Emergency! Are My Teeth Supposed to Move Like This?
Most patients realize there is an emergency when a wire is poking, a bracket is loose, or there has been trauma to their mouth while wearing braces. Another kind of emergency occurs when unexpected movements of the teeth occur, even though there is nothing wrong with the braces themselves.
Unraveling process may make teeth look worse temporarily
During the first few months of treatment, there will be all kinds of tooth movement associated with your braces. As expected, most crooked teeth start to look better right away. As part of the straightening process however, some teeth that were once straight may actually look worse temporarily. Teeth that were together at the beginning of treatment may space apart or start to overlap. These unexpected changes are part of the unraveling process and are to be expected.
After the braces have been in place for several months however, patients should pay particular attention to their teeth and report unexpected changes to their doctor. This article outlines some of the things to look for.
Bent wires and loose brackets
You know that if you find a broken or bent wire or bracket that you should call your orthodontist and schedule a repair appointment. Loose brackets are sometimes hard to detect because they are held in place on the wire by rubber bands or steel ligature ties. One hint that there is a loose bracket is when a tooth that has been straight for several appointments suddenly moves out of alignment. The tooth may suddenly appear taller or shorter than adjacent teeth or suddenly move forward or backward. You should check your teeth daily to make sure that they are getting better and not worse, especially in the last months of treatment. If you see a tooth getting crooked, call your doctor on the next business day for a repair appointment.
Spaces develop between teeth
Spaces developing towards the end of treatment may also be a sign that there is a loose bracket or a broken chain. Waiting too long to get either issue fixed could delay the removal of your braces. Call your orthodontist on the next business day and get in within a week to avoid unnecessarily lengthening your treatment.
Over-correction of crooked teeth
Another emergency occurs when your teeth move TOO well. We call this "over correction." Over correction may occur anywhere in the mouth. Sometimes your doctor will need to create more space for a crowded tooth. He may place a spring on the wire to spread the teeth apart. In some patients the teeth move very quickly and it becomes obvious that the space is bigger than required. You should report this to your orthodontist on the next business day. This also occurs with each tooth. Your doctor might adjust your upper incisors because one is in front of the other. If the back tooth responds "too well," you might notice that it is now in front of the adjacent tooth. As before, report this to your doctor's office on the next business day.
Over-correction and over-expansion
Two other examples of over correction are over-expansion or over-constriction of an arch form. You might notice that the adjustment made by your orthodontist to fix a cross bite in the back of your mouth might feel better within a week of your visit and then suddenly feel "off" again. If the new wire causes your teeth to "overshoot" the desired bite, you need to let your doctor know. The same holds true for your elastic wear. If you are trying to fix an over bite and you gradually notice an under bite developing, you should say something. If you are wearing a rubber band to align the midline of the upper and lower arches and you notice that they are going too far, contact your doctor.
Pay close attention and call office when in doubt
These types of emergencies are especially important towards the end of treatment. Most of these problems are easy to fix and should not prolong your treatment if addressed right away. It would be a shame to show up to get your braces off and notice that you have a space between two teeth or that your midline is over-corrected. The key to finishing on time with excellent results is paying close attention to your teeth and communicating with your doctor.
NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.