Straightening teeth

Published by Bupa's health information team, September 2009.
 
This factsheet is for people who are planning to have their teeth straightened, or who would like information about it.
 
Teeth straightening involves using a brace to improve the appearance and function of crooked or crowded teeth. Straight teeth are easier to clean and are less vulnerable to tooth decay and gum disease. This area of dentistry is called orthodontics.
 

About orthodontics

How a brace can affect your lifestyle
Types of braces
Having a brace fitted
Taking care of braces
Surgical orthodontic treatment

About orthodontics

The way that our teeth bite together is called the occlusion. People who have teeth that don’t bite together evenly have a malocclusion. How straight our teeth are is often inherited from our parents. It can also be caused by the early loss of milk teeth, accidents or thumb sucking.
 
You may have upper front teeth that stick out, or you may find the way your upper and lower jaws meet leads to an incorrect bite and makes your teeth look unsightly.
 
Orthodontic treatment usually involves wearing a brace (appliance). This puts gentle pressure on specific teeth to move them into the right place and usually takes one to two years, depending on the severity of the problem. During this period, your orthodontist will need to monitor you closely and make adjustments to the brace.
 
Teeth straightening is usually carried out in childhood. Malocclusions can be successfully corrected in adults but the treatment may take longer. 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 your mouth, you may need to have teeth taken out before orthodontic treatment. If the condition is very severe, you may need to have jaw surgery.
 

Getting an orthodontic assessment

You will usually be referred to an orthodontist by your dentist. The orthodontist will check your teeth to see if you need treatment.
 
The best time to have an orthodontic assessment is after you have lost your milk teeth but before all your adult teeth come through, usually around the age of 10 or 11. By this time your jaw has grown enough to see whether your new adult teeth will have enough room to come through.
 
At the initial appointment your orthodontist will do a very detailed dental examination. You may have X-rays of your teeth taken. These show your orthodontist how your 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.
 
Treatment is only successful if you’re motivated to look after your teeth. Therefore, if you have lots of decayed teeth or your oral hygiene is poor, the orthodontist probably won't recommend any treatment involving braces. Orthodontic treatment is time-consuming and you need to be motivated to get the best results. It can also make your teeth more difficult to look after so you will need to take extra care with your oral hygiene.
 
Younger children may be asked to come back for treatment when they’re older. Sometimes, crowded teeth straighten out on their own as the child's face grows. If this happens, the orthodontist may want to assess your child again when he or she has grown.
 
If treatment is recommended, your orthodontist will explain your treatment options, including:
 

• which type of brace is most suitable
• what the treatment involves and how long it will take
• what you will need to do to help achieve the best result

How a brace can affect your lifestyle

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 need to swallow more often.
 
Sometimes children may find it difficult to eat for a few days because the brace makes their mouth more sensitive than usual. Try mashing food and adapting your child’s diet so that he or she doesn’t get frustrated with the treatment.
 
When you play sports you need to take out a removable brace, and wear a gumshield for contact sports if you wear a fixed brace.
 
You may have to take out a removable brace if you play musical instruments such as the flute or trumpet. If you wear a fixed brace, you may find it difficult to play these at first but will soon adapt.
 
Your orthodontist will give you a box to keep your removable brace in so that it doesn't get damaged when it’s not in your mouth.
 

Types of braces

There are different kinds of braces. Some can be removed while others are fixed in place. Your orthodontist will discuss with you which type is most suitable for your teeth.
 

Removable braces

These braces are made of plastic and usually have wire clips and springs to move specific teeth. They are mostly 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. Do this at least three times a day after you have brushed your teeth. After meals remove your brace, clean it and put it straight back in your mouth.
 

Fixed braces

Fixed braces (sometimes called ‘train tracks’) can’t be removed except by your orthodontist. They are made of small brackets that are stuck with filling material to your 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 filling material are cleaned off your teeth.
 
You may need to have small elastic bands attached to your fixed brace – these are usually used to keep the wires in the brackets on your teeth. They are available in different colours and you may wish to personalise your brace with them.
 
It’s possible that you will need to wear headgear. This is a frame with wires that come out of your mouth attaching your brace to a headband. Although it can take some time to get used to, headgear is an essential part of the treatment for some people. You may only have to wear this in the evening or at night. Ask your orthodontist to show you a photograph of headgear so you know what to expect.
 
Sometimes an orthodontic mini-screw is used to help the brace straighten your teeth more effectively. A brace works by using the teeth to provide a stable support to move crooked teeth but sometimes the force can cause the wrong teeth to move. If this happens, a mini-screw can be inserted to act as a support instead.
 
Mini-screws are inserted through your gum into your jaw bone and attached to the brace for several months. Your orthodontist will give you a local anaesthetic when the mini-screw is inserted and you may have a mild ache for 24 hours. Mini-screws are also known as micro-screws, mini-implants or temporary anchorage devices (TADs).
 

Retainers

Retainers are braces that don’t actively move teeth. Instead they make sure that your teeth stay in their correct positions after other orthodontic treatment, such as a fixed brace, has finished. They can be removable or fixed. Without a retainer teeth tend to move back towards their original positions.
 
You will probably need to wear a retainer for at least six months, usually all the time at first and then just at night, but follow your orthodontist’s instructions. Rarely, older adults may have to have a fixed retainer stuck permanently onto the inside of some teeth to prevent them moving back.
 

‘Invisible’ braces

These are a relatively new type of orthodontic treatment that uses removable, see-through, plastic aligners. You wear a set for two weeks before replacing it with a new one. You need to wear them for at least 23 hours a day and remove them for eating, drinking, brushing and flossing. This treatment is only suitable if you have all your adult teeth.
 

Having a brace fitted

Having a brace fitted doesn't hurt but your teeth will probably feel tender for a few days after it’s fitted or adjusted. You may wish to take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
 
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

Orthodontic braces don’t cause tooth decay but they may trap food so you need to take extra care when brushing. Brush both your teeth and the brace thoroughly at least twice 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 aren’t kept extremely clean.
 
If you have a brace, there are some foods and drinks that you need to avoid. These include:
 

• chewing gum and other sticky, chewy foods because they get stuck in the brace and may damage it
• sweets, fruit juice and fizzy drinks (including the diet varieties)

 
Cut hard or crunchy foods, such as apples, into small chunks before you eat them.
 
Try not to click your brace with your tongue – a habit that some people develop – because it can damage the wires.
 
If your brace breaks, 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 treatment

If the bones of your jaw are incorrectly positioned, you may need to have jaw surgery (orthognathic surgery) to move them into the right position so that your teeth can bite together properly.
 
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 jaw surgery.