What is orthodontic treatment?

Orthodontic treatment usually involves the wearing of braces (removable or fixed), often with the extraction of teeth and very occasionally jaw surgery.

Why might I need orthodontic treatment?

There are 3 main reasons for having orthodontic treatment:

· To improve the appearance of the teeth and face

· To improve the health of the teeth and gums

· To improve function i.e. to make it easier to eat.

Who is eligible for NHS treatment?

All patients are eligible for an NHS assessment. However, health service funding for treatment is directed at those patients in whom treatment will give an improvement in dental health and not just in the appearance of their teeth.

The way in which the orthodontist decides whether NHS funding is available is by using a complex system of measurements called the Index of Orthodontic Need (IOTN). As the name suggests this index gives a higher weight to those cases which need treatment for an improvement in their dental health.

Dental problems which will be provided for on health grounds include:

· Increased prominence of teeth in excess of 6mm

· Significant crowding of teeth

· Abnormal bites causing trauma

· Abnormal bites causing functional problems

· Missing or impacted teeth

Cases with a borderline need for treatment are then assessed on aesthetics (how attractive the teeth look) and cases with a low aesthetic score are unlikely to qualify for orthodontic treatment under the NHS. Milder cases will not be eligible for NHS funding.

What happens during my first visit?

We will send you a letter asking you to make an appointment. During your first appointment Dr. Buchanan will assess your need for treatment, and discuss with you your possible treatment options. This is a relatively short appointment as a high percentage of patients who attend a new patient appointment are not ready to begin treatment.

What happens after my first visit?

After your first visit, one of two things will happen for the majority of patients:

· You may not be ready to start treatment. You may still have some of your baby teeth present or you may not be brushing your teeth properly. In this case you will be put on recall and a letter sent out when it is time for a review appointment to be made. You may also be referred back to your dentist for oral hygiene advice.

· If you are ready to begin treatment a new appointment will be made for x-rays, photos and impressions of your teeth to be taken.

· Impressions of your teeth are sent to the lab to make study models and once they come back your treatment plan will be finalised.

· Your study models, a copy of your x-rays and your treatment plan is sent to the Dental Practice Board who needs to approve the funding of your treatment on the NHS. This process is called Prior Approval and can take up to 8 weeks. We cannot ask your dentist to take out teeth, if it is necessary, until funding is approved.

· Once approval for your treatment has been received your dentist will be asked to take out any teeth. We rely on you, the patient, to inform us that an extraction appointment has been made. Once you have an extraction appointment with your dentist, please ring the practice to make an appointment for your brace to be fitted. The brace should be fitted no sooner than 7 days after the teeth have been taken out. This allows the area to settle and heal before treatment starts. If you don’t tell us about your extraction appointment until after your teeth have been taken out you may have to wait longer for your brace to be fitted.

· If you don’t require extractions we will ring you when we receive the Prior Approval and make an appointment for you to have your brace fitted.

Does everyone get fixed braces?

Generally if you have been referred, fixed braces or “train tracks” will almost certainly be needed. However some patients may require functional removable appliances which need to be worn full time for a period of time before a fixed brace can be fitted.

Do braces hurt?

Getting your brace fitted does not hurt. It involves metal brackets being glued onto the teeth using a special composite and the whole process should only take about 40 minutes to complete. Several hours after the brace is fitted, patients may experience some discomfort and aching. This is normal and should settle down within a week. We advise patients to take a normal painkiller and eat soft foods such as pasta or soup. After each adjustment of the brace there may also be some discomfort.

How should braces be cared for?

It is important you brush your teeth well, three times a day with fluoride toothpaste. A fluoride mouthwash should also be used last thing at night, after tooth brushing to further protect the teeth. As well as your ordinary toothbrush, a small Tepe brush will be necessary to ensure that the area around the bracket is kept clean. Failure to keep your teeth and brace clean will lead to permanent scarring of your teeth, and this is why treatment cannot begin until your oral hygiene is of an acceptable standard.

What foods should I avoid?

Patients with braces need to avoid eating any hard, sugary, sticky foods as well as fizzy drinks which can cause damage to the teeth and brackets. This will result in treatment time being lengthened. Food should be cut up into small chunks and chewing gum is a definite no!

What happens if my brace breaks?

If your brace does break it is important that you phone us so that an emergency appointment can be made. On average a patient should only have 1.75 breakages over the entire length of time that the brace is on.

What happens once my brace is taken off?

Retainers are designed to keep your teeth straight and can either be removable or fixed to the teeth. Now that your teeth are straight, if you do not wear your retainer, your teeth are likely to drift towards their original position. If this happens it may be difficult to correct. Retainers will need to be worn 24 hours a day for the first month, followed by 12 hours a day thereafter. Review appointments will be made every 3 months for a year to check your teeth. After this you will be discharged from our care.

If you have any other questions please do not hesitate to contact us.