0.9 The long term consequences of treatment

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I have already mentioned some of the consequences of orthodontic treatment such as facial damage and root resorption but there are other longer-term risks such as re-crowding and some such as gum damage which have only recently been recognised. Because patients prefer to avoid extractions Orthodontists currently go to great effort to avoid extracting teeth where possible. Some orthodontists and many general dentists use a screw appliance or an ‘ALF’ to expand the upper jaw to provide enough space for all the teeth. However this does not usually provide room for the wisdoms which they may say are unnecessary.

These are a simple way of avoiding extractions but the teeth usually re-crowd a few years later. This is avoided by many clinicians who give the patient a retaining appliance or attach fixed wires to their teeth either permanently or until they brake or are removed. Other clinicians avoid extractions for a while by pushing the side teeth back to make room for the front teeth but this tends to result in a flat looking face, it is then more likely that the wisdom teeth will become impacted and have to be extracted which can involve complex surgery.

Few if any orthodontists seem to use the Orthotropic method of lengthening the jaw as well as widening it. This makes much more room for the teeth and provided it is done by the age of 8 or 9 should always provide room for the permanent teeth including the wisdoms. This of course also takes the whole upper jaw forward improving the appearance of the cheek bones, sometimes dramatically. See the picture below.

Another long-term problem is gum damage which has more recently become recognised as a matter of concern. As we explained earlier the teeth and their supporting bone are normally supported by the tongue, lips and opposing teeth. But if the teeth are moved and held in a different position for a long time, such as with a retainer, the bone around them remains unstable and tends to resorb. The blood supply to the gums is carried through the bone and if it resorbs the gum often recedes or dies leaving what are called ‘fenestrations’ or holes which can severely shorten the life of the teeth.

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