Tina Clarke, RDH, MEd
Tina has been a clinical dental hygienist for 20 years and an educator for nearly 15. During this time, she developed a passion for anatomy and local anesthesia. She has taught anesthesia to over 200 dental hygiene students and countless licensed hygienists. For over ten years Tina has provided CE courses for live and virtual audiences. She has been featured in national publications and podcasts and is the founder of Teacher Tina RDH, an educational resource for oral health professionals. Her passion for dental hygiene extends to her volunteerism with the ADHA serving in various roles. She brings energy you will find upbeat, fun, and infectious.
A few months ago, I finished my clear aligner journey. This experience helped me better understand what my patients may encounter, how to advise them on their journey, and which questions to ask them. It also helped me discover fantastic ways to improve comfort and oral care during treatment!
I've been a dental hygienist for over twenty years, and this journey reminded me of how much dental work has changed. There is always more to learn, and I am learning firsthand. Of course, any good teacher shares what they've learned with others. What may be common knowledge to some was a new adventure for me. Once I started my journey using a clear aligner system, I noticed how many of my patients were also using them. It was like when you buy a car and suddenly see it on the road everywhere! Invisalign, ClearCorrect, and other brands have made aligner treatment easier and more affordable than ever before.
Whether your practice offers in-house ortho or refers out, there's a strong chance you have patients in a clear aligner journey. Here are a few questions you should ask them:
- Are you currently experiencing tooth discomfort?
- Does it feel like your aligners fit well?
- How long are you wearing them, and when do you take them out?
- What is your current interval for new trays?
- How often do you brush your aligners or use an aligner cleaner?
- What struggles are you having with your aligners?
Aligner Comfort and Fit
As with any orthodontic treatment, the discomfort and pressure from tooth movement is real, and my treatment was no exception. I had total empathy for teething babies, who constantly drool and chew on everything because it makes their mouths feel better. That is exactly what I was doing too! When I started using my aligners, I drooled like crazy and wanted to chew on something.
Chewies to the Rescue
I was so thankful to discover Chewies Aligner Seaters, which are small, flavored, squishy tubes that fit easily in your mouth. The satisfying relief of being able to bite down while wearing my trays was heavenly. Chewies helped reduce my discomfort and the discomfort of everyone else I knew going through the aligner process too.
Chewies for Proper Seating
This relief was a bonus because the primary purpose of Chewies is to ensure that the aligner is correctly seated on your teeth, which has a direct impact on orthodontic progress. By biting on them, you remove air gaps between the teeth and the tray, ensuring a proper fit. Since the aligners were snug on my teeth and seated correctly, my tooth movement and alignment progressed more quickly. When I did not have a chewie on hand, I would fold a towel and bite down on it a couple of times to get a snug fit. Trust me, I got odd looks. When using a Chewie, it looked like I was chewing on a large piece of gum, and no one noticed.
Because of my success with Chewies, I began suggesting them to my patients. I explained how this product could help their teeth feel better and keep them on track with their aligner progress.
Checking Aligner Fit
Checking to see if your patient's tray fits well is quick and easy. Have your patient put on their tray and look for gaps between the teeth and the aligner. It should sit evenly across the teeth. If the aligner sits higher or lower than the tips of the teeth, there's a gap, and your patient should use a Chewie to secure it into the correct place. If you push on the tray and it moves easily, the aligner isn't fitting well. Your patient may be due for their next tray, or in some cases, they may need re-evaluation to see if they are on track. Sometimes, a stubborn tooth or patient non-compliance requires an extra step to be added to their journey.
Recommended Wear and the Struggles of Aligner Removal
When I first got my aligners, I was told it might be a bonus weight loss program since eating and drinking (with the exception of water) while wearing the trays is not advised. No more mindless snacking or sipping on coffee all day long. Taking them out was always with purpose. After all, the more you wear the aligners, the quicker your teeth respond to the positioning movement and settle in. I wanted to be done with the process as quickly as possible, so wearing them all the time was a must.
Recommended Wear Time
Reviewing the importance of wearing the aligners regularly and following the detailed plan set for your patient is key to their success. Most aligner programs require they be worn 20-22 hours per day to stay on track. Some patients I've spoken with hated putting in / taking out their aligners because it was too hard. Often, they would try to eat a little while wearing their aligners or would take them out for long periods of time. Both of which are big no-nos.
Removing Aligners Easily
I found this to be especially relatable when I first obtained my aligners and during certain phases of my treatment. Trying to figure out how to move my fingers just right to get the aligner out was a challenge, but I worked at it until I figured it out. My sister, who was also using aligners around the same time, had a fantastic tool called an aligner remover to help release them from her teeth. In hindsight, she was the wiser one; she didn't struggle with drool running down her chin, saliva bathing her hands, or split any fingernails trying to get the aligners out.
If your patient struggles with removing their aligners and does not have an aligner remover, encourage them to start in the back by their molars. They should use their fingertip on the inside back molar to slowly pull the aligner off the teeth and then move to the other side of the mouth before trying to take off the front. Caution them not to rely on their nails to avoid scratching their gums. Remind your patient that eating and drinking while wearing aligners can damage their trays and impact treatment time. It can also stain their aligners, making them cloudy and highly visible on the teeth.
Along with encouraging daily wear, double-check how often your patient is supposed to change their aligners for a new tray. Even if your office provides this service in-house, it's a good idea to make sure your patient understands at what point they are supposed to move to the next aligner. As a kindness to your patients, write the usage dates on the packaging. My office did this for me and it was extremely helpful!
Tips for Aligner Cleaning
I chose removable aligners instead of traditional-bracket ortho because I could easily take them out to eat, to clean the trays, and to clean my teeth. I encourage you to remind your patients of that fact, too. Just like any other oral appliance, aligner trays need to be cleaned regularly.
Most patients, myself included, receive a compact case to store their aligners along with a mini travel toothbrush. This allowed me to give them a quick brush before and after taking them out. Brushing the aligners helps remove debris, especially if you have a weak moment, and pop that little chocolate candy into your beautifully retained mouth. However, even though I brushed my aligners a couple of times each day, they still got a little cloudy and smelly. Even the best toothbrush can't remove all the bacteria build-ups inside the trays.
Every few days, I would use a special aligner cleaner like Retainer Brite Tablets. After soaking my trays for 15 minutes, they would look brand new, were odor free, and tasted minty fresh! The solution kills 99% of odor-causing bacteria and helps remove plaque and tartar from the trays. If you've been in the dental field longer than 2 hours, you have seen some of the grossness that can be inside a person's mouth. Taking a moment to review cleaning these little tooth movers will benefit your patients and yourself!
Other Aligner Issues
You never know what else is going on and if your patient finds their aligner experience normal or not unless you ask. Trays can have rough edges which rub on gums, lips or the tongue, leaving them raw and uncomfortable. For some patients, headaches occur during early use and when switching trays. And there can be other unique situations. For example, I have a retained primary tooth with more sensitivity than my other teeth. Because I am a dental hygienist, I wasn't afraid to speak up; however, part of me was hesitant to do so. Thankfully, I did say something, and my clinic was able to make the appropriate adjustments for that specific tooth. The experience made me wonder how many of our patients don't say anything because they think their discomfort is "normal" or don't want to sound like one of "those" patients - even when there might be a great solution available!
Remember, one of our roles is to advocate for our patients as their oral health coach. Asking them to share issues they're experiencing opens the door to further communication and builds rapport for lasting impact.
A Satisfying Journey
I am so happy with my results and the insights this process has given me—especially my new ability to talk to my patients about their clear aligner journeys. Next time you're working with patients in clear aligners, take a moment to talk about their experience and ask questions. Having key support tools on-hand such as aligner seaters, an aligner remover tool, travel brushes and aligner cleaner is an added benefit to their home care goodie bag.