Braces (dental)

Page last reviewed: 13/07/2011

Orthodontics is a Greek word that literally means 'to straighten teeth'. It is a type of dental treatment that aims to improve the appearance, position and function of crooked or abnormally arranged teeth.

Orthodontics uses mechanical devices, such as a brace, over a certain period of time (usually 18 months to two years) to correct the position of the teeth.

Healthcare professionals who specialise in orthodontics are known as orthodontists. They usually work in dental surgeries or specialist hospital units.

Who needs orthodontics?

Sometimes, a child's teeth and jaw do not develop in the normal way. The medical term for teeth that are out of position is malocclusion.

Some cases of malocclusion occur for no obvious reason. Other cases are the result of certain behaviours, such as frequent thumb sucking, or an injury to the teeth or bones of the face.

Many cases of malocclusion do not pose serious health concerns. However, if malocclusion is not corrected during the teenage years, it may affect the appearance of the teeth and the shape of the face. This could cause psychological and emotional problems, such as lack of self-confidence, anxiety and depression.

More severe cases of malocclusion can affect the functioning ability of the teeth, mouth and jaw. For example, it can make it difficult for a person to eat food; cleaning the teeth may be harder and the teeth may be vulnerable to damage.

Malocclusion is much more common than most people think. For example, a recent study carried out in England found that around a third of 12 year olds would benefit from some degree of orthodontic treatment.

See Orthodontics - why it is used for more information.

Orthodontics in the HSE

The HSE provides free orthodontic treatment for those patients with the most severe orthodontic problems.  The criteria used to decide whether a child qualifies for treatment in the HSE is determined by nationally agreed eligibility guidelines based on an international grading system called the Index of Orthodontic Treatment Need (IOTN).

HSE dental surgeons are trained in the 2007 guidelines for eligibility and so can advise and refer you to the local HSE orthodontic unit for assessment, if your malocclusion is sufficiently severe.  The types of orthodontic problems that qualify under the guidelines include front teeth that are buried and fail to erupt, multiple missing teeth, very prominent front teeth or severe problems with the bite or jaw development.  It is important that the teeth are healthy and the cleaning is very good before any orthodontic treatment is considered, so diet, tooth-brushing and regular visits to the dentist are important. 

Treatment waiting times vary from region to region depending on orthodontist manpower. The most severe cases are prioritised and seen first.  In the majority of the HSE Orthodontic units, the orthodontists working are fully qualified as specialists having undergone an extra 3 years training in orthodontics. 

Private treatment

If you or your child is having orthodontic treatment for purely cosmetic reasons (or you do not want to wait for public treatment), you will have to pay for private treatment.

Private orthodontic treatment is widely available but it can be quite expensive.

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Braces are a type of orthodontic treatment appliance that are used to correct the position of the teeth. 

Orthodontics and adults

Although children and teenagers commonly require orthodontic treatment to correct developmental problems with their teeth, an increasing number of adults are now also seeking treatment. This can be to correct problems that were not treated in the past or to improve the appearance and function of their teeth.

Another reason why adults may need orthodontic treatment is if they have a condition known as sleep apnoea. This is where the muscles and soft tissue at the back of the throat collapse inwards during sleep. This causes breathing difficulties and disturbed sleep which resukts in tiredness the following day.

People with mild sleep apnoea often benefit from an orthodontic device called a mandibular repositioning splint (MRS), which is designed to prevent the area at the back of the throat from narrowing.

See the Health A-Z topic about Sleep apnoea for more information and advice.

Page last reviewed: 13/07/2011

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.

Sometimes, having abnormally shaped or arranged teeth can make teeth cleaning more difficult. This can lead to dental conditions, such as:

  • tooth decay - where acids in your mouth dissolve the outer layers of your teeth
  • gum disease - red and inflamed (swollen) gums; in particular, a severe type of gum disease, known as periodontitis, can occur as a result of abnormal dental development

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.

Cleft lip and palate

Cleft lip and palate is a type of birth defect where a child is born with a split (cleft) either in their upper lip or the roof of their mouth (the palate) or both. It occurs when separate areas of the face do not join together properly when a baby is developing in the womb.

Most children with a cleft lip and palate will need one or more courses of orthodontic treatment to correct the appearance and function of their teeth and jaw. As a child with a cleft lip and palate has a clear clinical need for orthodontic treatment, the treatment is provided free by the HSE.

See the Health A-Z topic about Cleft lip and palate for more information.

Page last reviewed: 13/07/2011

A course of orthodontic treatment will usually only be started after a child's adult teeth have fully developed.

For most children this will be when they are about 12 or 13 years of age. However, in some cases, problems with a child's teeth may only become apparent when they are 15 years of age. In certain cases , orthodontists may wish to postpone treatment until 15 years of age or later until teh growth pattern of the jaws has been determined and the treatment options become clear.

In some cases, a child may need to have orthodontic treatment before their adult teeth have fully developed. For example, this could be due to an underlying condition that affects the normal development of their skull, jaw or teeth, such as a cleft lip and palate or in cases where early intervention can prevent a larger problem later in a child's development. This is known as interceptove orthodontics.

For adults, orthodontic treatment  can begin at any age.

Oral hygiene

Orthodontists (healthcare professionals who specialise in orthodontics) will not begin a course of orthodontic treatment until the patient has achieved a good standard of oral hygiene.

The appliances that are used in orthodontics can attract pieces of food, which can make teeth brushing more difficult and increase the risk of tooth decay during treatment. If your oral hygiene is poor and you have a significant level of tooth decay, orthodontic treatment can make these problems much worse.

Maintaining a good standard of oral hygiene during orthodontic treatment will also help to prevent tooth decay.

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Page last reviewed: 13/07/2011

Assessment

In the first stage of orthodontic treatment, an assessment of the current state of the patient's teeth and their likely development is made. This usually involves taking X-rays and making plaster models of the teeth.

After completing the assessment, the orthodontist will be able to provide more information about the type of treatment that is needed, and the likely results.

Orthodontic appliances

Orthodontic treatment uses appliances to correct the position of the teeth. The four main types of appliance are:

  • removable appliances - which are usually plastic plates that cover the roof of the mouth and clip on to some teeth; they can be taken out and cleaned
  • functional appliances - a pair of removable plastic braces that are joined together or are designed to interact together and clip on to the upper and lower teeth
  • fixed appliances - a non-removable brace that is fixed to each tooth with a metal or ceramic bracket or attachment
  • headgear - this is not an orthodontic appliance itself, but it is used with other appliances to add a certain type and direction of pressure

The four types of orthodontic appliances are discussed in more detail below.

Removable appliances

Removable appliances can be used to correct minor problems, such as slightly crooked teeth. They can also be used to discourage children from sucking their thumb.

Although the appliance is easily removable, it should only be taken out of the mouth for cleaning. However, removing the appliance may also sometimes be recommended 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 relative position of the upper jaw and teeth and the lower jaw and teeth, such as a retruded lower jaw and teeth (backward movement of the lower jaw).

Most people who use functional appliances will need to wear them all of the time. It is very important to follow your orthodontist's instructions about how and when to wear the appliance because if it is not worn correctly, the treatment will be unsuccessful.

It may be necessary to remove your functional appliance while you are eating.

Fixed appliances

Fixed appliances are the most common type of orthodontic appliance. They can be used to treat cases where a number of teeth need to be corrected, or where a high degree of precision is required to guide the development of the teeth and prevent problems in the future.

You will be able to eat normally while wearing a fixed appliance. However, certain foods and drinks, such as toffee, hard sweets and fizzy drinks, must be avoided because they can damage the appliance and teeth. Your orthodontist will be able to give you further dietary advice.

If you are 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.

Many braces are usually made out of metal, so they will be noticeable on the front of your teeth. Many private orthodontists now offer ceramic or clear plastic braces that are much less noticeable. However, these types of braces are usually more expensive than the metal variety.

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 you are wearing headgear.

It is important that you follow all of your orthodontist's instructions relating to the use of your headgear, such as how to put it on and take it off, and how to use it at night. Failure to use headgear correctly could lead to a facial injury or, more seriously, an eye injury.

Your orthodontist will be able to train you to use your headgear correctly and safely.

Other treatments

Retainers

Retainers are often used near the end of a course of orthodontic treatment. Retainers are dental devices that hold newly fixed teeth in place while the surrounding gum and bone adjusts to the new position of the teeth. Retainers can be either removable or fixed.

Tooth removal

In some cases, it may be necessary to remove a tooth to correct the position and appearance of nearby teeth. However, as a result of recent advances in orthodontic treatment, the need to remove a tooth has become much less common.

Page last reviewed: 13/07/2011

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

See the Health A-Z topic about Tooth decay - prevention  for more information and advice.

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Page last reviewed: 13/07/2011

Following your orthodontist's instructions is the most important factor in determining the outcome of your orthodontic treatment.

If you maintain good oral hygiene, wear your appliances as instructed and follow your orthodontist's dietary advice, you are likely to achieve good results, usually within 18 to 24 months of starting treatment.

However, if you neglect your oral hygiene, do not wear your orthodontic appliance as instructed, and ignore the advice about what foods to avoid, you are likely to achieve poor results or, even worse, your teeth may end up in a worse state than before your treatment began.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.

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