Are there any side effects or problems?
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.
Our orthodontists 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 can be 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.
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
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
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.
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
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
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
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.
Most orthodontic problems can be easily avoided if you follow your
orthodontist’s advice and instructions regarding the proper care of your
braces and how you can help with treatment.