Dental Care

If you’ve been considering orthodontic treatment, you might have heard or read about the possibility of developing back triangles in your teeth after braces or Invisalign®. But what are black triangles? And does orthodontic treatment actually cause them? The team at Richard Chan Orthodontics will be covering everything you need to know.

What are Black Triangles Between Teeth?

Ideally, there is a piece of gum tissue, known as an interdental papilla (papillae plural), that extends from the gumline and sits between two teeth, firmly attaching to both. In the front of the mouth, the papillae are shaped like pyramids, or triangles. They keep the tooth roots safe and prevent food from getting stuck between the teeth and causing decay and cavities. 

When the papillae don’t project from the gum line and fill the space between the teeth, it creates a triangular void between the teeth and the gumline. This is what people sometimes refer to as a black triangle. 

In a study published in the European Journal of Prosthodontics and Restorative Dentistry, participants ranked black triangles between the teeth, technically called open gingival embrasures or gingival triangles, as the third most disliked smile aesthetic issue after cavities and crown margins.

While black triangles do compromise the appearance of your smile, it’s not merely a cosmetic problem. Depending on the size of the space, it can increase your risk of tooth decay and gum disease. It may also interfere with your ability to properly produce certain speech sounds. 

What Causes Black Triangles in Teeth?

According to a literature review in the British Dental Journal, there are a number of causes of black triangles in teeth and they often develop because of a mixture of factors, including:

• The amount of space between teeth
  You need enough width between the teeth to facilitate blood flow to the papillae but not so much space that the tissue is stretched or unable to fill in the area.
• Genetics
  Inherited traits like the natural shape and position of your tooth roots, as well as the distance between the jawbone and the first point of contact between two teeth can make you susceptible to black triangles.
  The shape of your teeth, which is also genetic, plays a role too. People with square or rectangular-shaped teeth tend to have better contact between teeth from top to bottom when the teeth are properly spaced. Triangular-shaped teeth, on the other hand, often meet closer to the chewing surfaces where they’re wider, but as the teeth narrow towards the gumline, a black space can occur.
• Your age
  The risk increases with age and certain systemic diseases like osteoporosis.
• Your gum biotype
  People with thin, scalloped gums are more likely to develop black triangles, because this gum biotype responds to trauma and inflammation by receding. A thick, flat gum biotype often means the gums have greater blood flow and are better able to withstand inflammation, which helps keep the papillae in place.
• The presence of periodontal (gum) disease and gum recession
  As the gums recede, the papillae will also recede and can begin to lose attachment with the teeth, creating black triangles.
• Diverging tooth roots
  This is when the tooth roots are spaced or angled in a way that creates space between the teeth near the gumline.
• Misshapen dental restorations
  Crowns or other restorations that aren’t the correct size and shape can lead to a space between the teeth.
• Poor oral habits
  Nail biting, excessive toothpick use, and aggressive flossing can damage the papillae and/or cause gum recession.

Do Braces and Invisalign Cause Black Triangles?

No, Invisalign and braces do not cause black triangles in between the teeth. There is a misconception that it can be a consequence of orthodontic treatment. But the truth is, when teeth are crowded, crooked, or overlapping, the black triangles aren’t visible. 

As your braces or Invisalign aligners straighten the teeth, black triangles can start to appear. This is simply because there isn’t enough gum tissue to fill in the space where the crowded or rotated teeth used to be. So if you have new black triangles in your teeth after Invisalign or braces it’s likely becuase orthodontic treatment revealed an existing issue. 

When you visit Richard Chan Orthodontics, we assess your teeth, gums, and bite before you start treatment. Dr. Richard Chan then creates a personalized treatment plan based on your unique dental and facial anatomy. He may take certain steps or coordinate with your dentist to minimize or prevent black triangles and create your ideal smile.

How Can I Prevent Black Triangles in My Teeth After Braces or Invisalign?

While you can’t do anything about genetics, your age, or your gum biotype, there are things you can control, including keeping your gums healthy to ward off recession. 

Black triangles, or open gingival embrasures, are frequently an early sign of gum disease. If Dr. Chan believes you have gum disease, you’ll need to have it treated prior to beginning orthodontic treatment.

Once you get braces or Invisalign, it’s important to maintain excellent oral hygiene. To keep gums healthy and reduce your risk of black triangles:

• Brush your teeth with a soft-bristled toothbrush and fluoride toothpaste in the morning and after all meals and snacks for two full minutes each time. If you have braces, pay extra attention to the tight areas around your brackets and the space between your brackets and gumline. Be sure to gently massage your gums while you brush as well to keep them stimulated and prevent swelling.
• Floss at least once per day.
• In addition to flossing with dental floss, you may want to consider using a water flosser too. This will help remove even more plaque and food debris and stimulate your gums. 
• Ask Dr. Chan about including an antibacterial mouthwash into your daily routine. He can recommend a rinse that fights plaque and boosts gum health if needed. 
• Avoid biting your nails or using toothpicks excessively. When you floss, be gentle with your gums. 
• Continue to see your general dentist for routine dental exams and cleanings once every six months during your braces or Invisalign treatment. 

How to Fix Black Triangles in Teeth

If you do notice black triangles, there are solutions. The best treatment for you will depend on the underlying cause and your individual needs. Dr. Chan and/or your dentist can make personalized recommendations for how to fix black triangles in your teeth in a way that will promote good oral health. 

Options could include:

• Orthodontic treatment. In some cases, when gum disease isn’t the culprit, orthodontic treatment can actually fix black triangles. In these instances, once the teeth are properly aligned, the unwanted voids will be eliminated. Plus, straight teeth are easier to keep clean, which reduces your risk of gum disease and recession going forward.
• Interproximal reduction. If the shape of your teeth is behind black triangles, this technique can be used to gently file down enamel. Once your teeth are reshaped, we can use braces or Invisalign to shift them into place. They’ll then be flush against one another and the black triangles will disappear.
• Cosmetic dentistry. A dentist can enhance a tooth, or teeth, with bonding materials to eliminate or reduce black triangles. Dental crowns, veneers, and recontouring procedures could also be possibilities.
• Hyaluronic acid. Similar to cosmetic facial fillers, hyaluronic acid can also be injected into the gum tissue to add volume and encourage the tissue to fill in the space between the teeth.
• Grafting or tissue engineering. For severe gum recession or disease, your dentist might recommend attempting to regrow gum tissue. This can be achieved through procedures such as gum grafting and tissue engineering.
• Other options. There are other options as well that you may want to discuss with your dentist. These can include using pink restorations or gingival veneers to hide the black triangles. 

Say Goodbye to Black Triangles

Want to find out if orthodontic treatment can fix black triangles between your teeth? Or are you looking for an experienced orthodontist who can create a treatment plan that helps you avoid them? Richard Chan Orthodontics has you covered! Schedule a visit with our Juneau, AK and Bothell, Monroe, and Mill Creek, WA orthodontist today.

At Richard Chan Orthodontics, we always teach our patients how to keep their teeth healthy so they can make the most out of their treatment. After all, no one wants to invest in braces or Invisalign® and then do something to harm their smile.

Of course, there are obvious things like not brushing or flossing your teeth that will have a negative impact on your oral health. But, there are also a number of common habits and practices that you might not think twice about that can damage teeth too. In this post, Dr. Richard Chan will be sharing what these habits are and how they can affect your smile.

1. Grinding Teeth

Teeth grinding and clenching, called bruxism, can have a significant effect on your teeth. While a mild, daytime teeth grinding habit might not be a huge concern, chronic bruxism, especially if you grind your teeth at night, will cause complications if not addressed.

Teeth grinding often results in excessive wear of the enamel, chipped or fractured teeth, damaged restorations, headaches, pain, temporomandibular joint (TMJ) dysfunction, earaches, loose teeth and more.

Wearing a night guard will help prevent complications by providing cushioning against the grinding forces. Depending on the cause of bruxism, additional treatment could be needed to help stop the habit and minimize or correct teeth grinding damage.

2. Chewing on Ice, Pencils or Other Objects

What does chewing on ice do to your teeth? First, it can wear away your enamel, which protects your teeth from cavity-causing acids. As enamel erodes, teeth are more susceptible to decay, they become sensitive to hot and cold and, if the underlying dentin is exposed, they can even look yellow. Chewing on ice is also a culprit behind cracked and chipped teeth and worn-down bite edges.

Chewing on pens, pencils, fingernails and other hard objects will probably have the same outcome. Hard plastics like pens or anything with sharp edges can lead to hairline cracks in the enamel and injure the soft tissues of the mouth. Plus, any time you put objects in your mouth, you’re also introducing germs.

3. Eating Lots of Starchy Foods Like Potato Chips and Crackers

There’s always a lot of talk about sugar and teeth. But, the bacteria in the mouth feed on carbohydrates, meaning both sugars and starches. When they do, they release acids that leach minerals from the tooth enamel. Frequent acid attacks cause tooth decay. As tooth decay progresses, a hole forms in the tooth, which is what we call a cavity.

In addition to containing carbohydrates, whether or not a specific food is likely to cause cavities also depends on how long it will be in contact with the teeth and how fast the food is eaten.

Starchy foods like potato chips and pretzels are heavy on the carbs, tend to be snacked on at a leisurely pace and get stuck in the teeth. So, they check all of the cavity-causing boxes. In fact, if you’re in the mood for a treat, when it comes to harming your teeth, you’d be better off having a scoop of ice cream than you would a handful of crackers since ice cream is eaten quickly and rinses off the teeth easily.

4. Not Wearing a Mouthguard When Playing Sports

It’s important to wear a mouthguard during any sport or physical activity that could result in a blow to the mouth. Unfortunately, only a handful of sports require a mouthguard, though a large number of dental injuries occur during basketball and baseball where mouthguards aren’t typically worn.

Common orofacial injuries include cuts to the soft tissues of the mouth, chipped, fractured or knocked out teeth and/or a broken jaw. Wearing a mouthguard is a proven way to reduce these types of injury and keep your smile safe. If you have braces, wearing a mouthguard is especially crucial as an injury can damage your appliance and the brackets and wires can cause even more extensive trauma to your mouth.

5. Drinking Soft Drinks, Energy Drinks or Sports Drinks

While you can drink soda with braces, we always encourage moderation because soda is one of the worst drinks for your teeth. It contains a large amount of sugar, giving fuel to your oral bacteria and causing them to release acids. Soda also contains acids itself, including citric acid. Citric acid is bad for your teeth in large amounts because it causes enamel erosion. The one-two punch of sugar and acidity is a major contributor to tooth decay.

Is diet soda better for your teeth? Nope. While you skip the sugar, it still leads to acid erosion. Some diet drinks have more acidity because of the artificial sweeteners. In fact, a study on enamel dissolution from various beverages found no difference between regular and diet versions of the same brand.

Energy drinks, sports drinks, bottled iced tea and lemonade tend to be up there with soda too, as they’re all acidic and high in sugar. The same study on enamel dissolution found that canned iced tea actually caused more enamel erosion than most soda, with the exception of Mountain Dew and Sprite.

The effects of acid on enamel are cumulative, so the prolonged exposure inherent in sipping a carbonated drink makes you more likely to experience teeth damage. Your best bet is to drink plain water. If you do have a soft drink, enjoy a small glass as part of a larger meal and rinse your teeth with water when you finish.

6. Brushing Your Teeth Right After Having Something Acidic

Speaking of acidity, as part of a balanced diet things like tea and citrus fruits are fine and, in the case of fruit, even beneficial. But if you do have something acidic, when you brush your teeth matters. So, should you brush your teeth before or after coffee or your morning orange juice? The answer is, before!

That might sound counterintuitive, but the acidity weakens your enamel for about 30 minutes to an hour after eating or drinking. If you brush your teeth before the pH in your mouth returns to normal, you can inadvertently cause further damage to your enamel while it’s in its temporarily weakened state.

Instead, brush your teeth before breakfast and then rinse your mouth out with water afterwards. If you’re prone to coffee breath, you can chew a piece of sugarless gum to get rid of the odor and encourage saliva production. Or, if you’re not in a rush, wait an hour after having coffee, juice or acidic foods to brush.

7. Using Your Teeth as a Tool

It can be tempting to use your teeth to tear open a plastic package or rip a stubborn tag off, but the habit increases your risk of teeth damage. Using your teeth as a tool can weaken them and cause chips or cracks, leading to pain, infection and aesthetic concerns. Preserve your pearly whites by using scissors instead.

8. Constant Snacking or Sipping

How often you eat and drink is nearly as important as what you eat and drink. Again, every time you eat, plaque bacteria feed on the sugars and starches and release cavity-causing acids. It takes 30 minutes to an hour for your saliva to neutralize the acidity in your mouth. Every sip and bite starts the clock over again, exposing your teeth to more acids.

Snacking also produces less saliva than eating a full meal does. This means food bits aren’t as effectively rinsed away and they sit on the teeth for a longer period of time.

To prevent tooth decay and damage to your teeth, minimize snacking and sipping on anything aside from water. When you do snack, eat something that’s smile friendly and low in carbohydrates like nuts, cheese or carrot sticks. Have sugary or starchy foods and drinks with a meal, so your saliva production is in full gear in order to promote remineralization and whisk away debris.

9. Frequently Indulging in Chewy and Sticky Treats

Just as with the starchy things like chips or crackers, chewy and sticky foods stick in the teeth, making you more susceptible to cavities. Raisins and other dried fruits and gummy bears, Sour Patch Kids, Starburst and other candies are especially harmful because they also contain sugar.

10. Sucking on Hard Candies or Cough Drops With Sugar

As long as you don’t chew them, hard candies, lollipops and cough drops should be better for your teeth since they dissolve and won’t get stuck in the nooks and crannies, right? Unfortunately, no.

These types of foods are high in sugar and still expose your teeth to carbohydrates and acid attacks. Since you’re sucking on them and they dissolve slowly, exposure is prolonged. Steer clear of hard candy and lollipops or opt for sugarless varieties (bonus points if they contain xylitol, which helps fight cavities). If you’re sick and need cough drops, look for sugarless ones or at least rinse your mouth out with water after having one.

Are You Ready to Experience Amazing Oral Health?

Aside from avoiding these teeth damaging habits, you can also improve your oral health with orthodontic treatment. Straight teeth are easier to clean and an aligned bite keeps your jaw healthy and strong. To find out your options for braces or Invisalign in Bothell, Monroe or Mill Creek, WA or Juneau, AK, schedule a complimentary consultation at Richard Chan Orthodontics today!