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Appliance Therapy Information NHS
What is a brace?
There are different types of braces and each brace works differently, your orthodontist will
prescribe the correct brace for your individual problem.
Fixed appliance:
This brace consists of small metal attachments stuck to your teeth with a special glue.
There is a wire that runs through these attachments and is held in place by small coloured
elastics. Other smaller elastics and wires are also used. The result is a delicate
framework that if looked after properly will move your teeth to where we want them.
Elastic bands:
You may need to wear small elastic bands between the teeth later in treatment, it is
important that you wear these as advised. Failure to wear these will prolong treatment and
may lead to incorrect tooth movement.
Temporary Anchorage Devices:
Your treatment may include the use of a temporary anchorage device(s) (i.e. metal screw
or plate attached to the bone.) The use of these devices does not mean that alignment of
the teeth will always be successful. NICE (the National Institute for Health and Clinical
Excellence) has said that ‘although there is not very much evidence about how well these
small screws work, there are no major safety worries about using them’. However, there
are specific risks associated with them. It is possible that the screw(s) could become
loose which would require its/their removal and possibly relocation or replacement with a
larger screw. The screw and related material may be accidentally swallowed. If the device
cannot be stabilized for an adequate length of time, an alternate treatment plan may be
necessary. It is possible that the tissue around the device could become inflamed or
infected, or the soft tissue could grow over the device, which could also require its
removal, surgical excision of the tissue and/or the use of antibiotics or antimicrobial rinses.
It is possible that the screws could break (i.e. upon insertion or removal.) If this occurs, the
broken piece may be left in your mouth or may be surgically removed. This may require
referral to another dental specialist. When inserting the device(s), it is possible to damage
the root of a tooth, a nerve, or to perforate the maxillary sinus. Usually these problems are
not significant but additional dental or medical treatment may be necessary. Local
anesthetic may be used when these devices are inserted or removed, which also has
risks. Please advise the doctor placing the device if you have had any difficulties with
dental anesthetics in the past.
Removable appliance:
This can be taken out of the mouth for sports/swimming, to eat with and to brush your
teeth. Otherwise it must be worn all the time for it to work. Part time wear is not an option,
it will not work!
Functional appliance
This is used to help correct the way your jaws are growing and as such can benefit your
profile as well as the position of your teeth. It is removable and can be taken out of the
mouth for sports/swimming, to eat with and to brush your teeth. Otherwise it must be worn
all the time for it to work. Part time wear is not an option, it will not work!
What are the benefits?
Your orthodontist will discuss with you your personal treatment objectives which will be
tailored to your presenting problem. The brace can straighten your teeth and will often be
used to correct the way the teeth bite together. The result aims to create balance and
harmony between the teeth and face for an attractive and healthy smile. This enhances
self esteem and as a result this can improve the quality of life itself. Well aligned teeth are
easier to keep clean thus decreasing the tendancy for tooth decay and gum disease.
What are the risks?
1. Tooth decay and gum disease
You are more prone to tooth decay and gum disease with braces on. However, this can
be prevented by following the guidance given to you at the time the brace is fitted. Good
oral hygiene and a diet free from sugary drinks and snacks will ensure your teeth and
gums remain healthy.
2. Root shortening
The roots of the teeth tend to shorten a little, this does not affect normal functioning of the
teeth. In a small per cent of the population roots can shorten substantially, risk factors for
this include:
• Roots that have already shortened
• Previous trauma to the teeth e.g fell and knocked the front teeth, please advise your
orthodontist of any history of trauma to the teeth
• Teeth that have been root filled or have very large fillings
• Roots that take a certain shape on the pre treatment Xray, your orthodontist will check
this and advise you if there is any concern.
• Impacted teeth seen on your pretreatment Xray, your orthodontist will check this and
advise you if there is any concern.
If you are at higher risk of root resorption then don’t panic, it doesn’t mean the roots will
definitely shorten, most don’t. A mid treatment Xray will be taken to monitor for root
shortening. If the roots are found to shorten substantially then treatment may need to be
stopped early and you will be advised accordingly.
3. Loss of tooth vitality
Very occasionally teeth can become non vital and may require root treatment. This is
most likely to happen where teeth have been previously traumatised or have a very large
filling.
4. Relapse
When your braces have been removed your teeth are not stable and can move back to
where they came from. This is called relapse. Therefore, retainers are fitted to prevent
this and allow the teeth to stabilise. After 12 months of wearing retainers the teeth are
much more stable but they can still move in position as you grow and get older. For this
reason it is recommended to continue wearing retainers long term/ indefinitely. You will be
kept under review for 12 months after your braces have been removed then discharged
back to your own dentist.
5. Unfavourable growth
Insufficient or abnormal growth of the jaws may limit the ability of orthodontic appliances to
acheive the desired result. Disproportionate growth during or after treatment may cause
the bite to change requiring additional treatment or in more severe cases, the option of
surgery to the jaws may be considered.
6. Adjunctive dental care
Teeth vary in shape, size and number. This can affect the ability of orthodontics to obtain
the desired result. Restorative dental treatment may therefore be required during or after
orthodontic treatment. In some cases complete closure of excessive space may not be
possible e.g where teeth have been extracted previously for purposes other than
orthodontic therapy or space where teeth have not developed.
7. Jaw joint problems
Some people experience clicks or pain in the jaw joints and sometimes related headaches
and ear ache. These jaw joint problems can occur with or without orthodontic treatment.
These problems may worsen, improve or stay the same during treatment.
FAQ
Will it hurt?
As the teeth move there is some inflammation around the tooth which is normal. This can
cause the teeth to become tender particularly during the first few weeks of treatment and
2-3 days after adjustments. The tenderness will subside. A soft diet and painkillers as
needed are advised.
Some people experience discomfort and sometimes ulcers to the inside of the mouth.
This is from the brace rubbing. After 1-2 weeks the mouth usually toughens up to the
brace and this discomfort subsides. Wax can help with this.
A functional brace can cause the jaw muscles to ache at first, this will subside after 1-2
weeks of full time wear.
Will I have to change my diet?
When wearing a fixed brace, you will not be allowed to eat foods that are hard, sticky or
chewy as these will break your brace. You can not eat sticky toffees, sweets and chewing
gum. Apples must be chopped up and eaten at the back of the mouth. You can eat the
middle of a pizza but not the crust, same applies with crusty bread. If your brace is broken
then it will not move your teeth and treatment will not progress. If there are more than 2
breakages during treatment you will be issued an official warning and any further
breakages will result in removal of the braces even if your teeth have gaps and are not
straight.
To maintain the health of your teeth and prevent tooth decay you must avoid sugary foods
and drinks between meals.
Will it affect my speech?
Removable and functional type braces can affect your speech and will make you produce
a lot of saliva at first. However, this is only temporary and will go away within 1-2 days of
full time wear. Practice reading out loud at home when the braces are in.
Will I need to change the way I brush my teeth?
More time will need to be spent brushing your teeth than normal in order to prevent
damage to your teeth and gums which can result in permanent markings to the teeth. You
will be advised how to keep your teeth clean when the brace is fitted.
How can I protect my teeth and brace during contact sports such as hockey or
rugby?
Because your teeth are changing position a normal mouthguard will not work. It is advised
that you purchase a re-mouldable mouth guard which can be re-moulded on numerous
occasions to fit your teeth in their current position.
Are there any habits I might have to stop?
You must not bite your nails, chew on pen tops or pick at your brace. This will break the
brace. Remember if there are more than 2 breakages during treatment you will be issued
an official warning and any further breakages will result in removal of the braces even if
your teeth have gaps and are not straight.
When will I need to attend appointments?
Your brace will need adjustment at regular intervals of between 4-8 weeks as advised. It
is important you attend regularly in order to allow your treatment to progress.
Appointments to check your brace will generally last 15 minutes and will be on a Monday,
it is likely you will need to take some time out of school to attend these appointments.
Remember that if you fail to attend an appointment this will prolong your treatment. If you
fail more than 2 consecutive appointments or frequently fail appointments then your
treatment may be discontinuued and further treatment will not be offered on the NHS.
Please note: It is also important to attend your regular dental check up or scheduled
appointments with your own dentist during any treatment with your orthodontist.
What happens if my brace breaks?
You will need to be seen sooner than your next appointment and must ring to arrange a
new appointment at the next available slot. If the broken brace is causing you discomfort
then ring the practice for an emergency appointment and one of the dentists will see you
to make your brace comfortable. You will then need booking back in to see your
orthodontist for full repair to the brace.
Are there any NHS charges?
Your braces are provided free of charge on the NHS. However, you will be charged an
NHS fee for repairs. After you are discharged from orthodontic care you will be charged
for any new retainers required, these can often be made by your own dentist.
TAKE HOME MESSAGE: IF YOU WORK WITH YOUR ORTHODONTIST BY CO
OPERATING WITH THE ADVICE GIVEN YOUR TREATMENT WILL BE A SUCCESS,
ITS OVER TO YOU!