Other items related to Informed Consent

Danielle Bauer Wheaton orthodontist

While these are not risks, there are topics that need to be discussed that pertain to orthodontic treatment. Anyone who is in orthodontic treatment needs to be aware of these topics!

1. TMJ dysfunction: The TMJ (temporo-mandibular joint) is the joint that connects the lower jaw to the skull.

Problems may occur in these joints, i.e., temporomandibularjoints (TMJ), causing pain, headaches or ear problems. Many factors can affect the health of the jaw joints, including past trauma (blows to the head or face), arthritis, hereditary tendency to jaw joint problems, excessive tooth grinding or clenching,poorly balanced bite, and many medical conditions.Jaw joint problems may occur with or without orthodontic treatment. Orthodontic treatment does not cause TMJ problems, not does it treat them. Symptoms may get better or worse while in braces, but it is mainly a coincidence. Any jaw joint symptoms, including pain, jaw popping or difficulty opening or closing,should be promptly reported to the orthodontist. Treatment by other medical or dental specialists maybe necessary.

2. Extractions (removal of teeth): Sometimes it is not possible to fit all the teeth in the mouth without removal of some permanent teeth. For example, if there is just too much crowding and aligning the teeth will cause damage to the surrounding bones and gum tissue, we need to have some teeth removed to fit everything in maintaining optimal health. I prefer not to have any teeth removed unless completely necessary. If extractions are necessary, you will be sent to your general dentist or oral surgeon to have them removed, and we will have a conversation about which ones will be removed and how we proceed.
I always place braces first (without wires), then send you to get the teeth out, the the wires will be placed a week later. This way there is no confusion as to which teeth should be taken out.
Look at my photos of patients who had extractions for various reasons. Notice no spaces will be left in the mouth-all the space gets taken up by the crowded teeth.

3. This is a BIG one that often gets overlooked. While rare, a patient can “outgrow” the orthodontic correction. This is more common in males than females, since males grow a little longer than females do.
The reason for this occurring is that the lower jaw follows a similar growth pattern to long bones of the body (the femur, or leg bone). If there is a large growth spurt, the lower jaw will have a growth spurt as well, leading to the look of a “strong lower jaw” or “underbite.”
Please visit the website on jaw surgery to read up on this if needed.
This is an unpredictable growth, which is why we don’t know it will happen (or IF it will happen). It occurs more frequently in patients with a family history of a strong lower jaw. If there is a family history, I need to know about it, as we can be more prepared for a growth spurt.
How do we manage this? Usually, we deal with what is happening at the time, so it is after orthodontic treatment is completed and the patient may need a surgical procedure to correct the jaw discrepancy. In this event, braces get placed on and we work closely with the surgeon on preparing for surgery. The surgeons I use are highly skilled in this surgery and have literally done thousands of these!!!

Again, this is rare and can happen to mostly males, but I have seen it happen to females as well. I just had a 14 year old girl in a few weeks ago who had full braces a few years ago (finished beautifully) and her lower jaw spurted out (unexpectedly of course), even though she was about done growing. Most female growth is finished about a year after they get their first period.

To clarify: orthodontics does NOT cause this to happen, the cause is an unexpected growth spurt after growth has finished (or we thought).
Again, this is rare, but needs to be addressed so we are all on the same page!!!


Danielle Bauer DDS, MS