Orthodontics

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Introduction

Orthodontics

Orthodontic treatment (usually with braces) is most often used to improve the appearance and alignment of crooked, protruding or crowded teeth, and to correct problems with the bite of the teeth.

This topic covers:

Why it's used

Who can have it

Types of orthodontic treatment

Accessing treatment

Taking care of your teeth

Why orthodontics is used

The benefits of orthodontics can include:

  • correction of dental crowding and straightening of your teeth
  • correction of your bite so the front and back teeth meet evenly 
  • reducing the chance of damage to prominent teeth
  • improving your appearance, including your smile 

Many people have crowded or crooked teeth, or their teeth don't meet correctly when they bite. These problems can mean the teeth are more likely to become damaged or put a strain on jaw muscles.  

In some cases, abnormal development of the teeth and jaw can affect the shape of the face.

Orthodontics can also be used to treat other health problems, such as a cleft lip and palate or cases of mild sleep apnoea.

Who can have orthodontics

Orthodontic treatment is usually only started after most of a child's adult teeth have started to come through.

This is usually when they're about 12 years old, but depends on the number of adult teeth and the growth of their face and jaws.

Orthodontic treatment for adults can begin at any age, but the treatment options are more limited. 

Treatment also won't begin unless you have a good standard of oral hygiene as orthodontic treatment can increase the risk of tooth decay.

Types of orthodontic treatment

Orthodontics mainly uses braces to correct the position of the teeth. Your exact treatment will depend on the problems with your teeth.

In some cases, you may have to wear headgear at night, or have small pins placed temporarily in the jaw as well as a brace. You may also need to have some teeth removed as part of your treatment.

The length of treatment will depend on how complicated the problem is, but it's usually between 18 and 24 months.

Read about the types of orthodontic treatment.

Accessing orthodontic treatment

In most cases, your dentist will refer you to an orthodontist, although you may be able to seek treatment directly.

Find a local dentist

If orthodontic treatment is recommended, you may have to decide whether to have treatment privately or on the NHS.

You can find a list of all specialist orthodontists registered in the UK on the General Dental Council (GDC) website.

NHS treatment

NHS orthodontic treatment is free for people under the age of 18 with a clear health need for treatment. But because of high demand, there can be a long waiting list.

NHS orthodontic care isn't usually available for adults, but may be approved on a case-by-case basis if needed for health reasons.

A rating system known as the Index of Orthodontic Treatment Need (IOTN) is used to assess your eligibility for NHS treatment. The British Orthodontic Society's website has more information about the different grades used for the IOTN.

NHS treatment is available for grade 4 and grade 5 cases. Grade 3 cases are usually judged on an individual basis. Treatment may also be made available if the appearance of a person's teeth, jaw or face is of concern.

Private treatment

If you don't qualify for free NHS treatment or you don't want to wait for treatment to start, you may choose to have private treatment.

Private orthodontic treatment is widely available, but expensive. The fee can range from £2,000 to £6,000, depending on the complexity of the treatment and the type of appliances used, but fees can be higher.

A private orthodontist will estimate the treatment cost after an initial assessment of the problem.

The BOS has an online service you can use to find orthodontic treatment in your area.

Taking care of your teeth

A common complication of orthodontics is tooth decay. You can get tooth decay when acid is produced from plaque, which builds up on your teeth.

Many people with appliances find it difficult to keep their teeth clean, so extra brushing is essential during treatment.

Your orthodontist may recommend using toothpaste with high levels of fluoride, or a mouthwash that contains fluoride, to reduce your risk of decay. You should also try to avoid sugary foods and fizzy drinks.

Read about how to take care of your teeth.

Howitisperformed

Orthodontic treatments

There are many different types of orthodontic treatment, depending on the exact problem with your teeth or jaw.

The first stage of treatment is to assess the state of your teeth and how they're likely to develop.

This usually involves taking X-rays, making plaster models, and taking photographs of your teeth.

Orthodontic appliances

Orthodontic treatment uses appliances to correct the position of the teeth.

The four main types are:

  • fixed braces - a non-removable brace made up of brackets that are glued to each tooth and linked with wires
  • removable braces - usually plastic plates that cover the roof of the mouth and clip on to some teeth; they can only carry out very limited tooth movements
  • functional appliances - a pair of removable plastic braces that are joined together or designed to interact together, and fit on to the upper and lower teeth
  • headgear - this isn't an orthodontic appliance itself, but can be used with other appliances and is usually worn at night

In more severe cases, treatment may involve fixed braces and surgery to move the jaw. This treatment is carried out in hospitals.

These treatments are outlined in more detail below. Further information can be found on the British Orthodontic Society (BOS) website.

Fixed braces

Fixed braces are the most common type of orthodontic appliance. They can be used when a number of teeth need to be corrected, or when the treatment needs to be precise to prevent problems in the future.

You'll be able to eat normally while wearing a fixed appliance. However, you should avoid certain foods and drinks, such as toffee, hard sweets and fizzy drinks, as they can damage the appliance and your teeth.

If you're using a fixed appliance and you play a contact sport such as rugby, you should wear a gum shield to protect both your mouth and the appliance.

Fixed braces are usually made out of metal, so will be noticeable on the front of your teeth.

Many private orthodontists now offer ceramic or clear plastic braces, although they're usually more expensive. Their use also depends on the particular problem and tooth position.

Removable braces

Removable braces can be used to correct minor problems, or as part of fixed brace treatment. They can sometimes be used to discourage children from sucking their thumb.

These braces should only be taken out of the mouth for cleaning or as a precaution during certain activities, such as cycling or playing a wind instrument. Your orthodontist can advise you about this.

Functional appliances

Functional appliances can be used to treat problems with the position of the upper jaw and teeth, and the lower jaw and teeth.

Most people need to wear them all the time. It's very important to follow your orthodontist's instructions about how and when to wear the appliance. If it's not worn correctly, the treatment won't work.

It may be necessary to remove your functional appliance for cleaning and while you're eating.

Headgear

Headgear is used to correct the position of the back teeth or to keep them in position while the front teeth are being treated.

Most people only need to wear headgear for a few hours during the evening or when they're sleeping. You won't be able to eat or drink while wearing headgear.

Other treatments

There are other types of braces available privately, such as aligners, or invisible or lingual braces that fit on the back of the teeth.

You'll need to talk to your orthodontist to see whether they can be used for your problem. The cost of these braces is usually higher.

Retainers

Retainers are used near the end of a course of orthodontic treatment. They hold straightened teeth in place while the surrounding gum and bone adjusts to their new position, and can either be removable or fixed.

Under the NHS, your orthodontist is responsible for your care for 12 months after normal treatment ends. After this period, you'll have to pay privately for continuing care, retreatment, and any replacement or repair of retainers.

It's likely there will be some tooth movement if you stop wearing your retainer. Changes in the position of your teeth can continue throughout life and are part of the normal ageing process.

The only way to have permanently straight teeth is to wear a retainer on a part-time basis for life.

Removing teeth

In rare cases, it may be necessary to remove a tooth to correct the position and appearance of nearby teeth.

Results

You're likely to achieve good results within 18 to 24 months of starting treatment as long as you:

  • take good care of your teeth
  • wear your appliances as instructed
  • follow your orthodontist's dietary advice
  • wear your retainer to maintain the results