05 February 2021

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Orthodontic risks: what should we tell our patients?

Davide Elsido

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Risk communication involves giving patients information about potential risks they may encounter as a result of a disease, a clinical procedure, or a particular behavior. An orthodontist may be liable to legal action by the patient and disciplinary proceedings if a patient is not given sufficient, meaningful, and balanced information about the risks of treatment. Effective communication of risk is a requisite for valid consent, shared decision-making, and the provision of person-centered care. The risks of orthodontic treatment have been defined broadly as any of the deleterious or iatrogenic effects of orthodontic treatment, or any potential adverse outcomes or consequences. 

The communication of risk is particularly difficult in orthodontics as care is often elective and it takes place over an extended period. Because of the considerable investments of time and resources, the potential harms must be carefully weighed against the anticipated benefits.

Although paternalism has no place within health care, neither does the abandonment of patients by health care professionals failing to contribute to the decision-making process. The principles of shared decision-making encourage health care professionals to use their expert opinion for the benefit of patients as part of the consent process. In addition, because of heuristic strategies to make quick and effortless decisions, patients often do not seek new information but rely heavily on health care professionals’ advice about treatment.

Today, no agreed standard for the content of discussions with patients about the risks of orthodontic treatment exists. 

This study, published on the January issue of the American Journal of Orthodontics, aimed to produce a professional consensus recommendation about the risks that should be discussed with patients as part of consent for orthodontic treatment. 

A serial cross-sectional survey was completed by 237 orthodontists who reached a professional consensus that 10 risks should be discussed as part of consent for orthodontic treatment; demineralization, relapse, resorption, pain, gingivitis, ulceration, appliances breaking, failed tooth movements, treatment duration, and consequences of no treatment.

The results of this study support the need for treatment providers to have the necessary knowledge and communication skills to explain orthodontic risks to patients effectively. 

Deciding what risk information should be given to orthodontic patients is a common clinical dilemma and has been made more complex by developments in consent law. To assist consent discussions, clinicians should consider discussing the salient risk information highlighted in this study.

For further information: Professional consensus on orthodontic risks: What orthodontists should tell their patients.