Orthodontics (Braces and Aligners)

When teeth are not evenly aligned, more bacterial plaque builds up between and around them. Acids produced by the bacteria in this plaque can lead to decay in the enamel and periodontal (gum) problems.

Protruding front teeth that are left untreated are also more prone to injury. Fractured front teeth are common in children whose upper incisors stick out, and an injured tooth may then need root canal treatment, a filling or a crown.

A child's first orthodontic check should take place around the age of 7. This is when the front teeth come through and the first signs of any problem start to appear. If there is not enough room for the front teeth, they can push against neighbouring teeth and cause crowding; creating space at the right time may remove the need for extractions later on.

Crowded or protruding teeth often point to an underlying jaw growth problem. In such cases treatment may be planned in two phases: first the jaw relationship is corrected, growth is guided and, if needed, the jaw is expanded; then any remaining tilting or irregularity of the teeth is addressed. Because most facial and jaw growth is completed by adolescence, delaying treatment for jaw-related problems limits the opportunity to guide growth.

Primary teeth stage (pre-school)

Problems linked to habits such as thumb sucking, lip biting or prolonged use of a bottle or dummy can be treated before a permanent skeletal problem develops if they are addressed at this stage. Appliances that work from inside or outside the mouth may be used for this purpose.

Mixed dentition stage (primary school age)

Baby teeth act as guides for the permanent teeth developing beneath them. If a baby tooth is lost too early, neighbouring teeth can drift into the gap and reduce the space for the permanent tooth. A baby tooth that is shed too late can also cause the permanent tooth to erupt out of position or remain impacted in the jaw.

Permanent dentition stage

From the mixed dentition stage until the end of adolescence, discrepancies between the jaws, such as a lower jaw that sits too far forward or too far back, are addressed.

Orthodontic treatment is suitable for all age groups; there is no age limit for moving teeth. Age is not a deciding factor in treating crowding between teeth, although early intervention matters for jaw-related problems. Treatment in adults may take somewhat longer.

Appearance tends to matter more to adult patients, so ceramic (tooth-coloured) braces, which are less noticeable than metal ones, and clear aligners are popular choices. Clear aligners are removable, are taken out for meals and are practical for everyday life. The most suitable option is decided together with your dentist after an examination.

Orthodontic appliances, commonly called braces, mostly work by applying controlled forces to the teeth. Small attachments called brackets are bonded to the teeth and transfer the force generated by orthodontic wires, springs and small elastics. In response, bone remodels on the side the tooth is moving towards, and new bone forms on the opposite side.

• Removable appliances: can be taken in and out of the mouth and apply force through components such as springs and screws.
• Fixed appliances: brackets are bonded to the teeth and stay in place until treatment is complete.
• Passive appliances: such as habit breakers and retainers, which hold the current position rather than move teeth.

The choice of appliance is made by the dentist, taking into account the child's willingness and ability to cooperate as well as the family's circumstances.

1. Any decay and gum problems should be treated before orthodontic treatment starts.
2. Once the appliance is fitted, oral hygiene needs extra care; plaque must not be allowed to build up around the appliance.
3. Follow your dentist's advice given at review appointments.
4. Do not miss appointments.
5. Let your dentist know if a removable appliance breaks or a bracket comes loose.
6. Wear your retainers for the period and at the times your dentist recommends.

When orthodontic treatment ends, the teeth are in a new position. New bone forms in some areas and needs time to mature, and the periodontal ligaments that hold the teeth have not yet adapted to the new position. As a result, teeth tend to move back towards their original position once the appliance is removed.

To maintain the result, retention with special appliances is needed, in the way and for the period your dentist considers appropriate, until the teeth have settled in their new position.