Orthodontics and Periodontal Disease

Does having periodontal disease mean I can’t or shouldn’t have braces to straighten my teeth?

Periodontal disease, when active, results in bone loss around teeth.

Orthodontics involves moving teeth through bone to relocate them in better places for both appearance and function.

The process of moving teeth activates bone cells to remove bone in front of the moving tooth and lay new bone down behind it. All of this occurs due to the light forces being applied by either wires or appliances patients must wear over the months necessary to accomplish the task.

What is not helpful, as active orthodontics is taking place, is to have a bacterial infection and inflammatory response going on at the same time.

This does not mean, however, that people who have had periodontal disease treated and controlled cannot undergo orthodontic procedures. In fact, sometimes this is desirable because it moves teeth to positions that are more easily cleaned.

So let’s discuss how someone might proceed through orthodontics who has or has had periodontal disease.

  1. Make sure the periodontal disease is under control. Do not start orthodontics until released by the dentist involved with treating this condition.
  2. Understand the risk to each tooth before starting orthodontics as well. If a tooth has a poor or questionable prognosis (outlook for future retention and stability), it may be best to remove the tooth before starting treatment.
  3. Commit to on-going periodontal supportive care at a tighter interval to assure that periodontal disease does not recur. Usually following active periodontal therapy involving surgical procedures it is wise to be on a three-month supportive care interval for the first year. However, when starting orthodontics, this interval should be cut in half. This means having supportive periodontal therapy every six weeks through active therapy and starting this care within a few weeks after initial banding, bracketing or using aligners. If over time, it can be shown that conditions are stable enough, the interval can be stretched.
  4. Once active orthodontics is completed another comprehensive periodontal evaluation needs to be performed in order to see if any problems have developed that need to be addressed before returning to supportive periodontal therapy. There are cases where orthodontics vastly improves pocket depths, but nothing can be assumed and after-treatment measurements are very important.

If a tooth is lost because of orthodontics, does this mean that it was a bad idea to have the teeth straightened?

To answer this question, let me ask another one. Should a weak tooth or teeth dictate decisions for people? Keep in mind that teeth of this nature can easily be lost without orthodontics. Perhaps orthodontics accelerates a process but it doesn’t cause periodontal disease. Certainly as much as is possible it is good to predict possible outcomes in order to prepare for what might happen, but let’s remember that there are ways to exchange weak teeth with dental implants. This can actually result in a stronger longer lasting tooth or teeth over attempting to hold on to weak ones a little longer.

Which brings me to my final point when planning orthodontics.

If you need a dental implant but you also are considering having your teeth straightened in the future, please let your dentist know. Dental implants, once placed, do not move like teeth do. For this reason, dental implants are often placed after orthodontics is completed. There are exceptions to this because many dentists and orthodontists use dental implants as anchors for moving teeth.

So in conclusion, if you want your teeth straightened and you have or have had periodontal disease, discuss this with everyone who will be involved with your care during the planning stage. Periodontal disease must be under excellent control and managed throughout the process of active orthodontics and dental implants may need to be delayed until active orthodontics is completed.

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