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Straightening teeth

Teeth straightening improves the appearance and function of crooked or crowded teeth through the use of a fixed or removable brace. This branch of dentistry is called orthodontics, and is becoming increasingly valuable for improving health and wellbeing, at any age.

Dr Steve Preddy, Bupa UK’s Dental Clinical Director says: ‘Orthodontic treatment gives you straighter teeth that are easier to clean, and less likely to be lost. It can improve your ability to eat more comfortably, and lower your risk of having jaw and joint problems caused by an incorrect bite. And, with so many different types of braces available, you can get the right treatment for your specific needs.

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Details

  • What is malocclusion? What is malocclusion?

    Teeth straightening is a treatment used to correct malocclusion – a condition in which your teeth aren’t properly arranged. If you have malocclusion, you might have:

    • overcrowded teeth or too much space between your teeth improper bite (the abnormal meeting of the upper and lower teeth when the jaws are closed)
    • An overbite (when your upper teeth cover your lower teeth on closing your mouth) is a common type of malocclusion. Orthodontic treatment is often used to correct this problem.

    Orthodontic treatment is also commonly used to treat gaps and spaces between teeth.

    Correcting malocclusion with orthodontic treatment improves the positioning of your teeth and, in turn, their look and function. And, since crowded teeth are more difficult to keep clean, orthodontic treatment may sometimes reduce the risk of tooth decay and gum disease.

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  • What orthodontic treatment involves What orthodontic treatment involves

    Treatment for teeth straightening involves wearing a fixed or removable brace. A brace works by slowly moving your teeth to the right position using gentle pressure. You will usually have to wear your brace at all times, for between six months and one to two years, depending on your specific needs. Every two to 10 weeks, your orthodontist (a dentist who specialises in straightening teeth) will check your brace and make adjustments as necessary.

    People of any age can benefit from teeth straightening. Most people have it done when their milk (baby) teeth have all come out – usually between the ages of 11 and 12. But an increasing number of adults are seeking treatment. For more information about having treatment as an adult, see our FAQs.

    It’s important to discuss your treatment with your orthodontist. It might be different from what we’ve described in this topic, as it will be designed to meet your specific needs.

    Deciding on teeth straightening

    Like all treatments, teeth straightening has benefits as well as risks. For example, while it can improve teeth appearance and self-esteem, there’s a small chance of damage to the roots of your teeth. This is called resorption and may cause teeth loss. However, there are techniques your orthodontist can use to help prevent this from happening.

    In addition, factors such as poor oral hygiene and smoking during treatment may lead to the development of gum disease. It’s important to discuss the benefits and risks of teeth straightening with your dentist or orthodontist, before making the decision to have treatment.

  • Preparation Preparing for teeth straightening

    Before starting treatment to straighten your teeth, you will need a full assessment by your dentist or orthodontist. This involves looking at your teeth and taking X-rays and maybe photographs, to find out what are the best options for you. For example, in rare instances you may need surgery of the jaw (orthognathic surgery) as well as wearing braces. More commonly, you may need to have extractions (teeth taken out), if there isn't enough room in your mouth.

    A full examination will also help to establish that you have a healthy mouth – teeth straightening isn't recommended if you have decayed teeth or inflamed gums. Excellent oral hygiene is very important, too. It lowers the risk of developing complications during treatment.

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  • Alternatives What are the alternatives to teeth straightening?

    If orthodontic treatment with conventional braces isn’t an option for you, you may want to consider the following alternatives.

    • Veneers (or caps). A veneer is a thin layer of porcelain or composite material that is bonded to the front of a tooth. Veneers work relatively quickly and can be used to correct mild forms of malocclusion, such as gaps between teeth. 
    • Dental contouring. This is the reshaping of natural teeth to make them look more straight, or to repair them if they are cracked or chipped. Like veneers, dental contouring achieves quick results, but can correct only minor problems.
  • Types of braces Types of braces

    Braces are used to treat malocclusion (when your teeth are crooked, crowded or you have an overbite). During your first assessment, your orthodontist will talk you through treatment options and available types of brace.

    Braces are worn at all times. Some can be removed, whereas others are fixed to the front or back of your teeth. Your orthodontist will discuss with you which type of brace is most suitable for you.

    Removable braces

    Removable braces consist of a plastic plate that has wire clips and springs attached to it to move specific teeth. They can only move teeth by tipping or tilting them. For this reason, they are generally used when the crowding of your teeth is mild.

    If you have a removable brace, you will need to wear this at all times, including at night and during meals. Eating with a brace can feel awkward at first, but it gets easier with practice. If you play sports, you may want to take out your brace and wear a mouthguard.

    You will need to take your brace out to clean it. Brush it gently under running water with a regular toothbrush and toothpaste - your orthodontist will show you how to do this properly. You may want to clean your brace at least twice a day, when you brush your teeth. Clean your brace over a sink full of water – if you drop it, it’s less likely to get damaged.

    Aligners

    Aligners are computer-generated removable moulds made of clear plastic. They are used to move your teeth into place, if your condition is mild and you have most of your adult teeth.

    You will need to wear a set of two aligners (one for your upper teeth, and one for your lower teeth) for two weeks. Then you will need to replace them with a new set. This will continue until your teeth have moved in to the correct position. Your dentist or orthodontist will take a bite impression of your teeth, which will be used, via computer technology, to produce all the sets you need.

    Aligners have advantages. They are difficult to notice, because they are almost completely transparent. They are also easier to clean than braces. And, while you need to wear them all the time, you can remove them for eating and drinking. However, it may take longer to correct your teeth than with braces. See our FAQs for more information.

    Fixed braces

    Fixed braces are attached to the surface of the teeth, so only your orthodontist can remove them. They can move your teeth in a very precise manner, and are the most commonly used type of brace.

    A fixed brace consists of small brackets that are cemented to your teeth and joined together with a wire. It’s usually made of metal, but can also be made of plastic or ceramic, which are less noticeable. There may be separators between teeth. And you may need small elastic bands, to keep the wires in place and move your teeth into the right position. Brackets and elastics are available in different colours.

    Some forms of malocclusion require the use of a headgear. This is a frame on a headband that attaches to your brace. It’s used to ensure the correct development of teeth and jaws, while your teeth are being straightened. You may only need to wear it in the evening or at night. It may take a while to get used to wearing a headgear, but it’s an essential part of orthodontic treatment for some people. For example, it can help prevent the upper jaw from sticking out when the brace is removed.

    An orthodontic mini-screw (also called a mini-implant or temporary anchorage device) can be used to help straighten teeth. This works by providing a stable point to move your teeth around. It is put into your jawbone under local anaesthetic, and is attached to your brace. After the procedure, your mouth and teeth may feel tender and painful for a few days.

    Once your treatment is finished and your brace has been removed, your orthodontist will clean the brackets and filling material off your teeth. The small wound left by the mini-screw will heal by itself.

    Retainers

    Immediately after the end of your orthodontic treatment, there’s a small chance that your teeth may move back towards their original position. This is called relapse. Retainers are special braces that help stop this from happening, by keeping your teeth in the correct position. How long you will need to wear them for, will depend on your specific needs.

    Retainers can be removable or fixed, and both have advantages and disadvantages. Removable retainers can be taken out at home and are easy to keep clean. But it is also easy to forget to wear them. Fixed retainers may break and need more attention to stay clean. But they usually provide stronger teeth support, and it’s impossible to displace or forget them. Your orthodontist will help you choose the retainer that is best for you.

  • Having a brace fitted Having a brace fitted

    Having a brace fitted doesn’t hurt. The specific procedure you have varies depending on the type of brace. If you’re having a fixed brace, your orthodontist will put it in place by attaching brackets and metal wires to your teeth. For a removable one, you will be shown how to insert and remove your brace correctly.

    You will need to visit your orthodontist regularly, usually every four to 10 weeks. He or she will check your brace and whether the treatment is working, and will adjust the pressure on your teeth, as necessary. You will also need to continue visiting your dentist for regular check-ups.

    How long your treatment will last depends on many factors, including the severity of your malocclusion (teeth positioning) and the type of brace you will be wearing. For most people, it usually takes between six months and one to two years to achieve the desired results.

  • After care What to expect after having a brace fitted

    After your brace has been fitted, you may feel some discomfort and pain in and around your teeth and gums. This is normal. It happens because your teeth slowly start to move. The pain may start two to four days after having your brace. And you may need to take over-the-counter painkillers such as paracetamol or ibuprofen. However, the soreness usually wears off within a few days.

    You may also feel some discomfort as a result of your brace rubbing your lips, tongue or the inside of your cheeks. Your orthodontist can give you a soft wax to help ease this.

    Your speech may be affected at first, because the brace can make it difficult to pronounce certain words. This problem usually happens more with removable braces, but tends to improve over time.
  • Teeth straightening treatment

    Our Bupa Dental Centres offer a range of routine, specialist and cosmetic treatments including teeth straightening. Find out more.

  • Taking care of your brace Taking care of your brace

    Good oral hygiene is always important, but it’s especially so while wearing a brace. Braces can trap food, which can lead to plaque build-up, increasing the risk for tooth decay and gum problems. So, it’s really important to keep your teeth and brace clean. Brush them for at least three minutes, at least twice a day (and always after meals) with fluoride toothpaste.

    You need to take extra care when brushing, to prevent any damage to your brace – your orthodontist or hygienist can show you how to do this. If your brace breaks, see your orthodontist as soon as possible. When you’re not wearing your brace, your teeth may start to return to their original position (relapse), and treatment may take longer.

    When you first have a brace fitted, you may prefer to eat soft foods while you get used to it. Once you feel you can eat normally, there are foods you’re advised not to have, as they could damage or break your brace. These include:

    • chewing gum and other sticky, chewy foods such as toffees, as they can get stuck in your brace
    • crunchy foods such as apples or crusty bread. (If you want to eat them, it may help to cut them into small pieces beforehand)

    When you play sports, make sure you wear a mouthguard. Your orthodontist can make one that fits precisely to your brace. If you have a removable brace, you should remove it before wearing your mouthguard. You may also have to take out your removable brace if you play a musical instrument such as the flute or trumpet. If you wear a fixed brace, you may find it difficult to play these instruments at first, but you will soon adapt.

  • Side-effects and complications Side-effects and complications of teeth straightening

    Side-effects

    You may have short-term side-effects as well as an increased risk for certain complications during teeth straightening, just as with any treatment. You may want to discuss these with your dentist or orthodontist, before deciding whether or not to have a brace fitted.

    Most people have some soreness and pain after a brace has been fitted and their teeth slowly start to move. The pain can be eased with over-the-counter painkillers such as paracetamol or ibuprofen, and normally gets better within a few days.

    Complications

    Poor oral hygiene and diet during treatment may lead to tooth decay and gum problems. Orthodontic braces themselves don't cause these. But, because they can trap food, plaque can easily build up on and between your teeth, increasing the risk of tooth decay and gum disease. There are two important ways you can reduce this risk.

    • Practice good oral hygiene. Brush your teeth and brace thoroughly, at least twice a day – and always after meals. Use fluoride toothpaste to help prevent tooth decay. Your orthodontist may also give you a fluoride mouthwash to use. 
    • Control your diet. Take care not to eat too many sugary foods such as sweets and fruit juices, and fizzy drinks, including the diet varieties.

    Another potential complication of orthodontic treatment is damage to the roots of the teeth. This may happen as a result of the force applied to your teeth during treatment. Your orthodontist will take steps to keep this risk to a minimum.

  • Can adults have their teeth straightened? Can adults have their teeth straightened?

    Answer

    Yes, adults can have orthodontic treatment to correct dental problems.

    More information

    Adults can have orthodontic treatment to correct the same dental problems that children have, such as crowding, an overbite or gaps between the teeth. Treatment may help improve the appearance of your teeth and their function. And it is likely to involve wearing a brace.

    Before you have orthodontic treatment, it’s important that any other dental problems, such as tooth decay or gum disease, are treated. Your jawbone is no longer growing, so you may need jaw surgery (orthognathic surgery) to correct any jaw problems, before or after getting your brace.

    Depending on the problem that needs correcting, you may need to wear a brace for six months to two years. Your dentist will be able to tell you more about orthodontic treatment.

  • Can I have braces that aren't noticeable? Can I have braces that aren't noticeable?

    Answer

    Depending on the type of brace you need, you may be able to have one that isn’t very visible. Your orthodontist will discuss your options with you.

    More information

    If you have a fixed brace, you may be able to have one made of a material that isn’t so obvious. For example, ceramic brackets can be transparent or tooth coloured. While these are less noticeable than metal ones, they are generally more expensive. They are also more likely to break or get discoloured over time.

    You may be able to have lingual braces. These special braces are attached to the back of your teeth and so they can’t be seen. However, they may cause soreness of your tongue and affect your speech. In addition, your treatment may take longer than with conventional braces.

    If your condition is mild, and you have most of your natural teeth, another option you may want to consider is aligners, also called ‘invisible braces’. These are removable, see-through, plastic moulds – one for the upper teeth and one for the lower teeth. You replace each set of two aligners every two weeks with a new set. You will need to wear them all the time – day and night – but you can remove them when you eat, drink and brush your teeth.

  • How much will it cost? How much will it cost to have my teeth straightened?

    Answer

    The price of orthodontic treatment varies. Your orthodontist will be able to provide a written estimate of the costs involved.

    More information

    Orthodontic treatment is provided by the NHS for children up to the age of 18, who have severe crowding or other form of malocclusion. Adults usually have to pay for private orthodontic treatment. Aesthetic treatment, that is, treatment for appearance alone, is usually only available privately, regardless of age.

    The cost of private treatment will vary depending on how severe your condition is. It will also depend on the type of brace, the techniques involved, and the experience of your orthodontist. If you decide to have private treatment, your orthodontist will assess your teeth. And then he or she will discuss your options with you, and will give you an idea of the cost.

  • Resources Resources

    Further information

    Sources

    • Orthodontic treatment. British Dental Health Foundation. www.dentalhealth.org, accessed 12 May 2015
    • Why orthodontics? British Orthodontic Society (BOS). www.bos.org.uk, accessed 12 May 2015
    • Malocclusion. The Merck Manuals. www.merckmanuals.com, reviewed August 2014
    • Treatment & brace types. British Orthodontic Society (BOS). www.bos.org.uk, accessed 14 May 2015
    • Restorative and cosmetic dental treatments. British Academy of Restorative Dentistry. www.bard.uk.com, accessed 14 May 2015
    • Removable appliances. British Orthodontic Society (BOS). www.bos.org.uk, published 2012
    • Fixed appliances. British Orthodontic Society (BOS). www.bos.org.uk, published 2012
    • FAQs. British Orthodontic Society (BOS). www.bos.org.uk, published 2014
    • What are the options for referring adults or patients with mild problems? British Orthodontic Society (BOS). www.bos.org.uk, accessed 12 May 2015
    • Preoteasa CT, Ionescu E, Preoteasa E. Risks and complications associated with orthodontic treatment. In Orthodontics – basic aspects and clinical considerations, F Bourzgui (editor). InTech, 2012:404–29. doi:10.5772/31692
    • Alfuriji S, Alhazmi N, Alhamlan N, et al. The effect of orthodontic therapy on periodontal health: a review of the literature. Int J Dent 2014; doi.org/10.1155/2014/585048
    • Topkara A, Karaman AI, Kau CH. Apical root resorption caused by orthodontic forces: a brief review and a long-term observation. Eur J Dent 2012; 6(4):445–53
    • Orthognathic surgery. Medscape. www.emedicine.medscape.com, published 2 December 2014
    • Orthognathic treatment. British Orthodontic Society (BOS). www.bos.org.uk, published 2014
    • Luther F, Nelson-Moon Z. Orthodontic retainers and removable appliances. 1st ed. Chicester: Wiley–Blackwell, 2013
    • Ireland R. Advanced dental nursing. 2nd ed. Chichester: Wiley–Blackwell; 2010: 269
    • Living with my brace. British Dental Health Foundation. www.dentalhealth.org, accessed 12 May 2015
    • Clear aligners. British Orthodontic Society (BOS). www.bos.org.uk, accessed 12 May 2015
    • Freedman GA. Contemporary esthetic dentistry. 1st ed. At. Louis, Missouri: Elsevier, 2012
    • Headgear. British Orthodontic Society (BOS). www.bos.org.uk, published 2013
    • Orthodontic mini-implants (TADs). British Orthodontic Society (BOS). www.bos.org.uk, accessed 12 May 2015
    • Mini/micro screw implantation for orthodontic anchorage. National Institute for Health and Care Excellence (NICE), 2007. www.nice.org.uk
    • Retainers. British Orthodontic Society (BOS). www.bos.org.uk, accessed 12 May 2015
    • Veneers. British Dental Health Foundation. www.dentalhealth.org, accessed 12 May 2015
    • Contouring. British Dental Health Foundation. www.dentalhealth.org, accessed 12 May 2015
    • Adult orthodontics. British Orthodontic Society (BOS). www.bos.org.uk, published 2009
    • Xiaoting L, Yin T, Yangxi C. Interventions for pain during fixed orthodontic appliance therapy. Angle Orthodontist 2010: 80(5):925–32. doi:10.2319/010410-10.1
    • Orthodontic treatment. What are the risks? British Orthodontic Society (BOS). www.bos.org.uk, published 2006
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