A Guide to your Orthodontic Treatment

This leaflet is for patients (and for parents of young patients) who are about to start a course of orthodontic treatment. It aims to give you an idea of what to expect during treatment, and what will be expected of you as a patient and parent.

Why have orthodontic treatment?

Your orthodontist will use fixed braces, functional braces or removable braces to straighten your teeth, improve your bite and facial profile. However, the success of treatment and patient cooperation are difficult to predict at the start of the treatment course.

Benefits of orthodontic treatment  

Facial appearance	Orthodontics can give you a beautiful and healthy smile and can also improve the appearance of your facial profile.
Psychological well-being	An attractive smile can boost our self-esteem. This can actually improve our feeling of well-being.
Trauma	An increased overjet is caused by prominent upper teeth. These teeth can readily get damaged. Orthodontic treatment of an increased overjet can reduce the risk of trauma to upper front teeth.

Risks and Limitations of Orthodontic Treatment

All dental treatment (including orthodontics) has associated risks and limitations. Luckily, in orthodontics complications are occasional and when they do occur they are usually inconsequential. However, the potential risks should be born in mind when considering orthodontic treatment.

General risks of orthodontic treatment

X-rays	X-rays are needed for as part of your diagnosis. Your dentist will only request X-rays if necessary .Any X-ray carries a low risk of radiation exposure; Risk of fatal cancer from a panoramic X-ray is 1 in 1,000,000, Risk of fatal cancer from a cephalometric X-ray is 1 in 3,500,000 to 1 in 10,000,000.
Allergy	Some patients may be aware that they are allergic to some of the materials commonly used in orthodontic treatment, such as latex, nickel or bonding cements. If you know you have such an allergy, please inform your orthodontist. Alternative materials can be used in these cases. However, others may only become aware of these allergies during treatment.

Potential risks of orthodontic treatment

Jaw joint problems	Jaw joint problems include pain, clicking or limited opening. These symptoms may occur during orthodontic treatment but are also common in those patients who are not undergoing orthodontic treatment.
Trauma	Research shows that orthodontics neither causes nor treats jaw joint problems. Pre-existing jaw joint problems may rarely worsen with orthodontic treatment. Occasionally, some patients may be required to wear headgear as part of their orthodontic treatment. Component parts such as the facebow or headgear strap can become detached and traumatize the mouth or possibly the eyes.

Potential risks of orthodontic treatment to the teeth and mouth

Dental decay	Tooth decay and decalcification (permanent marks on the teeth) occurs in 2-96% of patients. It occurs if patients consume foods or drinks that contain too much sugar and/or acid (e.g, sweets, fizzy drinks, fruit juice). This can also also happen if patients do not brush their teeth properly or regularly.
Root shortening	Some patients may experience shortening (resorption) of the roots (1-2 mm) of their teeth, if they are treated with fixed appliances. Certain teeth are more prone (blunt or pipette shaped roots) or those teeth that have been traumatized in the past. Long-term effects are generally rare, but very occasionally, treatment may need to be stopped if root resorption is extreme.
Gum disease	Gingivitis will occur if a good standard of oral hygiene is not maintained. Periodontal disease with associated bone loss is uncommon.
Loss of tooth vitality	Temporary inflammation of the pulp of the teeth can occur, but sometimes orthodontic treatment can exacerbate nerve damage in a previously traumatized or restored tooth. This may require root treatment by your dentist and so temporarily stop your treatment.
Pain and discomfort	It is common for patients to experience discomfort after a brace is placed or adjusted, but the extent of this varies greatly between patients. Pain may first be felt after 2 hours, worst at 24 hours and then reduce after 3 days. Analgesia such as Paracetamol or Ibuprofen can help.
Damage to dental restorations	Ulceration caused by trauma from the brace to lips or cheeks is common and wax can be applied to the brace to help reduce the soreness.   Heavily restored teeth such as those with large fillings or crowns can be damaged when the fixed brace is removed.

Treatment times

Most orthodontic treatments last at least 12 months, however, your individual treatment plan will estimate the length of your treatment.  Active treatment is then followed by a period of retention, in which a retainer appliance will need to be worn for varying amounts on a long-term basis to maintain the teeth in their new position. Missed appointments and breakages to the appliances will prolong the treatment time.

Patient co-operation

Orthodontic treatment is a big commitment. Your treatment may take 2 years or more with regular appointments during school and work times. Any missed appointments or breakages of your brace will increase the length of your treatment.

If you do not wear your appliances as directed, this will also increase your treatment time and could lead to a change in treatment type.

You may be asked to wear elastics as part of your treatment and if these are not worn as directed, your treatment will suffer.

Your teeth are at risk from trauma if you play contact sports such as rugby, hockey, boxing. We strongly advise all our patients to wear a mouthguard when playing these sports to protect their teeth and braces.

Changes to the treatment plan may be necessary in some circumstances; for example, poor compliance, unfavourable growth of the facial bones.

Headgear

If your orthodontist has planned headgear as part of your treatment, you will need to follow some instructions.

Do not take part in any physical sports or activities while you are wearing headgear.. If pulled, headgear can snap back and seriously injure your face and eyes and you could be injured .

Dental extractions

Your orthodontist may require you to have teeth extracted with your dentist as part of your treatment. Your orthodontist will not request extractions unless absolutely necessary. Research has shown there to be no significant difference to long-term profile if you have extractions.

Extractions are generally undertaken under local anaesthetic and you can expect some discomfort  and swelling post-operatively. Specific extractions can cause other risks, but these will be discussed with your orthodontist if they are part of your treatment plan.

Continued care with your dentist

You must continue to have regular check-ups with your dentist during treatment.

Retainer wear and relapse

When you have completed your active orthodontic treatment, you will need to wear retainers as prescribed by your orthodontist. To prevent the teeth from moving back to their original position. No responsibility will be taken for relapse if these retainers are not worn.