Risks and Limitations of Braces
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 anesthetic 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.
Results and Outcome
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. cooperation) will also affect the final outcome, but will be beyond the control of the orthodontist.
Length of Treatment
Most comprehensive orthodontic treatment plans will last approximately two years. There is significant variability in each patient in how fast the teeth move, as well as cooperation 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 (more detail on retainers and retention can be found in chapter 4). 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.
Root resorption is a shortening of the roots during braces. 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. A rare situation will develop in some patients where up to one-half or more of the root shortens away. This could significantly affect the long-term health and stability of the affected teeth. The exact cause 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 2-3 years) will increase the chances of root resorption. Many orthodontists will take initial, mid-treatment, and final panoramic x-rays to determine if root resorption has occurred during treatment.
Decalcification and Cavities
The importance of excellent oral hygiene cannot be stressed enough for patients that 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 jaw bone, 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.
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.