Orthodontic braces apply gentle, constant pressure to teeth and jaws, slowly guiding them into proper alignment. The goal is to correct malocclusion (an improper bite) and improve overall dental function and health. Understanding the risks involves separating temporary, manageable side effects from structural concerns that arise primarily from poor oral hygiene or rare biological reactions.
Navigating Initial Discomfort and Adjustment
The immediate aftermath of getting braces involves temporary physical discomfort as the mouth adapts to the new appliance. This soreness results from the application of force, which initiates the bone remodeling necessary for tooth movement. The discomfort is typically a dull ache or pressure, often peaking in the first few days and gradually fading within a week of placement or adjustment appointments.
The brackets and wires can also irritate soft tissues inside the mouth, such as the cheeks, lips, and tongue. This mechanical friction may lead to temporary sores or ulcers until the soft tissues adapt to the hardware. Orthodontists recommend a diet of soft foods and the use of over-the-counter pain relievers to manage this initial, short-term phase.
Potential Structural and Enamel Concerns
One significant and preventable risk during active treatment is enamel decalcification, which appears as permanent white spots on the teeth. Brackets create new surfaces where plaque, a sticky film of bacteria, easily accumulates and is difficult to remove. The bacteria produce acid, which leaches minerals from the tooth enamel, resulting in these opaque white lesions. Diligent oral hygiene, including the targeted use of fluoride, is necessary for prevention, as the incidence of these white spot lesions can be high.
A less common structural concern is external apical root resorption (EARR), the shortening of the tooth root tip due to the sustained pressure of movement. While minor root shortening is a normal biological cost, severe resorption (loss of more than one-third of the root length) is rare. Factors like prolonged treatment duration, tooth extractions, or large movements of the front teeth are linked to a higher risk of this root shortening.
Fixed orthodontic appliances also challenge periodontal health, often leading to gingivitis (inflammation and swelling of the gum tissues). The wires and brackets trap food debris and increase the bacterial count, making effective cleaning along the gum line difficult. Fortunately, this gingivitis is usually transient, and the inflammation fully resolves once the appliances are removed and proper hygiene habits are restored.
Maintaining Results: The Lifelong Role of Retainers
Orthodontic treatment enters the retention phase immediately after braces are removed. Without intervention, teeth tend to shift back toward their original positions, a phenomenon known as relapse, driven by the periodontal ligament fibers and the forces of the tongue and cheeks. Consistent retainer wear is mandatory to stabilize the teeth and allow the surrounding bone and ligament to fully adapt to the new alignment.
Retention appliances fall into two main categories: removable and fixed. Removable retainers, such as clear, vacuum-formed models or the traditional Hawley plate, rely entirely on patient compliance for success. Fixed retainers consist of a thin wire bonded to the tongue-side surface of the front teeth, providing continuous stability. Lifelong retention is frequently recommended to preserve the long-term results of the treatment.
When Correction is Crucial: Consequences of Untreated Alignment Issues
While braces carry manageable risks, it is important to consider the consequences of untreated, severely misaligned malocclusion. A poor bite can lead to abnormal wear patterns where certain teeth bear excessive force during chewing, resulting in chips, fractures, or premature surface loss. Crowded or crooked teeth also create hard-to-reach areas that become chronic plaque traps, increasing the risk of cavities and gum disease.
An uncorrected bite can also place strain on the temporomandibular joints (TMJ) that connect the jaw to the skull. This misalignment can contribute to chronic symptoms like headaches, facial pain, and clicking or popping in the jaw joint. For patients with severely protruding front teeth, the risk of traumatic dental injury, such as a fracture, is increased. In many cases, orthodontic treatment is a necessary intervention for long-term health and function.