Dental Health

18 October 2018

Orthodontics is related to improving the appearance, position and function of crooked teeth. The most common time for orthodontics is around age 13 when all the adult teeth have come through.

Healthcare professionals who specialise in straightening teeth are known as orthodontists. A list of registered orthodontists can be found on the General Dental Council website.

Problems with crooked teeth are very common. They can be caused because the jaw has not developed properly or having a small jaw or the teeth themselves are not formed properly.

Problems with teeth can include:

  • Protruding teeth is one of the most common reasons for having orthodontic treatment, especially as these teeth can be prone to damage in sports or falls.
  • Crowding or crooked teeth can cause problems with cleaning. People with narrow jaws often lack enough space for their teeth, resulting in crowding or in some cases asymmetrical faces.
  • Impacted teeth - the teeth are growing in the wrong place.
  • Reverse bite - the upper teeth bite inside the lower teeth.
  • Deep bite - the upper teeth cover the lower teeth too much.
  • Open bite – where the upper and lower front teeth don’t meet properly when the mouth is closed. This is often caused by prolonged thumb sucking.

Having orthodontic treatment to straighten the teeth can help with function such as eating and speech. If the teeth are very crooked the chewing function is affected and this can cause facial pain. Crooked teeth can make cleaning teeth difficult and cause discomfort and bad breath. In some cases, abnormal development of the teeth and jaw can affect the shape of the face, which could cause psychological and emotional problems, such as lack of self-confidence.

Orthodontics uses different ways to straighten teeth but the exact treatment will depend on your individual clinical need. After a full assessment the orthodontist will decide what type of orthodontic appliance is best. This includes taking your full medical history to check if there’s any genetic factor or disease or illness which may affect the bone structure of the jaw, taking x-rays and moulds of the teeth and photographs. It may be necessary to remove some teeth to make room for the teeth to be moved into the correct position. The orthodontist will refer you back to the dentist for the extractions to be done.

Options for orthodontics

Fixed braces (train tracks): a non-removable brace made up of brackets that are glued to each tooth and linked with wires. This is the most common form of treatment. They can be used when there’s a number of teeth that need to be corrected.

You can eat normally when wearing fixed braces. However it’s best to avoid certain foods especially chewy toffees and fizzy drinks as they can damage your appliance or teeth. The orthodontist will give advice on foods and drink. 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 they’ll be noticeable on the front of your teeth. Many private orthodontists now offer ceramic or clear plastic braces that are much less noticeable, although they’re usually more expensive. However, their use also depends on the particular problem and tooth position.

Removable braces: usually plastic plates that cover the roof of the mouth or inside of the lower jaw and have wires that press on the teeth to exert pressure to move them.

Removable braces can be used to correct minor problems, such as slightly crooked teeth. They can also 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 sport or playing a wind instrument. Your orthodontist can advise you about this.

Lingual or invisible braces: These braces fit onto the back of the teeth. You would need to discuss with the orthodontist to see whether they can be used for your problem. The cost of these braces is usually higher and only available privately.

Functional appliance: A pair of removable plastic braces that are joined together, or are designed to interact together and fit onto the upper and lower teeth. Functional appliances can be used to treat problems with the position of the jaws and teeth.

Most people will need to wear them all of the time. It’s very important to follow your orthodontist's instructions about how and when to wear the appliance. If the appliance is not worn correctly, the treatment will be unsuccessful. It may be necessary to remove your functional appliance for cleaning and while you’re eating.

Headgear: These are tension straps attached to the appliance which winds round the back of the head. It’s used to correct the position of the back teeth or 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.

Retainers: a simple, removable appliance worn near the end of orthodontic treatment once the teeth are straightened and the braces have been removed. This is needed to allow time for the bone to settle around the newly moved teeth and stop the teeth from springing out of position after being held in tension for so long.

Getting referred to an orthodontist

In most cases your dentist will refer you to the orthodontist.

If orthodontic treatment is recommended, you may have to decide whether to have treatment on the NHS or privately. NHS orthodontic treatment is free for people under the age of 18 with a clear clinical need for treatment. However, due to high demand there can be a long waiting list for NHS orthodontic treatment.

If your child doesn’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 treatment is widely available but it can be expensive, with an average fee of between £2,000 and £6,000.

Treatment will usually last 18-24 months if the treatment instructions are followed.

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