Orthodontists are fully qualified dentists who have commonly completed a further period of training and examinations in order to specialise in orthodontics. A specialist orthodontist will have carried out at least 3 years of extra training after dental school becoming a qualified dentist. Only those dentists who have completed this training or equivalent can register with the GDC as a specialist orthodontist.

An orthodontic therapist is a registered member of the dental team. They assist dentists/orthodontists in carrying out orthodontic treatment and provide some aspects of the treatment themselves. They can only work to the treatment prescribed from a dentist/orthodontist and within their competence (ability) and scope of practice as defined by the GDC and within the recommendations of BOS.

Any dentist can carry out orthodontics. The General Dental Council (GDC) regulate dentists and it states that any dentist can work in any area of dentistry, as long as they feel competent (able) to do so. However, orthodontics is a very specific area of expertise and only those registered on the orthodontic specialist list with the GDC can call themselves a specialist orthodontist.

A diligent orthodontist or dentist will always:

  • Ask you about your concerns.
  • Outline all the different treatment options and their risks and benefits.
  • Explain about the different types of braces.
  • Estimate how long the treatment should take.
  • Explain about retainers at the start of treatment, and the possible need for lifelong wear if the teeth are to stay in their new place.
  • Explain how likely the teeth are to stay in their new position at the end of treatment (that is the stability of the final result).
  • At the start, explain what other procedures may be required as part of the treatment.
  • Give you thinking time to decide if you want to go ahead.
  • Give you a written treatment plan and fee estimate (if appropriate).
  • Tell you how much orthodontic training they have had.

All children under the age of 18 are able to have an orthodontic assessment under the NHS. The NHS will pay for orthodontic treatment but only the more severe cases are covered under current rules - minor problems are not covered. Orthodontic treatment for children who qualify is free of charge. There are clear criteria (Index of Orthodontic Treatment Need – IOTN) about who qualifies. To find out more see the information on IOTN. However treatment for adults is not commonly funded by the NHS.

The NHS contract for orthodontics funds all braces, adjustments and repairs required during the entire treatment. The only exception is the charge for replacement of removable braces lost or damaged beyond repair. It is not permitted to charge patients under the age of 18 for a brace or any part of the treatment, nor to insist that part of the treatment is undertaken privately before acceptance as an NHS patient. Any such practice is a serious breach of NHS rules which renders the orthodontist/dentist liable to disciplinary action if reported to the local PCT/Health Board or the General Dental Council.

Fees for private orthodontic treatment vary widely. The fee varies due to the complexity (difficulty) of the problem, the locality, and the experience of the orthodontist/dentist. Certain techniques such as aligner systems or lingual braces are also more expensive. Prospective patients should always ask for information from the orthodontist/dentist. A written quotation will be given to you but is normally only possible after the orthodontist/dentist has had a chance to assess your problem at a consultation.

Fixed braces are the most common and most sophisticated type. They can be made from different materials, most commonly, silver-coloured metal (stainless steel) but also gold and tooth-coloured material so they don’t show as much. They are usually fitted to the outside of the teeth but a more recent development has seen braces that are fitted to the back of or tongue side of the teeth (called lingual braces). Aligners are another type – they are clear, removable mouthguard-style braces that straighten the teeth gradually. Removable braces are also often used and are made of wire and plastic that can do simple, limited tooth movement. Many different factors need to be taken considered before deciding what type of brace is right for the individual patient.

There is now a wide choice of more discrete brace options for patients of all ages, including:

  • Ceramic brackets - made in a white or tooth coloured material
  • Lingual braces - placed out of sight on the back of the teeth
  • Aligners - removable clear plastic appliances which fit over the teeth and progressively move them to the desired position

Each option has its advantages and disadvantages and specialist advice is essential.

Ceramic brackets

Ceramic brackets are tooth coloured or translucent. They are less conspicuous than metal brackets and therefore often favoured by adults. However they do have a number of drawbacks which need to be taken into account. The brace tends to become discoloured over the course of time by contact with foods and may become less pleasing in appearance. The brackets are more prone to breakage than metal brackets; the wires slide through the slots less freely so treatment may take longer; the brackets tend to be abrasive and may cause wear to teeth in the opposite jaw if they should make contact when biting; the brackets can sometimes be difficult to remove with a slightly higher risk of damage to the tooth surface. The brackets are also more costly than metal brackets, and with all the associated problems the overall treatment can be expected cost significantly more. Having said all this, if appearance is at a premium, ceramic brackets may still be the first choice for many patients.

Lingual Appliances

These are attached to the lingual surface of the teeth, i.e. the surface towards the tongue. In this position they are virtually invisible. The technique involves special skills and needs considerable experience on the part of the orthodontist to achieve good results. Only a limited number of orthodontists offer this technique and you may need to search for a suitable practitioner who has the requisite experience. The main drawbacks are that it can cause soreness of the tongue and affect speech. Fees are always much higher than for conventional fixed braces because of the higher material costs, greater surgery time involved and the extra training needed.

Aligners

These relatively new appliances blend modern technology with the long-standing concept of using clear flexible splints to ease teeth into line. A succession of splints is worn, each splint bringing the teeth a little closer to the desired position. The splints are effectively invisible and are therefore an attractive option from the standpoint of appearance.

Aligners can be very effective if all that is required is to align mildly irregular teeth. However there are several drawbacks. In the more severe cases, notably those where extractions are required, aligners lack the necessary control of the teeth to give consistently good results and often lead to disappointment. Likewise they are not well suited to correcting problems like prominent upper incisor teeth.

The cost is much higher than for conventional fixed braces owing to the high laboratory costs in making the aligners. In selected cases they they are very effective but their scope is limited.

Simple straightening can sometimes be carried out as quickly as 6 months, particularly if it’s only the front 6 teeth. However, a relatively short treatment like this usually produces limited changes and this is not always a long-term solution as often this isn’t enough time to move the whole tooth, including the roots, into the right place. This may mean the teeth may quickly move back to their original positions once the braces are taken off. It often takes between 1 or 2 years to get the teeth to bite in a better way, in harmony with the jaws and lips. It may take longer for more difficult problems.

A degree of discomfort is likely to start with. You can expect some aching and tenderness in the gums as the teeth start to move, but this mostly wears off after a few days.

Fitting the brace should not be painful. For a fixed appliance the brackets are simply glued to the faces of the teeth; metal bands may also need to be cemented round the back teeth. No anaesthetic is needed.

As the biological processes get under way round the tooth roots to allow the teeth to move, you can expect some aching and the teeth will be tender to bite on. This usually settles down in a few days, although some patients do experience a degree of tenderness for a longer period. The amount of discomfort varies enormously from person to person. It may be helpful to take your normal painkillers or a day or two.

Some further discomfort may be experienced when the brace is adjusted subsequently, but this depends very much on what adjustments have been made.

You will usually need regular appointments every four to ten weeks. It is not advisable to start treatment if you know you will not be able to keep these appointments.

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.

Probably not, changing orthodontists is best avoided if possible as orthodontists work in different ways with different appliances and a transfer will almost inevitably mean a setback in the progress of your treatment. Nevertheless there are times when a transfer cannot be avoided and your orthodontist should be able to find someone to take over your treatment at your new location. The NHS makes full provision for a transfer of treatment between orthodontists.

It is undoubtedly preferable not to start treatment with one orthodontist and then to move on to another orthodontist in a different location. If you know you are about to move it is better to wait until you have arrived at your new location. Most orthodontists would strongly prefer to treat a case all the way through and not have to step in part way through.

Recent research shows that treatment takes an average of six months longer in transfer cases. Patients who are moving to another location, should give the orthodontist as much notice as possible and ask him or her to find an orthodontist at the new location. Ask for a referral to the new orthodontist with a history of the treatment so far. Ask for the study models and x-rays to be sent on or to be given to you to take with you to the new orthodontist.

The BOS provides a transfer form on the BOS website for members to use. In addition you can use the 'Find treatment' section on this site to help find a new orthodontist.

Under the new NHS contract, since 1st April 2006 there has been no official obstacle to changing orthodontists. Orthodontists with NHS contracts can accept an NHS patient who has moved from another part of the country (or from overseas) and who is already under orthodontic treatment. The patient will count as a new NHS case start and brings the full credit for a new start, as long as the patient is over 10 years and under 18 years of age when first seen by the new orthodontist. If you started NHS orthodontic treatment under 18 years of age but have become over 18 by the time you moved, you may still be permitted to contine with NHS treatment but your new orthodontist will need to get permission from the Primary Care Trust or Local Health Board.

Most probably yes. The tissues and bone around the roots take time to adjust to the new tooth positions and there is a particular risk of relapse in the early months after the brace is removed. Even in the longer term some risk remains and the best advice is to continue retention for the long term if possible.

Retainers may be removable or fixed, and there are advantages and disadvantages to both.

  • Removable retainers may be worn full time initially, but reduced to night times later or night times only from the start of the retention period. Your orthodontist will advise you on when to wear your retainer. They are effective but obviously depend on the patient remembering to wear them. They will need occasional repair or replacement, a relatively simple task although you may be charged for a replacement.
  • Fixed retainers are usually glued to the back of the teeth. They are therefore in place all the time. A high standard of tooth cleaning in the vicinity of the retainer is essential to avoid gum problems. They do need regular inspection because if any of the glue fails, the tooth in question may start to drift out of position. For this reason it is essential for the patient to contact the orthodontist at once if there is a breakage. Some general dentists are unhappy about repairing a fixed retainer and a visit to an orthodontist might be needed under these circumstances.

There are a number of things that may go wrong with brace treatment since the teeth are part of a complex biological system involving the gums, jaw bones and facial muscles.

Examples include:

  • Issues with the gums including gum disease or gum recession if the teeth are pushed out of the jawbone if there is not enough space for all your teeth.
  • The way the teeth bite together can also be affected:
  • The teeth bite up into the gum of the roof of your mouth causing soreness.
  • The opposite can be true where the contact between your teeth is less, so reducing biting efficiency.
  • The top teeth can be pushed out to make them appear to 'stick out'.

One of the most common problems that can occur is that teeth tend to return to where they came from once the treatment is finished – this is called 'relapse'. This is often seen where there were spaces between teeth and very twisted teeth at the start. This particularly happens where the treatment is very quick or retainers are not provided appropriately (teeth can take at least a year for the jawbone and gums to settle).

How long will the treatment take?

Will the end result be stable?

Will I have to wear retainers? If so for how long?

What are the risks of treatment?

How much will the treatment cost in total? Does this include any breakages and retainers?

Will I be treated by an orthodontist/dentist or an orthodontic therapist?

No, not really. Teeth can be moved at any age as long as the teeth and gums are healthy. Adults are not usually eligible for NHS treatment so most commonly have to pay for treatment. This gives a wider range of types of braces that can be used.

The expectations from treatment may be different in adult patients, e.g. adults may want different treatment endpoints. This is something that should be discussed with you by your orthodontist when outlining the treatment options.

Most children begin treatment around the age of 12 or 13, once all their permanent teeth have erupted. In a few instances treatment is better started early and your dentist may want to make an earlier referral. But age is not a barrier to treatment and the number of adults seeking treatment is on the increase.

The colours are tiny elastic rings which are mostly used to hold the wires into the brackets on your teeth. They are readily available in many different colours so you can personalise your brace. Most orthodontists are happy to offer the colour of your choice. You should be aware however that certain types of bracket are not designed for use with elastic rings and colours are not an option in such cases. Your orthodontist can advise you.