Orthodontics: It's not just cosmetics

June 11, 2013
Lower incisor crowding is one of the most common dental findings in Dr. Zackary Faber’s orthodontic practice during his daily exams. He goes through examples of patients who present with “shifting” lower front teeth and explains that by correcting these issues, the patient and the dental team have the ability to restore these teeth to healthy function.

Lower incisor crowding is probably the most common dental finding on our daily exams. I am an orthodontist, and my patients seek out my services due to their “shifting” lower front teeth, but isn’t there more to this story?

All of us see crowded lower incisors every day. With all of the methods to correct this, from braces to Invisalign, the conversation should start with hygiene. It only makes sense that nicely aligned incisors are easier to clean from both a personal and professional point of view. From a professional standpoint, there are functional and practical reasons to correct these tooth positions.

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There are numerous studies that correlate an increase in Little’s Irregularity Index (incisor crowding) and an increase in the gingival index and plaque index. (1) Crowded teeth, as expected, are much harder to maintain than aligned incisors. (2) Increased plaque index and gingival index are seen on the lingual of mandibular incisors that are misaligned. All patients have an increase of calculus buildup on the lingual of their incisors. However, when the lower incisors are crowded and crooked, they are not easily flossed or brushed. (3) This also can allow for food impaction, occlusal prematurities, and difficult access.

If the long axis of the tooth is not in line with the forces of mastication, then the tooth has a tendency to create future periodontal issues. Occlusal traumatism has always been a chicken vs. egg idea, but teeth that are susceptible to a loss of attachment due to their abnormal position have an increased risk of periodontal destruction. (4) This periodontal destruction aided by the inability for the patient and practitioner to access the area for routine cleaning only adds to this “snowball.” This is not a quick process. Patients do not have periodontal destruction overnight. However, in an era of prevention and “holistic” medicine, patients deserve the ability to cleanse these areas in order to maintain their natural dentition over their lifetime.

By correcting these issues, a patient (and our team) has the ability to restore these teeth to healthy function.

Zackary T. Faber, DDS, MS, followed his father, Dr. Richard Faber, and grandfather, Dr. Albert Reitman, to the Baltimore College of Dental Surgery at the University of Maryland. He completed his orthodontic training at the University of Connecticut. Dr. Faber is an active member and founder of several study clubs across Long Island that collaborate across dental specialties. As an assistant clinical professor, he teaches orthodontic residents at SUNY Stony Brook School of Dental Medicine and volunteers at the Dentofacial Deformities Clinic and the Pediatric Residency Program at Cohen's Children's Hospital. Dr. Faber maintains a private practice in Melville, N.Y. You may contact him at [email protected] or at www.faberortho.com.


1. Nagwa Helmy El-Mangoury, Soheir M. Gaafar, and Yehya A. Mostafa. Mandibular Anterior Crowding and Periodontal Disease. The Angle Orthodontist Jan. 1987;57(1):33-38.

2. Boyd RL, Baumrind S. Periodontal considerations of banded vs. bonded molars in adolescents and adults. Angle Orthodontist 1992;62:117-126.

3. Boyd RL. Mucogingival considerations and their relationships to orthodontics. Journal of Periodontology 1978;49:67-76.

4. Hallmon WW. Occlusal trauma: effect and impact on the periodontium. Ann Periodontol. 1999;4(1):102-108.