Wednesday, July 31, 2013

Invisalign vs Wires and Brackets

I frequently get some variation of the question "Doc, is it better to do braces or invisible braces?"

I'll briefly discuss the advantages and disadvantages with each of these options. For this blog, braces are wires/brackets and invisible braces are Invisalign aligners.

Wires and brackets


In some difficult cases, certain tooth movements are only possible with wires and brackets. Invisalign cannot work in every case.

Although the teeth are straight, the inability to maintain
 adequate hygiene has resulted in discolored and decayed teeth.
  • Unpredictable final outcome.
  • Oral hygiene is compromised.
  • Treatment time on average is 2-3 years.
  • When brackets are removed, there is often some decay or discoloration of the teeth. Also, during bracket removal, tooth structure is often inadvertently chipped off the tooth surface.
  • Food restrictions. Some foods are off limits.
  • Wires and brackets often poke the soft tissue and sore irritated areas often develop.
  • More discomfort when teeth move.



  • Final outcome is more predictable.
  • Better oral hygiene.
  • Treatment time is much faster. On average, treatment is typically about a year.
  • Invisalign aligners are nearly invisible
     and are very tolerable to wear.
  • No food restrictions.
  • Less discomfort as teeth move because of the predictable and precise movements.
  • More aesthetic.


If not compliant with wearing the aligners, then the teeth will not move to the desired position. In other words, if you don't wear them, the teeth will not move.


In conclusion, I prefer Invisalign (when feasible to treat with this modality) over wires/brackets. However, I have friends and family that prefer to have wires. I don't understand why. I think for school age kids, it may be a status symbol to have brackets. I don't get it.

Feel free to visit the Invisalign website ( for more information.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Thursday, July 18, 2013

Is there a difference between a DMD and a DDS?

Over the years, I've been questioned many times on what the difference is between a DMD degree and a DDS degree. There is much confusion over this.

Some believe that a DMD degree is the better degree because it is a variation of the MD degree. Some believe that the DDS degree is better because, the " S" in DDS indicates that they may be more competent in surgery.

The only real diference in these two degrees is simply one different letter in a different order. That is the only difference. The training and credentialing process is exactly the same. Most have undergraduate degrees in the hard sciences such as biology, chemistry and physics. Once accepted into dental school, the first two years are mostly shared with medical students in a lecture setting. The third year of school is when the clinical training really ramps up. Dental students diverge from their medical counterparts at this stage. To graduate and get licensure, we all take the same National, Regional and State Boards (clinical and written), have the same requirements to maintain our continuing education, and are regulated by the same agencies.

Here is a little historical perspective:

  • Baltimore College of Dental Surgery was founded in 1840 and was the first dental college. It is now known as the University of Maryland. They awarded a DDS (Doctor of Dental Surgery) degree.
  • It wasn't until 1867 when Harvard opened up a dental school when a DMD (Doctor of Dental Medicine) degree was awarded. At the time, they felt that the DMD degree as a more accurate description of the profession.
  • We now have over 60 US dental schools. Approximately 2/3 of the schools offer the DDS degree; 1/3 offer the DMD degree.

The ADA (American Dental Association), is well aware of this mass confusion. Many discussions have been held. Some have proposed that we eliminate the DDS degree. Some have proposed that we eliminate the DMD degree. Some have proposed that we come up with an entirely new degree. There has not been any consensus or resolution up to this point.

So, in conclusion, the only difference is one letter. Everything else is exactly the same.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Wednesday, July 10, 2013

Top Ten Ways To Keep Your Teeth

Most people want to keep their teeth for life. Teeth are not only important for chewing our food to initiate the digestive process. Teeth are also important for overall health and well being. Having teeth can also benefit your pocketbook and your love life. The power of a smile is immense.

Here are ten things (in no particular order) to consider if you want to keep your teeth for life:

10. Brush

This is obviously an important factor. If possible, use an electric toothbrush. It will clean plaque off of teeth more efficiently while at the same time being gentler on the gums and teeth.

9. Floss

If you don't floss, you're only cleaning part of your teeth. Floss the ones you want to keep.

8. Frequent hygiene

Brushing and flossing is only part of the battle. It is vitally important that good oral hygiene is performed frequently. Preferably after each meal, after awakening and prior to bed.

7. Keep sugary snacks down to a minimum

I'm not suggesting that you not eat any sugary snacks, but keeping it to a minimum will improve your chances of keeping your teeth.

6. Visit your dentist regularly

Visit your dentist regularly so that you can catch problems earlier. The sooner you address any problems, the better off you'll be from an oral health perspective; and from a financial perspective.

5. Wear an athletic mouthguard when participating in contact sports

Many teeth are lost unnecessarily every year in athletic events. Even sports that are not considered contact sports such as basketball cause a tooth to be knocked out. Wear the athletic mouthguard if you value your teeth.

4. Maintain good overall health

There are many oral manifestations that are evident in many diseases. Poor overall health will oftentimes lead to poor oral health. For example, diabetics tend to have a higher incidence of periodontitis.

3. Avoid bad oral habits

Habits such as chewing ice or biting on fingernails will increase the chances of early tooth loss.

2. Do not smoke

Smokers tend to have a significantly higher incidence  and severity of oral diseases.

1. You must really care about keeping them

This is probably the most important factor. If your teeth are not a priority and are not that important to you, then you will likely not even worry about the previous nine ways to keep your teeth.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit

Monday, July 1, 2013

Reconsideration of Tooth Removal in Orthodontic Cases

We (dentists) have all learned that the primary problem in orthodontics is either too much or too little spacing between teeth. When there is inadequate space, teeth come in crowded and crooked. When there is too much space, the teeth will have gaps between them.

Small arch size resulting in crowding
Large arch size resulting in spacing

All dentist to some extent have been trained in  orthodontics. Many general dentist perform orthodontic procedures in their offices. Some refer to orthodontists if they don't enjoy this part of their practice.

When we encounter crowded teeth, we need to create space. There are several ways to create the necessary space. One way is to pull some teeth. Many adult teeth have been pulled with the intent of straightening teeth. While this may solve the patient's primary concern and give them a straight and beautiful smile, we have inadvertently create another problem. That problem is obstructive sleep apneaSleep apnea is very serious and will take 12-15 years off of a typical life-span.

I have spoken to some of my orthodontist friends and discussed this issue. Years ago when I was in dental school (1993-1997), we were taught that this was a good way to create space. This is still being taught. However, as the medical/dental community has learned more about sleep apnea, we have discovered that a narrowed arch will push the tongue upward and/or posteriorly. In either case, the airway is compromised. This will only exacerbate the problem of sleep apnea.

I have been a member of the American Academy of Sleep Medicine for nearly two years. In the last year and a half, I have been trying to educate my general dentist and orthodontic colleagues on this issue. Advancements in medicine and dentistry occur very rapidly these days. As we make new discoveries, we must modify our old ways of thinking. We must consider alternative ways to straighten teeth without narrowing the arch size. Fortunately there are ways to accomplish this. The details are beyond the scope of this blog.

So the message here is this: if you or someone you know will be undergoing orthodontic treatment, carefully evaluate all of your options before having teeth extracted. Your dentist/orthodontist may not yet be fully aware of this issue. They certainly will be soon. But if they aren't aware of this yet, ask questions. Specifically, ask if the arch size will become more narrow and if there is a potential for obstruction of the airway thereby exacerbating obstructive sleep apnea.

Dr. Cisneros maintains a practice in Freeburg and Columbia, IL. Both are in the Greater St Louis, MO area. For more information on a wide variety of subjects, please visit