Braces (dental)

Orthodontic treatment is used to improve the appearance, position and function of crooked or abnormally arranged teeth.

Orthodontic treatment can straighten the teeth and move them into a better position.  

Healthcare professionals specialising in orthodontics are known as orthodontists. You can find a list of all specialist orthodontists registered in the UK on the General Dental Council (GDC) website.

What does orthodontic treatment involve?

Orthodontics uses devices such as a brace 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 as well as a brace, and 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. 

How is it performed

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

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

• maintain good oral hygiene
• wear your appliances as instructed
• follow your orthodontist's dietary advice
• wear your retainer to maintain the results

Assessment

The first stage of treatment is to assess the state of your teeth and their likely development. This usually involves taking X-rays, making plaster models, and taking photographs of your teeth.

This will give the orthodontist an idea of the treatment needed and the likely results.

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, and 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, because they can damage the appliance and your teeth. Your orthodontist will be able to give you further advice.

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 are 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, 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 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 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 it's not worn correctly, the treatment will be unsuccessful.

It may be necessary to remove your functional appliance for cleaning and while you are 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 are sleeping. You will not be able to eat or drink while wearing headgear.

Other treatments

There are other types of braces available privately, such as "invisible" or lingual braces that fit on the back of the teeth. You will need to discuss them with your orthodontist to see whether they can be used for your problem. The cost of these braces is usually higher.

Retainers

Retainers are often used near the end of a course of orthodontic treatment. Retainers hold newly fixed teeth in place while the surrounding gum and bone adjusts to the new position of the teeth. Retainers 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 will have to pay privately for continuing care, re-treatment, and any replacement or repair of retainers.

Your orthodontist will advise you when to wear your retainer. 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 some cases, it may be necessary to remove a tooth to correct the position and appearance of nearby teeth. But, as a result of recent advances in orthodontic treatment, removing teeth has become much less common. 

However, if baby teeth have been extracted, there is a greater likelihood that adult teeth will need to be extracted as part of orthodontic treatment.

Who needs orthodontic treatment?

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.

Problems with crooked and out-of-place teeth are quite common in the UK. It's thought around a third of 12-year-olds would benefit from some degree of orthodontic treatment.

Orthodontic treatment is most commonly used to improve the appearance and function of misaligned or crooked teeth.

Teeth that are straighter and better aligned should be easier to clean, and may reduce strain on the muscles and joints of the jaw.

The improved appearance of your teeth or jaw might also help boost your self-esteem and self-confidence.

Teeth problems

Some of the most common teeth problems requiring orthodontic treatment include:

• protruding upper front teeth – one of the most common reasons for needing orthodontic treatment
• crowding – people with narrow jaws often lack enough space for their teeth, resulting in crowding
• impacted teeth – the adult teeth may not come through as they grow in the wrong position
• asymmetrical teeth – in some people, the centre of their upper and lower teeth don't match, giving their teeth an asymmetrical or crooked appearance
• deep bite – the upper teeth cover the lower teeth too much
• reverse bite – the upper teeth bite inside the lower teeth
• open bite – the upper and lower front teeth don't meet when the mouth is closed; an open bite is often a result of children sucking their thumb over a long period of time

Other reasons for treatment

Orthodontics can also be used to treat other health problems. For example, orthodontics is part of the treatment for cleft lip and palate.

It may also help in cases of mild sleep apnoea. An orthodontist can make a dental appliance similar to a gum shield, which can help prevent the airway closing while you sleep.

When can treatment start?

Orthodontic treatment will usually only be started after all of a child's adult teeth have started to come through.

For most children, this will be when they're about 12 or 13 years old. For adults, orthodontic treatment can begin at any age, but what can be done is more limited.

Oral hygiene

Orthodontists will not usually begin a course of orthodontic treatment unless you have a good standard of oral hygiene. This is because orthodontic treatment can increase the risk of tooth decay.

How can I access orthodontic treatment?

In most cases, you or your child will be referred to an orthodontist by your dentist, although you may be able to seek treatment directly.

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

NHS orthodontic treatment is free for people under the age of 18 with a clear clinical need for treatment. However, because of the high demand for treatment, there can be a long waiting list for NHS orthodontic 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 treatment is widely available but can be expensive, with an average fee of between £2,000 and £6,000.

Free orthodontic treatment is sometimes available on the NHS, although you can also pay for private treatment.

The starting point for both types of orthodontic care is usually your dentist, who may refer you to an orthodontist. You may also be able to seek treatment directly yourself.

Orthodontics on the NHS

Orthodontic treatment is only available at no cost on the NHS for young people under the age of 18, and students aged 19, who have a clear clinical need for treatment.

NHS orthodontic care is not 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.

In some parts of the country, there currently aren't enough trained NHS specialist orthodontists to meet patient demand. This means there may be a long wait for treatment, even if your child qualifies for NHS orthodontic treatment.

Depending on your local clinical commissioning group (CCG), waiting times for orthodontic treatment can range from six months to two years or more.

Private treatment

If you or your child don't qualify for NHS orthodontic treatment, or you don't want to wait for NHS treatment, you can pay for 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. However, it can sometimes be even more than this.

A private orthodontist will give an estimate of 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.

Keeping your braces clean

A common complication of orthodontics is tooth decay. This can happen because orthodontic appliances can sometimes stimulate the production of saliva, which leads to plaque and causes the enamel to decay.

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

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

Risks

Like any type of medical treatment, orthodontic treatment carries a risk of complications as well as benefits. The best way of minimising any possible risk is to maintain a high standard of oral hygiene and always follow your orthodontist’s instructions.

Enamel decay

Each tooth is covered with a hard outer surface called enamel. A common complication in people who are having a course of orthodontics is that the enamel in one or more of their teeth begins to decay. This can happen for a number of reasons.

Orthodontic appliances can sometimes stimulate the production of saliva, which combines with small particles of food and bacteria to form a sticky film known as plaque. The plaque causes the enamel to decay. In addition, many people with appliances find it difficult to keep their teeth clean.

In more severe cases of enamel decay, the outer layer of a tooth breaks down and the inside of the tooth can become infected, resulting in toothache. If the decay is extensive, it may need to be repaired with a filling or crown. See the Health A-Z topic about Tooth decay - treatment for more information.

Reducing the risk

To reduce your risk of enamel decay, your orthodontist may recommend that you use toothpaste with high levels of fluoride or a mouthwash that contains fluoride. Fluoride is a mineral that helps to strengthen enamel.

Avoid eating foods and drinking drinks that are high in sugary or starchy carbohydrates because they will stimulate the growth of bacteria in your mouth. Examples of sugary or starchy carbohydrates include:

• fizzy drinks
• coffee and tea with sugar added
• chocolate
• sweets
• cakes
• crisps
• biscuits
• white bread

Healthier alternatives include:

• cheese
• brown bread
• pasta
• rice
• potatoes
• leafy green vegetables
• eggs

Why is it necessary 

The primary goal of orthodontics is to improve the appearance and function of misaligned or crooked teeth.

Sometimes, problems that affect the normal development of teeth run in families. This suggests that there may be certain genes that you inherit from your parents which disrupt the development of your teeth and jaw. Genes are units of genetic material that control how your body and characteristics develop.

In many cases, developmental problems with a person’s teeth and jaw occur for no apparent reason. However, a person’s teeth and jaw can sometimes be damaged in an accident, such as a fall, or as a result of activities, such as thumb sucking, that persist well into childhood.

In children, crooked or abnormally arranged teeth are not usually an immediate health problem. However, these types of abnormalities may affect the later development of the child’s teeth, mouth and jaw. In severe cases, such abnormal developments can affect a child’s physical appearance as they grow older.

Reasons for treatment

Some of the most common reasons why people are referred to an orthodontist for orthodontic treatment are listed below.

• Protruding upper front teeth - one of the most common reasons for needing orthodontic treatment, particularly as the teeth may be more prone to damage during falls or contact sports.
• Crowding - people with narrow jaws often lack enough space for their teeth, resulting in crowding.
• Impacted teeth - the adult teeth come through in the wrong position.
• Asymmetrical teeth - in some people, the centre of their upper and lower teeth do not match, giving their teeth an asymmetrical or crooked appearance.
• Deep bite - the upper teeth cover the lower teeth too much.
• Reverse bite - the upper teeth bite inside the lower teeth.
• Open bite -  the upper and lower front teeth do not meet when the mouth is closed; an open bite often occurs as a result of prolonged thumb sucking.