Unacceptable or inappropriate orthodontic treatment


Our experienced dental negligence lawyers understand the anxiety, uncertainties and frustration that may arise when orthodontic treatment does not go to plan or gives an unexpected outcome. We also understand the practical problems and social embarrassments that may be caused by unwanted or unexpected changes in appearance.

Dental claims and dental negligence law is a very specialist area. Our team have helped many people make successful claims and receive compensation for their injuries as well as for any corrective treatment that may be required.

What is orthodontic treatment?

The word ‘orthodontic’ comes from the Greek meaning ‘straight teeth’.

Orthodontic treatment works by putting gentle pressure on teeth to encourage bone growth on one side and bone resorption (dissolving) on the other. It is the gentle but sustained pressure that causes gradual changes in the bone so that a tooth can move through it and so change its position.

Problems with orthodontic treatment

It is not uncommon to experience some discomfort in the teeth when new or newly increased pressure is applied. This is quite normal and usually resolves after a day or two. Your dentist or orthodontist should explain this to you and advise on any analgesics (pain relief) you may wish to take.

If orthodontic movement occurs too rapidly, the nerve and blood supply to the tooth may be disrupted and cause an irreversible pulpitis (death of the nerve in the tooth). If irreversible pulpitis occurs, the tooth will require root canal treatment and will have to be very carefully assessed before any further orthodontic treatment can be undertaken.

Before starting any type of orthodontic treatment, it is important to be told how to look after your teeth and gums whilst wearing the orthodontic appliances (whether fixed or removable).

The failure to receive preventive care and/or advice may result in permanent discolouration of the teeth or even tooth decay.

Dental negligence and orthodontics

Most dental negligence claims for orthodontic treatment involve wrongful tooth extractions although some claims arise as a result of the orthodontic appliance (brace) itself, whether fixed to the teeth or removable.

Dental negligence claims may also arise as a result of an incorrect diagnosis of the underlying cause(s) of the crowding/occlusal problems and the implementation of an inappropriate orthodontic treatment plan.

Wrongful tooth extractions

In the context of orthodontic treatment, a wrong tooth may be extracted as a result of errors in either writing or reading which tooth requires extracting. This seems to occur more frequently when a specialist orthodontist requests extractions to be carried out by another dental professional, perhaps the patient’s own dentist or an oral surgeon.

Dental negligence may also occur as wrongful tooth extractions when undergoing surgery to remove supernumerary (extra) teeth or to surgically expose unerupted teeth, in particular upper canines (‘eye teeth’).

Orthodontic solutions after wrongful tooth extraction

If the wrong tooth is extracted prior to starting orthodontic treatment, it may be possible to change the orthodontic treatment plan in order to take account of the unexpectedly missing tooth. Sometimes, this can still produce a pleasing appearance and comfortable bite – although the amended orthodontic treatment may take longer than the original treatment plan.

Alternatively, the unexpected loss of the wrong tooth may be a devastating blow and require changes in the original orthodontic treatment plan to keep a space for a replacement tooth when the orthodontic treatment has finished.

Whilst It is one thing to accept orthodontic braces (whether fixed wires or a removable appliance) in the knowledge that your smile will be so much better when the treatment has finished, it is quite another thing to live with an unwanted and unnecessary gap while wearing those braces, especially if the gap is obviously noticeable.

Permanent tooth replacement after orthodontic treatment

The options for the permanent replacement of a single missing tooth are either the placement of dental implants to support a crown or a bridge.

Although an implant will ensure that adjacent teeth are not affected by being used as abutments to support the bridge, implants require good oral hygiene and most importantly, no smoking in order to have the best longevity. It is therefore essential that good preventive care and/or advice is given before embarking on this treatment option.

If an implant is contra-indicated, the only other way of permanently replacing a tooth is by inserting a bridge. However, this usually means that at least one adjacent tooth needs to be adjusted, reshaped or even completely cut down in order to make space for the support of the bridge. It is also important to be told how to maintain good oral hygiene around the bridge in order to prevent tooth decay and/or gum disease.

It is sensible not to place implants or insert a bridge until at least the age of 16, so a child may have to wait and continue with orthodontic treatment in order to maintain the space. Alternatively, it may be possible to add a false tooth to a removable retainer. This option will both maintain and fill the gap, so improving cosmetics while keeping the other teeth in their new position.

Unacceptable or inappropriate diagnosis and/or treatment planning

Occasionally, the initial orthodontic assessment fails to correctly diagnose the cause of the need for orthodontic treatment. For example, there may be a more complex problem arising from the relationship between the upper and lower jaws (for example, they may be disproportionately sized or asymmetrically positioned).

Orthodontic treatment can only reposition teeth within the confines of the jaw bone. If the jaws are not correctly aligned with each other, there is only so much that orthodontic treatment can achieve.

If there is an underlying skeletal discrepancy between the upper and lower jaws, this requires a comprehensive maxilla-facial assessment to see if surgery is required to change the position of one, or even both, jaws before any orthodontic treatment can be considered.

Even if you do not want to have major surgery to correct a skeletal discrepancy and decide to accept a compromised orthodontic plan (or indeed none at all), it is important that you are given comprehensive information about the treatment options. This is so that you can give your full and informed consent for the surgery or any compromises within the orthodontic treatment plan.

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