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Straightening teethPublished by BUPA's health information team, healthinfo@bupa.com, August 2007. This factsheet is for people who would like information about having their teeth straightened. This branch of dentistry is called orthodontics. Having your teeth straightened can improve your appearance and boost your self-esteem. Also, straight teeth are easier to clean, so they are less vulnerable to tooth decay and gum disease.
About orthodonticsThe way that our teeth bite together is called the occlusion. People who have teeth that don't bite together evenly have a malocclusion. Orthodontic treatment usually involves wearing a brace (appliance). This puts gentle pressure on specific teeth to move them into the right place. This usually takes one to two years, depending on the severity of the problem. During this period, the orthodontist needs to monitor the occlusion closely, and make adjustments to the brace. Orthodontic treatment is usually carried out in childhood. Malocclusions can be successfully corrected in adults, but the treatment may take longer. How straight our teeth are is often inherited from our parents. It can also be caused by the early loss of milk (baby) teeth or thumb sucking. To get the best results from orthodontic treatment, you need to wear the brace as instructed, go to all of your appointments and take special care of your teeth. Sometimes, if there isn't enough room in the mouth, teeth need to be taken out before orthodontic treatment. In very severe cases, jaw surgery may be needed. The orthodontic assessmentUsually, people are referred to an orthodontist by their dentist. The orthodontist will check your teeth to see if you need treatment. The best time to have an orthodontic assessment is before the adult teeth come through. Treatment usually begins after you have lost all your milk (baby) teeth, which is normally in your early teens. This is when there is favourable growth to straighten teeth. At the initial appointment, your orthodontist will do a very detailed dental examination. If necessary, a number of X-ray pictures may be taken. These show your orthodontist how the facial bones and teeth are developing. The orthodontist may also make some moulds of your teeth and take some photographs. If you have any decayed teeth, these will need to be treated by your dentist before orthodontic treatment starts. If you have many decayed teeth, or your oral hygiene is poor, the orthodontist probably won't recommend any treatment involving braces. Orthodontic treatment is time consuming and to get the best results, you need to be motivated. Your orthodontist will be reluctant to start any treatment unless you can show that you keep your teeth very clean. Younger children may be asked to come back for treatment when they are older. Sometimes crowded teeth straighten out on their own as the child's face grows. In these cases, the orthodontist may want to assess them again when they have grown some more. If treatment is recommended, your orthodontist will explain:
Types of bracesThere are different kinds of braces. Some can be removed while others are fixed in place. Your orthodontist will explain which is most suitable for your teeth. Removable bracesThese braces are made of plastic and usually have wire clips and springs to move specific teeth. In most cases, they are used to move upper teeth. A removable brace must be taken out to be cleaned, but it should be worn at all other times, including meal times and at night. Eating with a removable brace can feel awkward at first, but it gets easier with practice. Clean your brace by brushing it gently with your toothbrush and toothpaste. You should do this at least three times a day, after meals and when you have brushed your teeth. The brace should be removed, cleaned and put straight back in your mouth. It usually takes a few days to learn to speak normally with a brace. Some people find it helps to practise by reading aloud. For the first few days you may produce more saliva than usual, and may need to swallow more often. Fixed bracesFixed braces (sometimes called "train tracks") can't be removed. They are made of small brackets that are glued to the teeth and joined together with a wire. Fixed braces can be used on upper and lower teeth. Once the treatment is finished, the brackets and glue are cleaned off the teeth. In some cases, small elastic bands may need to be attached to a fixed brace. In others, headgear may be necessary. This is a frame with wires that come out of your mouth, attaching your brace to a headband. Though it can take some time to get used to, headgear is an essential part of the treatment for some people. This is often only worn in the evening or at night. You could ask your orthodontist to show you a photograph of headgear, so you know what to expect. RetainersRetainers are braces that don't actively move teeth. Instead, they make sure that teeth stay in their correct positions after other orthodontic treatment has finished, such as a fixed brace.. They can be removable or fixed. Without a retainer, teeth tend to move back towards their original positions. A retainer is usually worn for at least six months. Plastic alignersA relatively new type of orthodontic treatment allows teeth to be straightened using removable, see-through, plastic aligners (eg Invisalign). This treatment is only suitable for certain people. Having a brace fittedHaving a brace fitted doesn't hurt, but your teeth usually feel tender for a few days after it's fitted or adjusted. Take the painkillers you usually take for a headache to relieve any discomfort and follow the instructions in the patient information leaflet that comes with the medicine. If the brace rubs your lips or the inside of your cheeks, ask your orthodontist for some special wax that can help to ease this. Taking care of braces and teethOrthodontic braces don't cause tooth decay, but they may trap food so extra care needs to be taken when brushing. Your teeth and the brace must both be brushed thoroughly three times a day with fluoride toothpaste. Your orthodontist may also prescribe a fluoride mouthwash, and will give you instructions on how to use it. Your teeth can be permanently damaged if they are not kept extremely clean. When you have a brace, there are some foods and drinks that you should try not to have such as sweets, fruit juice and fizzy drinks (including the diet varieties) or chewing gum and other sticky, chewy foods, because they get stuck in the brace and may damage it. Hard or crunchy foods, such as apples, should be cut into small chunks before you eat them. A removable brace should be taken out during sport, and it may be necessary to take it out when playing musical instruments such as the flute or trumpet. Your orthodontist will give you a box to keep your brace in so that it doesn't get damaged when it's not in your mouth. If you have a fixed appliance, you must wear a gumshield during contact sports. Some people get into the habit of clicking their removable braces with their tongue. This can damage the wires and you should try not to do this. If your brace breaks, you must make an appointment to see your orthodontist as soon as possible. A broken brace can add months to the length of your treatment, and can damage your teeth. Surgical orthodontic treatmentIf the bones of your jaw are incorrectly positioned, jaw surgery (or orthognathic surgery) may be needed to move them into the right position, so that your teeth can bite together properly. Usually this involves a short stay in hospital. This kind of treatment is generally reserved for adults who have severe malocclusions resulting in speech problems, difficulty eating or psychological trauma. Ask your orthodontist if you would like more information about orthognathic surgery. Further information
Sources
Related topicsThis information was published by BUPA's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Brian Franks BDS (U. Lond) LDS RCS (Eng) MFGDP (UK) FPFA ACIArb, clinical director (dentistry) BUPA Wellness and BUPA doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: August 2007. Expected review date August 2009.
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