Can a dental brace damage my teeth?
Any brace has the potential to damage the teeth and the periodontium – just like an effective drug that produces unwanted side-effects in addition to doing what it is supposed to do.
Root apsorption means that there are apical granuloma in the roots of the teeth which can manifest itself either as small recesses or lead to the disappearance of a complete root tip. Root apsorption can of course occur naturally in teeth that are not being treated at all but are usually a common side-effect of orthodontic treatment. As a rule, root apsorption partly repairs itself although more severe defects usually remain once the treatment has finished. Most root apsorption is so minor that it does not even show up on a panoramic X-ray and would never cause any noticeable problems throughout a person’s life. In about 20% of the patients who are treated with a brace noticeable changes can be detected on closer examination of their panoramic X-rays. However, these changes rarely lead to anything in later life. Losing teeth as a result of root apsorption is theoretically possible but, in all the scientific literature, there are very few documented instances of this actually happening. Apart from any genetic disposition, the most important known risk factors are the length of the treatment and the distance that the roots have to cover. Similarly, using excessive force or bad workmanship can lead to root apsorption. However, it has never been proven conclusively that dental braces or similar treatment procedures can cause root apsorption. But root apsorption can never be completely prevented even when treatment is undertaken very carefully.
Recession of the Gum and Bone (Dehiscence)
When crooked teeth are straightened, this normally happens as a result of an enlargement of the dental quadrants. This means that all the roots of the teeth are actually moved outwards through the jaw bone. In many people the roots are only covered by a very thin layer of gum and bone anyway, so there would be a natural tendency towards recession of the gum in exposed roots even without orthodontic treatment. If the dental quadrants are then enlarged as a result of a brace, this process can often accelerate but only becomes apparent several years after orthodontic treatment has been completed. There is an increased risk of this today because many orthodontists no longer extract teeth even when there is severe overcrowding because they are more concerned with expanding the dental quadrants. The next few years will show that whilst this approach is very popular, it is not a very effective treatment strategy. In the long term, patients will have to suffer all the consequences of the neck of the teeth being exposed just because of an absurd preoccupation with quadrant expansion. If they want the results of their treatment to last for many years, orthodontists will in future have to reduce the increased volume of teeth by carrying out extractions or reduction of the amount of enamel. At the end of the day, it is normally younger patients who are treated and they have a very long life expectancy. The risk of dehiscence should be kept to a minimum by carrying out less expansion of the dental quadrants.
Enamel Decalcification (Demineralisation)
Brackets on the teeth are a very effective form of treatment but they also require good dental care. Patients who neglect this often develop small white or brown areas on the tooth enamel after treatment with a brace and these can remain for life. This is because the surface of the teeth under the brackets is sealed and is not affected but the area immediately around the brackets is affected and this can often be seen when the brace is removed revealing decalcification around the outline of the brackets.
Of course the whole thing is crazy from two perspectives: as a rule, orthodontists should not really treat patients who have bad dental hygiene (not even removable braces would be an option for these patients because it would require their cooperation). But the really serious and interested patients are sufficiently motivated to stay healthy during their treatment. At least this is one risk that patients can control 100% by themselves if they so wish.