Risks with orthodontic work you should know

Orthodontic treatment isn’t particularly risky, but as with any intervention to your body, it does carry some minor risks.

Whether you’re looking into orthodontic treatment for your child, or you’re considering treatment options as an adult, it’s important to have the information to be able to weigh up the risks and benefits of treatment before making a decision.

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Toothache and mild discomfort

When you first start treatment, you may feel some mild discomfort as your mouth gets used to the orthodontic equipment and your teeth begin to move. This discomfort will vary from person to person, and will depend on your own pain threshold and the treatment you have chosen.

If you feel any discomfort due to the pressure on your teeth, we recommend taking over-the-counter pain relief.

Scratches and ulcers

At the start of your orthodontic treatment, it’s fairly common to feel some small scratches and ulcers on the inside of your mouth, especially if you’re wearing a fitted device such as braces. This will usually only happen for a couple of days, until your mouth gets used to the shape of your braces.

However this can be easily solved using orthodontic wax, which is an easy and immediate way to protect your mouth during this initial phase.

Gum infection

Maintaining good oral hygiene is important for everyone, but it’s especially important if you’re undergoing any type of orthodontic treatment. Poor oral hygiene can lead to gingivitis and gum infection which can slow down the movement of your teeth – if you’re wearing an orthodontic appliance then this can mean treatment takes longer. In some cases, the infection can cause irreversible damage to the tissues which support your teeth.

Make sure you maintain a healthy oral hygiene routine and follow the guidance of your orthodontist to prevent gum infections. Regular professional cleans with your dentist will also help.

 

Enamel demineralisation

Enamel demineralisation, where the enamel wears away on the tooth, can occur during orthodontic treatment, particularly with fixed appliances such as braces. It is primarily caused by sugar, which starts a decay process in the enamel. If left to progress, over time this demineralisation can lead to cavities and tooth decay, which appears as white or yellow stains on the teeth.

 

Root shortening

For some patients, the length of the roots of their teeth become shorter during treatment. It’s nearly impossible to predict whether or not it will happen to you – but some people are more prone to it than others. In general, root shortening doesn’t have significant consequences, but on very rare occasions it may threaten the longevity of the tooth.

Tooth vitality

As orthodontic treatment moves the teeth, some pre-existing conditions (such as trauma or decay) might be aggravated by wearing an orthodontic appliance. The movement the tooth undergoes during treatment might further aggravate the tooth. While very rare, this can lead to the tooth becoming discoloured or requiring root canal treatment.

Risks and complications in orthodontic treatment

Toothache, occasional discomfort or pressure on the teeth

When beginning orthodontic treatment and after the each inspection, you may feel unpleasant pressure on your teeth, toothache, or just discomfort. It depends on the individual and on their pain threshold.
Scratches and bruises

White spots on the surface of the teeth

This complication is caused by long-term bad oral hygiene. White patches appear around the brackets. The enamel beneath the brackets remains undamaged. A coating built up on the surface of the enamel causes demineralisation. This occurs due to harmful bacteria which break down leftover food around the brackets into acids. The acids eat into the enamel resulting in demineralisation.

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This is a stage preceding tooth decay.

If this complication arises and repeated instruction on oral hygiene and visits to a dental hygienist have no effect, the doctor reserves the right to premature termination of treatment. The priority is a healthy set of teeth and only afterwards a straight set.

Gum infection – gingivitis

Insufficient oral hygiene can lead to gum infection. This infection can complicate treatment by meaning slower tooth movement and so treatment is slowed and sometimes leads to irreversible damage to the teeth’s supporting tissues.
Tooth root resorption
Some patients have a tendency to the occurrence of resorption. In practice this means that the teeth’s roots get shorter. This complication however does not shorten the lifespan of teeth.

Relapse of orthodontic defects
Every orthodontic treatment has a tendency to relapse, i.e. the teeth return to their original position. We prevent this by using retention devices and retainers. Retention devices are laboratory products made to fit your teeth exactly.

Retainers are wires which are stuck to the back surface of your teeth to maintain their position. This phase is very important for orthodontic treatment.

Risk Factors in Dental Implant Surgery

This article is the second in a series for Oral Health. The first article was published in the August 2015 issue, with the title “Surgical Risk Factors in Implant Dentistry: Influence on Failures and Bone Loss”. Table 1 in this article, organizes risk factors in implant dentistry into four categories. These were introduced in the August 2015 article together with the concept of “Evidence Based Dentistry” and a representative case presentation.

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Patient Related Systemic Risk factors: (Table 1)
This category of risk factors includes but is not limited to patient related: a) complaints, expectations, psychological suitability and limitations (e.g. clinical limitations and financial limitations), b) history of periodontitis (especially aggressive periodontitis) and c) smoking, systemic disease and medications.

• b) History of Periodontitis:
A patient’s history of periodontitis and in particular aggressive periodontitis needs to be determined from the information gathered from both the initial patient interview, previous dental records as well as from the diagnostic information gathering phase. There have been several articles studying this issue. Readers are referred to a meta-analysis published in 2014.1 A conclusion can be drawn from this review that a history of aggressive periodontitis poses a negative risk factor for and should be taken into account and included as part of the “informed consent” process and treatment.

• c) Smoking, Systemic Disease and Medications:
The patient’s dental, medical and habit history and in particular current conditions that could impact upon the outcome, need to be questioned and evaluated at the initial patient interview and where indicated investigated in more detail. Outside consultations may be needed to determine if any pre-treatment precautions need to be taken or if treatment is absolutely contra-indicated.

Patient Informed Consent
Successfully achieving “patient informed consent” is a critically important aspect of overall patient care. It is a legal and ethical duty for dentists to make sure that the patient understands the important aspects of treatment. There have been several recent RCDSO Dispatch articles that have addressed this issue, for example “Dental Implant lawsuits”, August/September 2015 issue, “Informed Consent Learning program”, November/December 2015 issue and “Informed Consent From
Material Risks to Material Information”, February/March 2016 issue.

Short Term Complications With Dental Implants

Short term failure is best described as those failures that occur before the final teeth are made. It could be immediately following the surgery , during the first few months of healing or even a year later.

dental implant patient

1. Infection and Poor Healing
Placing an implant is a surgical procedure. Provided the dentist follows aseptic/sterile surgical techniques and precautions the chance of infection is extremely low, even when we consider we are working within the mouth which is full of bacteria. Patients are generally covered with antibiotics as an added precaution. Discomfort following surgery is usually mild to moderate and lasts for 1-4 days on average, and of course depends on the specific procedure being done. Make sure to ask your dentist what is a normal expectation for yourself.

2. Medical Condition Affecting Healing
Generally speaking, if you have lost teeth, you are a potential candidate for dental implant surgery. However, there are certain conditions and diseases that can affect whether dental implants are right for you – this is where the importance of a proper medical assessment comes in.

3. Surgical Technique
A skilled dental surgeon will know the osseo-integration process (how the dental implant anchors to the jaw bone) and be skilled in proper surgical techniques. In those cases healing is often very comfortable and uneventful. If not, the site is more prone to swelling, pain, infection and possible failure of the implant. This becomes more critical if the area is slightly deficient in bone volume or is very dense….overheating of the bone will cause necrosis (bone death) and the implant will likely fail to integrate.

4. Micromovement of the Dental Implant
Dental implants must remain immobile for a long enough period to allow osseo-integration to occur. The analogy I give my patients is similar to when we break a bone in our arm or leg. The fracture is immobilized by use of a cast because if there is movement the bony fracture will not heal. Implants are very similar.

New study finds troubling rates of dental implant complications

The study evaluated rates of dental implant loss and peri-implantitis as the result of dental implants.

Any dental procedure comes with the chance of infection, but a recent study out of Sweden has discovered that patients with dental implants run a high risk – and that several contributing factors can exacerbate this risk

The research out of the University of Gothenburg aimed to evaluate the correlation between dental implants, implant loss and peri-implantitis, a destructive infection that affects the tissue surrounding dental implants and can result in loss of supporting jawbone. Researchers also explored the relationship between periodontitis and rates of implant loss.

The study consisted of 4,716 randomly selected participants that had all had dental implants in 2003-2004. Researchers sent out a survey and received dental records and charts for 2,765 patients in the study. 596 patients were also examined at a nine-year follow-up appointment. The results found that almost eight percent of patients with dental implants experienced the loss of at least one implant within that timeframe.

More research on dental implants: New discovery can prevent dental implant infections

“Altogether, 7.6 percent of patients had lost at least one implant and 14.5 percent had developed peri-implantitis with pronounced bone loss,” reported Dr. Jan Derks, a researcher at Sahlgrenska Academy. 50 percent of patients presented with some signs of peri-implantitis, but only 14.5% were considered to have moderate to severe implications (equating to a crestal bone loss exceeding 2 mm). The 7.6 percent that had lost an implant showed an average loss of 29 percent of bone support.

Dr. Derks’ research also found that patients with preexisting periodontitis experienced an increased risk of peri-implantitis. Smoking was also identified as a risk factor contributing to early implant loss. The study also reported that “progression of peri-implantitis occurred in a non-linear, accelerating pattern, and, in the majority of cases, the onset of the disease had occurred early.”

More emerging research: Study finds protein can inhibit bone loss from periodontitis

Interestingly, the rate of implant failure did not differ between the general practice and specialty practices. “22% of all patients in the present sample received their implants in a general practice setting, and implant los in this subgroup was not different from outcomes in patients treated in specialist clinics,” the study stated.

“Peri-implantitis appears to develop within a few years and then progresses quickly at an accelerating pace,” said Dr. Derks. He hopes that the information gained from the study can help dentists minimize the risk of peri-implantitis and implant loss.