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The “colours” are tiny elastic rings which are mostly used to hold the wires into the brackets on your teeth. They are readily available in many different colours so you can personalise your brace. Most orthodontists are happy to offer the colour of your choice. You should be aware however that certain types of bracket are not designed for use with elastic rings and colours are not an option in such cases. Your orthodontist can advise you.

Most children begin treatment around the age of 12 or 13, once all their permanent teeth have erupted. In a few instances treatment is better started early and your dentist may want to make an earlier referral. But age is not a barrier to treatment and the number of adults seeking treatment is on the increase.

No, not really. Teeth can be moved at any age as long as the teeth and gums are healthy. Adults are not usually eligible for NHS treatment so most commonly have to pay for treatment. This gives a wider range of types of braces that can be used.

The expectations from treatment may be different in adult patients, e.g. adults may want different treatment endpoints. This is something that should be discussed with you by your orthodontist when outlining the treatment options.

There are 6 simple questions that you need to ask:

• How long will my treatment take?
• Will the end result be stable?
• Will I have to wear retainers? If so, for how long?
• What are the risks of treatment?
• How much will the treatment cost in total? Does this include any breakages and retainers?
• Will I be treated by an orthodontist/dentist or an orthodontic therapist?

There are a number of things that may go wrong with brace treatment since the teeth are part of a complex biological system involving the gums, jaw bones and facial muscles.

Examples include:

• Issues with the gums including gum disease or gum recession if the teeth are pushed out of the jawbone if there is not enough space for all your teeth.
• The way the teeth bite together can also be affected:
  • The teeth bite up into the gum of the roof of your mouth causing soreness.
  • The opposite can be true where the contact between your teeth is less, so reducing biting efficiency.
  • The top teeth can be pushed out to make them appear to ‘stick out’.

One of the most common problems that can occur is that teeth tend to return to where they came from once the treatment is finished – this is called ‘relapse’. This is often seen where there were spaces between teeth and very twisted teeth at the start. This particularly happens where the treatment is very quick or retainers are not provided appropriately (teeth can take at least a year for the jawbone and gums to settle).

Orthodontic treatment

Teeth and brace friendly food and drink

The tissues and bone around the roots take time to adjust to the new tooth positions and there is a particular risk of relapse in the early months after the brace is removed. Even in the longer term the risk of relapse remains and the best advice is to continue retention for the long term. BOS believes retainers are essential and should be universally recommended.

Retainers may be removable or fixed – here are the key differences:

Removable retainers may be worn full-time initially, but reduced to night times later or night times only from the start of the retention period. Your orthodontist will advise you on when to wear your retainer. They are effective but obviously depend on you remembering to wear them. They will need occasional repair or replacement, a relatively simple task although you may be charged for a replacement.

Fixed retainers are usually glued to the back of the teeth. They are therefore in place all the time. A high standard of tooth cleaning in the vicinity of the retainer is essential to avoid gum problems. They do need regular inspection because if any of the glue fails, the tooth in question may start to drift out of position. For this reason it is essential for the patient to contact the orthodontist at once if there is a breakage. Some general dentists are unhappy about repairing a fixed retainer and a visit to an orthodontist might be needed under these circumstances.

Retainers Patient Information Leaflet

Probably not, as changing orthodontists is best avoided if possible as orthodontists work in different ways with different appliances and a transfer is likely to mean a setback in the progress of your treatment. Nevertheless, there are times when a transfer cannot be avoided and your orthodontist should be able to find someone to take over your treatment at your new location. The NHS makes full provision for a transfer of treatment between orthodontists.

It is undoubtedly preferable not to start treatment with one orthodontist and then to move on to another orthodontist in a different location. If you know you are about to move, it is better to wait until you have arrived at your new location. Most orthodontists would strongly prefer to treat a case all the way through and not have to step in part way through.

Research has shown that treatment takes an average of six months longer in transfer cases. Patients who are moving to another location should give the orthodontist as much notice as possible and ask them to find an orthodontist at the new location. Ask for a referral to the new orthodontist with a history of the treatment so far. Ask for the study models and x-rays to be sent on or to be given to you to take with you to the new orthodontist.

The BOS provides a transfer form on the BOS website for members to use.

Under the NHS contract, since 1st April 2006 there has been no official obstacle to changing orthodontists. Orthodontists with NHS contracts can accept an NHS patient who has moved from another part of the country (or from overseas) and who is already undergoing orthodontic treatment. If you started NHS orthodontic treatment under 18 years of age but have become over 18 by the time you moved, you may still be permitted to continue with NHS treatment but your new orthodontist will need to get permission from the Primary Care Trust or Local Health Board.

Yes definitely, the orthodontist only looks after the braces. Your teeth are actually at greater risk during orthodontic treatment and it is particularly important that you keep up regular contact with your own dentist.

How to keep your teeth and gums healthy: general information about keeping your teeth and gums clean and in great shape for braces

You will usually need regular appointments every four to ten weeks. It is not advisable to start treatment if you know you will not be able to keep these appointments.

A degree of discomfort is likely to start with. You can expect some aching and tenderness in the gums as your teeth begin to move, but this normally wears off after a few days.

Fitting the brace should not be painful. For a fixed appliance, the brackets are simply glued to the faces of the teeth; metal bands may also need to be cemented round the back teeth. No anaesthetic is needed.

As the biological processes get under way round the tooth roots to allow the teeth to move, you can expect some aching and the teeth will be tender to bite on. This usually settles down in a few days, although some patients do experience a degree of tenderness for a longer period. The amount of discomfort varies enormously from person to person. It may be helpful to take normal painkillers for a day or two.

Some further discomfort may be experienced when the brace is adjusted subsequently, but this depends very much on what adjustments have been made.

Find out about some of the problems that can occur during brace treatment as well as how they can be prevented below.

Orthodontic treatment

Simple teeth straightening can sometimes be carried out as quickly as in 6 months; particularly if it’s only the front 6 teeth. However, a relatively short treatment like this usually produces limited changes. This is not always a long-term solution as often there isn’t enough time to move the whole tooth, including the roots, into the right place. This may mean the teeth may quickly move back to their original positions once the braces are taken off. It often takes between 1 or 2 years to get the teeth to bite together in a better way, in harmony with the jaws and lips. It may take longer for more difficult problems.

Every course of orthodontic treatment needs to be tailored to the needs of the individual patient. In some patients, adults as well as young people, extractions are necessary to align crowded teeth or correct the bite.

How will I know if I need teeth extracted?

Much depends on the problem which needs correcting. A decision can only be reached on the basis of a detailed case assessment by your dentist or orthodontist. For some patients, in order to get the best appearance and long-term stable result, extractions will be part of a gold standard plan.

Is extraction-free orthodontics an option?

Any claims that treatment can be completed without extractions, especially before an assessment has been completed, should be regarded with considerable caution. If you are unsure about the advice you are receiving, you should discuss your concerns with your own dentist or seek a second opinion from a specialist.

Is there an alternative to having teeth taken out?

In many cases there is no satisfactory alternative to extractions to allow the teeth to be straightened. The extraction spaces are closed up during treatment so that there are no gaps left at the end.

Orthodontics can be a lengthy process. Some patients will look to have crowns or veneers fitted to their teeth instead, in order to mask the irregularity. Whether this is a good option for you needs good professional advice and a full assessment of the risks and benefits. Doing nothing at all is also an option which must not be overlooked.

Veneers are added to the front surface of the teeth to mask irregularities. The teeth can be reduced in size and crowns or “caps” can be fitted to give a larger change in appearance. These approaches also allow defects in the tooth surface to be hidden.

These restorative approaches offer the attraction of rapid results and may be the treatment of choice in some cases. Drawbacks that you need to be aware of are:

• The preparation of the teeth is, to a greater or lesser extent, a destructive and irreversible process
• The crowns or veneers cannot be expected to last indefinitely and the need for replacements over the years should be borne in mind
• There are definite limits to the amount of irregularity which can be tackled successfully in this way. Veneers can be become excessively thick, crowns can only be reshaped by a limited extent
• There may be adverse effects on the underlying gum tissues over the years from having the edges of the crowns or veneers encroaching on the gums.

There is now a wide choice of more discreet brace options for patients of all ages, including:

Ceramic brackets – made in a white or tooth coloured material

Lingual braces – placed out of sight on the back of the teeth

Aligners – removable clear plastic appliances which fit over the teeth and progressively move them to the desired position

Each option has its advantages and disadvantages and specialist advice is essential.

Ceramic brackets

Ceramic brackets are tooth coloured or ‘translucent’. They are less conspicuous than metal brackets and therefore often favoured by adults. However, they do have a number of drawbacks which need to be taken into account. The brace can become discoloured over the course of time by contact with foods and may become less pleasing in appearance. The brackets are more prone to breakage than metal brackets; the wires slide through the slots less freely so treatment may take longer; the brackets tend to be abrasive and may cause wear to teeth in the opposite jaw if they should make contact when biting; the brackets can sometimes be difficult to remove with a slightly higher risk of damage to the tooth surface. The brackets are also more costly than metal brackets, and with all the associated problems the overall treatment can be expected to cost significantly more. Having said all this, if appearance is at a premium, ceramic brackets may still be the first choice for many patients.

Lingual appliances

These are attached to the lingual surface of the teeth, i.e. the surface towards the tongue. In this position they are virtually invisible. The technique involves special skills and needs considerable experience on the part of the orthodontist to achieve good results. Only a limited number of orthodontists offer this technique and you may need to search for a suitable practitioner who has the requisite experience. The main drawbacks are that it can cause soreness of the tongue and affect speech. Fees are always much higher than for conventional fixed braces because of the higher material costs, greater surgery time involved and extra training needed.

Aligners

Aligners blend modern technology with the long-standing concept of using clear flexible splints to ease teeth into line. A succession of splints is worn, each splint bringing the teeth a little closer to the desired position. The splints are effectively invisible and are therefore an attractive option from the standpoint of appearance.

Aligners can be very effective if all that is required is to align mildly irregular teeth. However, there are several drawbacks. In the more severe cases, notably those where extractions are required, aligners lack the necessary control of the teeth to give consistently good results and often lead to disappointment. Likewise, they are not well suited to correcting problems like prominent upper incisor teeth.

The cost can be higher than for conventional fixed braces owing to the laboratory costs in making the aligners. In selected cases they are very effective but their scope is limited.

Under the NHS the orthodontist/dentist is free to choose whatever brace they wish to use. They are not under an obligation to use or offer any particular brace. A good ethical orthodontist/dentist will discuss all the possible types of brace that can be used for your problem, together with the risks and benefits of each one.

There are often also different ways that your teeth may be improved such as simple straightening or full bite correction. You should be wary if you are only offered one option or one type of brace. It is always advisable to ask the orthodontist/dentist how much training they have had in orthodontics and the brace system being suggested.

Fixed braces are one of the most common treatment types. They can be made from different materials, most commonly, silver-coloured metal (stainless steel) but also gold and tooth-coloured material so they are more discreet. They are usually fitted to the outside of the teeth but a more recent development has seen braces that are fitted to the back of or tongue side of the teeth (called lingual braces). Aligners are another type – they are clear, removable mouthguard-style braces that straighten the teeth gradually. Removable braces are also often used and are made of wire and plastic that can do simple, limited tooth movement. Many different factors need to be taken considered before deciding what type of brace is right for the individual patient.

Treatment & Brace Types

In principle, adult orthodontic treatment can be provided under the terms of the NHS provided the need for treatment is sufficient. However, as a general rule the NHS contracts held by most orthodontists do not include adult patients.

In some areas there are no orthodontists at all with NHS contracts to treat adults. An enquiry to your local PCT or Health Board may be useful. Adult treatment under NHS contract incurs the standard NHS charge for complex dental treatments which is currently around £250.

For the most severe problems, notably those requiring jaw surgery, treatment for adults may be provided by the NHS through the hospital service. A referral from your dentist or orthodontist is needed to access these services. However, hospitals do not normally accept routine orthodontic cases for treatment and in the majority of cases adult orthodontics is carried out under private contract.

All children under the age of 18 are able to have an orthodontic assessment under the NHS. The NHS will pay for orthodontic treatment but only the more severe cases are covered under current rules – minor problems are not covered. Orthodontic treatment for children who qualify is free of charge. There are clear criteria (Index of Orthodontic Treatment Need – IOTN) about who qualifies. However treatment for adults is not commonly funded by the NHS.

The NHS contract for orthodontics funds all braces, adjustments and repairs required during the entire treatment. The only exception is the charge for replacement of removable braces lost or damaged beyond repair. It is not permitted to charge patients under the age of 18 for a brace or any part of the treatment, nor to insist that part of the treatment is undertaken privately before acceptance as an NHS patient. Any such practice is a serious breach of NHS rules which renders the orthodontist/dentist liable to disciplinary action if reported to the local PCT/Health Board or the General Dental Council.

Fees for private orthodontic treatment vary widely. The fee varies due to the complexity (difficulty) of the problem, the locality, and the experience of the orthodontist/dentist. Certain techniques such as aligner systems or lingual braces are also more expensive. Prospective patients should always ask for information from the orthodontist/dentist. A written quotation will be given to you but is normally only possible after the orthodontist/dentist has had a chance to assess your problem at a consultation.

Find out about accessing and funding for NHS treatment as well as the Index of Orthodontic Treatment Need (IOTN)

The day is here and you are to begin your orthodontic journey. What can you expect?

To begin with, your orthodontist will examine your mouth to assess your teeth and gums. You may need to have X-rays and/or photographs taken. The orthodontist will then want to discuss the possibilities for treatment with you and agree how to proceed. If there is no waiting list and orthodontic treatment is to be started then impressions or “moulds” of your teeth may also be taken. It is very unlikely that you would have braces fitted at the first appointment.

Be prepared – find out about what will happen, who you might see and the next step on the journey to starting orthodontic treatment.

Your first visit to the orthodontist

A diligent orthodontist or dentist will always:

• Ask you about your concerns.
• Outline all the different treatment options and their risks and benefits.
• Explain about the different types of braces.
• Estimate how long the treatment should take.
• Explain about retainers at the start of treatment, and the likely need for lifelong wear if the teeth are to stay in their new place.
• Explain how likely the teeth are to stay in their new position at the end of treatment (that is the stability of the final result).
• At the beginning, explain what other procedures may be required as part of your treatment.
• Give you thinking time to decide if you want to go ahead.
• Give you a written treatment plan and fee estimate (if appropriate).
• Tell you how much orthodontic training they have had.

All qualified dentists can undertake orthodontics. The General Dental Council (GDC) regulate dentists and it states that any dentist can work in any area of dentistry, as long as they feel competent (able) to do so. However, orthodontics is a very specific area of expertise and only those registered on the orthodontic specialist list with the GDC can call themselves a specialist orthodontist.

Visit the GDC website to view the register of all Dentists, Specialists and Orthodontic Therapists working in the UK

An orthodontic therapist is a registered member of the dental team. They assist dentists/orthodontists in carrying out orthodontic treatment and provide some aspects of the treatment themselves. They can only work to the treatment prescribed from a dentist/orthodontist and within their competence (ability) and scope of practice as defined by the GDC and within the recommendations of BOS.

Orthodontists firstly become fully qualified dentists before completing a further period of training and examinations in order to specialise in orthodontics. A specialist orthodontist will have carried out at least 3 years’ extra training after becoming a qualified dentist. Only those dentists who have completed this training or equivalent, can register with the GDC (General Dental Council) as a specialist orthodontist.

Visit the GDC website to view the register of all Dentists, Specialists and Orthodontic Therapists working in the UK

Orthodontics is the movement of the teeth within the jaw bones to straighten them and help them to bite more evenly together. Orthodontic treatment is about making the best of your teeth; it’s about improving the harmony of your mouth and jaws.

Orthodontic Treatment