What problems could there be?
Clinical research and technological advancements have revolutionised orthodontic treatment over the past 20 years. Many of the improvements in orthodontics have been aimed at making treatment comfortable and trouble-free for the patient. Dr Sarah Good and Dr Pourghadiri use their knowledge, experience and training; as well as the latest in orthodontic braces, advanced clinical techniques and state-of-the-art appliance technology to ensure smooth problem-free treatment progress for their patients.
Nevertheless, those who are considering orthodontic treatment may encounter certain difficulties during treatment which they should be aware of prior to embarking on treatment.
Putting braces on or fitting them certainly does not hurt. No needles or sharp objects of any kind are involved, and you don’t have to go to sleep to have them fitted! Removable braces simply clip onto the teeth; and fixed braces are glued to the teeth. After braces have been fitted, there may be some discomfort for a few days.
The level of this discomfort varies quite a bit from individual to individual. In general, the teeth may feel a little sore, slightly loose, and tender to biting pressure. Painkillers such the ones you would normally take for headaches would take care of any soreness or discomfort that may be experienced for the first few days.
Parts of the brace may rub on the lips, cheeks or tongue causing soreness. Very occasionally, some patients get mouth ulcers. There may also be increased saliva flow, and a minor temporary effect on speech. This is normal, and soon patients get used to wearing their brace and their speech will go back to normal. Patients are supplied with some orthodontic wax. If any part of the brace is rubbing against the lips or cheeks, a small piece of wax could be moulded over the troublesome component of the brace to act as a cushion.
After those first few days of orthodontic treatment, braces become comfortable to wear, and most of the time patients forget that they even have them on their teeth.
Oral Hygiene, Gum Disease and Tooth Decay/Stains
Many people wrongly believe that orthodontic braces lead to swelling of the gums, leave marks or stains on the teeth, or damage the enamel of teeth. This is not true.
However, poor oral hygiene as a result of hurried or insufficient brushing of the teeth could cause these problems. Poor diet, sugary snacks and too many acidic drinks could also be damaging to teeth. With fixed braces especially, failure to maintain excellent oral hygiene and a good healthy diet will cause gum disease and bleeding of the gums, tooth decay and marking/staining of the teeth around the brackets.
Root resorption is a shortening of the tooth roots. It can occur with or without orthodontic appliances and it is very difficult to forecast susceptibility to this condition. Some orthodontic patients are predisposed to this problem, while most are not. Very slight changes in root length are normal in orthodontic treatment and are usually insignificant; they cause no long term ill effects in a healthy mouth.
Very rarely and unpredictably there may be more serious changes and the longevity of the teeth involved may be affected. The incidence may increase with unnecessarily extended orthodontic treatment: that is why your cooperation during treatment is very important so that treatment can be completed on time. Depending on your orthodontic circumstances, your orthodontist may take additional radiographs (X-ray films) to check for root resorption during treatment.
Previously Traumatised Teeth
Some patients suffer a blow or knock to their front teeth before or during orthodontic treatment. Regardless of how much damage is sustained or when the incident happened, traumatised teeth become predisposed to three possible conditions. These consequences are generally uncommon, but should be considered before deciding to go ahead with orthodontic treatment.
The first is ‘loss of vitality’ or degeneration of the nerve inside the tooth. The affected tooth may discolour, and become painful. A root filling and later cosmetic work may be required to treat this problem. Loss of vitality is also more common in teeth with very large/deep fillings or crowns, or teeth which have severe gum problems.
The second is ‘root resorption’ or a shortening of the root of the tooth. The outcome and possible treatment depends on the degree of resorption, but the longevity of the affected tooth could seriously be affected.
The third possible consequence is ‘ankylosis’ or the fusion or attachment of the tooth root to its surrounding bone. Normally a fibrous layer separates the root from jaw bone. An ankylosed tooth cannot be moved with orthodontic braces, and it may require removal, or surgery to move it into position.
Injuries from Appliances
A number of orthodontic appliances or braces are used in your treatment, and it is very important that you closely follow your orthodontist’s instructions regarding their use to avoid accidents. However, there is always some risk of injury with the use of appliances.
Because your braces cover your teeth, a blow or knock to the mouth can scratch or cut the inside of your lips or cheeks. Be sure to wear a mouthguard when taking part in sports or physical activity.
Loose or broken wires and brackets can also scratch or irritate your cheeks, gums or lips. Follow your orthodontist’s advice regarding the foods or habits to minimise the chances of such problems occurring. Dislodged or broken braces could also be swallowed or inhaled.
You must follow your orthodontist’s instructions for safe and effective use of headgear to prevent facial injuries. Never wear your headgear when playing physical games or sports. Never remove your headgear in one go by taking out the facebow first and pulling the headgear over your head. Always remove the safety strap and the headgear straps before removing the metal facebow. Always remember to wear the white ‘safety strap’ with your headgear. Make sure the hooks on the ends of the inner arms of the facebow are correctly engaging at the back of the molar bands. In the past, there have been very rare reports of eye injuries occurring while wearing headgear. If this happens, treat it like a medical emergency. Go to your local hospital Accident & Emergency Department to see an eye specialist as soon as possible.
If any brace or part of brace is damaged or you feel is not functioning properly, you must contact your orthodontist so that it can be repaired or adjusted.
Loose or Poor Quality Fillings, Crowns or Bridges
These can be dislodged while removing your braces; but usually this problem can easily be resolved by your dentist.
Risks with Orthognathic Surgery
A very small minority of patients may need both orthodontic treatment and surgery to modify the size, shape or position of your jaws. As with all surgical procedures, the risks and complications of oral surgery is a possibility. These risks need to be discussed in detail with the surgeon if your orthodontist recommends surgery.
Jaw Joint Clicking and/or Pain
Occasionally problems may occur in the jaw joints (temporomandibular joints or TMJ) and associated facial muscles, causing joint pain, limited opening, muscle aches and joints noises (clicking). Earaches and headaches are sometimes related complaints. Multiple factors which may be difficult to pinpoint are usually responsible for these signs and symptoms. Orthodontic treatment is not a cause, but such problems may occur at the same time as treatment as a matter of coincidence.
Some of the most common causes of TMJ disorders are chronic muscle tension associated with clenching or grinding of the teeth, parafunctional habits such as nail or lip biting, or stressed jaw posture at work or during sleep. The symptoms may also originate from a joint disease, such as arthritis, or result after previous trauma, such as a blow to the face or sometimes from a whiplash type injury.
The severity of the symptoms may be affected by stress, tension, mood, and emotional distress. Neck and shoulder muscle tensions may be a major contributor by referring pain and tightness to the jaws and face.
Severity of symptoms may be exaggerated by faulty function of the pain suppression system at various levels of the nervous system.
In the past, it was believed that an imperfect bite (malocclusion) and/or certain types of orthodontic treatment were possible causes of TMJ problems. However, extensive research has disproved this relationship. Bite problems that occur concurrently with TMJ disorders are most often the result of the problems rather than the cause of the problems.
TMJ disorders are musculoskeletal problems similar to aches and pains in other joints of the body. A TMJ problem is most often treated as a medical problem and not necessarily a dental problem. Treatment may require specialized care from other health professionals such as a TMJ specialist, physical therapist, and/or stress control specialist. These procedures are beyond the scope of the usual orthodontic treatment. Orthodontic treatment – in the same way that it does not cause TMJ problems – cannot guarantee a cure for TMJ disorders either.
Any TMJ signs or symptoms should be reported promptly to your orthodontist.
Orthodontic relapse is the tendency teeth have to return to their original positions after the completion of orthodontic treatment. Your orthodontist will use the optimum clinical techniques to minimise the chances of relapse. However, the main method of wearing relapse is wearing retainers after braces have been removed. You should follow your orthodontist’s advice about wearing retainers to prevent unwanted tooth movement after your treatment.
Removable retainers are worn full-time for the first 1 to 3 months. They are then worn only at nights for the next few months, phasing down to every other night for a few months, and eventually 1 or 2 nights a week. You should then keep wearing your removable retainers 1-2 nights a week for as long as possible; in other words for as long as you want your teeth to remain straight! This is called ‘long-term retention’. With fixed or bonded retainers, again you should expect ‘long-term retention’, keeping them on for as long as possible.