Risks and Limitations of Orthodontic Treatment
Successful orthodontic treatment is a partnership between the orthodontist and
the patient. The doctor and staff are dedicated to achieving the best possible
result for each patient. As a general rule, informed and cooperative patients can
achieve positive orthodontic results. While recognizing the benefits of a beautiful,
healthy smile, you should also be aware that, as with all healing arts- orthodontic
treatment has limitations and potential risks. These are seldom serious enough to
indicate that you should not have treatment; however, all patients should seriously
consider the option of no orthodontic treatment at all by accepting their present
oral condition. Alternatives to orthodontic treatment vary with the individual’s
specific problem, and prosthetic solutions or limited orthodontic treatment may be
considerations. You are encouraged to discuss alternatives with the doctor prior to
Orthodontics and Dentofacial Orthopedics includes the diagnosis, prevention,
interception and correction of malocclusion, as well as neuromuscular and
skeletal abnormalities of the developing or mature orofacial structures.
Results of Treatment
Orthodontic treatment usually proceeds as planned, and we intend to do everything
possible to achieve the best results for every patient. However, we cannot
guarantee that you will be completely satisfied with your results, nor can all
complications or consequences be anticipated. The success of treatment depends
on your cooperation in keeping appointments, maintaining good oral hygiene,
avoiding loose or broken appliances and following the doctor’s instructions
Length of Treatment
The length of treatment depends on a number of issues, including the severity of the
problem, the patient’s growth and the level of patient cooperation. The actual
treatment time is usually close to the estimated treatment time, but treatment may
be lengthened if, for example, unanticipated growth occurs, if there are habits
affecting the dento-facial structures, if periodontal or other dental problems occur, or
if patient cooperation is not adequate. Therefore, changes in the original treatment
plan may become necessary. If treatment time is extended beyond the original
estimate, additional fees may be assessed.
The mouth is very sensitive so you can expect an adjustment period and some
discomfort due to the introduction of orthodontic appliances. Non-prescription pain
medication can be used during this adjustment period.
Completed orthodontic treatment does not guarantee perfectly straight teeth for the
rest of your life. Retainers will be required to keep your teeth in their new positions
as a result of your orthodontic treatment. You must wear your retainers as instructed
or teeth may shift, in addition to other adverse effects. Regular retainer wear is often
necessary for several years following orthodontic treatment. However, changes after
that time can occur due to natural causes, including habits such as tongue thrusting,
mouth breathing, and growth and maturation that continue throughout life. Later in
life, most people will see their teeth shift. Minor irregularities, particularly in the lower
front teeth, may have to be accepted. Some changes may require additional
orthodontic treatment, or in some cases, surgery. Some situations may require nonremovable
retainers or other dental appliances made by your family dentist.
Some cases will require the removal of deciduous (baby) teeth or permanent teeth.
There are additional risks associated with the removal of teeth which you should
discuss with your family dentist or oral surgeon prior to the appointment.
Orthognathic Surgery (Corrective Jaw Surgery)
Some patients have significant skeletal disharmonies which require orthodontic
treatment in conjunction with orthognathic (dentofacial) surgery. There are additional
risks associated with this surgery which you should discuss with your oral and/or
maxillofacial surgeon prior to beginning orthodontic treatment. Please be aware that
orthodontic treatment prior to orthognathic surgery often only aligns
the teeth within the individual dental arches. Therefore, patients discontinuing
orthodontic treatment without completing the planned surgical procedures may
have a malocclusion that is worse than when they began treatment.
Decalcification and Dental Caries
Excellent oral hygiene is essential during
orthodontic treatment as are regular visits to your family dentist. Inadequate or
improper hygiene could result in cavities, discoloured teeth, periodontal disease
and/or decalcification. These same problems can occur without orthodontic treatment,
but the risk is greater to an individual wearing braces or other appliances. These
problems may be aggravated if the patient as not had the benefit of fluoridated water
or its substitute, or if the patient consumes sweetened beverages or foods.
The roots of some patients’ teeth become shorter (resorption) during orthodontic
treatment. It is not known exactly what causes root resorption, nor is it possible to
predict which patients will experience it. However, many patients have retained teeth
throughout life with severely shortened roots. If resorption is detected during
orthodontic treatment, your doctor may recommend a pause in treatment or the
removal of the appliances prior to the completion of orthodontic treatment.
A tooth that has been traumatized by an accident or deep decay may have
experienced damage to the nerve of the tooth. Orthodontic tooth movement may, in
some cases, aggravate this condition. In some cases, root canal treatment may 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 family 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 the doctor performing your orthodontic treatment 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 orthodontic appliances are removed. This problem may be more likely
when esthetic (clear or tooth-coloured) appliances have been selected. If damage to a
tooth or restoration occurs, restoration of the involved tooth/teeth by your dentist may
Orthodontic headgears can cause injury to the patient. Injuries can include damage to
the face or eyes. In the event of an 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 headgear.
Temporomandibular (Jaw) Joint Dysfunction
Problems may occur in the jaw joints, i.e. temporomandibular 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 difficulty opening or
closing, should be promptly reported to the doctor performing your orthodontic
treatment. Treatment from 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 can 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 doctor
performing your orthodontic treatment about adjunctive care.
As third molars (wisdom teeth) develop, your teeth may change alignment. Your
dentist performing your orthodontic treatment 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 discontinuance
of treatment prior to completion. Although very uncommon, medical management of
dental material allergies may be necessary.
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 us of any changes in your general
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
Temporary Anchorage Devices
Your treatment may include the use of a temporary
anchorage 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 a dental specialist.
When inserting the device(s), it is possible to damage the root of a tooth, a nerve, or
to perforate the maxillary sinus. Usually these problems are not significant; however,
additional dental or medical treatment may be necessary.
Local anesthetic may be used when these devices are inserted or removed, which
also has risks. Please advise the doctor placing the device if you have had any
difficulties with dental anesthetics in the past.
If any of the complications mentioned above do occur, a referral may be necessary to
your family dentist or another dental or medical specialist for further treatment. Fees
for these services are not included in the cost for orthodontic treatment.
ACKNOWLEDGEMENT AND ORTHODONTIC CONSENT
I hereby acknowledge that I have read and fully understand the treatment
considerations and risks presented in this form. I also understand that there may be
other problems that occur less frequently than those presented, and that actual results
may differ from the anticipated results. I also acknowledge that I have discussed this
form with the undersigned general practitioner and have been given the opportunity to
ask any questions. I have been asked to make a choice about my treatment. I hereby
consent to the treatment proposed and authorize the general practitioner indicated
below to provide the treatment. I also authorize the general practitioner to provide my
health care information to my other health care providers. I understand that my
treatment fee covers only treatment provided by the general practitioner for
orthodontics, and that any other dental treatment provided, or any other services
rendered by any medical professional are not included in the fee for my orthodontic
CONSENT TO UNDERGO ORTHODONTIC TREATMENT I hereby consent to the
making of diagnostic records, including x-rays, before, during and following orthodontic
treatment, and to the above doctor(s) or other staff performing orthodontic treatment
prescribed by the above doctor(s) for the above individual. I fully understand all the
risks associated with this treatment.
AUTHORIZATION FOR RELEASE OF PATIENT INFORMATION
I hereby authorize
the above doctor(s) to provide other health care providers with information regarding
the above individual’s orthodontic care as deemed appropriate. I understand that once
released, the above doctor(s) and staff have no responsibility for any further release by
the individual receiving this information.
CONSENT TO USE OF RECORDS
I hereby give my permission for the use of
orthodontic records, including photographs, made in the process of examinations,
treatment, and retention for purposes of professional
Consultations, research, education, or publication in professional journals.
I have the legal authority to sign on behalf of:
Once fully read and reviewed, please make sure that the above document is filled out appropriately.
By signing below and submitting this document, we are assuming that it has been read in its entirety.
All patient signatures will be verified for authenticity in the office.