• Reference Number: HEY-207/2021
• Departments: Oral Surgery, Dentistry and Max Fax
• Last Updated: 31 May 2021

Introduction

This leaflet has been produced to give you general information about your treatment. Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

The majority of orthodontic treatment takes approximately two years to complete, assuming regular adjustment appointments are attended.  Teeth move slowly and any attempt to speed up the natural progress of tooth movement will lead to unwanted complications. Successful orthodontic treatment depends on good growth response and patient co-operation.  If progress is slow, your treatment plan may need to be adjusted.

What is orthodontic treatment?

Orthodontic treatment is the use of fixed or removable braces to straighten crooked teeth and improve the way the teeth bite together. Once the brace is fitted it is normal for the teeth to ache, though by taking pain relief such as paracetamol or ibuprofen this will settle quickly. In some patients the teeth may feel slightly loose; this is due to the forces exerted on the teeth by the braces.

Can there be any complications or risks?

The main risks associated with orthodontic treatment are:

Decalcification – This is permanent tooth discolouration, which happens when patients do not keep their mouth and braces clean during treatment.  Plaque and food debris should be removed after every meal and you should use a fluoride mouthwash to keep your teeth healthy during orthodontic treatment.

Root Shortening – Moving a tooth puts pressure on the roots of the tooth. A recognised risk which occurs in almost all cases is shortening of the roots of the teeth by perhaps a few millimetre throughout a two-year treatment; this is regarded as acceptable.

In some cases more severe changes can occur where there is more root shortening than is acceptable. The cause of these changes is not known and they can occur in anyone. Progress X-rays are taken to check for root shortening. If there is more than the acceptable amount then your treatment may be stopped.

Tooth movement after treatment – It is a well-known fact that teeth move throughout life whether orthodontic treatment is carried out or not. Small changes in tooth position will occur once the teeth are not held in place by braces or retainers. The only way to guarantee the position of the teeth does not change is the indefinite wearing of retainers at night time.

Jaw joint pains – Some people experience pain, clicking and stiffness in and around the jaw joints. It is more common in females than males. Orthodontic treatment can aggravate existing symptoms and, in susceptible individuals, trigger symptoms.

Discomfort – Orthodontic treatment does not require local anaesthetic. The teeth can ache for several hours after the braces are adjusted and in these instances taking pain relief is recommended. The braces can rub your mouth to begin with and you may develop ulcers. You will be given a packet of wax to place on any sharp parts of the brace that rub the gums to prevent sore patches developing.

How do I prepare for the treatment?

Please read this information leaflet.  Share the information it contains with your family (if you wish) so that they can be of help and support.  There may be information they need to know, especially if they are taking care of you following this examination.

Patient co-operation is essential to achieving successful orthodontic treatment.

Looking after orthodontic braces

Orthodontics and eating

Hard sticky foods and foods high in sugar must be avoided.  Hard foods can damage the wires or break the brackets that are glued to the teeth.  Try to cut hard foods e.g. apples into small pieces and chew them on the back teeth, rather than biting into them with the front teeth.  Sticky foods such as toffees will stick to the brace and make the teeth more likely to become decayed.  You should also avoid chewing gum.

Sugary foods and drinks can lead to permanent marks on the teeth or cause tooth decay.  Any sugary food or drinks should be kept to mealtimes, as snacking on these foods damages the teeth.

Orthodontics and tooth decay

If the teeth are not kept clean, decalcification (please see the section on ‘Complications or risks’) or tooth decay will occur.  If the oral health is unsatisfactory the gums will bleed, or grow over the brace making it hard for the orthodontist to adjust the brace.

Tooth brushing should take place after every meal, using fluoride toothpaste. Brushing with braces on takes longer and requires extra attention, compared to brushing your teeth without braces.  You should also use a fluoride mouthwash once a day at a different time to brushing, such as when you come home from school or work.

You should bring your toothbrush and toothpaste to every appointment and ensure the brace is clean before it is adjusted.

If the teeth and braces are not kept clean, the brace may be removed before all the treatment is completed.

Dental check-ups

You should continue to see your dentist regularly during orthodontic treatment to check that there is no tooth decay or gum disease and to maintain registration at the dental practice.

Mouth guards

If you play contact sports you will be expected to wear a mouth guard.  These are not provided as part of your treatment, but we can advise you on where you can order a suitable mouth guard that will fit around your brace.

Appointments

We make every effort not to cancel appointments; it is unfortunate that cancellations are unavoidable on occasions.  We will try to reappoint you as soon as possible, though we hope you understand that appointments that suit you most will probably also be in demand from other patients.  If you are unwell, including having a cold sore, please contact the department as we may need to rearrange your appointment

Missed appointments

Please do not leave the department without arranging your next appointment.  If you miss an appointment we will write to you to remind you to contact the department to arrange another appointment.  Unless we hear from you we will not send you another appointment.

Orthodontic braces must be checked at least every couple of months to avoid complications.  If you decide to discontinue treatment, or you move elsewhere, it is your responsibility to make arrangement for fixed braces to be removed, or treatment to be continued elsewhere.

Progress – Good results require patient co-operation.  Missing appointments, not keeping the braces clean or not following instructions from the orthodontist may result in treatment being stopped.

 Breakages – Even though you are careful with your brace, you may occasionally damage it.  Should any part bend, break or become loose, please contact the department to arrange for it to be repaired.  Your own dentist is unlikely to be able to help you.

What happens afterwards?

At the end of active treatment you will be asked to wear a retainer (a removable brace) to hold the teeth in their new position.  If the retainers are not worn the teeth will move and the retainer will no longer fit.  Retainers are normally worn for 12 months, after which wearing the retainers at night indefinitely will prevent any movement of the teeth. After 12 months you will be discharged.  Your own dentist will be responsible for any replacement retainers, which are not normally available on the NHS.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Orthodontic Secretary on (01482) 674965.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats your child, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to your child. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your child’s condition, the alternatives available for your child, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about your child

We collect and use your child’s information to provide your child with care and treatment. As part of your child’s care, information about your child will be shared between members of a healthcare team, some of whom you may not meet. Your child’s information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide your child with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your child’s doctor, or the person caring for your child.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about your child. For further information visit the following page: Confidential Information about You.

If you need information about your child’s (or a child you care for) health and wellbeing and their care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.