A tooth that has been traumatized by an accident or deep decay may have experienced damage to the nerve
of the tooth. Also, the nerve of a tooth may die for no apparent reason, and this is known as
“spontaneous pulpal necrosis.” Orthodontic tooth movement may, in some cases, aggravate these conditions
and cause root canal treatment to be necessary. In severe cases, the tooth or teeth, may be lost.
Periodontal (gum and bone) disease can develop or worsen during orthodontic treatment due to many
factors, but most often due to the lack of adequate oral hygiene. You must have your general dentist, or
if indicated, a periodontist monitor your periodontal health during orthodontic treatment every three to
six months. If periodontal problems cannot be controlled, orthodontic treatment may have to be
discontinued prior to completion.
Injury From Orthodontic Appliances
Activities or foods which could damage, loosen or dislodge orthodontic appliances need to be avoided.
Loosened or damaged orthodontic appliances can be inhaled or swallowed or could cause other damage to
the patient. You should inform your orthodontist of any unusual symptoms or of any loose or broken
appliances as soon as they are noticed. Damage to the enamel of a tooth or to a restoration (crown,
bonding, veneer, etc.) is possible when ortho¬dontic appliances are removed. This problem may be more
likely when esthetic (clear or tooth colored) appliances have been selected. If dam- age to a tooth or
restoration occurs, restoration of the involved tooth/teeth by your dentist may be necessary.
Orthodontic headgear can cause injury to the patient. Injuries can include damage to the face or eyes.
In the event of injury or especially an eye injury, however minor, immediate medical help should be
sought. Refrain from wearing headgear in situations where there may be a chance that it could be
dislodged or pulled off. Sports activities and games should be avoided when wearing orthodontic
Temporomandibular (Jaw) Joint Dysfunction
Problems may occur in the jaw joints, i.e., temporoman- dibular joints (TMJ), causing pain, headaches
or ear problems. Many factors can affect the health of the jaw joints, including past trauma (blows to
the head or face), arthritis,
hereditary tendency to jaw joint problems, excessive tooth grinding or clenching, poorly balanced bite,
and many medical conditions. Jaw joint problems may occur with or without orthodontic treatment. Any jaw
joint symptoms, including pain, jaw popping or diffi- culty opening or closing, should be promptly
reported to the orthodontist. Treatment by other medical or dental specialists may be necessary.
Impacted, Ankylosed, Unerupted Teeth
Teeth may become impacted (trapped below the bone or gums), ankylosed (fused to the bone) or just fail
to erupt. Oftentimes, these conditions occur for no apparent reason and generally cannot be anticipated.
Treatment of these conditions depends on the particular circumstance and the overall importance of the
involved tooth, and may require extraction, surgical exposure, surgical transplantation or prosthetic
You can expect minimal imperfections in the way your teeth meet following the end of treatment. An
occlusal equilibration procedure may be necessary, which is a grinding method used to fine-tune the
occlusion. It may also be necessary to remove a small amount of enamel in between the teeth, thereby
“flattening” surfaces in order to reduce the possibility of a relapse.
Due to the wide variation in the size and shape of the teeth, missing teeth, etc., achievement of an
ideal result (for example, complete closure of a space) may not be possible. Restorative dental
treatment, such as esthetic bonding, crowns or bridges or periodontal therapy, may be indicated. You are
encouraged to ask your orthodon- tist and family dentist about adjunctive care.
As third molars (wisdom teeth) develop, your teeth may change alignment. Your dentist and/or
orthodontist should monitor them in order to determine when and if the third molars need to be removed.
Occasionally, patients can be allergic to some of the component materials of their orthodontic
appliances. This may require a change in treatment plan or discon- tinuance of treatment prior to
completion. Although very uncommon, medical management of dental material allergies may be necessary.
Transmission of Disease
Although our orthodontic office is following the State and Federal regulations and recommended
universal personal protection and disinfection protocols to prevent transmission of communicable
disease, it is possible that that they will not always be successful in blocking the transmission of a
highly infectious virus. It is not possible to render orthodontic treatment with social distancing
between the patient, orthodontist, assisting staff and sometimes, other patients. Knowing that you could
be exposed to communicable diseases anywhere, by presenting yourself or your child for orthodontic
treatment, you assume and accept the risk that you may inadvertently be exposed to a communicable
disease in the orthodontic office
General Health Problems
General health problems such as bone, blood or endocrine disorders, and many prescription and
non-prescription drugs (including bisphosphonates) can affect your orthodontic treatment. It is
imperative that you inform your orthodontist of any changes in your general health status.
Use of Tobacco Products
Smoking or chewing tobacco has been shown to increase the risk of gum disease and interferes with
healing after oral surgery. Tobacco users are also more prone to oral cancer, gum recession, and delayed
tooth movement during orthodontic treatment. If you use tobacco, you must carefully consider the
possibility of a compromised orthodontic result.
Temporary Anchorage Devices
Your treatment may include the use of a temporary an- chorage device(s) (i.e. metal screw or plate
attached to the bone.) There are specific risks associated with them. It is possible that the screw(s)
could become loose which would require its/their removal and possibly relocation or replacement with a
larger screw. The screw and related material may be accidentally swallowed. If the device cannot be
stabilized for an adequate length of time, an alternate treatment plan may be necessary.
It is possible that the tissue around the device could become inflamed or infected, or the soft tissue
could grow over the device, which could also require its removal, surgical excision of the tissue and/or
the use of antibiotics or antimicrobial rinses.
It is possible that the screws could break (i.e. upon insertion or removal.) If this occurs, the broken
piece may be left in your mouth or may be surgically removed. This may require referral to another