Any medical or dental procedure is not without risks. While the risks of braces may not be as significant as a severe reaction to an anaesthetic in surgery, there are rare complications that can result in considerable problems. The following is a summary of a few possible complications from braces, although an orthodontist should be consulted for specific risks and limitations for a particular patient.
While every treatment is performed with the intention of improving the bite and alignment, there are limitations between individuals that may be beyond the control of the patient and orthodontist. This would include growth and development of the jaws, which ultimately has an effect on the tooth/bite position. Areas that are under the control of the patient (i.e. co-operation) will also affect the final outcome, but will be beyond the control of the orthodontist.
Most comprehensive orthodontic treatment plans may last two or more years. There is significant variability in each patient in how fast the teeth move, as well as co-operation and growth issues. Therefore, the orthodontist will give an estimate on treatment length for each individual, but this may change as the treatment progresses.
Relapse is the movement and shifting of teeth after the braces are removed. Patients are usually provided retainers following treatment to prevent relapse. If the retainers are not worn as instructed by the orthodontist, the risk of relapse is very high, especially immediately after the braces are removed. There is a tendency for teeth to move even a few years after braces, which is due to normal age related changes. These changes occur to varying degrees in almost every patient. Long-term use of retainers would be needed to prevent this from happening, or else slight misalignment would need to be accepted. Patients should consider purchasing a spare set of retainers at the end of treatment.
Root resorption is a shortening of the roots during tooth movement. In some patients it can be seen as nothing more than a slight blunting of the root tips. This will generally not result in any long-term problems for those teeth. If the roots of your teeth are already short or show signs of being at “high risk”, then consider avoiding treatment. The exact cause of rare “idiopathic” resorption is not completely known at this time, and there is no effective way of predicting if it will occur. Although, it is known that braces over a long period of time (i.e. over 3 years) will increase the chances of root resorption.
The importance of excellent oral hygiene cannot be stressed enough for patients who have braces. The results of improper care are devastating to the health and appearance of the teeth. White marks (decalcification) and cavities can form on the teeth rather quickly if food and plaque is not removed on a regular basis. Prevention by thorough brushing, flossing, a low sugar diet, and use of a daily fluoride rinse can significantly reduce the chances of decalcification.
Besides the risk of cavities, the health of the tissues and supporting bone around the teeth can also be affected by oral hygiene. Patients that have active periodontal disease are not good candidates for orthodontic treatment. Treatment followed by evaluation for stable periodontal health is needed before treatment begins. Frequent evaluation and maintenance visits during treatment may also be recommended to monitor the gum tissue and health of the supporting tissues. Consult with an orthodontist, general dentist, and/or periodontist for more specific recommendations.
Another rare but serious complication during braces is ankylosis. Ankylosis is a fusion of the tooth root to the bone. If a tooth has fused to the underlying jawbone, braces will be unable to move the tooth. In fact, all of the surrounding teeth will start to move around the ankylosed tooth. This is a serious complication that would not allow proper alignment of the teeth and bite. A history of trauma where a tooth had completely come out of the mouth and been reimplanted by a dentist has a high rate of ankylosis. Other than that, it is difficult to predict whether a tooth has become ankylosed prior to braces. X-rays and clinical examination may provide diagnosis of ankylosis only in certain situations.
Teeth that have previously suffered a blow, trauma or knock have a higher risk of losing their blood supply (devitalization) during orthodontics. This can lead to the tooth going grey and can sometimes lead to toothache. The tooth would then need to be treated with root canal treatment by your general dentist.
Fixed and removal orthodontic appliances can be broken if you do not follow the advice given to you regarding avoiding hard, chewy or sticky foods. Breakages can result in discomfort, additional visits for repairs and increased treatment times. If advice is repeatedly not followed, we may need to end treatment.
The orthodontic movement of teeth is normally accompanied by mild pain and discomfort for a few days following each adjustment and sometimes from the appliances rubbing inside the lips and cheeks. Normally mild painkillers and the use of orthodontic wax is advisable.
While the risks may cause significant problems if they do occur, the probability of occurrence is usually low. Therefore, most patients find that the risks are not significant enough to forego treatment. Each patient/parent must weigh the risks and benefits, and decide for themselves if they warrant foregoing treatment.