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What is Orthodontics?

Orthodontics is 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 is all about making the best of your teeth by 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 himself or herself an orthodontist, this simply means that they use braces on some of their patients.

A SPECIALIST ORTHODONTIST 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.

What is a malocclusion?

A malocclusion is basically a bite that is not ideal. There are many different types of bite problems. Malocclusions may be described as being mild, moderate or severe.

Do I need Orthodontic treatment?

If you are concerned that your teeth are overcrowded, protrude or your bite is irregular or uncomfortable then it would be a good idea to ask your dentist to refer you for a consultation with a specialist orthodontist. Some bite problems are listed below:

  • 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 grow through 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 psychosocial 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:

  • Removal of dental crowding (or sometimes closing gaps)
  • Alignment of the upper and lower dental arches
  • Correction of the bite of the teeth so that the front teeth meet on closing and the back teeth mesh together
  • Reducing the likelihood of damage to prominent teeth
  • Enhancing facial aesthetics
  • Accommodating impacted, unerupted or displaced teeth
  • Preparation for advanced dental treatment, such as crowns, bridges or dental implants
  • Reversing the drifting of the teeth in older patients who have suffered from advanced gum disease

Do I have to pay for NHS orthodontic treatment?

To be eligible for NHS orthodontic treatment, patients are assessed using nationally agreed guidelines that were first introduced in 2006. The guidelines are called the Index of Orthodontic Treatment Need (I.O.T.N.) and look at every aspect of the bite for example the degree of dental crowding, the presence of impacted (buried) teeth and amount of protrusion of the teeth etc. The only exception is the charge for replacement of removable appliances lost or damaged beyond repair (£80.70 in 2019).

The NHS contract for orthodontics funds all appliances, adjustments and repairs required during the entire treatment. The practitioner is free to choose whatever technique and appliance s/he wishes within these requirements. S/he is not under an obligation to use or offer any particular appliance. It is not permitted to charge patients under the age of 18 for an appliance or any part of the treatment, nor to insist that part of the treatment is undertaken privately before acceptance as an NHS patient. To do so is, in effect, asking to be paid twice. Any such practice is a serious breach of NHS regulations.

Is there an NHS waiting list?

The Exeter Orthodontic Practice does not have a waiting list for older children or for those patients with more significant bite problems. It is usually best to plan orthodontic treatment when the adult teeth have grown through and when the jaws have had time to grow and develop, for this reason, younger patients may be advised to wait a while.

What can I do if the NHS will not fund treatment for my child?

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 not 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.

The Exeter Orthodontic Practice offers a range of treatments and payments options available.

How do I get referred for an orthodontic examination?

Most children are referred for a consultation appointment by their family dentist. Adult patients who wish to be seen for a private consultation are welcome to use the self-referral form.

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. Sometimes 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 transparent braces on the upper teeth and sometimes the lowers depending on the bite.  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. Click here to view our fee guide.

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, stretchy elastic rings are often used to hold the wire in position. The wires start to exert gentle pressure to move the teeth into a new position. The brackets can be metal, ceramic or even gold and the elastic rings 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 base plate 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 6-12 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 but it is important to 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 however be eaten with care if you cut them up first.

What if my brace breaks?

Please call the practice as soon as is reasonably possible and we will advise you about what needs to happen next. If the brace is repeatedly broken, there may be no option but to discontinue the course of treatment.

If a wire comes loose and starts to poke into your cheek and the practice is closed, we would advise carefully trimming the wire with nail clippers or small wire cutters if you have them, to make things comfortable. Please call us when the practice reopens and we will arrange to take a look and ensure everything is ok.

What about tooth brushing?

It is important you brush your teeth well, three times per day and use fluoride toothpaste. If possible carry a brush with you for use after lunch. Pay particular attention to brush where the gums meet the teeth. Brushing may take a little longer when you have a fixed brace. Failure to keep your teeth and brace clean may lead to permanent white and brown marks appearing on your teeth. Please always make sure that you brush your teeth carefully before your orthodontic appointment.

Once fixed braces have been fitted we always recommend that our patients buy a “Brace Pack”, this contains a small interdental toothbrush that can be used to clean around the individual brackets and underneath the wires to keep the braces clean.

Should I use a mouthwash?

We advise that patients wearing fixed braces should use a fluoride mouth rinse every day, to help to protect the teeth. It is best to use the mouthwash as described on the bottle. It is ideal if the mouthwash is used at a different time from when you brush your teeth; this means that your teeth will have an additional exposure to fluoride to keep the surface enamel strong. Once you have used the mouthwash do not rinse with water or you will dilute away the helpful effects of the fluoride.

Should I use a gum shield (mouth guard)?

It is recommended that you should wear a gum shield for sports such as rugby, hockey and martial arts. It would also be sensible to wear one for activities where there is a chance that you might fall on your face such as roller-skating, or skateboarding. You will be advised about this.
There are two types of gum shields that we recommend at the Exeter Orthodontic Practice:

  • 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.
  • If you are serious about contact sports please ask us about buying a custom-made mouth guard. The orthodontist will need to take an impression of the teeth so that they can be fabricated in a dental laboratory. Although these mouth guards are more expensive, they are thicker and offer more protection to the teeth. They are also available in loads of different colours.

What if I play a musical instrument?

If you play a wind instrument, particularly the flute or a brass instrument, then a fixed brace may make it more difficult. With time, most patients manage to adapt to play their musical instruments and we will advise to of techniques to make playing them more comfortable.

Should I have check-ups with my own dentist during orthodontic treatment?

Yes definitely, the orthodontist only looks after the braces. Your teeth are actually at greater risk during orthodontic treatment and it is particularly important that you keep up regular contact with your own dentist.

What are retainers?

Retainers are designed to keep your teeth straight and can either be removable or fixed to the teeth. Now that your teeth are straight, if you do not wear your retainer, your teeth are likely to drift towards their original positions. Although it is possible to re-straighten teeth that have moved, this is not allowed on the NHS and would have to be arranged on a private basis.

How long will I have to wear the retainers?

This will vary according to how your teeth originally looked, before the orthodontic treatment was started. However, as a general rule you will be asked to wear a removable retaining appliance for at least twelve months at nights.

The best available evidence shows that straightened teeth tend to want to move for many years, if you are keen to keep your teeth perfect, it will be important to wear your retainers on a part time basis for as long as possible. Your orthodontist will provide advice regarding how long it will be sensible to continue wearing your retainer for.

What do I do if my retainers break?

Ring up for an appointment as soon as is reasonably possible. Do not wait for your next routine appointment as your teeth may move whilst not wearing your retainers. Sometimes retainers can be repaired but if a replacement retainer is required, as is frequently the case, there will be a charge.