Your questions answered
What is orthodontic treatment?
Orthodontic treatment usually means wearing braces to straighten your teeth.
- improve the way your teeth look
- make it easier to look after the health of your teeth and gums
- make it easier to eat by helping your teeth fit together correctly
- help teeth come through which have become stuck under the gums
- move teeth to close spaces if other teeth are missing, or arrange space in the right place for replacement teeth
When should I be referred?
Most patients start their orthodontic treatment when the majority of their adult teeth have come through at around 10 to 14 years of age. Your dentist may refer you earlier than this for particular orthodontic problems. For example teeth which stick out a long way, or which bite the wrong way round might need treatment sooner. Your dentist might also ask for our opinion if your teeth are not growing through correctly.
When deciding whether to refer a patient, your dentist will assess how bad your teeth are. Sometimes developing problems are obvious and will clearly warrant NHS treatment. In other people problems develop later. Sometimes a problem is mild, causing no dental health concerns in which case your dentist can discuss whether you would like a referral for private treatment aimed to improve appearance.
Treatment can also be carried out much later than this and most treatments can be successfully carried out for adults, so don’t worry that you have “missed the boat”. An increasing number of adults of all ages are wearing braces, so you will not be alone.
Will I need teeth out and how is this done?
Sometimes teeth need to be removed (extracted) to make room to move the other teeth. We only do this if absolutely essential. The teeth most commonly removed are premolar teeth, which are usually easy to take out, but if you have other teeth which are less healthy, we will take this into account. You will always be left with enough teeth to function well and we will not leave spaces at the end of treatment.
If extractions are needed, this can be carried out either by your own dentist if you prefer, or we run an extraction clinic ‘in-house’. Our team are used to looking after children, teenagers and adults. They have a lot of experience, which makes the whole process much easier for anyone who is nervous. The tooth to be extracted will be made numb with 2 small injections and the tooth is removed only when you are completely numb.
Most patients find that having teeth out is not as bad as they expected. Probably the most difficult part of the appointment is psyching yourself up to visit the practice!
Is orthodontic treatment successful?
One of the most important factors in the success of orthodontic treatment is the co-operation of the patient. Patients who attend regularly will complete treatment more quickly. Patients who look after their teeth and braces well will have healthy straight teeth at the end of treatment.
Perhaps the biggest challenge in orthodontic treatment is keeping the teeth straight in the long term and it is essential to wear retainers as instructed by your orthodontist. Teeth can and do move at any age, so the longer you continue to wear your retainers the better. Certainly, it is essential to continue wearing retainers while you are still growing.
Our orthodontists all have years of experience and will be able to discuss exactly what you can expect from treatment and whether there are any limitations to what can be achieved.
What sort of braces are there?
There are many types of brace. Some of the most common are:
- Fixed appliances. These are glued to the teeth. They can be metal or tooth-coloured. They can be glued to the outside or inside of the teeth (called labial or lingual appliances). The NHS provides metal braces for the outside of the teeth. Teenagers often call these ‘train tracks’ and they can be customised with colours. Private orthodontic treatments offer the full range of options. Fixed appliances are often the most effective treatment, especially when a lot of tooth movement is needed.
- Removable appliances can be taken out for eating or cleaning. They are used for simpler tooth movements.
- Functional appliances are special removable appliances which work by holding your jaw in a new position. These usually fit both the upper and lower jaw. They can be helpful if cases where the teeth stick out.
Your orthodontist will work out which type of braces may be suitable for you and will discuss the options using models and/or computer demonstrations.
Are there braces which don’t show so much?
Yes, there are several types of brace which are less noticeable and are available privately. These may be made of ceramics, plastic or other tooth-coloured materials, or may be transparent shields (“Invisalign”), or braces placed on the inside surface of the teeth (lingual appliances).
How do I look after my brace?
During the first few days, you may need to place special wax (given at your first appointment) to stop the brace rubbing. Just dry the bit of the brace where you want to place the wax and then squeeze it on. You are also likely to need to take painkillers for the first few days – take whatever you would usually use if you had a headache.
You will need to be careful when eating not to damage the brace. The easiest rule to remember is that if you can’t cut it up small, you can’t eat it. Sticky or hard sweets and crusty bread are some examples of foods which can break your braces.
Also, braces can trap food and drink, allowing bacteria in your mouth to create decay. This shows as ugly brown or white scars on your teeth, so you must not eat or drink sweet things between meals. The best drinks are milk, water or unsweetened tea. Fizzy drinks are bad because they are both acidic and sweet. Most fruit juices are acidic and can dissolve your teeth when drunk regularly, so moderation is best. Also many fruit juices are sweet, so are best at mealtimes.
Fluoride helps combat decay and keep teeth healthy and attractive during treatment. You should brush with a fluoride toothpaste and rinse once a day (for most people this is best at night) with a mouthwash containing 0.05% fluoride. To clean your braces (which you should do after each time you eat) use both a normal brush, and an interdental brush. Our videos show how. If you aren’t sure whether you are doing it right, just ask. We have a hygienist if you need extra help with your technique.
Removable appliances should usually be worn full time, unless told otherwise by your orthodontist, apart from when cleaning or eating. When out of your mouth, keep them in a protective case. To clean (at least 3 times a day), rinse with water and clean with a toothbrush. Recommended cleaning products such as ‘Retainer Brite’ or ‘effer-ves’ can be used to clean them. These are available at reception and from some chemists. When wearing a removable appliance, avoid sweet drinks, as these are more likely to cause tooth decay, due to being held next to the brace.
How much will it cost?
NHS treatment is free of charge, unless you lose or damage your retainers, in which case there is a fee for replacement.
Recent NHS changes have included the introduction of an index of orthodontic treatment need (IOTN). The severity of a child’s orthodontic problem is assessed and rated on the scale. If the problems are mainly cosmetic, then NHS treatment is not available. Orthodontic treatment can still be carried out privately to improve dental appearance – just ask your orthodontist. Adults are accepted privately.
Fees are published elsewhere on this site. Payments can be spread over 12 months in most cases.
How do I get referred?
Most of our patients, especially children, are referred by their dentist, who can give us helpful background information and work out when the best time is for a referral. You can also refer yourself for private orthodontic assessment. If you have questions about being referred, our receptionists can help – just give us a call.
What will happen when my braces are removed?
Having fixed braces removed is surprisingly easy. It takes very little time and involves a special instrument squeezing the thin base of the bracket, which bends and pings off. All that is left then is to polish off the glue. Once the brace is off we either take an impression of your teeth, or make a 3D image of your teeth with a scanner. This lets us make the retainers you will wear in bed at night to keep your teeth straight.
Why do so many people get braces these days?
People’s expectations of how their teeth should look increase all the time. Research shows that we are judged by the way we look. Your smile is an important part of the first impression you give.
Knowing you have an attractive smile can improve self-confidence and quality of life. As orthodontic technology improves, treatment can do more in less time and is also easier for the patient.
Also with more people keeping all their teeth, not losing them to decay during childhood, mouths are becoming more crowded!
Will my teeth stay straight?
It is essential to wear retainers as instructed by your orthodontist. Teeth can and do move at any age, so the longer you continue to wear your retainers the better. Certainly, it is essential to continue wearing retainers while you are still growing. If you have high expectations and want the best possible long term result, retainer wear also has to be long term and ideally for life.
Fortunately, there are a range of retainer types to suit your needs. These include removable transparent retainers, durable retainers made of hard plastic and metal wires, and even hidden retainer wires glued behind the teeth. Most patients start with transparent removable retainers, as these are easy to wear for most people and hold all the teeth.
Your orthodontist will monitor your teeth for signs of problems during the first year after your braces are removed. Let them know if you are not getting on with your retainer so they can nip problems in the bud.
What will happen on my first visit?
At your first visit, we will talk about what you, the patient, feel about your teeth and any problems you have. We will then examine the teeth and explain what we have found and options for treatment if appropriate. We have models and computerised demonstrations to help explain things.
We may take X-rays to assess the health of your teeth and/or to check if they are all there. We may need to take a further x-ray to assess the size and position of your jaws and angulation of your teeth. If you are going ahead with treatment, you will usually have a 3D image of your teeth taken – this lets us plan your treatment.
We are very aware that patients are often nervous, or may not have had any dental treatment before. We take pride in taking the time to explain things carefully and of course you can ask questions.
Can I still play woodwind instruments?
It takes time to get used to wearing braces and playing woodwind instruments. It is best not to have the brace fitted close to exams or performances. There are shields available, which can make your lips more comfortable while playing and most keen musicians do manage to adapt.
What about when I play sport?
For any contact sport, you should wear a mouthguard. These can still be worn when wearing a fixed brace. We sell special guards for wear over fixed appliances, or can make a custom-made guard for you. Prices are available from our receptionists.
Do I still need to see my dentist?
Yes, keep seeing your general dentist throughout treatment, as they will provide your emergency care (although we will usually deal with orthodontic emergencies). Your dentist is there to take care of the health of your teeth and mouth and we will make sure your teeth are straight and bite well. Together we will make sure you have a beautiful and healthy smile. (We will need your help too!)
How long will treatment take?
The length of treatment depends on how far we need to move your teeth, how old you are and how well you cooperate with treatment. Treatment goes fastest for patients who take care of their brace, remember their appointments and follow instructions well. For most children wearing full fixed braces, treatment takes 12 to 18 months. Treatments can be longer or shorter than that, but your orthodontist will be able to give you an estimate before your treatment starts.
Adult teeth move more slowly, so a full treatment often takes 18 months to 2 years. Adults often ask what can be achieved in a shorter time though, and your orthodontist can discuss simple options to improve the appearance of your smile if you don’t need to change the bite of your teeth. Treatments with limited objectives tend to take an average of 6 to 9 months. Be wary of adverts suggesting perfect results in short time frames. If something seems too good to be true, it probably is. Marketing for short term orthodontic techniques often show pictures of mild cases which would be finished quickly with any system.
Will the treatment damage my teeth?
Orthodontic treatment does not damage teeth as long as you follow instructions, keeping your teeth clean, using a fluoride mouthwash and toothpaste and making sure you do not eat or drink sweet things between meals.
Does it hurt?
Most people have tender teeth and aching during the first few days to a week after the brace is fitted. This happens again for a couple of days after each adjustment. Having the brace fitted or adjusted is easy and no injections are needed.
How often do I need to come?
Most patients attend every 6-10 weeks depending on the type and stage of treatment.
Appointments can be made at different times on different days to avoid taking too much time off school for children and some appointments will be during school holidays. Remember that a lot of our patients are children, and there are only so many after school slots available, but our receptionists work very hard to find appointment times that fit into your schedule. We try to prioritise patients who are in their GCSE years at school for the most popular appointment times.
What do I do if my brace breaks?
If your brace is broken, ring us straight away. We can then advise you how quickly you need to be seen. If your brace breaks close to the date of your next appointment it may be alright to wait and have it fixed then. If something is painful, we will try to see you as soon as possible. It will help our receptionists if you are able to be flexible about appointment times if you need an urgent appointment, as otherwise it can be very hard to fit you into our day – we reserve emergency slots in our diary for repairs.
We have an out of hours advice line – ring 0117 982 8222 for details. Sometimes you may wish to contact your general dentist on their emergency number, but it is often best to call us first, as repairs are easier with our specialist equipment.