At Home Orthodontic Treatment

Possible Risks Associated With Treatment

With the advent of online, at-home aligner companies, I feel it is my duty to help people make informed decisions about their teeth before they begin orthodontic treatment. The problem with doing treatment at home without a local provider monitoring your case is that many people have started without a proper exam from a dentist or orthodontist. So what are the main risks of moving your teeth in general?

Root resorption

A small percentage of the population is genetically predisposed to shortening roots during treatment. The root is the part of the tooth that is held in the bone and keeps the tooth firm in the mouth. When the root shrinks, the tooth can get loose. It’s usually a very minor side effect, but pre-treatment X-rays are essential to diagnose properly and assure patients that their teeth are healthy enough to move. Or at the very least, inform the patient that they may have a higher risk of root resorption and then allow the patient to make an educated decision. Failing to provide the patient with this information before starting treatment would be unethical. We can’t always predict exactly who is going to have major root resorption, and this is why most orthodontists take x-rays every 6-9 months during treatment to monitor the roots. Make sure you are having your teeth monitored by a licensed professional if you decide to do your treatment at home!

Gum recession

Most orthodontic treatment is expansive by nature. In order to make room for crooked teeth, rather than pulling adult teeth all the time, on many occasions orthodontists will expand to make room to straighten the crooked teeth. As we make space, teeth sometimes move to the outer edge of the bone in which they reside. This can create unwanted side effects of gum recession, where the gums start to shrink and the tooth becomes sensitive. While this side effect is usually rare, it has been reported to be severe in some situations and should be monitored closely. At the very least, your dental professional should explain to you if you are at risk of gum recession before you being treatment so that you can make an informed decision.

Bone loss

As we age, we all begin to lose bone around our teeth. Much like gum recession, as we move teeth to create space for crooked ones, we may lose some bone around the outer surface of the tooth. Bone loss eventually makes teeth loose. Patients with severe bone loss should NOT undergo orthodontic treatment of any kind without prior consent from a periodontist (a dental specialist that is an expert at diagnosing bone loss and level of severity).

TMJ pain

Most jaw-joint pain is muscular in nature. Patients who have jaw pain before starting treatment may or may not still have jaw pain during or after treatment. Straightening your teeth will not always make your jaw pain better, and in some cases, might make your jaw pain worse. For example, if straightening your teeth puts your bite in a worse position, patients may continually adjust their jaw to get a comfortable bite, and this will cause an overstimulation of those jaw muscles that will eventually cause pain. Make sure you see an orthodontist to help you understand the risks of aligning your teeth without bite correction.

Tooth flaring

When orthodontists straighten teeth without extracting any adult teeth, sometimes the front teeth tip forward depending on the severity of crowding. While the teeth are straight, they aren’t always esthetic when they tip forward. To help upright these teeth, orthodontists program their treatment torque to help upright the teeth. In some cases, we file in between the teeth to make them a little more narrow so we can eventually close the space and tip the teeth back. Sometimes just straightening the teeth can lead to unwanted flaring. Just because the teeth get straight doesn’t always mean they look good! If your case finishes as Bucky the Beaver, you’re not going to be happy. Orthodontists can help you decide what is the best treatment option to get you the best smile possible.


Whether you have braces or clear aligners, bad hygiene during orthodontic treatment can cause stains around your attachments (aligners) or brackets (braces). As long as proper hygiene is practiced during treatment, the incidence of stains is very low. When kids or adults don’t brush around their appliances, there is a high risk that when we remove them, there will be a white stain around the area that was missed during treatment. Please make sure you brush as well as you can during your treatment, and if you are wearing aligners or opt to choose at-home treatment, please brush your teeth and your trays before you put them back in your mouth – every time!

Black Triangles

This is one of the more common side effects during orthodontic treatment. When teeth are crooked, the gingiva (gums) gets used to being in a certain position for many years. We disrupt that gum architecture when we begin to straighten the teeth. Depending on the anatomy of the teeth, they may come together and form a natural contact at the bottom of the tooth away from the gums when they are aligned properly. If the teeth touch just at the very bottom (away from the gums), as they taper up toward the gum line, many will notice a space. We call it a black triangle. Even though the teeth are touching, space remains near the gum line unable to close because the teeth are already in contact. In order to close the space, we have to flatten the sides of the teeth to allow them to come together closer and make the black triangle disappear.

Please keep in mind that the majority of patients don’t have severe side effects from orthodontic treatment. Most patients have very few complications – which could be a byproduct of orthodontists who are particular and selective of every patient to assure their teeth are healthy enough teeth to undergo treatment. Remember, orthodontists do not charge 5x more than online companies. For simple cases that take 4-6 months, which is what the average treatment time is for these online companies, orthodontists usually charge 1/3 of what a normal 14-18 month case would take. Don’t be fooled – see a specialist and get the proper monitoring that should be accompanied by every medical or dental procedure.

Please reach out to us with any questions – we’d be happy to answer!