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D. Nguyễn Thành Trung
Dentist
Braces are the best solution for correcting misaligned teeth, bites and facial aesthetics. But quite a few patients regret getting braces because they suffer harmful effects.
Many people regret getting braces because of unwanted complications
The gap between a brilliantly successful orthodontic case and a complication sometimes comes down to an error in the doctor's calculation of force or the following factors:
- Braces given for the wrong indication, common in cases of severe skeletal protrusion or underbite, or where there is already serious bone loss or weak periodontal health…
- A doctor without expertise who makes an inaccurate treatment plan and cannot control the force.
- Poor-quality materials that irritate the soft tissue.
- Poor oral hygiene, allowing plaque to build up and leading to tooth decay and periodontitis during braces.
Behind the spectacular "transformation" photos after braces come off lies a long journey of perseverance with countless "hidden sides" that not everyone understands. Lac Viet Intech Dental will help you "unpack" the truth about the 13 most common harmful effects of braces. Understanding these risks is not meant to make you give up on improving your smile but to give you a complete picture so you can choose the right reputable clinic and a trustworthy doctor.
Braces act simultaneously on the roots, the alveolar bone and the periodontal ligament system. So unwanted side effects are hard to avoid if the technique is wrong. For the best results, let's go through the following 13 dangerous complications:
The brackets, the area under the archwire and around the bracket bases create low-oxygen "dead spots", ideal conditions for Gram-negative bacteria. These bacteria release lipopolysaccharide (LPS) endotoxins and protein-degrading enzymes, triggering a strong inflammatory response in the gingival crevicular fluid. So orthodontic patients must strictly follow the doctor's instructions on home oral hygiene to completely remove plaque and reduce tartar formation.
A patient with gingivitis due to improper cleaning
The tightening force itself also causes a controlled sterile inflammatory response for bone resorption and formation. Combined with toxins from plaque bacteria, this response turns into acute or chronic infection. Gingivitis and periodontitis are the main causes of bone loss and gum recession and shorten the life of the teeth.
At Lac Viet Intech, patients have their tartar removed and teeth cleaned at every check-up. If they develop gingivitis, the doctor will treat it and give home care instructions so it does not progress to periodontitis.
Tooth decay during braces is the result of changes in the chemical and biological environment of the mouth. It is a process in which demineralization happens faster than natural remineralization can keep up.
Decay at the necks of the teeth during braces due to improper cleaning
The 3 places that are hard to clean and prone to decay are:
- The necks of the teeth: where plaque builds up between the brackets and the gum line.
- Under the archwire: the bracket bases and edges are often missed when brushing horizontally.
- Around the molar bands: if the cement comes loose or leaves a gap, food gets inside, causing rapidly progressing decay under the metal.
An early sign of decay is white spots on the tooth surface, appearing only 4–6 weeks after brackets are attached if cleaning is poor. Plaque and tartar are home to Streptococcus mutans bacteria. They consume carbohydrates from leftover food and release acid right at the junction between the bracket base and the enamel.
The acid lowers the local pH below the 5.5 threshold. At this point, the hydroxyapatite crystals of the enamel dissolve, creating microscopic holes. Light refracted through these holes creates an opaque white color (white spots), signaling that the enamel is being "eroded" from the inside.
At the white spot stage, the doctor can control decay by applying fluoride varnish. This is also how the doctors at Lac Viet Intech Dental prevent the harmful effects of braces.
Root resorption can occur even without braces, usually due to periapical inflammation, root cysts, chronic pulpitis or trauma. So the doctor also needs to examine the roots carefully before braces.
Shortened roots make the teeth weaker
During braces, root resorption is the result of the doctor not controlling the orthodontic force. Orthodontic force that exceeds what the periodontal blood vessels can tolerate causes hyalinization. To clear this dead tissue, the body mobilizes phagocytes. If the force remains too strong or lasts too long, these cells not only consume the necrotic tissue but also erode the cementum protecting the root, leading to root shortening.
According to statistics, up to 90% of orthodontic patients have microscopic root resorption. This is completely normal and does not harm the teeth. About 1 - 5% of patients experience excessive root resorption, meaning more than 1/3 of the original root length is lost. The upper central incisors are most prone to resorption because they usually move the furthest.
The doctor needs to take regular X-rays (every 6–12 months) to compare root length. If root resorption is detected early, the only solution is to pause the force for 2–3 months so the root tissue has time to restore its protective cementum.
Many people think bone loss and gum recession are harmful effects of braces that appear in old age. However, this complication can occur during braces due to 2 causes:
- The doctor does not accurately assess the initial condition and cannot control the orthodontic force.
When the force exceeds the tissue's self-repair threshold, the blood vessels in the compression zone are squeezed, causing "hyalinization". Instead of resorbing bone directly at the surface, the body then has to mobilize osteoclasts from the nearby bone marrow. As a result, the root becomes very loose and the alveolar bone cannot rebuild in time.
Severe bone loss exposes the roots
To prevent this, the doctor must carefully assess the patient's bone before braces and control the orthodontic force. Lac Viet Intech patients have Cone Beam CT scans and precise force calculations with the support of the most advanced orthodontic solutions.
- The patient does not clean their teeth as instructed or attend check-ups on time.
Toxins from Gram-negative bacteria destroy the connective fibers and the attached epithelium around the necks of the teeth. Without the support of the alveolar bone (which has been resorbed), the gum margin automatically shrinks back toward the root tip to maintain the biological width.
So to protect a strong foundation for the teeth, choosing a highly skilled doctor and the patient's own self-discipline must come first.
Ankylosis is usually the result of serious trauma damaging the periodontal ligament. So before braces, patients should tell the doctor if a tooth has ever been knocked or injured so the doctor can screen carefully with a Cone Beam CT scan.
Ankylosis is considered a harmful effect of braces if it occurs because tightening force exceeds the load capacity, breaking the ligament system and the nourishing blood vessels and allowing bone to invade the root surface. An ankylosed tooth does not move as planned at all and can pull the surrounding teeth out of alignment toward it. The body recognizes the root as bone and begins to eliminate it by replacing the tooth tissue with bone, gradually shortening the root until it disappears.
If a tooth is found to be ankylosed during braces, the doctor usually has to change the treatment plan. Ankylosed teeth are very firm, so they can be used as anchorage to pull other teeth. If the ankylosed tooth is in a seriously misaligned position that spoils aesthetics or obstructs the bite, it may need to be extracted and restored with an implant.
Temporomandibular joint disorders in orthodontics occur through three main effects:
- Temporary bite changes: tooth movement creates "premature contacts", and the jaw muscles contract abnormally to find a new closing position, causing aching facial muscles.
- Displaced condyles: excessively retracting or pushing the jaw with strong force can force the condyle out of its central position in the socket. If the condyle is pushed back, it compresses the tissue behind the disc, causing pain and a "clicking" sound when opening the mouth.
- Inter-arch force overload: using inter-arch elastics for the wrong indication or with too much force for a long time stretches the joint ligaments and displaces the disc forward.
This complication is caused by the doctor not screening the joint with X-rays before braces, so the treatment plan focuses only on "straight teeth" and overlooks the "functional bite".
Temporomandibular joint disorders cause a clicking sound when moving the jaw
Patients who grind their teeth or clench their jaw under stress without control, increasing pressure on the joint during braces, can also develop temporomandibular joint disorders.
However, temporomandibular joint disorders are not necessarily a harmful effect of braces. About 15–20% of people already have latent joint disorders, and incorrect braces "trigger" an acute flare-up. When there are signs of pain or limited mouth opening, the doctor must stop the tightening force to stabilize the joint before continuing.
Pulp damage is considered the most dangerous complication in orthodontics. It results from a combination of incorrect force and existing damage.
- Caused by the patient having untreated tooth decay
Braces increase the risk of tooth decay if the patient does not clean properly. When a cavity progresses quickly without being filled in time, bacteria enter the pulp chamber directly, causing infection.
- Caused by the doctor not controlling the orthodontic force
When the doctor uses orthodontic force beyond the physiological level, moving teeth a long distance in a short time, the root is pressed hard against the alveolar bone plate, deforming or blocking the blood vessels entering the root tip and causing local ischemia. The pressure inside the pulp chamber then rises.
Teeth with dead pulp become discolored, brittle and easily broken
Because the pulp sits in a "sealed box" of enamel and dentin, it has no room to swell. This pressure compresses the nerve fibers, causing severe or dull pain depending on the degree. If the compression lasts, the blood supply is completely cut off, and the pulp moves from acute to chronic inflammation and finally sterile necrosis.
To eliminate this risk, the doctor needs to examine Cone Beam CT scans carefully before braces and keep the orthodontic force light and continuous.
Not every body is fully compatible with orthodontic materials. Continuous contact with a foreign object in the mouth can trigger unwanted immune reactions:
- Irritation from nickel in metal brackets: in sensitive people, this substance can cause widespread redness, itchy gums or persistent mouth ulcers. If the doctor does not detect it early and switch to titanium or ceramic materials, the inflammation may spread and interrupt tooth movement.
- Latex allergy from elastics: some inter-arch elastics or separators made from natural rubber (latex) are a potential allergen. Prolonged latex allergy wears down the health of the periodontal tissue, weakening the ligaments around the teeth and leading to the risk of loose teeth or early gum recession during treatment.
You should prefer reputable dental clinics that commit to using genuine brackets and appliances of clear origin to ensure the highest biocompatibility. In particular, do not hesitate to tell the doctor in detail about any history of metal or rubber allergies; this lets the doctor switch to safe alternative materials such as ceramic brackets, titanium or non-latex elastics, protecting the gums and alveolar bone throughout orthodontic treatment.
Mouth ulcers and sores on the lips and cheeks are harmful effects of braces that almost 100% of patients experience. These sores usually appear right after appliances are attached or archwires are changed.
90% of patients get mouth ulcers during braces
From a clinical perspective, the mechanisms behind this include:
- Mechanical trauma: the angular parts of brackets, excess archwire or hooks constantly rub against the lining of the lips and cheeks when talking or chewing. This friction breaks the epithelial barrier, forming localized erosive ulcers.
- Soft tissue irritation: in the early stage, the mouth lining has not yet "toughened" to adapt to the appliances. The lips and cheeks being stretched excessively over the brackets increases local pressure, causing mild ischemia and forming ulcers.
- Hygiene and infection: small scratches that are not kept clean become entry points for opportunistic bacteria, causing ulcers to spread, swell and heal slowly.
Understanding this, Lac Viet Intech Dental gives patients free dental wax. The doctor needs to show patients how to use dental wax to cover sharp spots and use protective gels on the mouth lining. After about 1 week, the lining adjusts and the condition eases significantly.
Teeth loosening during orthodontic treatment is an inevitable biological response within the permissible limits of alveolar bone resorption and formation. This process creates a physiological space that gives the teeth slight mobility of 0.2–0.5 mm. It is a positive sign that the teeth are moving as planned. The feeling of tightness and soreness usually lasts only 1–3 days after each tightening and gradually settles as new bone forms around the roots.
Teeth usually feel loose when the brackets are first attached
Loose teeth during braces become abnormal when mobility exceeds the physiological level. A tooth may move horizontally >1mm or show signs of sinking or rising vertically. Clinically, this is the result of orthodontic force too strong for the periodontal tissues to tolerate, leading to occlusal trauma or alveolar bone loss exceeding 20–30% of the root length. Accompanying warning signs include periodontal pockets deeper than 3 mm, persistently red and swollen gums, or sharp pain lasting more than 7 days without easing.
The cause may be imprecise force control or progressive periodontitis destroying the tooth-supporting system. To ensure safety, when these extreme symptoms appear, the doctor needs to take periapical X-rays to assess bone density and adjust the force system immediately.
Hollow cheeks and temples during orthodontic treatment are actually not a harmful effect of braces but the result of changes in soft tissue and muscle function. There are 3 main mechanisms behind this:
- Loss of fat pads: a restricted diet of soft foods and anxiety cause overall weight loss, making the already thin cheek and temple fat disappear.
- Muscle atrophy from reduced function: limiting chewing of hard foods or chewing on only one side weakens and flattens the masseter and temporalis muscles, creating deep hollows and making the cheekbones look higher.
- Changes in the supporting framework: excessive retraction of the front teeth or uncontrolled narrowing of the dental arch removes support for the soft tissue of the lips and cheeks.
This condition can fully recover after braces are removed if the patient maintains physiological chewing force and stable psychology and nutrition.
Many people mistakenly believe bad breath is a harmful effect of braces. However, not everyone with braces has bad breath, and many people without braces have bad breath too. Patients need to clearly distinguish between a temporary reaction and a sign of disease.
Patients may have bad breath if they do not clean thoroughly
Normally, brackets, archwires and supporting appliances such as inter-arch elastics create countless "blind spots" where food plaque easily builds up. Even with thorough cleaning, the presence of a foreign object in the mouth can slightly change the pH of saliva, causing a different breath odor 1–2 hours after eating or right after waking up. This is a purely mechanical issue that can be completely resolved by controlling plaque through brushing, rinsing and cleaning the tongue.
Bad breath becomes abnormal when the unpleasant odor persists despite local cleaning, usually accompanied by progressive periodontal disease. If the breath has a strong bad smell combined with red, swollen gums that bleed when brushing or periodontal pockets deeper than 3 mm, this is a sign of overgrowth of anaerobic bacteria such as Porphyromonas gingivalis. It is more dangerous if pus appears around mini-screws or under molar bands. This sign warns of the risk of spreading infection and alveolar bone loss.
In safe movement, teeth move within the limits of the alveolar bone plate at an average speed of 0.5–1 mm per month, ensuring bone always forms to cover the roots. The thickness of the outer or inner bone plate must remain at least 0.5 mm to ensure blood supply and keep the supporting structure firm. This is a controlled "translation" process in which bone-forming cells work in harmony to keep the roots always inside the jaw's protective "shell".
A root pushed out of the alveolar bone
This condition becomes abnormal and dangerous when the root is pushed through the alveolar bone plate and exposed under the mucosa. Clinically, the main cause is uncontrolled external force. Patients may have roots pushed out by accidents or injuries in daily life.
Rarer is the case where the doctor uses force beyond the physiological threshold or in the wrong direction, causing the tooth to tip excessively instead of moving bodily. Excessive force pushes the root hard toward the thinnest bone plate. If the bone base is thin or of low density, this force means bone cannot form in time, leaving no bone around the root.
To treat it, a Cone Beam CT scan is needed to assess how much root is exposed, followed by immediately reversing the force direction or performing bone graft surgery to save the periodontal structure.
As you can see, most of the complications and problems above stem from 2 factors: incorrect orthodontic technique and patients not following care and hygiene instructions. So Lac Viet Intech has taken many measures to prevent these conditions:
Lac Viet Intech always values the human factor, so its orthodontists are among the leading orthodontic experts in Vietnam. Many of them are members of prestigious international orthodontic organizations such as WFO and AAO… The doctors also continuously update the most advanced treatment techniques through professional training courses with experts in Vietnam and abroad.
The doctors at Lac Viet Intech are members of prestigious orthodontic organizations
Close control of the treatment journey by these "golden hands" helps detect abnormal signs early and adjust promptly, completely eliminating the risk of complications from incorrect technique.
Lac Viet Intech commits that 100% of its brackets, archwires and aligners are genuine imports from the world's leading dental corporations such as 3M, Ormco and Invisalign. These appliances are made from premium materials with excellent biocompatibility and refined designs that maintain stable force according to the treatment plan.
Transparency about origin not only protects patients' overall health but also keeps orthodontic progress on track, minimizing incidents of appliances coming loose or breaking and damaging the mouth.
Lac Viet Intech affirms its leading position by applying modern technology systems and digitizing the entire orthodontic process to prevent risks from the planning stage. Instead of guessing from experience, the doctor makes the whole process and results concrete through simulation images and videos. This allows the doctor to screen for complications and gives patients a complete view of their treatment journey.
Beyond improving its doctors' skills and updating modern technology, Lac Viet Intech commits to comprehensive care for patients throughout treatment through gift packages of items (water flossers, interdental brushes, dental floss, …) or services.
Before the brackets are attached, patients have their teeth cleaned and any oral diseases treated. During treatment, patients receive free decay screening, gingivitis treatment, scaling and X-rays. After the brackets are removed, patients still receive free follow-up X-rays for the number of times specified in the contract.
The harmful effects of incorrect braces can have serious consequences for health and aesthetics, but we can actively prevent them by choosing the right reputable dental clinic. Entrusting your smile to a clinic that brings together modern technology, highly skilled doctors and comprehensive care is the best "insurance" for your orthodontic journey. Come to Lac Viet Intech today for an examination and advice on a safe, scientific treatment plan that avoids dangerous complications!
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