The General Dentist’s Role in Managing Retention

I met a friend for lunch recently and she told me she was talking about me the previous weekend. I don’t know about you, but it always gets my attention to learn that I’m being talked about!

She clarified, “Well, not you specifically; I was with friends celebrating my sister’s 50th birthday. There were four of us drinking wine in the hotel room and we discovered we all had our retainers in our toiletry kits. None of us knew for sure if we still needed them. Not one of us had braces less than 25 years ago. Why are we still wearing them? Do we need to?”

I gave her what I have found to be one of my most useful answers: “It depends.”

I am particularly interested in those circumstances in which orthodontics and general dentistry overlap. One of those areas is orthodontic retention. While it may seem trivial, orthodontic relapse is a source of resentment and frustration for many patients. How many patients in your practice have the same questions my friend had? In keeping with our goal of comprehensive patient care, should we be willing and able to help our patients with this?

General dentists are often asked to clean, adjust, repair, or replace retainers. These requests are potentially fraught with hazard, both real and imagined, so many general dentists simply avoid involvement with retainers and retention altogether. In fact, based on my experience and discussion with colleagues, there is little or no expectation for general dentists to have any role in retention.

This can leave patients without a means of dealing with their needs and concerns around maintaining their orthodontic treatment result. This is particularly true for patients who have moved away from the community in which they lived when they were treated by the orthodontist.

In my opinion, retention is within the scope of care that a patient can reasonably expect to be provided by a general dentist. As long as all parties understand and accept the benefits and limitations involved, retention monitored by the general dentist may be the best — and sometimes only — way for patients to manage retention long-term.

If we accept the premise that having general dentists involved in the management of retention may be of benefit to our patients, why is it not already common? Consider how general dentists provide posttreatment follow-up with other specialties. For example, it’s typical for a general dentist to take over or share soft-tissue management at some point after periodontal surgery. Endodontists, in collaboration with general dentists, make recommendations regarding postendo restorations, which the general dentists then provide.

Given that retention is so crucial to maintaining a beautiful orthodontic result, it would seem that patients, general dentists, and orthodontists would all have an interest in how long-term retention can be managed and who will do it. As with other specialties, this starts with collaboration and creating expectations.