Dental gutters: in which cases should they be used?


There are many devices made of plastic or resin, suitable for different uses. Le Figaro takes stock.

Hard or soft, plastic or resin, dental trays are medical devices intended to treat oral diseases, improve your hygiene and comfort you in the idea that it is never impossible to (re) find a smile. What are the different types of gutters? By whom are they prescribed? When and how to clean them? Answers with Pr Elvire Le Norcy, orthodontist in the department of oral medicine at the Bretonneau Hospital in Paris.

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What is a dental tray used for?

A dental tray is a removable device made of medical plastic or resin from the dental impression. “ Each gutter is made to measure in order to perfectly match the shape of the teeth and therefore to optimize its use. “, explains Professor Le Norcy. While some are worn all the time, others are only used at night. For good reason, the use of gutters meets various medical needs such as dental whitening, enamel protection (dental fluoridation), correction of the positioning of the teeth, treatment of sleep apnea or joint pain in the jaw level.

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Which professional can prescribe a gutter?

Since gutters are a medical device, they must be prescribed by a specialist: dental surgeon and orthodontist exclusively. Over time, these professionals will be able to modify and adjust the shape of the gutter so that the treatment is the most suitable. Beware, however, of buying gutters without prior medical advice: “ Gutters sold on the internet can create problems where there are none or make them worse “, warns Professor Le Norcy.

“For any type of splint, you cannot do without the expertise of the dental surgeon or the orthodontist. It is a device that requires a specific indication and regular monitoring”

Elvire Le Norcy, orthodontist in the department of oral medicine at the Bretonneau Hospital in Paris.

What are the different types of gutters?

The bite guard : it aims to relieve patients suffering from joint disorders in the jaw, or temporomandibular joint (TMJ). These problems can be caused by a dislocation or stress, says Elvire Le Norcy. In particular, occlusal splints are prescribed for patients who have poor contact between the two jaws or suffer from bruxism, that is to say an involuntary grinding of the teeth during the night which causes pain, headaches and sleep disturbances. “ The occlusal splints have the particularity of being rigid and thick », specifies the orthodontist. They can be worn day or night depending on the patient.

The orthodontic gutter : this type of gutter has the same role as certain dental devices such as “ rings “. It corrects a misalignment of the teeth when they overlap or are too far apart. A distinction is generally made between orthodontic aligners, prescribed to put teeth back in place, and retention aligners, which are used at the end of orthodontic treatment to consolidate the result. “ For these devices, there is no space between the tray and the teeth, so there is no unwanted tooth movement », Explains the orthodontist. The advantage of these gutters is that they are easier to maintain than rings and remain rather discreet. “ In addition to the aesthetic aspect, they are offered to patients who cannot wear a conventional device because of problems with the mucous membranes making them more sensitive to the risk of irritation, as well as to people suffering from immune diseases or having too much enamel. fragile, two problems incompatible with bonding bands directly to the teeth », Elvire Le Norcy.

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The bleaching tray : it is used to lighten the teeth by eliminating persistent yellowish stains. For this, it is used with a gel based on hydrogen peroxide, a whitening agent, which the patient applies directly to the gutter.

The fluoridation gutter : it prevents the formation of cavities thanks to the presence of a solution containing fluorine. “ The hyperfluorinated solution exists in the form of gel or foam and allows remineralization of the enamel “says the orthodontist. This type of tray is particularly indicated for patients who do not produce enough saliva, a natural agent that protects the enamel, which can promote the development of cavities. “ We also recommend fluoridated solutions to people with acid regurgitation or vomiting, because in these cases, the oral acidity increases and can accelerate the demineralization of the teeth. “, adds the doctor.

Please note: the fluoridation or whitening trays are identical and are both to be used only at night, although they have different indications. “ Their specificity is that, unlike orthodontic gutters, we will leave a small space between the gutters and the teeth so that patients can put either the whitening product or fluoride “, specifies Pr Le Norcy.

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When and how to clean a gutter?

Maintenance should be daily to prevent the development of dental infections or cavities. If the gutter is worn at night, it is recommended to clean it as soon as you wake up with cold water, a toothbrush and toothpaste while taking care to rinse and dry the device well in order to avoid water stagnation. “ Above all, do not use hot water for cleaning as this will tend to deform the gutter since heat is used to thermoform the plastic during manufacture. “Warns the orthodontist. Also beware of products sold without a prescription which may degrade the plastic.

Regarding trays to be worn during the day, it is imperative to remove them during meals or to consume sweet drinks (coffee or sweet tea, sodas, etc.), at the risk of damaging the enamel. “ Before drinking a sweet liquid, it is best to remove the tray and then brush your teeth, or at least rinse your mouth thoroughly before putting it back on. “, advises Elvire Le Norcy.

Failure to perform these actions diligently runs the risk of encouraging the deposition of tartar and the proliferation of bacteria, factors likely to aggravate or create other oral problems as well as carious lesions.

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When should a dental splint be changed?

For orthodontic gutters, they are generally changed every two weeks because they are regularly readjusted according to the evolution of the positioning of the teeth. “, explains Professor Le Norcy. When the dental surgeon considers that the gutter has fulfilled its mission, it is necessary to stop wearing it. However, regular monitoring after wearing the tray is necessary for better stabilization of the result, the recurrence of the problem is never completely avoidable.

What price and what support?

For the orthodontic aligners count between 1000 and 5000 euro. They are partially covered (70% to 100%) by health insurance in patients under 16 years of age. Beyond this age, there is no coverage by social security but some mutuals can participate in the reimbursement.

The bite guards and of fluoridation cost €172.8 at approved sector 1 dentists. In this case, they are fully covered by health insurance.

For the whitening traysthe price varies from 400 to 1000 euros. Considered as an aesthetic treatment, they are not covered by health insurance.

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