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What is orthodontics?

The word orthodontics means “to straighten teeth” and it is a type of dental treatment that aims to improve the appearance, position and function of teeth that are crooked or badly positioned. It can also help to look after the long-term health of the teeth, gums and jaw joints, by spreading the biting pressure evenly over all the teeth.


The repositioning of the teeth is achieved by means of braces or aligners. 

Braces may be removable structures with plastic plates supporting a custom made arrangement of wires; or they may be fixed arrangements of brackets bonded to the relevant teeth and fitted with wires fixed to the brackets. In both cases the wires apply continuous pressure to move your teeth in the desired direction; the arrangements of wires may need to be adjusted as the teeth move. 

Aligners are custom-made plastic moulds or trays which fit closely over your teeth and cause the desired movements to occur gradually; you may need to wear a series of aligners over time as teeth move, to achieve the desired result.


Braces and aligners may be used in conjunction with so-called “functional appliances”, which can widen or expand the palate and jaws; with elastics, which can move teeth forwards or backwards in the jaws; or with “headgear” which are appliances that use certain types and directions of pressure to influence the growth of the upper jaw.


Orthodontic treatment is often most successful in children and adolescents when their jaws and faces are developing. However advances in technology are decreasing treatment times, and aesthetic improvements are making braces much less noticeable, so more adults are opting for orthodontic treatment, especially for cosmetic reasons.


Advances in modern orthodontics have made the treatment much less likely to involve extracting teeth.  In the past it was thought necessary to remove teeth to “make room” for the remaining teeth to fit side by side when newly aligned in what had been a crowded jaw.  Orthodontists and dentists (who have undertaken the relevant training) now understand how to widen the palate and broaden the jaw by means of the functional appliances, making room for all the teeth and creating broad, natural and attractive smiles.  These techniques are most effective when the jaw and palate are still growing.


Orthodontic treatment periods vary from as little as 6 weeks to three years, depending on the degree of movement required and the appliances used.


When might orthodontic treatment be needed?

Teeth may be or become badly positioned due to many factors, including:

  • abnormal facial development conditions such as cleft palate
  • incorrect development of the upper or lower jaw, leading to an incorrect “bite” – ie the teeth do not meet together properly when the jaws are closed
  • adult teeth erupting in a small or narrow jaw leading to crowding  and even impaction (where eruption is blocked by an existing tooth)
  • constant thumb-sucking or use of a dummy will cause the front teeth to protrude, sometimes so severely that they cannot be closed together
  • continual breathing through the mouth forces the tongue to thrust forward when swallowing, and over time this will push the front teeth out of position and affect growth of the jaws
  • accidental loss of one or more teeth, so neighbouring teeth move into the vacant space
  • the effects of aging: teeth do tend to move forwards in the jaw, causing crowding and crookedness particularly in the lower front teeth


Early Treatment for Children


Orthodontic treatment can be undertaken at any age although it is more complex and takes longer in an adult. The earlier you or your child are checked by your dentist, the more likely these situations are to be identified. Your dentist or a specialist orthodontist will be able to detect potential problems from the age of seven or even earlier, and early treatment may prevent more serious problems from developing, or make future treatment less complicated and less lengthy. The best results are often obtained between the ages of seven and thirteen while the child is still growing; indeed some results may not be achievable once facial growth has finished.


The recognition and treatment (if appropriate) of a developing orthodontic problem in younger children is often called Functional Jaw Orthopaedics. Dentists offering this treatment have usually undertaken specific training in this area and will assess the patient from a more holistic viewpoint. They will look at the child’s sleep patterns and breathing, any history of ear infections and their posture and will also be keen to avoid extracting permanent teeth if possible.


In cases where an inappropriate habit is causing the problem, unless the habit is addressed, moving the teeth back into the correct positions will be a waste of time as the habit will in time force them out of position again. As a first step your dentist can recommend specialists to address breathing problems, retrain tongue movements, and supply thumb- and finger-guards to prevent thumb sucking, and orthodontist-recommended dummies.


Once the inappropriate habit is removed, teeth can be moved gently over time into the correct positions by means of orthodontic braces and other appliances as necessary.  


Why is it necessary to correct misaligned teeth?

  • It is easier to maintain good oral hygiene with properly aligned teeth, which reduces the risk of tooth decay and gum disease
  • The appearance of the face and smile is greatly improved, which in turn improves confidence
  • Prominent teeth not only look unsightly, but are more easily damaged; correction reduces the risk of damage
  • Improper bites can cause excessive wear on the back teeth, and can lead to jaw-joint disorder (see The Good Dentist Guide to Jaw, Head and Neck  Pain)
  • Misaligned upper and lower teeth can cause speaking difficulties and poor tongue function. This can affect the growth and development of the jaws in a growing individual
  • Severe cases can lead to difficulties chewing and eating, so nutrition can be improved by treatment


What does orthodontic treatment involve?

There are generally four stages; details of fitting and adjustment will vary according to the appliance used.


The initial consultation:

at which your dentist or orthodontist will look carefully at your teeth, take x-rays and often photographs and take impressions or moulds of your teeth. These are used to make physical or digital models of the teeth. On the basis of these they will suggest a course of treatment involving some kind of custom-made braces or aligners and possibly other appliances as well, to achieve the best possible result.


Fitting the appliance(s):  

depending upon the type of appliance being used, this may involve bonding brackets to the inner or outer surface of the teeth to be moved and fitting wires into the brackets; or fitting the first of a series of removable aligners.


Adjusting the appliance:

the braces are adjusted or aligners changed at regular intervals to help shift the teeth into the correct position. 



post treatment, retainers are worn to prevent the relapse of the teeth, as bone and gums need additional time to stabilize around the teeth. The time period for wearing the retainers will depend upon the individual patient condition. Retainers may be fixed or removable.


What types of braces and aligners are there?

Conventional fixed braces

A metal bracket is bonded to each of the teeth to be moved, using a light-cured dental cement. A stainless steel wire is then threaded between the brackets and fixed to each bracket either by means of a fine wire tie, or by a rubber o-ring. The wire is bent, shaped and tightened frequently during the course of treatment to achieve the desired end result. 

Self-ligating braces

Self-ligating braces are made from the same materials as traditional braces; however instead of requiring metal or elastic ties to hold the archwire in the brackets, each bracket has a special built-in clip to hold the wire in place.  This makes fitting and adjusting the braces much easier, reduces the trapping of food debris and plaque, and gives a more aesthetic effect as the brackets are typically smaller and neater. 


The clip may hold the wire more or less tightly in place; if it holds more tightly, additional forces are placed on the teeth to be moved and the system is called “active”.  If the clip holds the wire loosely and allows it to slide, the system is called “passive”.  Passive systems have less friction, lighter forces and so treatment times are reduced.

Temperature-sensitive archwires

In place of stainless steel, modern orthodontics makes frequent use of nickel-titanium, which is temperature sensitive, to make archwires.  The archwire is made to a perfect arch shape; it is then chilled, which makes it flexible and easily threaded through fixed brackets. Once in place, the archwire warms to body temperature and seeks to return to its original shape, creating constant light forces on the teeth.

The Damon system

The Damon system is internationally recognised and makes use of self-ligating brackets with slots and clips designed to give the archwire freedom to move freely without friction, ie Damon is a passive system.  A temperature-sensitive alloy of copper, nickel and titanium is used for the archwires; treatment starts with very light wires which are replaced with successively larger wires as the teeth move into position. The forces involved are very light which has been shown to optimise the ability of the jaw to grow new bone to support the teeth in their new position.

Aesthetic braces

A number of systems of braces have been designed to correct relatively minor misalignments of the upper and lower front teeth, as quickly as possible, and to be as discreet as possible when worn. These include:



your dentist takes impressions of your teeth which are used as the basis for a computer-generated 3-D model. The Invisalign computer then simulates the tooth movements required to move from this model to the desired end result and controls the fabrication of a series of transparent plastic Invisalign aligners which fit closely over your teeth and cause these movements to occur gradually.  


The aligners are worn for at least 20 hours per day; after two weeks wearing the first aligner, teeth will move to the correct positions for you to switch to the second aligner, and so on through the sequence. 


The aligners are practically invisible and have the advantage that they can be removed to eat and clean your teeth.


Inman aligner:

less discreet than the Invisalign aligners, the Inman aligner uses a coiled spring that sits behind the front teeth and provides a “pushing” force; and a metal bar across the front of your front teeth which provides a “pulling” force.  The two are fixed to a transparent acrylic casing which fits over your teeth, and the metal components between them squeeze the teeth into the correct positions.


The aligner is worn for 16-20 hours per day and treatment times can be as short as several weeks.  It is removable for eating and teeth cleaning.


6-Month Smiles:


This system of braces focusses only on those teeth which show when you smile, and uses clear brackets and tooth-coloured wires which are very much less noticeable than conventional braces.

Lingual braces:  

Unlike conventional braces where the brackets and wires are fixed to the visible front surface of your teeth, lingual braces put all the metalwork on the inner surface of your teeth, meaning that none of it can be seen at all. The brackets and wires are specially designed to be light, small and comfortable and not interfere with your speech. 

How do I look after my braces and teeth?

It is especially important to maintain good oral hygiene while wearing braces as the wires, plates, springs, rubber bands and other appliances can trap food debris and plaque, which can stain your teeth, damage the tooth enamel and cause gum disease.  Your dental hygienist and orthodontist will advise you on how to keep your braces and other attachments clean but you should be prepared to brush your teeth carefully and clean between the braces and your teeth with floss or specially designed brushes after every meal.


You should avoid hard foods that can break or damage the braces, and avoid sticky foods as they may be hard to remove from the appliances in your mouth.


Use a specially designed mouthguard when playing vigorous sports.

What is the cost of orthodontic treatment?

For a serious condition, you may be entitled to orthodontic treatment under the National Health Service; this is free for children up to the age of 18 and students up to the age of 19 as long as there is a clinical need; the NHS assesses cases according to a clear rating system. 


Orthodontic treatment for moderate, minor or purely cosmetic problems would normally be charged privately.  Early treatment options for children tend also not to be available on the NHS.

Treatment costs can vary depending on what is involved and the time scale.


If you decide to have treatment privately, your dentist or orthodontist will be able to estimate the cost of your treatment and give you details. It is advisable to get a written estimate and treatment plan before beginning any dental treatment.


Are the results permanent?

When treatment is finished the teeth need to be held in position for a time. Appliances called retainers hold newly straightened teeth in position while the surrounding gum and bone settles; the retainers can be removable or fixed depending on the original problem. Some retainers are worn all the time, others only at night.


Even after retention, however, it is normal for minor tooth movements to happen throughout life, so no permanent guarantee can be given and retainers may need to be worn permanently to ensure long-term stability. 


Surgical Orthodontics

It may be necessary to use surgery to correct orthodontic problems that cannot easily be corrected with braces; such circumstances may include congenital problems such as cleft palate or situations where an underlying discrepancy in the size, shape or position of one or both jaws means that the teeth cannot be brought into the correct relationship with each other.


Surgical orthodontics requires careful teamwork between dentist, orthodontist, surgeon and perhaps psychologist and plastic surgeon if facial appearance is to be significantly altered.  It may be a lengthy process involving the re-alignment of teeth both before and after the surgery.




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