Orthodontics | Dental Treatment Guide

Orthodontics is the specialist branch of dentistry that straightens or moves teeth to improve their appearance and functionality. It is also growing in popularity. More and more adults are requesting treatment as they realise that correctly aligned teeth and jaws will allow them to eat more comfortably and smile more beautifully. Furthermore, orthodontics make it easier to clean and care for your smile, and also improve the long-term health of your teeth, gums and jaw joints. So how do you know if orthodontic treatment is right for you?

This article is purely an overview of orthodontics and no substitute for consulting a dentist or specialist orthodontist. However, by gathering the facts about the different methods, treatments and procedures, and by answering a few frequently asked questions, this article may help patients to decide whether or not to choose treatment. At the very least, it will enable dental patients to speak confidently to dentists and specialist orthodontists about any action they might wish to take.

Orthodontics: the facts

Orthodontic treatment is about making the best of your teeth, correcting any imperfections so that they work more efficiently and look much better. Here are some facts about this area of expertise:

the first braces were constructed in 1728;
the first orthodontic brackets were invented by Edward Angle in 1915;
his design, slightly-modified, remained in use until the 1970s;
in the UK alone, almost one million people began orthodontic treatment last year.

As you can see, orthodontic work is not a new area for dentists to explore. However, as new products and treatments become more available and more accessible, more people are finding it is a viable, cost-effective way of enhancing their smile.

Orthodontics: the most common treatments

Why do people require orthodontic work? Broadly speaking, it falls into two areas: cosmetic or functional. It could be that a patient simply wants their teeth to look better and orthodontics is the appropriate procedure. Alternatively, orthodontics can help with a number of conditions that, if left untreated, can cause problems with breathing, swallowing, chewing and speech.

These conditions include:

Teeth are crowded: In cases were the dental arch is small and teeth are larger than average, teeth can become crooked. When teeth become very crowded, it can lead to a number of problems, such as thin gums and impacted molars.

Upper teeth are protruding: The problem with upper teeth that jut out is that they are easily damaged. Therefore, orthodontic work is often carried out for more than simply aesthetic reasons. Treatments are often performed to reduce the possibility of the teeth becoming damaged, broken or knocked out.

Teeth have gaps between them: Sometimes, teeth can have large gaps between them which are unsightly. Orthodontic work can correct these gaps.

Teeth do not meet when biting: The space between the upper and lower front teeth can cause problems with chewing and eating. Because the front teeth do not meet, extra strain is put on the back teeth which can lead to problems over the longer term.

Teeth create an overbite: An overbite can be uncomfortable and painful, especially if the teeth come into contact with the gums on a regular basis.

Teeth form a crossbite: When the teeth do not meet when biting, it causes problems with biting, chewing and eating. A crossbite is therefore usually seen as an essential procedure to be performed as early as possible – it is not simply done for cosmetic reasons.

The teeth come together with an underbite: Some people have a lower jaw that is slightly longer than the upper jaw. The teeth, therefore, do not meet and the front teeth stick out.

Orthodontics: the options

The term orthodontics actually covers a number of different treatments and products. However, the vast majority of orthodontic work involves the extraction of teeth and the application of braces to help the teeth straighten and grow more naturally. From a patient’s perspective, it is important to engage in a full consultation with a dentist or specialist orthodontist to decide on the best course of action. The different types of braces currently available include:

Conventional fixed braces: The least aesthetic option, these braces are effective yet often uncomfortable.
Removable braces: Suited to less serious conditions, removable braces are worn at certain times, usually at night.
Lingual braces: Lingual braces attach to the back of the teeth rather than the front and are therefore ‘invisible’. A more expensive option, they are usually the celebrity choice.
The Damon System: Other products on the market suit patients with more specific needs. For example, the Damon System uses a sliding mechanism rather than elastics, which is more hygienic, stronger and faster at re-aligning teeth.

Orthodontics: the parental perspective

Often, it is a difficult decision for a parent to decide whether or not their child should have orthodontic treatment. Braces can stay in for a long time and be unsightly and embarrassing for children. So very few children would choose to wear them. At the same time, lack of treatment can create long-term problems that require even more complex dental work later in life.
If a dentist recommends orthodontic work for a child, the key for parents is to approach the consultation with an open mind and plenty of prepared questions. First ask the orthodontist about the techniques he or she uses and his or her general approach. Some orthodontists try to make the treatment as short and painless as possible. Others try to make the treatment as inexpensive as possible. Understanding the treatment philosophy will help to understand whether the orthodontist's treatment philosophy is right for your child.
It is also important to ask about the type of materials an orthodontist plans to use. Sometimes, the orthodontist will be required to use a special bracket because of something specific to your child's case. However, other times the orthodontist will have some latitude to choose one of several different bracket designs. If so, you may be able to have some input into which bracket your orthodontist chooses.

Orthodontics: the procedure

Regardless of the type of brace you choose, correcting teeth is a gradual process and involves a number of visits to the dentist. Treatment with braces usually takes between 6 and 24 months to complete, depending on the complexity of the treatment. Once your brace has been fitted you will need frequent and regular appointments for it to be adjusted. Finally, when the brace has been removed, you may also be required to wear a retainer brace, to allow your teeth to settle into their new shape.
Within this procedure, most patients have different requirements. For example, some require tooth extractions before their brace can be applied. Others require their brace to be supported by headgear– this helps to exert increased pressure on the teeth at certain points in the procedure. Each patient is different, so no two approaches are entirely the same.

Orthodontics: the level of aftercare

Because orthodontic work lasts a long time, it is important that the patient takes personal responsibility for looking after their brace and keeping it hygienic. Your dentist will recommend the right approach for cleaning your brace and will also recommend regular trips to a hygienist during the course of the treatment.

Sometimes, the brace can break. If this happens, it is important that a dental consultation is arranged quickly so that the brace can be reapplied and the treatment can continue.

For many patients, taking care of their brace throughout the treatment cycle means more than simply cleaning their teeth regularly. They also have to adapt their diet, the way they talk, the way they chew and the way they swallow their food. These are usually minor adjustments, but wearing a brace initially can feel strange and care must be taken until a patient feels comfortable with, and has adapted to, their new brace.

Orthodontics: the costs

Orthodontic treatment is available free of charge on the NHS for young people who are under 18 years of age and students up to the age of 19, provided they have a clear clinical need for treatment. Other people entitled to free treatment are patients on a low income, pregnant women and nursing mothers. Everybody else has to pay NHS or private charges.

It should be noted that patients are only entitled to free NHS treatment if their case is serious; minor, cosmetic problems will be charged on a private basis. NHS decisions on clinical need are reached via a clear rating system, known as the Index of Orthodontic Treatment Need. This index runs from Grade 1 through to Grade 5, with 1 being virtually perfect teeth and 5 being the signifier for serious dental problems.

As every course of orthodontic treatment is tailored to an individual patient’s particular needs, costs for private treatment can vary. Prices can typically range from £3,000 to £5,000. This may sound like a lot of money, but whether the treatment is for a child or an adult, it is actually a small price to pay for such an important investment in a person’s long-term health and happiness.

Orthodontics: the results

The benefits of good orthodontic treatment cannot be overestimated. The confidence that comes with a beautiful smile will last a lifetime, but the benefits are not just aesthetic. Orthodontic treatment provides lasting health benefits, by improving the strength and wellbeing of teeth, gums and jaws joints – and with gum disease linked to heart problems this is no small consideration. The correct alignment of the jaws and teeth can also help patients to eat more comfortably, and may help with some speech problems. It also enables people to care for their teeth more easily, allowing them to maintain that celebrity smile!