As a rule, excellent orthodontic results can be achieved with informed and co-operative patients. Thus, the following information is routinely supplied to anyone considering orthodontic treatment in our office. While recognizing the benefits of a pleasing smile and healthy teeth, you should also be aware that orthodontic treatment, like any treatment of the body, has some inherent risks and limitations.
Oral hygiene: Decalcification (permanent white/brown marks), decay, or gum disease can occur if patients do not brush their teeth properly and thoroughly during treatment period. Excellent oral hygiene and plaque removal is a must. Consumption of sugary food and snacks as well as snacking should be reduced as much as possible.
A non-vital or dead tooth is a possibility: A tooth that has been traumatized from a deep filling or even a minor blow can die over a long period of time with or without orthodontic treatment. An undetected non-vital tooth may flare up during orthodontic movement, requiring endodontic (root canal) treatment
Root resorption: In some cases, the root ends of the teeth are shortened during treatment. This is called root resorption. Under healthy circumstances the shortened roots are not of any disadvantage. However, in the event of gum disease in later life the root resorption may reduce the longevity of the affected teeth. It should be noted that not all root resorption arises from orthodontic treatment. Trauma, cuts, impaction, endocrine disorders, idiopathic reasons can also cause root resorption.
Previous Orthodontic Treatment: If you have undergone any braces treatment previously, the teeth may have been moved of out the bone partially. This will be managed either by moving the teeth back into the bone or leaving it in the same position. There may also be signs of root resorption occurring on the root tips of the teeth. There may be a higher risk of root resorption occurring again with orthodontic
Gum tissues: The bone-gum relationship around teeth is always dependent upon whether there is enough bone to support the gum tissue properly. Many times, when very crowded teeth are straightened, there is a lack of bone support and gum tissues surrounding the teeth. Therefore, the gum tissue contour and support may not be adequate and require periodontal intervention. Poor oral hygiene will result in inflamed gums, bleeding, swelling and increased loss of gum tissue. This is commonly referred to as "black triangles"
Tooth decay: During your teeth movement, spaces may occur between the teeth. These spaces will trap food and bacteria. It is your responsibility to keep your teeth clean with brushing and flossing to avoid cavities. Sometimes, during the movement or after IPR, it will reveal existing tooth decay that were present but not visible previously. These appear as white or brown spots. Cavities will require a filling. Any filling or restoration that changes the tooth shape may need removal of the braces wire and or brackets so it is recommended to do the filling before the start of braces treatment.
Treatment time: The total time for treatment can be delayed beyond our estimate. Poor appliance/elastic wear, or headgear co-operation, broken appliances, poor oral hygiene, and missed appointments are all important factors that could lengthen treatment time and affect the quality of the result.
Need for surgical treatment: If there is an underlying skeletal condition which could include but not limited to jaw asymmetry, discrepancy in size of maxillary (upper) jaw and/or mandibular (lower) jaw, canting causing an uneven smile line, cleft lip/palate, vertical maxillary excess or gummy smile, the orthodontic treatment alone may not be able to correct these issues and will result in a compromised outcome. Skeletal discrepancies will require surgical treatment to fully correct and will need to be referred to a specialist.
Temporomandibular Joint Disorder: There is a risk that problems may occur in the temporomandibular joints (TMJ) Although this is rare, it is a possibility. Tooth alignment or bite correction sometimes can improve tooth related causes of TMJ pain, but not for all cases. Stress and tension appear to play a role in the frequency and severity of joint pain, and there are many other causes of TMJ dysfunction.
Other Occurrences: Swallowed appliances, chipped teeth, dislodged restorations and allergies to latex or nickel rarely occur but are possible. Please keep all dislodged pieces and contact us as soon as possible. Commonly, patients experience ulcers, pain, difficulty chewing and changes in speech during treatment.
Termination of treatment: It is understood that treatment can be terminated for failure to cooperate, missing appointments, not wearing appliances, excessive breakage, failure to keep financial commitments, relocation, personal conflicts or for any other reason the dentist feels necessary. If termination is necessary, the patient will be given ample time to locate another orthodontist to continue treatment or the braces will be removed. There will be no refunds at any stage for partially complete treatment.
Expectations: All orthodontic patients can expect improvement with their particular problem, but, in many cases, absolute perfection is impossible due to lack of muscle balance, existing facial/jaw structure, tooth shapes and sizes and varying degrees of co-operation during treatment, along with heredity aspects that affects everyone's specific treatment results.
Relapse: Teeth have a tendency to return to their original position after orthodontic treatment. This is called relapse. Very severe problems have a higher tendency to relapse and the most common area for relapse is the lower front teeth. At the end of your braces treatment, you are required to wear a set of retainers every night to avoid relapse. Retainers will need to be remade as they wear out over time and lose their retentive ability. You may opt for an additional fixed wire retainer (at additional cost) to minimize relapse. Full co-operation in wearing these appliances is vital.
Additional Treatment: Unforeseen circumstances such as abnormal growth, dental decay, or gum disease may cause the treating dentist to recommend additional treatment that were not previously discussed. If this occurs, the dentist will carefully explain the reasons for a change in treatment plan and any extra fees before proceeding.
THE PATIENT'S RESPONSIBILITY
It is the patient's responsibility to follow the brushing and oral hygiene instructions that are given, so that no harm will come to the teeth and surrounding tissues; to come to all appointments; to adhere to the list of food restrictions in order to prevent damage to the teeth and orthodontic appliance; to wear headgear, elastics and retainers, as prescribed, so that treatment time will be as short as possible and to achieve the best results. You are required to have a full scaling and polishing done at least every six months.
There will be additional orthodontic charges for replacement of appliances (such as retainers or braces) that are lost or damaged due to repeated patient neglect, or any excessive extension of treatment due to lack of patient co-operation or change in treatment plan caused by the patient. 100% patient co-operation is especially important.
Regular adjustment appointments are suggested every 4-8 weeks. Our clinic will inform you at each visit about when you should come for your next visit. It is your responsibility to make and attend these appointments.
If you have not attended for any braces appointments for 4 months or more without prior acknowledgment from our clinic, your treatment will be affected and complications may arise from the negligence. This may necessitate referral to an external orthodontist to continue the treatment at your cost.
As updated records will be taken and a new plan will have to be made to correct for unwanted movement of the teeth, there will be a reactivation charge of $1070 (not including any other charges). The treatment time may also be longer.