All forms of medical and dental treatment, including orthodontics, have potential risks and limitations. Fortunately in orthodontics, these are infrequent and when they do occur, they are usually of minor consequence. Nevertheless, all potential risks and limitations should be considered when making a decision to undergo orthodontic treatment. You should be aware if there are alternative options. Remember, not having braces is always an option! Ask your orthodontist to explain anything you do not understand.
This section covers most of the risks associated with orthodontic treatment. Other more specific risks which are relevant to you and your treatment will be raised at your consultation.
Decalcifications of Teeth (Scarring)
Decalcifications are very white, yellow or brown marks that develop on a tooth around the part of the brace attached to the tooth. If decalcifications progress, you will get tooth decay.
If cleaning of your teeth and brace is good and you follow a healthy diet, decalcifications should not develop. If the teeth and brace are not cleaned adequately, plaque (bacteria which builds up on everyone's teeth all the time) starts to attack the teeth. Plaque is what we all remove when we brush twice a day. Plaque thrives on sugar so a sugary diet will accelerate decalcifications. Brush as you are instructed, use a fluoride mouthwash and avoid lots of sweets, chocolates, cakes and biscuits to prevent decalcifications. Fizzy drinks, including diet drinks should not be consumed when you have braces.
Most decalcifications are irreversible. Therefore, if we see signs of decalcification, this is one of the few times we abandon treatment whether it is finished or not. It is much better to have crooked teeth that are healthy rather than straight teeth that are unhealthy.
Gum Health
The health of the bones and gums which support the teeth may be affected by orthodontic tooth movement. Cleaning is made more difficult when you have braces so some patients may feel their gums are swollen and bleed easily. Good cleaning will keep this at bay. Sometimes, the swollen gums will not resolve until the treatment is finished and the braces removed.
A very small amount of bone loss and gingival recession may be experienced with braces. Usually, this is not of any significance.
If a condition already exists, such as gum disease or gum recession, this may be made worse with orthodontic treatment. Therefore, patients with active gum disease will not be offered orthodontic treatment until their gum condition has stabilised. If you have gum recession, you wil be advised on the most appropriate course of treatment.
Root Shortening
Almost all types of orthodontic treatment result in some shortening of the roots of the teeth (root resorption). Usually, this shortening is in the region of a millimetre or two so it has no detrimental affect on the longevity of the teeth.
Some patients experience more than the usual shortening. There are some predictors to excessive shortening but sometimes it can happen unexpectedly. Rarely, it may affect the longevity of the teeth. You may have an xray taken 6 months into treatment to check the lengths of the roots if we think you are at risk.
Root shortening is strongly linked to length of treatment so it is important to complete your treatment in a reasonable time frame.
Discomfort
The gums, lips and cheeks may be irritated by the brace but this is usually only for the first week or so. You will be advised on how to minimise this discomfort.
The teeth will also get tender at the start of treatment and after each adjustment visit. This is usually for only a few days and painkillers can be taken if needed (always follow the instructions on the packet).
Loose Braces
Very rarely, a loose or broken brace may be accidentally swallowed or aspirated. You should therefore always contact the orthodontist if you feel something is not feeling right with your brace.
Jaw Joints
Occasionally, patients may suffer pain or dysfunction in the jaw joints (tempero-mandibular joints). This may present as joint pain, ear ache or headaches. There is often a link with stress and jaw joint problems.
Some patients are susceptible to jaw joint problems and some are not. These problems may occur with or without orthodontic treatment. Numerous studies have shown that the movement of teeth with orthodontic treatment is unrelated to the onset of jaw joint problems.
Just as for painful conditions in other joints, discomfort in the jaw joint can last from several days to a week or longer. Sometimes the problem can be chronic.
If you are experiencing jaw joint problems before starting treatment, you will be advised if it is appropriate to embark on a course of orthodontic treatment.
Headgear
If improperly handled, headgear may cause injury to the face. Patients are warned not to wear headgear during times of boisterous or competitive activity. If any injury occurs to the eye, no matter how slight (even if no injury is visible), medical attention should be sought.
Atypical Growth
Insufficient, excessive or asymmetrical changes in growth of the jaws may limit our ability to achieve the desired result. We will usually be able to identify patients at the start of treatment with whom we may struggle to achieve an ideal result.
If growth becomes disproportionate during orthodontic treatment, your treatment may be prolonged and very occasionally, surgery may be suggested.
Treatment Time
The total time to complete treatment may exceed the estimate. Poor co-operation in wearing braces or elastics, poor cleaning and broken braces will all prolong your treatment. Missing or cancelling appointment will also lengthen the treatment time.
Your Co-operation
Co-operation on your part is necessary to obtain the desired result. This means complying with instructions to wear braces and elastics, ensuring good cleaning and following dietary instructions. You will need to look after your braces and attend for your appointments regularly. Failure to co-operate could force us to change the goals of your treatment.
Complementary Aesthetic Dentistry
If your teeth vary from the norm in number, size or shape, achievement of an ideal result (such as completely closing any gaps) may require restorative treatment. You will usually be advised of this at the start of your treatment.
The most common types of restorative treatment needed are composite fillings and veneers. Sometimes, some teeth have to be trimmed to make them look more in harmony with the rest of your mouth.
Tooth Vitality
Sometimes a tooth may have been traumatised by a previous accident or a tooth may be decayed and then filled. All of this may damage the nerve of the tooth.
Orthodontic tooth movement in some cases aggravates this condition and in rare instances may lead to loss of tooth vitality and discolouration of the tooth occurs. Root canal treatment is then needed and other dental treatment to restore the colour of the tooth. Even more rarely, loss of vitality and discolouration of a healthy tooth may occur during treatment or just after the braces are removed.
Tooth and Filling Fracture
Some teeth that have previously been filled with either a filling, veneer or crown can be difficult to attach to. A brace may not stay on very well and in other cases it stays on too well. This means that when the braces are removed, there is a small chance the filling/veneer/crown may fracture or a weak part of the tooth may come away. If you have any at risk teeth, this will be highlighted to you before you start treatment.
Relapse
Teeth have a tendency to change in their positions throughout our lives. This happens whether we have orthodontic treatment or not. This movement is more obvious during our late teens and early twenties as growth of the facial bones slows down. This can lead to changes in the position of the teeth, particularly in the lower front teeth.
The long-term wear of retainers will reduce the tendency for teeth to move after completion of orthodontic treatment. Fixed retainers may also be recommended.
Very occasionally, tooth movements will be severe enough to merit a further course of treatment to ensure a satisfactory result. This can be likened to 'touch-up' cosmetic surgery which has to be done to maintain a certain result.
General Health
General medical problems can affect orthodontic treatment. You should keep us informed of any changes in your medical health.