Orthodontic Dental Treatment – A Guide

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Orthodontics is a type of dental treatment that is used to improve the cosmetic appearance, position and function of crooked or abnormally arranged teeth.

It is available through the NHS, but the treatment is not always free (see below).

Why orthodontics is necessary
When orthodontics should be done
How orthodontics is performed


An orthodontist is a dental surgeon who specialises in orthodontic treatment and makes use of a range of appliances, such as braces. These are used to correct the position of teeth over a period of time, usually between 18 months and two years. The improved cosmetic look of the teeth after the treatment is often of psychological benefit to the patient in a way similar to someone undergoing teeth whitening.

Orthodontics on the NHS

Orthodontic treatment is only available free of charge on the NHS for young people who are under 18 years of age and who have a clear clinical need for treatment.

A rating system, known as the Index of Orthodontic Treatment Need (IOTN), is used to assess the need and eligibility of individual cases. The IOTN is made up of five grades, which are listed below.

  • Grade 1 almost perfect teeth.
  • Grade 2: minor irregularities with the teeth, such as slightly protruding upper front teeth.
  • Grade 3: greater irregularities with the teeth do not require treatment for health reasons. For example, upper front teeth that protrude 4mm (0.15 inches) or less.
  • Grade 4: a severe degree of irregularity with the teeth that requires treatment for health reasons. For example, upper front teeth that protrude more than 6mm (0.25 inches).
  • Grade 5: severe dental health problems. For example, upper front teeth that protrude more than 9mm (0.35 inches).

NHS treatment is available for grade four or five cases. Grade three cases are usually judged on a case-by-case basis, and treatment may be made available if the appearance of the teeth is particularly unattractive.

Finding an orthodontist

If your dentist feels that orthodontic treatment for your child is clinically necessary, he or she will contact your local primary care trust (PCT) to arrange a referral to an NHS orthodontist. In some PCTs the number of NHS orthodontists is limited, and waiting lists for treatment can range from six to 18 months.

The cost of private treatment depends on the type and duration of the treatment required. The average cost for a course of treatment is around £2,000-£2,500.

The website of the British Orthodontic Society provides a search facility for orthodontist services in your local area. It originally came into existence on 1 July 1994 by the unification of five existing national orthodontic societies.

Why orthodontics is necessary

In many cases, developmental problems with the teeth and jaw occur for no apparent reason. Alternatively, the development of the teeth and jaw can be damaged through an accident, such as a fall, or as a result of certain activities, such as thumb sucking that persists well into childhood.

In children, crooked or abnormally arranged teeth don’t usually present an immediate health problem. However, over time these types of abnormality may affect the later development of the teeth, mouth and jaw.

This could lead to problems with everyday tasks, such as eating, or increase your risk of developing a serious dental condition, such as gum disease, or periodontitis (an infection of the jaw). See Useful links for more information on these topics.

Orthodontic treatment can improve the appearance of the teeth and face, and prevent any worsening of appearance.

Common reasons for treatment

Some of the most common reasons people are referred for orthodontic treatment are listed below.

  • Protruding upper front teeth. This is one of the most common reasons for orthodontic treatment.
  • Crowding. People with narrow jaws often find there is not enough space for their teeth, resulting in crowding.
  • Impacted teeth. Impacted teeth are adult teeth that 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. This is when the upper teeth cover the lower teeth too much.
  • Reverse bite. This is when the upper teeth bite inside the lower teeth.
  • Open bite. This is when the upper and lower front teeth do not meet when the mouth is closed. An open bite is often the result of prolonged thumb sucking.

When orthodontics should be done

Usually, a course of orthodontic treatment will only be started after a child’s permanent teeth have developed. For most children, this will be when they are around 12 or 13 years old.

However, in some circumstances an orthodontist will recommend that treatment begins at an earlier age. Orthodontic treatment for adults can begin at any age.

The importance of oral hygiene

Most orthodontists will not begin a course of treatment until you, or your child, have achieved a good standard of oral hygiene. The appliances that are used in orthodontics can attract pieces of food, which can make brushing teeth harder as well as increasing the risk of tooth decay occurring during treatment.

Therefore, if your oral hygiene is poor and you have a significant level of tooth decay, orthodontic treatment can make these problems much worse.

It is also necessary to maintain good oral hygiene during treatment in order to prevent tooth decay.

How orthodontics is performed

Initial assessment

The first stage of your or your child’s treatment will involve an initial assessment of the current state of their teeth and their likely development. This usually involves taking a series of X-rays and making plaster models of the teeth.

Once the assessment is complete, the orthodontist will be able to provide more information about the type of treatment required and the likely results.


Orthodontic treatment uses appliances to correct the position of the teeth. The four main types of appliance that are used in orthodontic treatment are listed below.

  • A removable appliance is usually a plate that fixes to the roof of the mouth and can be taken out and cleaned.
  • Functional appliances are a pair of removable metal braces that are fixed to the upper and lower teeth.
  • A fixed appliance is a non-removable metal brace that is fixed to each tooth with a metal or ceramic brace.
  • Headgear is an appliance that fits on the side of your head and is connected to the back teeth

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 thumbs.

Although the appliance is easily removable, it should only be taken out of the mouth for cleaning. There may be a number of activities, such as cycling or playing a wind instrument, where it would be recommended to remove the appliance as a precaution. Your orthodontist will be able to advise you.

Functional appliances

Functional appliances can be used to treat moderately crooked or abnormally arranged teeth.

Most people with functional appliances are only required to wear them for a certain number of hours each day. It is important to follow your orthodontist’s instructions regarding this matter because if you don’t wear the appliance for the correct length of time, the treatment may be unsuccessful.

Some people may also be required to remove the appliance while eating.

Fixed appliances

Fixed appliances 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 future difficulties.

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

If you are wearing a fixed appliance and you play contact sports, wear a gum shield in order to protect your mouth and the appliance.


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 will 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 wearing your headgear.

It is important to follow all instructions relating to 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 result in facial injury or, more seriously, an eye injury.

Your orthodontist will be able to provide you, or your child, with training in how to use the headgear correctly and safely.


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

Tooth removal

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


The most important factor affecting the outcome of your orthodontic treatment is whether you follow your orthodontist’s instructions.

If you maintain good oral hygiene, wear your appliances as instructed and follow the dietary advice given by your orthodontist, you are likely to achieve good treatment results.

However, if you neglect your oral hygiene, don’t wear your appliance as instructed and ignore the advice on what foods to avoid, it’s likely that you’ll achieve poor treatment results, or your teeth may end up in a worse state than before treatment began.

More information:

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