What are the risks of orthodontic treatment and how can I prevent it?

Orthodontic treatment is safe and well-established — but like any medical or dental treatment, it is not without risks. Being informed about these risks and knowing how to prevent them is an important part of being an empowered patient.

1. Root resorption

Root resorption refers to a shortening of the roots of the teeth that can occur during orthodontic treatment. In most cases it is mild and clinically insignificant — but in rare cases it can be more significant.

Who is at higher risk?

• Patients with naturally short or unusual root shapes

• Patients undergoing longer treatment duration

• Patients requiring significant tooth movement

How to minimise the risk:

• Attend all scheduled appointments so your orthodontist can monitor progress with periodic X-rays

• Follow your dentist’s instructions carefully — unnecessary delays in treatment can increase the total duration and risk

• Inform your dentist of any previous dental trauma to affected teeth

2. Tooth decay and white spot lesions

Brackets and wires create additional surfaces for plaque to accumulate — and if oral hygiene is not maintained, this can lead to cavities or white spot lesions. White spot lesions are areas of early enamel demineralisation that appear as chalky white marks on the tooth surface and can be permanent.

How to prevent it:

• Brush after every meal

• Use a fluoride toothpaste and consider a fluoride mouth rinse if recommended (especially for patients at high risk of decays)

• Use interdental brushes and floss threaders to clean areas a regular toothbrush cannot reach

• Attend your regular dental check-ups and professional cleanings throughout treatment — do not skip them

• Minimise sugary and acidic food and drinks

• Need a product recommendation?

3. Gum disease

Poor oral hygiene during orthodontic treatment can also lead to inflammation of the gums — known as gingivitis — or in more severe cases, periodontitis which affects the bone supporting the teeth.

How to prevent it:

• Maintain excellent oral hygiene throughout treatment — brushing, flossing, and interdental brushing

• Attend regular professional cleanings — your hygienist or dentist can clean areas you may be missing

• Inform your dentist if your gums bleed regularly, are swollen, or feel tender

4. Relapse

Relapse refers to teeth moving back towards their original position after orthodontic treatment. Some degree of relapse is normal and expected — which is why retainers are such an important part of treatment.

How to prevent it:

• Wear your retainer as instructed — for most patients this means full-time initially for at least 6 months, then nightly long-term

• Never go extended periods without wearing your retainer — teeth can shift surprisingly quickly

• Understand that retention is a lifelong commitment — not just for a few months after treatment

• Contact your dentist promptly if your retainer feels tight, breaks, or is lost

5. Temporomandibular joint (TMJ) discomfort

Some patients experience jaw discomfort, clicking, or muscle soreness during orthodontic treatment. In most cases this is mild and temporary.

How to minimise the risk:

• Inform your dentist of any pre-existing jaw pain or clicking before treatment begins

• Avoid very hard and chewy foods that place excessive strain on the jaw joints

• Let your dentist know if you develop jaw discomfort during treatment so adjustments can be made

6. Allergic reactions

Although rare, some patients may have sensitivities to materials used in orthodontic treatment — such as latex, nickel in metal brackets and wires, or certain adhesives.

How to minimise the risk:

• Inform your orthodontist of any known allergies before treatment begins

7. Soft tissue irritation

Brackets, wires, and attachments can occasionally rub against the cheeks, lips, and gums causing irritation or ulcers — especially in the early stages of treatment.

How to manage it:

• Use orthodontic wax generously over any bracket or wire causing irritation

• Warm salt water rinses to soothe irritated tissue

• This almost always settles as the mouth adapts — usually within 2–4 weeks

8. Treatment taking longer than expected

Orthodontic treatment timelines are estimates — not guarantees. Broken brackets, poor compliance with wear instructions, and biological variability can all affect the duration of treatment.

How to keep things on track:

• Attend all scheduled appointments — missed appointments add time

• Wear aligners or elastics exactly as instructed — compliance directly affects results

• Avoid foods that break brackets

💡 Dr Watt's tip: The single biggest factor within your control is oral hygiene. I have seen beautiful tooth alignment achieved — only to be overshadowed by white spot lesions or gum problems caused by poor brushing during treatment. Your teeth being straight means very little if they are not also healthy. Please brush well 😊