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Potential problems

Before embarking on a programme of orthodontic treatment, it is advisable that you and/or your parents be made aware of the following risks associated with treatment. Our orthodontists are experts at what they do so such risks are minimal.

Cavities or dental decay and decalcification

Orthodontic appliances do not cause cavities, but because of their presence, food particles are retained more readily and the cavity potential is thereby increased. The retained food may also lead to swollen gums.

The permanent white lines (decalcification) that are sometimes visible when braces are removed are usually found between the metal band or direct bond bracket margins and the gum lines and signal the early stage of cavity formation.

These problems can be prevented with proper diet, good tooth brushing habits and regular check-up appointments with your family dentist.

It is important to brush your teeth immediately after eating and practice proper techniques of brushing with braces. If brushing is not possible at a given time, take several mouthfuls of water and rinse thoroughly.

Remember, decalcification (permanent markings), decay, or gum disease can occur if you do not brush your teeth properly and thoroughly during your treatment period. Excellent oral hygiene and plaque removal is a must. Sugars, sweets and snack foods should be avoided. Ideally, avoid eating between meals and snacking to allow teeth to remineralise.

Swollen gums and periodontal problems

In some areas of your mouth, braces may impinge or press on your gum tissue. This is usually not a problem, but if you do not brush well in the area, the gum tissue may become swollen. It is necessary that the gums, and teeth be brushed and cleaned thoroughly after eating to keep them healthy. Your should call the office if the problem persists or gets worse.

We do know that some individuals are more prone to developing gum problems than others. Factors that can contribute to this problem are inadequate oral hygiene, accumulation of plaque and debris around teeth and gums, incorrect brushing procedures and the general health of the patient.

Periodontal disease is cyclic in that it may remain quiescent for long periods of time and then flare up into an active state for no apparent reason. If the flare up occurs during the course of orthodontic treatment, it may be difficult or even impossible to control the degree of bone loss and teeth could be lost. This is not usually the case, but it can happen.

Your orthodontist may recommend you see a periodontist for evaluation of various conditions. In extreme cases, particularly in adults, your orthodontist may request you remain on recall with the periodontist during the entire course of orthodontic therapy.

Occasionally it may be necessary to move teeth into an area where there is inadequate bone support for the teeth. This could lead to recession of the gums around the teeth involved and the need for periodontal surgery.

Root resorption

This condition is a blunting of the root tips, which may occur to varying degrees during orthodontic treatment, but is usually mild and does not affect the health or longevity of the teeth. The upper incisors (front teeth) are most commonly involved. There have been instances where all the teeth are involved and an excessive amount of resorption occurred. If there is associated periodontal (gum) disease in later years, the longevity of the teeth can be threatened. It is difficult, if not impossible, to predict who is susceptible to root resorption.

Many patients have root resorption prior to orthodontic treatment. The incidence seems to increase with prolonged treatment. This emphasises the importance of patient co-operation. It is important to get treatment over with as soon as possible.

It should be noted that not all root resorption arises from orthodontic treatment. Trauma, impaction of adjacent teeth, endocrine disorders, drugs or idiopathic (unknown) reasons can also cause resorption.

Loss of tooth vitality

Discoloration and/or loss of tooth vitality is rarely related to orthodontic treatment, but may occur during the treatment. An undetected non-vital tooth, whether caused by a sharp blow in the past, small fracture lines, or from deep decay, may “flare-up” during treatment.

Endodontic (root canal) treatment is then necessary to maintain the health of the involved tooth. Usually a tooth treated with a root canal filling can be moved orthodontically. A discolored tooth may need to be bleached to restore a more natural color.

Impacted teeth

Teeth which stay partially or completely under the gum are called “impacted”. Most teeth become impacted as a result of what is known as “ectopic (misdirected) eruption pattern” due to crowding of teeth or just an accident of nature. On occasion orthodontic movement of teeth may cause an unerupted tooth to become impacted. The treatment of an impacted tooth depends on the cause and the relative importance of the tooth.

The most commonly found impacted teeth are the third molars or “wisdom teeth”. In most instances these teeth do not erupt properly into place due to insufficient room in the jaws. Usually the orthodontist will request that these teeth be extracted as soon as he can determine that they are impacted and when these teeth have erupted close enough to the surface to facilitate extraction. Occasionally impacted wisdom teeth will have to be extracted at a very early age if they are causing damage to adjacent teeth or are blocking the eruption path of the other teeth. If it is decided to move the impacted tooth into proper alignment by orthodontic means, it will require the aid of an oral surgeon or periodontist to expose the impacted tooth, to which an attachment is secured. This will provide a “handle” from which a force is applied, gradually moving and guiding the tooth into position.

The length of time required to move an impacted tooth can vary considerably. Factors include the difficulty of diagnosing the exact angle and position of the tooth, physical or mechanical limitations to pull the tooth in the desired direction, or the nature and amount of bone and gum tissue present in the site to which the tooth is to be moved. In some cases an impacted tooth may become ankylosed or fused to the surrounding bone. In these cases the tooth cannot be moved and will need to be extracted. These are not readily predictable factors; therefore, a time of treatment estimate could be quite inaccurate. The roots of adjacent teeth are sometimes damaged by the presence of an impacted tooth or movement of the impacted tooth.

Injuries from appliances

  • Braces. Consistent with effectiveness and comfort, safety devices have been developed and are being utilized. NEVERTHELESS ALL PRECAUTIONS SHOULD BE FOLLOWED. There is currently no foolproof device if a patient is careless while wearing the appliance.
  • Retainers. When wearing removable appliances, such as a retainer, reasonable judgement must be used. The patient must not wear it if there is a chance of it being dislodged, for example, while swimming. If a retainer breaks, do not wear the broken parts. Call the office immediately so that the retainer may be repaired or a new one made if needed.

Injuries during actual treatment procedures

When sharp instruments are used or placed in the mouth, it's possible you may be inadvertently scratched or poked, especially if you move at a critical time during the procedure.

It is possible for a foreign object to fall in the back of the mouth and be swallowed or inhaled.

Although great care is used in placing and removing the braces or bonded attachments, teeth previously weakened by cracks in the enamel, undetected cavities, or weak fillings may be damaged.

Jaw joint pain and/or clicking

Jaw joint (temporo mandibular joint, or “TMJ”) pain or clicking may occur at any time during one’s life. Usually a combination of factors is involved in causing this problem. A history of jaw injury or emotional stress is common. It is more common in females in the later teens or early twenties, and in the later forties. In most instances jaw muscle spasms are the cause of the pain. In some cases actual joint pathology such as arthritis may be present. The emotional state of a person predisposed to the problem has a direct relationship to joint pain. Therefore, the pain and/or clicking may fluctuate with the emotional state of the individual. Treatment of the problem may take several courses and can be very simple or become quite complex. Jaw joint pain may be treated as a medical disorder and not necessarily a dental disorder.

As stated above there are many factors which can cause TMJ problems, but interferences in the bite may be only one of the factors involved. Orthodontic therapy alone cannot create a total interference-free bite as there are too many factors beyond the control of the orthodontist.

Most TMJ problems cannot be solved by “fixing the bite”. Many different conditions mimic TMJ symptoms and a careful diagnosis must be made to determine what treatment is appropriate. Some people think TMJ problems are all “bite” related and this is simply not so.

Tooth attrition and enamel loss

The wearing of the biting surfaces of the teeth is usually, but not always, found in adult patients. It is usually due to the patient grinding or clenching their teeth causing excessive wear of the enamel on the biting surfaces. Tooth interferences during jaw movements can also contribute to tooth wear. The patient unconsciously tries to eliminate the interferences by “working” the teeth as in the case of a “high filling” and thus grind and/or clenches his teeth wearing the biting surfaces down.

Relapse tendencies

The term relapse, as used here, usually describes a movement of the teeth back toward their original positions after the braces have been removed. It is probable that all patients will experience at least some movement of the teeth once the braces have been removed. It is difficult to determine how much tooth movement will occur, and in most cases retainers can be used to reduce the relapse tendency.

Other causes of relapse include:

  1. Lack of patient co-operation during the period of wearing braces. Experience seems to indicate the
    more ideal the end result, the less likely the chances of relapse.
  2. Lack of co-operation in wearing retainers. This is especially true in the early months of retention.
  3. The more severe the original malocclusion, the greater the relapse tendency. When a tooth is severely rotated the gum fibres will tend to pull it back toward the rotated position. Therefore, in many cases, fibre transection (fiberotomy) will be recommended as part of the retention procedure.
  4. Occasionally a person who has grown normally and in average proportion may not continue to do so. If growth becomes disproportionate, the jaw relation can be affected and original treatment objectives may have to be compromised. Skeletal growth disharmony is a biological process beyond the orthodontist’s control. The treatment of relapse due to growth depends on the degree of relapse. In some instances, it may be necessary to re-band all of the teeth, once the growth is completed.

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