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Home > Risks and Limitations
Version: Last updated 16/04/2025
Positive orthodontic results can generally be achieved by informed and co-operative patients. For this reason, we routinely supply this information to all considering orthodontic treatment. Although having healthy teeth and a pleasing smile is a great benefit, it’s important to know that all orthodontic treatment has limitations as well as potential risks that should be considered when deciding whether to proceed with orthodontic treatment.
Risks
Tooth decay and periodontal disease: Orthodontic patients who consume food or drink containing excessive sugars or acids and/or fail to brush their teeth frequently and properly may experience tooth decay and permanent markings (decalcification) on their teeth. Failure to remove bacterial plaque daily with good oral hygiene can also lead to gum inflammation and loss of the supporting bone. While these problems can happen without orthodontic treatment, the risk is higher for those wearing orthodontic appliances. It is essential to maintain good oral hygiene and visit your general dentist regularly during orthodontic treatment. Where a patient is a minor, parents and guardians will need to reinforce and supervise patient commitment to home care (especially with regard to oral hygiene, diet, and appliance wear, care and maintenance).
Root resorption: In some patients the length of the roots of the teeth may be shortened during orthodontic treatment. Some patients are prone to this happening, most are not. Usually this does not have significant consequences, but on rare occasions it may threaten the longevity of the teeth involved. Root shortening can also be related to endocrine (hormonal) disorders and can occur for unknown reasons in the absence of orthodontic treatment.
Loss of tooth vitality: Physical trauma to a tooth, decay or large fillings may have caused damage to the nerve of the tooth. Orthodontic tooth movement may in some cases aggravate this condition and in rare instances root canal treatment may be needed.
Enamel trauma: Whilst all care is taken, there is a small chance of tooth enamel damage during the removal of orthodontic appliances and bondings. This is rare, and usually related to an already-present weakness within the tooth structure.
Tooth transplants: When a tooth is surgically moved (transplanted) from one location to another, there is increased risk of fusion of the tooth to bone (ankylosis), loss of vitality (root canal therapy may be required), or loss of the transplanted tooth. Every patient has a different situation to consider, but the risk should be evaluated against the potential benefit.
Loose appliances and discomfort: The gums, cheeks or lips may be scratched or irritated by appliances. You will be given instructions on minimising these effects. Very rarely loose orthodontic appliances may be accidentally swallowed or aspirated. You should inform your orthodontist of any unusual symptoms, or broken or loose appliances, as soon as they are noted. Usual post-adjustment tenderness should be expected and the period of tenderness or discomfort varies with each patient and the procedure performed.
Changes to speech: There may be an audible change to speech which should improve as the patient becomes accustomed to the new appliance/s.
Limitations
Patient compliance: Treatment success relies on patient commitment and cooperation. Negative outcomes associated with poor patient compliance include tooth decay, slow progress or adverse tooth movement. Examples include (but are not limited to): failure to schedule or keep regular appointments (whether with us, your general dentist, or another dental specialist as required), failure to take scans on time via the Dental Monitoring app where requested, failure to activate or wear the appliance as we have instructed, poor oral hygiene, and lost or broken appliances. We stress the importance of ongoing supervision during treatment, and encourage patients to contact our office if any problems arise.
Tooth ankylosis: In rare cases, a tooth can become fused to the bone (typically as a result of trauma, but it can happen to any tooth). This condition can make tooth movement challenging or even impossible. This condition is typically not detectable on X-rays, but is instead discovered when tooth movement doesn’t occur as expected. Impacted teeth are more commonly affected by this condition, and may need to be removed if they do not respond to treatment.
Jaw joint problems: Occasionally problems may occur in the jaw joints causing joint pain, muscle pain, increase in tooth grinding, limited opening, bite changes, headaches, or ear problems. Stress, trauma and hormonal changes are major contributing factors in jaw joint problems. Generally, the scientific literature demonstrates that orthodontic treatment plays a neutral role with regard to jaw joint problems. Most people who develop these problems have never had orthodontic treatment. If however, any of the above symptoms are noted, they should be reported to us.
Tobacco products: Tobacco use 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 smoke, vape or use other tobacco-based products, you must carefully consider the possibility of negative oral health consequences, including potentially a compromised orthodontic result.
Relapse and long-term retention: Most things in life require maintenance. Similarly, an orthodontic outcome requires ongoing maintenance. In orthodontics this maintenance is termed retention. Teeth have a tendency to change their positions after treatment, however consistent wearing of retainers as instructed should greatly reduce this tendency. Insufficient retainer wear can result in unfavourable tooth movement, which could result in further treatment being indicated. Long-term retainer wear is the best available strategy for those wishing to maintain tooth alignment over an extended time period.
Biologic considerations: Estimated treatment length is always an approximation, and actual treatment length can vary considerably, based on many factors, many of which are out of the orthodontist’s control. Similarly, the orthodontic outcome may be limited by biological factors which are not predictable at the commencement of treatment. Even with excellent patient compliance, people’s teeth respond differently to orthodontic treatment. Some factors which can impact patient response to orthodontic treatment include genetics, age, bone density, general medical problems, certain medications, as well as overall health, nutrition and lifestyle. It is important to keep your orthodontist informed of any changes in your health, habits or medication use.
In growing children, insufficient or abnormal jaw growth, including atypical growth, can limit the ability to achieve or retain the desired result. Disproportionate growth during or after treatment, or a late-developing tooth can cause changes in the bite that require additional treatment, including oral surgery in some cases. Growth disharmony is a biological process beyond the control of the orthodontist.
Additionally, maturational changes and certain medical conditions (including jaw joint disease) that occur during or after active orthodontic treatment can impact the quality and retention of treatment results.
Tooth size and shape: Irregularities in tooth size or shape, such as differences in the sizes of individual teeth, may impose some limitations on the orthodontic outcome, and/or indicate re-contouring or reduction ‘stripping’ between the teeth to achieve the desired orthodontic goals. In some cases, spacing may still be present after orthodontic treatment due to unusually-shaped teeth or bone loss. This spacing may appear as small “dark triangles” at the gumline. Your general dentist may be able to reduce the appearance of these spaces with bonding, veneers, or crowns.
Dental midlines: The midlines of the upper and lower teeth may not be completely aligned with each other, or with other facial midlines at the conclusion of orthodontic treatment. Various factors, including individual growth patterns, the extent of any initial disparity, the influence of other (possibly competing) treatment goals, tooth morphology, tooth number (especially where there are missing teeth), and level of patient compliance (e.g., wearing elastics where needed) can all potentially influence the final alignment of the midlines. Although a slight midline discrepancy might be present, it usually does not affect function, or cause a significant impact on the overall aesthetics of your final result.
Wisdom teeth: Unless specifically discussed, wisdom tooth straightening is not part of the orthodontic treatment plan.
For the vast majority of patients, orthodontic treatment is an elective procedure. One possible alternative to orthodontic treatment is no treatment at all. You could choose to accept the current condition and decide to live without orthodontic correction or improvement.
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