Straightening teeth

Published by Bupa’s Health Information Team, August 2011.

This factsheet is for people who are having their teeth straightened, or who would like information about it.

Straightening teeth involves using a brace to improve the appearance and function of crooked or crowded teeth. This area of dentistry is called orthodontics.

You will meet the orthodontist carrying out your treatment to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About straightening teeth

Orthodontic treatment is used to straighten or move your teeth to improve their appearance or function. It can also help to keep your teeth and gums healthy by spreading the pressure of your bite out evenly. Straight teeth are easier to clean and are less vulnerable to tooth decay and gum disease.

Orthodontic treatment usually involves wearing a brace on your teeth. This puts gentle pressure on specific teeth to move them into the right place. You will usually need to wear a brace for between six months and two years. During this time, your orthodontist (a dentist who specialises in straightening teeth) will monitor you closely and make adjustments to the brace.

Sometimes, if there isn't enough room in your mouth, you may need to have teeth taken out before starting orthodontic treatment. If your condition is very severe, you may need to have jaw surgery to correct your bite, but this is rare.

Orthodontic treatment is usually carried out during childhood, but adults can have it as well.

Having an orthodontic assessment

You will usually be referred to an orthodontist by your dentist. The best time to have an orthodontic assessment is after you’ve lost your milk (baby) teeth, but before all your adult teeth come through (usually around the age of 10 or 11). By this time, your jaw will have grown enough for your orthodontist to see whether your new adult teeth have enough room to come through.

At your initial appointment, your orthodontist will do a detailed dental examination. You may have X-rays of your teeth taken. These show your orthodontist how your facial bones and teeth are developing. He or she may also make moulds of your teeth and take photographs.

If your orthodontist thinks you need treatment, he or she will talk you through your options.

Braces

There are several different kinds of brace. Some can be removed, while others are fixed to your teeth. Your orthodontist will discuss with you which type of brace is most suitable for you.  

Removable braces

Removable braces are made of plastic and usually have wire clips and springs to move specific teeth. They are most commonly used to move your upper teeth.

You will need to take your brace out to clean it, but otherwise you should wear it 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.

You can clean your brace by brushing it gently with a toothbrush and toothpaste. Do this at least three times a day after you’ve brushed your teeth. Make sure you wash it over a sink full of water so that it’s less likely to get damaged if you drop it. 

Aligners

Aligners are removable, plastic moulds that are used to move your teeth into place. They are made from clear plastic so aren’t very noticeable. You usually wear a set of aligners for two weeks before having them replaced with a new set. You need to wear your aligners for at least 22 hours a day. You should only remove them for eating, drinking, brushing and flossing. Aligners are only suitable if you have all your adult teeth. 

Fixed braces

Fixed braces (sometimes called 'train tracks') can't be removed from your teeth – except by your orthodontist when your treatment is finished. They are made of small brackets that are glued to your teeth with filling material and are joined together with a wire. Fixed braces are usually made of metal, but can also be made of plastic or ceramic. You may need to have small elastic bands attached to your brace – these are used to keep the wires in place and are often available in different colours. Fixed braces can be used on both your upper and lower teeth.

You may need to wear headgear with your brace. This is a frame with wires that come out of your mouth and attach your brace to a headband. The headgear is used to move your back teeth when your front teeth are being straightened. You may only need to wear it in the evening or at night. Although it can take some time to get used to, headgear is an essential part of orthodontic treatment for some people. If you need to have this, ask your orthodontist to show you a photograph so you know what to expect.

Sometimes an orthodontic mini-screw can be used to help straighten your teeth more effectively. Mini-screws are put into your jawbone and are attached to your brace for several months. Your orthodontist will give you an injection of local anaesthetic before the mini-screws are put in. After the procedure, your mouth may ache for around 24 hours.

Once your treatment is finished, the brackets and filling material from the brace are cleaned off your teeth. 

Retainers

Retainers are braces that help your teeth stay in the correct place after your orthodontic treatment has finished. They can be removable or fixed. Without a retainer, your teeth will move back towards their original positions.

You will usually need to wear a retainer for at least six months – this may be all the time at first and then just at night. Generally, older people need to wear retainers for longer. Speak to your orthodontist for more information.

Having a brace fitted

Having a brace fitted doesn't hurt, but your teeth will probably feel tender for a few days after. If you find it’s particularly uncomfortable, 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 your brace rubs your lips, or the inside of your cheeks, ask your orthodontist for some special wax that can help to ease this.

It usually takes a few days to learn to speak normally with a brace. You may have problems saying certain words to start with. Some people find it helps to practise by reading aloud.

When you have a brace fitted, there are some foods and drinks you need to avoid. These include:

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

If you eat any hard or crunchy foods, such as apples, cut them into small pieces before you eat them.

When you play sports you will need to take out your removable brace and wear a gum shield for contact sports if you have a fixed brace. 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 kinds of instrument at first, but you will soon learn to adapt.

You will usually need to visit your orthodontist every four to six weeks so that he or she can check your brace and adjust it if necessary.

Taking care of your brace

Orthodontic braces don't cause tooth decay, but they can trap food in your mouth. Your teeth can be permanently damaged if they aren't kept clean, so you need to take extra care when brushing. To help prevent tooth decay, brush your teeth and brace thoroughly three times a day with a fluoride toothpaste. Your orthodontist may also give you a fluoride mouthwash to use.

If your brace breaks, make an appointment to see your orthodontist as soon as possible. You will also need to continue visiting your dentist for regular check-ups.

Surgical orthodontic treatment

If your jawbones are in the wrong position, you may need to have jaw surgery (orthognathic surgery). This will help to move them into the right place so that your teeth can bite together properly. Your teeth may also need to be moved into the correct position using a brace, either before or after you have surgery. If you need more information, ask your orthodontist. 

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.