What Happens if Braces Stay On Too Long? When to Worry

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If you’ve been in braces for years, you may be feeling frustrated and ready for the treatment to be over. After treating so many patients who have had braces on for longer than three years or more, I completely understand your worries. It is possible to keep braces on for too long, and in this article I’ll explain possible consequences.

Braces can take longer than planned for multiple reasons. Sometimes it’s because the patient doesn’t follow instructions as well as they should. Other times, it’s because the treatment plan wasn’t thought out properly. And, let’s be real, sometimes it’s just because the orthodontist isn’t the best at their job. All of these things can drag out treatment.

So if your orthodontic treatment is taking way too long, here’s what I recommend you do:

1. Make sure your actions didn’t prolong the treatment time;
2. Seek a second opinion;
3. As a last resort, switch orthodontists OR get your braces off early.

I’m sure you have plenty of questions, and hopefully, I can help you with some honest answers. Extended treatment times are more common than you might think, so you’re not alone in this. When things don’t go as planned, we often need to compromise, so let’s see if that’s your case.

How long is too long for braces?

On average, treatment with braces can take anything between 18 to 30 months, but that varies a lot depending on case severity and patient compliance.

I’ve rarely treated patients in full braces for less than 18 months unless the correction they needed was really minor, and rarely went over 3 years of treatment time. But life can get in the way (hello, 2020) and some patients fall off the radar only to return months or even a year later to continue their treatment.

If you’ve been in braces more than 3 years, I’d strongly recommend talking to your orthodontist about it. Some challenging cases do need 3 years or more to achieve all the planned movements, and most patients are aware of their situation. But, in my opinion, anything more than 3 to 4 years is excessive.

Keep in mind, when I say 4 years, I mean 4 continuous years with braces bonded on your teeth. This doesn’t include Phase 1 if you’ve had to wear appliances or braces as a child, and it doesn’t take into account getting braces twice or more.

With clear aligners like Invisalign, treatment time should be even shorter, so 3+ years is definitely excessive, not to mention expensive. But if you’re one of those extreme cases that need a multidisciplinary approach, I’m sure you’ve already discussed it with your orthodontist.

Note: there are some ways to speed up braces slightly, but a few months won’t make a significant difference. If you’re curious, check this article on how to make braces work faster.

So here’s the question on everyone’s mind: Why do treatments drag on like this?

I touched on this subject in the intro, but let me go into more detail. When the patient is at fault, it’s usually because they’re not taking care of their braces and not wearing their elastics. Broken brackets reverse progress, and a lack of compliance with rubber bands really limits what we can achieve. So, in the end, we either accept a compromise or keep the patient in braces longer hoping compliance will be better (hint: it almost never happens).

When the doctor is the problem, it’s usually because their assessment of the patient was superficial. The treatment didn’t go according to plan, because the plan was faulty from the start. Orthodontic treatment times can also drag on because orthodontists are often too busy to do what needs to be done at each appointment.

What side effects can braces have if left on for too long?

Leaving braces on for an extended period of time can potentially lead to a number of side effects, including:

Out of these 5 side effects, cavities and white spot lesions are what you should be worrying about the most. Cavities permanently scar teeth, and you may even end up needing a root canal to treat deep lesions, and a crown to protect your compromised tooth.

This is why it’s so important to brush thoroughly and use a powerful electric toothbrush.

Decalcifications like white spot lesions may heal after taking braces off, but they’ll look unflattering (think chalky white squares on your teeth), so you’ll need fillings to mask them, or even costly veneers. Some patients may see brown spots on their teeth, which means that the decalcifications have turned into cavities.

Not all patients will experience gum recession after an extended time in braces. It all depends on the level of oral hygiene they’ve committed to. But inflamed gums are a cause for concern with most orthodontists, and in some extreme cases, we may even take braces off early to allow the gums to heal.

Root resorption and TMJ issues are pretty rare. While most patients experience some root resorption, it’s usually clinically insignificant, and won’t affect the health of their teeth long term. This is true for long treatment times as well, because teeth don’t always move for the entire duration of orthodontic treatment.

How long can you go between appointments?

If you haven’t been to your orthodontist in months, then you probably know what’s taking so long. My obvious advice is to see your orthodontist as soon as possible.

However, if that’s not an option for you at the moment, know that you can safely go 3 months between appointments, provided that your braces are secure and you don’t have any loose brackets or poking wires.

This, of course, isn’t ideal, and it will slow down treatment time, but it’s fine if it happens once or twice throughout your journey with braces. During the 2020 lockdown, like most people, we had to put our plans on hold for many months, and only saw some patients after about 2-3 months.

Another scenario is treating pregnant women. I have an entire article on this and it’s not uncommon to take a break from orthodontic treatment for 3-4 months or more. If we know in advance about special cases like pregnancy or travel, we can better secure the braces and put passive wires in place.

Can a dentist adjust braces?

Ideally, you should always go to your orthodontist to tighten your braces, but if you’re moving or traveling, it’s not always possible. So, in cases of emergencies, it’s absolutely fine to go to a different orthodontist or even a dentist to check your braces.

Not all dentists are equipped to change ligatures and handle braces emergencies like broken brackets, so check with the office before you go. Expect only to get your emergencies handled, though. No dentist will change wires or help the progress of your treatment if they don’t know your case.

And if you’re looking for a dentist to take over your case, I’d strongly recommend you go with an orthodontic specialist instead, since braces aren’t taught in dentistry school and you need to go through a residency or take special courses in orthodontics.

Can you get Your braces off early?

If it’s been years and your progress has stalled, it’s best you have an honest conversation with your orthodontist while also seeking a second opinion. Sometimes, teeth just move very slowly and the treatment doesn’t progress according to expectations.

So if your braces have been on for longer than 3 years and your orthodontist wants to keep going, you need to check a few things:

• Are all the gaps between your teeth closed?
• Is your bite stable enough?
• Are you happy with how your teeth look?

If the answer to all of the questions above is YES, then getting your braces off earlier than your orthodontist recommends may be okay. MAYBE. It’s usually a situation where you and your orthodontist need to reach a compromise, and you need to be informed of all the risks.

As a patient, you have full control and can request to have your braces taken off early at ANY point throughout orthodontic treatment. We’ll have you sign some forms, but ultimately, it’s your decision.

Keep in mind, though, that many patients insist on taking their braces off early only to get them again later in their lives. That’s fine too, and if you’ve been in braces for years with disappointing results, a break might do you good. You might opt for clear aligners the second time around – they’re more comfortable and you can take them off any time.

Conclusion

It’s understandable to feel fed up after being in braces for a long time. As an orthodontist, I don’t enjoy overtreating my patients or extending treatment times longer than necessary. While it may not be possible to significantly reduce the overall treatment time, we can consider the pros and cons and decide to remove the braces before treatment is fully completed. It’s all about finding the right balance and making the best decision for you.