainers: thin, removable plastic trays that fit over the teeth.
• Wire retainers: a plate that sits on the roof of the mouth or under the tongue, with a wire across the teeth for support.

Removable retainers work well, but BOS notes that they depend on you remembering to wear them as instructed.

Fixed (bonded) retainers

A fixed retainer is a slender wire glued to the back of the teeth, on their inner side, so it does not rely on you remembering to put it in. It does need extra care when cleaning, and BOS advises that fixed retainers should be inspected regularly. If the glue comes away from a tooth, that tooth may start to drift, so BOS stresses contacting your orthodontist at once if a fixed retainer breaks.

How long retainers are worn

In the UK, the NHS says the orthodontist will tell you how long you need to wear your retainer. Schedules vary, but the guidance from orthodontic organisations points in the same direction.

BOS explains that the only way to make sure teeth cannot move is to wear retainers on a part-time basis for life. As a general rule, it describes wearing retainers every night for the first 12 months and then gradually reducing wear to at least once a week in the long term. BOS also notes that removable retainers may be worn full-time at first and reduced to night-time wear later. In the US, the AAO similarly says that a retainer is typically needed for a lifetime, although how often it is worn may decrease over time.

The exact schedule is individual. It depends on the original problem, the type of treatment and how stable your teeth are, so the instructions from your own orthodontist take priority over any general pattern.

It helps to see long-term retainer wear as a routine, much like brushing your teeth. BOS describes retainer wear as your personal responsibility, and points out that if retainers are not worn, there is a high chance the teeth will move and that this can be difficult to correct.

Getting used to a new retainer

A removable retainer can feel strange for the first few days. BOS describes two common, temporary effects:

• Speech: words may sound slightly different at first. Practising by reading aloud at home helps, and speech usually returns to normal within a few days.
• Saliva: you may produce more saliva and swallow more often to begin with. This normally settles after a few days.

If you have been asked to wear a removable retainer full-time, BOS advises taking it out only for eating, cleaning, contact sports and swimming. Avoid clicking it in and out with your tongue, as this can loosen or break it.

Daily care: cleaning, eating and sport

Good habits protect both the retainer and the teeth underneath it.

Cleaning

• Take a removable retainer out before brushing. Brush your teeth for at least two minutes, twice a day, with a fluoride toothpaste.
• Clean the retainer gently with a toothbrush and cold water, over a sink so it does not break if dropped. BOS advises against using toothpaste on retainers, as it can roughen them and change their colour.
• The AAO recommends cleaning your retainer daily, because bacteria can build up on it, and avoiding hot water and products that contain alcohol or bleach.
• With a fixed retainer, take extra care cleaning around the wire, following your orthodontist's advice.

Eating and drinking

BOS suggests avoiding sugary snacks and drinks between meals and at bedtime, sticky or hard sweets, and fizzy drinks. Hard or chewy foods such as apples, carrots and crusty bread can damage a retainer, so cut them up first. Poor cleaning combined with frequent sugar can lead to lasting damage to the teeth.

Storage and sport

When a removable retainer is not in your mouth, keep it in its protective box so it is not damaged or mislaid. For contact sports and activities that need a helmet, BOS advises wearing a mouthguard instead of a removable retainer, and taking the retainer out for swimming.

When a retainer breaks, is lost or stops fitting

Teeth may move during any period when you cannot wear your retainer, so problems should not be left until a scheduled check. If a retainer breaks or goes missing, BOS recommends ringing for an appointment straight away. Contact your orthodontist promptly if:

• a fixed retainer feels loose or a section has come away from a tooth;
• a removable retainer is cracked, lost or damaged;
• a retainer feels tight or no longer fits as it did, which the AAO notes may mean the teeth have shifted slightly.

The AAO advises not to keep wearing a retainer that is sharp, painful or badly distorted, and to see your orthodontist for a replacement. Bring your retainers to every review so they can be checked.

Follow-up during retention

Once retainers are in place, appointments are usually less frequent than during active treatment. Your orthodontist will review how the teeth are holding and whether the retainers still fit. In the UK, BOS notes that under the NHS the orthodontist is responsible for a retention period of 12 months, after which continuing care is arranged privately. Arrangements differ elsewhere, so ask how long-term retainer checks and replacements will work in your situation.

Regular visits to your dentist remain important throughout. BOS stresses that your dentist needs to keep checking your teeth for decay while you wear retainers.

Next steps

If you have recently finished orthodontic treatment, or your teeth have started to move after an earlier course of braces, an orthodontist can check your retainers and explain the retention plan that suits you. Read more about our orthodontics service, or try Find my physician if you would like help choosing a specialist.