Orthodontics

WHAT ORTHODONTICS TREATS

Crowding, where there is not enough room in the jaw for the teeth, so they overlap and rotate. This is the most common reason people seek treatment.

Spacing, where there are gaps between teeth — because the teeth are small relative to the jaw, because a tooth is missing, or because of a habit.

An increased overbite, where the upper front teeth project well ahead of the lower ones.

An underbite, where the lower teeth close in front of the upper.

A crossbite, where upper and lower teeth meet the wrong way round at one side or at the front.

An open bite, where the front teeth do not meet when the back teeth are closed, making it hard to bite through food.

Impacted teeth that have not come through, most often canines, which can sometimes be guided into position.

Asymmetry in the dental midlines or in the way the jaws meet.

Preparation for other treatment — creating space before an implant, uprighting a tilted tooth before a bridge, or aligning teeth before restorative work so that less of the tooth needs to be removed.

 

WHY ALIGNMENT MATTERS BEYOND APPEARANCE

Appearance is a legitimate reason for treatment and for many patients it is the main one. But there are functional reasons too.

Cleaning. Crowded and overlapping teeth are harder to clean, which makes decay and gum disease more likely in those areas.

Wear. Teeth that meet unevenly take load unevenly, and over years that shows as wear, chipping and sometimes cracks.

Chewing and speech, where the bite interferes with them.

Protecting restorative work. A crown or an implant placed into an unbalanced bite takes more force than it was designed for.

Equally, not every irregularity needs treating. Mild crowding in a healthy, well-cleaned mouth may be entirely reasonable to leave alone, and a good orthodontist will say so.

 

WHEN TREATMENT USUALLY HAPPENS

Childhood and adolescence. Most orthodontic treatment is carried out while the jaws are still growing, because growth can be used to help. Treatment is commonly begun once most of the adult teeth have come through, typically in the early teens.

Early treatment in younger children is sometimes carried out where there is a specific reason — a crossbite that is pushing the jaw to one side, a habit that is affecting development, teeth at risk of damage, or an impacted tooth that needs space creating for it. This is usually a short first phase rather than full treatment.

Adults. Teeth can be moved at any age, provided the gums and bone are healthy. Adult treatment differs in that growth cannot be used, and that there is more often existing dental work, missing teeth or previous gum disease to plan around. It is now a substantial part of orthodontic practice.

 

HOW TREATMENT IS PLANNED

Examination of the teeth, gums, jaw joints and facial proportions.

Records: photographs, X-rays including a full view of the jaws, and impressions or a digital scan of the teeth. A three-dimensional scan is used for more complex cases and for impacted teeth.

Diagnosis, which includes deciding whether the problem is dental — the teeth are badly positioned within jaws that are in a reasonable relationship — or skeletal, where the jaws themselves are out of proportion. That distinction determines what treatment can achieve.

The plan, which sets out what will be moved, with what appliance, whether any extractions are needed, roughly how long it will take, and what the limits are.

Where the discrepancy is skeletal and significant in an adult, orthodontics alone can disguise it but not correct it, and combined treatment with jaw surgery may be the only way to achieve a stable, properly functioning result. An orthodontist should tell you plainly when that is the case rather than attempting to camouflage a problem that will relapse.

 

THE APPLIANCES, IN BRIEF

Fixed braces — brackets bonded to the teeth and connected by a wire. Metal, ceramic or lingual.

Clear aligners — a series of removable transparent trays worn in sequence.

Functional appliances — used in growing patients to influence the relationship between the jaws.

Expanders — used to widen a narrow upper jaw, most effectively while growth is still occurring.

Retainers — worn after treatment to hold the result.

These are described in more detail on our Invisalign and braces page.

 

EXTRACTIONS IN ORTHODONTICS

Some cases need teeth removed to create space, most often premolars, and some do not. It depends on how much crowding there is, how the teeth sit relative to the face and lips, and what the plan is trying to achieve.

Extraction is neither inherently good nor inherently bad in orthodontics, despite what is often said online. It is a decision made case by case from measurements, and the reasoning should be explained to you.

 

RETENTION

Teeth move throughout life, and they tend to drift back towards their original position after treatment.

For that reason, retainers are a permanent part of orthodontic treatment rather than an optional extra at the end. Most patients wear a removable retainer at night indefinitely, often alongside a fine wire bonded behind the front teeth.

Anyone considering orthodontic treatment should understand this at the outset: the result is kept by the retainer, not by the braces.

 

WHAT TO EXPECT DURING TREATMENT

Aching and tenderness for a day or two at the start and after each adjustment or aligner change.

Regular appointments throughout, the frequency depending on the appliance.

More attention to cleaning than usual, particularly with fixed braces, because plaque accumulates around brackets and the consequences — white marks on the enamel and inflamed gums — are avoidable but common where cleaning slips.

Some adjustment to eating, speech and comfort in the first weeks, which almost everyone adapts to.

 

QUESTIONS PATIENTS ASK

What is the difference between a dentist and an orthodontist? An orthodontist is a dentist who has completed several years of further specialist training in tooth movement and facial growth. General dentists also provide orthodontic treatment, particularly with aligners, and the appropriate choice depends on the complexity of the case.

 

At what age should a child first be assessed? An early assessment around the age of seven to nine allows any problem that benefits from early intervention to be identified. Most children assessed at that age need nothing done immediately.

 

Is adult treatment different from treatment in a teenager? The mechanics are the same, but growth cannot be used, treatment can take longer, and existing dental work and gum health need planning around.

 

Can teeth be straightened if I have gum disease? Only once it has been treated and is stable. Moving teeth in a mouth with active gum disease can accelerate bone loss.

 

Will I definitely need extractions? No. Many cases are treated without, and the decision is made from measurements rather than as a routine.

 

How long does treatment take? It depends entirely on what has to be moved. A reliable answer requires a full assessment, including X-rays.

 

Will my teeth move again afterwards? They will if retainers are not worn. With retainers, the result is stable.

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