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.
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.