Frequently asked questions

What is Orthodontics?

Orthodontics, the branch of dentistry concerned with the growth of the face, the development of the bite (occlusion) and the prevention and correction of bite problems. Nearly one million people in the UK started having orthodontics last year and more adults than ever before want treatment. Why?

Orthodontic treatment about making the best of your teeth; it's about improving the harmony of your mouth and jaws. Once you can bite together correctly, you can eat more comfortably and care for your teeth and gums more easily. And your smile will benefit immensely!

What is an Orthodontist?

Any dentist can call themselves an orthodontist, this simply means that they use braces on some of their patients.

A specialist orthodontist is a qualified dentist who has completed three additional years of orthodontic training. They will usually have worked in a variety of hospital dental departments before applying for a postgraduate position. They need to have passed their specialist orthodontic examinations to have the letters MOrth RCS after their names.

All of the partners in the Exeter Orthodontic Practice are specialist orthodontists and all have Master of Science (MSc) degrees in orthodontics as well.

The General Dental Council keeps a register of Specialist Orthodontists practicing in the United Kingdom.

• Protruding upper front teeth - one of the most common dental problems
• Crowding – a narrow jaw may mean there is not enough room for your teeth, resulting in crowding.   Conversely, some patients have significant gaps between their teeth.
• Asymmetry – particularly when the centre lines of the upper and lower front teeth do not match,   perhaps because the teeth have drifted or the position of the jaw has shifted.
• A deep bite – when your upper teeth cover the lower teeth too much
• A reverse bite – when your upper teeth bite inside the lower teeth
• An open bite – when your front teeth remain apart when your back teeth meet; the tongue is   often still visible between the upper and lower front teeth.
• Impacted teeth - in some patients, secondary teeth come through in the wrong position or do not   erupt at all. Orthodontic treatment can help bring these teeth into the correct position.

What are the benefits of orthodontic treatment?

Most patients seek orthodontic treatment to improve their appearance. This is not vanity but recognition that an attractive smile is an essential component of self esteem. It has been clearly shown by psycho-social research, that facial appearance can influence the way that people are treated by others. We often find that children with very prominent upper teeth may experience teasing at school. Brace treatment can also be helpful in undoing the effects of thumb and finger sucking habits.

The benefits of orthodontic treatment can include the following:

Can I have orthodontic treatment on the NHS?

Historically in the UK, any child under the age of eighteen was entitled to free orthodontic treatment on the NHS. In April 2006 this all changed as the government introduced a system for restricting brace treatment to those patients that needed it most. In other words, patients who have moderate to severe malocclusions are still entitled to free NHS treatment, but those with milder problems are unlikely to qualify any more.

If your teeth bite together normally and are only mildly irregular, or if you only have small spaces between your teeth, there is no need for orthodontic treatment to secure dental health and we are no longer allowed to provide it on the NHS. In these circumstances the main benefit is cosmetic improvement and we are happy to provide this treatment under private contract if you request it.

Am I too old to have my teeth straightened?

Provided your teeth and gums are healthy, teeth can in many cases be straightened successfully at almost any age. With age, the bone around the teeth hardens up and this can mean that teeth can move a little more slowly than in younger patients.

The differences between adults and children impose certain limitations but successful treatment is nevertheless possible in the great majority of cases. In a small number of patients, it is necessary to refer patients to our orthodontic colleagues in the hospital so that a consultation can be arranged in collaboration with a maxillofacial surgeon for correction of jaw position.

In our experience, adult patients are highly motivated, take great interest in the progress of treatment and are a pleasure to treat.

Is it possible to have invisible braces?

Private patients have the option of tooth colored brackets on the upper teeth; usually we prefer to use metallic brackets on the lowers. In certain cases it may be possible to use invisible braces, these consist of a series of wafer thin positioners that can hardly be seen. Please feel free to ask your orthodontist about the available alternatives.

How much will private orthodontic treatment cost?

Treatment costs vary according to the complexity of the bite problem being treated. Following your private orthodontic consultation, your orthodontist will provide you with a detailed report outlining the suggested treatment plan for your teeth. The report will also include a written estimate of the treatment costs involved.

What type of brace will I need?

This will depend on the position of your teeth and there are a number of available treatments. Your orthodontist will discuss the alternatives and recommend the best solution at the time of your consultation.

When can I start?

Your teeth and gums need to be healthy before treatment can begin. Usually it is best to wait for the milk teeth to fall out before treatment starts.

What will happen on your first visit to the Orthodontist?

It is likely the orthodontist will have a look at your mouth and teeth using a small dental mirror and a ruler. X-rays, photographs and moulds (impressions) may also be taken. All of these measurements and records will help the orthodontist decide which is the best treatment for you.

What will happen next?

Every patient needs tailor-made treatment, planned by the orthodontist and agreed with you, the patient. Treatment can take more than two years so it is important you are happy from the outset with what is recommended. The types of braces which we use most often in the Exeter Orthodontic Practice include:

Fixed braces – these are the most common type of brace today, often known as "train tracks". Brackets are glued onto the teeth and linked by wires. Small elastic hoops are often used to hold the wire in position. The wires exert gentle pressure to move the teeth into a new position. The brackets can be metal, ceramic or even gold and the elastic hoops come in many colours.

Removable braces – these are sometimes used for correcting a simple problem, such as moving a single tooth or expanding the dental arch. It has a plastic baseplate with wires and springs attached. Removable braces need to be worn all the time except for cleaning or sport.

Functional appliances – these are used to harness the growth of the jaws and improve way the upper and lower teeth meet. There are several designs all of which fit on to both the upper and lower teeth and hold the lower jaw forward. They are mostly removable but should be worn as near to full-time as possible. The most popular functional appliances used in the Exeter Orthodontic Practice are called twin blocks. Although these braces can be quite chunky, if they are worn well, they can produce great results.

Retainers – at the end of treatment, all patients should wear retainers to hold their teeth in the new position. These can be removable or fixed and are an important part of treatment.

What about extractions in Orthodontics?

Extractions as part of orthodontic treatment are required rather less frequently these days on account of advances in orthodontic techniques. New types of braces can enable orthodontists to take advantage of the growth of the patient’s jaw, creating small amounts of additional space in the dental arch. These braces, often known as functional appliances, are routinely used by many orthodontists and often mean that extractions can be avoided. But they are not appropriate for everyone. For some patients, in order to get the best long-term result, extractions are essential.

It is sometimes asserted that functional appliances are appropriate in all cases and that narrow jaws can always be widened to bring overcrowded teeth into line without extractions. But the evidence is that this approach, applied uncritically, greatly increases the risk of subsequent relapse.

There is little doubt that good orthodontic treatment can enhance a patient’s dental appearance or facial aesthetics considerably and appropriate choice of extractions can be part of this process. Nevertheless orthodontic treatment, whilst improving looks, cannot totally over-ride the underlying genetic disposition.

Prior to reaching a decision on extractions, a full assessment of the patient’s face, teeth and state of development must be carried out. This will often involve taking X-rays, impressions and photographs. It is important to note that, in the absence of this assessment, a meaningful opinion cannot be given on whether extractions will be required. Every course of treatment has to be tailored to the needs of the individual patient

How often will I need an appointment?

Appointment intervals will vary according to the orthodontist providing the treatment and the type of brace being used. Usually a visit will be required every 6-10 weeks. It is very important that patients wearing braces ensure that they always know exactly when their next appointment is going to be. Long intervals during treatment can lead to damage occurring to the teeth. In cases where attendance is poor, there may be no alternative but to stop the treatment before it is finished!

Does brace treatment hurt?

Teeth are usually tender for the first few days after the brace is fitted and after the adjustment appointments. Generally after a week or so this settles down. Your orthodontist will advise you regarding suitable pain relief. If the brace rubs your lips or cheeks, you can use a special type of wax to help with this.

Can I eat normally?

Yes you should be able to eat normally. For your orthodontic treatment to work well and in the shortest possible time it is important you take care of your teeth and brace. In order to prevent damage to both, you should avoid the following:

• Toffees
• boiled sweets
• sugared chewing gum
• chocolate bars, etc.
• Fizzy drinks including diet drinks
• excessive amounts of fruit juice
• Hard foods which might damage the brace such as crunchy apples, crusty bread rolls, etc. (Hard foods can be eaten with care if you cut them up first.)

• Simple off the shelf gum shields bought in a packet that fit over the braces. These are reasonably cheap and provide some protection to the teeth.
• Custom made mouthguard If you are serious about contact sports your orthodontist will need to take an impression of the teeth so that they can be fabricated in a special laboratory. Although these mouthguards are more expensive, they are thicker and offer more protection to the teeth. They are also available in loads of different colours which is a bonus.