Frequently Asked Questions

Orthodontics is the branch of dentistry specialising in the diagnosis, prevention and treatment of dental and facial irregularities in children and adults in order to achieve improved appearance and better function. The technical term for orthodontic problems is malocclusion, which simply means bad bite.
The practice of orthodontics requires professional skill in the diagnosis and identification of facial disharmony and dental abnormality; as well as the design, application and control of a wide range of corrective appliances or braces that can bring teeth, lips and jaws into proper alignment and achieve facial balance for a lifetime of beautiful healthy smiles.

A British-trained specialist orthodontist is a highly trained professional who has completed a five-year university dentistry degree course to obtain a dental qualification; then worked in various branches of dentistry to gain a broad working knowledge and experience of its different fields; and then completed an approved three-year full-time university or hospital postgraduate orthodontic training programme to achieve higher qualifications. Our orthodontist Dr Adel Bou Saba has for years limited his practice to the treatment of orthodontic problems.

While orthodontic treatment requires some commitment, patients are rewarded with healthy straight teeth, proper jaw alignment and a beautiful smile that lasts a lifetime. Crooked and crowded teeth are a hassle to clean and can result in tooth decay, gum diseases and possible tooth loss. If left untreated, crooked teeth could lead to an improper bite, tooth wear and tooth injury. Crooked teeth can also lead to a decrease in one’s personal self-confidence.

It has been proven that improvements in personal appearance contribute to greater mental and physical well-being. Although treatment may sometimes seem lengthy, creating a beautiful smile through orthodontics is a reliable way of improving the health of your teeth as well as your self-esteem.

We recommend that children should have an orthodontic opinion at around the age of 8. Your orthodontist can detect many developing problems at this age. Occasionally treatment is necessary before the eruption of all permanent teeth in order to prevent potential problems, or to avoid the need for or at least simplify future treatment.

Most patients though start brace treatment when most or all of their permanent teeth have been shed. This happens typically at around the age of 12, but there is quite a lot of variation amongst individuals. However, please remember that orthodontic treatment is not only limited to children and adolescents, as adults can have orthodontic treatment too.

The majority of the patients seen in our specialist orthodontic practice are treated on a non-extraction basis; i.e. they do not have to have teeth taken out as part of their orthodontic treatment. Our specialist orthodontists employ the latest in orthodontic braces, advanced clinical methods and state-of-the-art wire technology to ensure that the need for extractions is minimised. In our practice, ‘expansion’ and ‘orthopaedic’ techniques are always used in appropriate cases to avoid the need for removal of teeth. Your orthodontist will use his knowledge, training and experience, as well as your radiographs (X-rays) and models of your teeth, to perform a full evaluation and analysis of your orthodontic condition before devising a treatment plan that is right for you.

Each individual case should be studied and analysed carefully, taking various factors and circumstances including the patient’s facial profile into consideration. Only then should treatment be planned based on the specific and unique factors that have created the orthodontic problems in that particular patient. The solution may or may not involve the extraction of teeth. In any event, our priority is always to obtain good facial balance and a full attractive smile.

There are several reasons why teeth may have to be taken out for some orthodontic patients. Some of these include:

• Extraction to relieve severe crowding of the teeth particularly when the jaws are very small, or the teeth are very large and/or impacted.
• Extraction because of the presence of more than the normal number of teeth.
• Extraction of teeth that are hopelessly distant from their correct positions and are impossible to move to where they should be.
• Extraction of very decayed, broken-down or infected teeth that cannot be saved by the general dentist in the long-term.
• Extraction of some baby teeth to encourage their corresponding adult teeth to grow into their correct positions.
• Extraction of some baby teeth to encourage spontaneous and natural alignment of crowded adult teeth.
• Extraction of side teeth to enable very protruding upper and/or lower teeth be pushed back.

In all of these cases no space is left behind after teeth are taken out and at the end of orthodontic treatment. The spaces either close naturally because other teeth need more room, and/or braces will help the closure of spaces in the right way.

Active treatment time with orthodontic braces typically ranges from six months to two years, but a few cases fall outside this range. The duration of treatment depends on the growth of the patient’s mouth and face, the individual biological response to the brace, the severity of the problem and the cooperation of the patient. Patient compliance with the orthodontist’s advice and instructions is crucial to completing treatment on time as planned.

After active treatment is completed, retainers will need to be worn. Removable retainers are worn every evening and night for the first year and then every other night indefinitely as teeth move all of our life, in other words for as long as you want your teeth to remain straight! This is called ‘long-term retention’. With fixed or bonded retainers, again you should expect ‘long-term retention’, keeping them on for as long as possible.

• You may need to stick to a softer diet only for the first few days of having your braces if your teeth feel a little tender. After that you should generally be able to eat normally.
• Having said that, we recommend that you totally avoid certain foods to avoid damage to your teeth or your braces. These include sticky, chewy or hard sweets (such as toffee, boiled sweets and wine gums). Avoid chewing gum or bubble gum. Do not bite directly into very hard food with your teeth.
• Eliminate fizzy and acidic drinks including fizzy water, diet soda and juices.  Reduce sugary food.
• Cut up harder fruit and vegetables (e.g. crisp apples, carrots) into smaller pieces before eating them. Be very careful with crusty bread, nuts, spare ribs, corn on the cob and stones in fruit.
• Think about what you eat and bite carefully to avoid breaking your brackets.

Biting your fingernails may result in damage to your brace. Do not touch, play with, or pick at your brace. Do not bite pens or touch your braces with them. Do not use your teeth as DIY or household tools! The more you look after your braces, the sooner your treatment will be completed.

If despite all your careful attention part of the brace becomes dislodged or damaged, contact the practice as soon as possible so that an appointment can be arranged either to repair the brace or to relieve any discomfort. Damage to your braces can prolong treatment. If appliances are repeatedly damaged and no progress is being made, treatment may have to be terminated.

1. We can provide you with a pack containing what you need to look after your braces. You will need to spend more time cleaning your teeth, brushing the gums and using interdental brushes to clean in between the brackets and under the wire. Neglect will cause swelling and bleeding of your gums, tooth decay and marking/staining of the teeth around the brackets. It takes two weeks for the gums to heal after only one day of not brushing teeth thoroughly.
2. Brush after each meal.
3. Make sure the gum margins are also brushed even if they bleed when you brush them.
4. Change the brush every three months. An electric brush can be used after the first week of fitting your braces (as teeth may be tender initially) and is more effective at brushing your teeth than manual brushing.
5. Use the interdental brushes for getting in between the brace components and the tooth surface.
6. Use a fluoride mouthwash twice a day.
7. It may also be useful to use disclosing tablets occasionally to check that you are removing all the plaque from your teeth.

This usually takes anywhere between 9-24 months but can vary according to how severe your case is. Failed and cancelled appointments or repeated breakages of the brace will add to the overall treatment time.

Once the active phase of your treatment has been finished, it will be necessary to wear a retainer. Your orthodontist will advise you whether removable retainers are sufficient to keep your teeth from moving or if you also need a fixed retainer behind your front teeth. Removable retainers need to be worn every night for the first year and then every other night indefinitely.  Some people choose to keep their fixed retainers for life and others choose to have them removed after 5 or 10 years and rely on removable retainers alone to keep their teeth from moving.

You will need regular appointments during treatment for the brace to be adjusted. This can be anywhere from 5 weeks to 10 weeks depending on your treatment plan.

Yes. It is important to continue having check-ups with your regular dentist throughout orthodontic treatment so that your teeth can be checked for decay.

You can buy a mouthguard from the practice. Wear your mouthguard for any sport or activity where accidents may cause damage to your teeth.

If you play a wind instrument, then fixed braces may initially make things more difficult. You will need to discuss this with your music teacher.

If your fixed braces become damaged, or a component is digging in your lips or cheeks, or if you are concerned that the fixed braces are continuing to be uncomfortable or troublesome beyond what is normally expected for the first few days, then telephone the practice for advice and/or an emergency appointment. Where possible, do not try and adjust the appliances yourself, as this may damage them.

A functional appliance is a functional brace that is worn on the upper and lower teeth at the same time to correct the way upper and lower teeth fit over each other. They are sometimes also called orthopaedic appliances or twinblocks. For example, a functional brace may be used to correct very protruding upper or lower front teeth, improve the way molar teeth bite together, or even improve your facial profile so that the jaws look more aligned with each other when you look at the face in profile.

Functional braces only work in growing children and adolescents. Research is still being carried out to evaluate exactly how functional braces work. It is thought that functional braces deliver their effects through a combination of ways. They may promote or modify growth of the jaws, adapt the soft tissues and muscles of the face to new positions, move whole groups of teeth at the same time or change the angulation of teeth.

Depending on the condition of the bite, functional brace treatment starts either at an early age when milk teeth are still present (age 7-10), or around the time of the pubertal growth spurt (age 11-14) when all or nearly all the milk teeth have been shed. Your orthodontist will assess and diagnose the problems with your bite and determine whether you need functional treatment, and when you should start.

For the first 5-12 days of having your functional brace, and for a day or two each time it is adjusted, you may experience some discomfort in your mouth. The teeth may get a little sore, and parts of the brace may rub on your gum, lips, cheeks or tongue. You may also notice increased saliva flow, and an effect on your speech. This is normal, and soon you’ll get used to wearing your brace and your speech will go back to normal. To improve your speech sooner, you can practise by reading aloud while wearing the brace. Try and wear the brace as much as possible during those first few days. If you leave your brace out for a long time, you will have to get used to it all over again when you start wearing it once more.

If necessary, you may wish to take mild painkillers such the ones you would normally take for headaches. Please read the instructions on the packet regarding how much you should take. Orthodontic wax may help if any part of the retainer is digging into your lips or cheeks (tear off a small piece of wax, roll it into a small pea-sized ball between your fingers, and gently mould this over any troublesome part of the retainer). This acts as a cushion, keeping your lips or cheeks away from the retainer components.

If you continue to have discomfort beyond the first few days, contact the practice so that an emergency appointment can be arranged as soon as possible to adjust your functional brace. Don’t just wait for your next appointment as this could prolong your treatment duration.

The key to successful orthodontic treatment with functional braces is wearing them full time, at least for 16 hours out of 24 hours. For most cases, progress can only be achieved with a minimum of 16 hours wear.  If the patient then only wears them for 12 hours, they would only maintain the progress already made. Wearing them for less than 12 hours can result in the bite reverting to the previous position. Functional braces do not work in your pocket! Wear your functional brace all day and all night wherever you are. There are only a few exceptions to this rule. You may remove them for:

• eating main meals
• brushing your teeth
• playing contact sports or very active physical games or PE (in which case you should wear a mouthguard instead)
• playing wind musical instruments
• if you sing or speak in performances as part of your school activities
• swimming

Going on holiday is not an exception to this rule! Only remove your brace for a short while for the above exceptions, and when you do, always store the brace in a small rigid container to avoid damage to, or loss of your functional brace.

Do not leave your functional brace lying around outside its container. Do not carry the brace loose in your pockets or in your bag. Do not wrap up your brace in tissue paper or a napkin and then leave it lying around. To avoid damage to, or loss of your brace, always store it in its container/box when it is not being worn. To keep your functional brace clean, brush it with your regular toothbrush and toothpaste whenever you brush your own teeth. You may wish to purchase brace cleaning tablets from the practice to clean them once every 1-2 weeks.

Always insert or remove your brace components according to your orthodontist’s instructions. Do not get into the habit of clicking the parts in and out or using your tongue to fix them in or take them out. This can be damaging to your teeth and to your brace.

You should brush your teeth thoroughly preferably after each meal. Take your brace out for toothbrushing. Use a fluoride mouthwash or brush with a fluoride gel last thing at night after brushing your teeth.

Your orthodontist would have given you some indication of this. Treatment with functional braces usually takes around 12 months. You need to attend for regular appointments so that your brace is adjusted and your tooth movements are checked.

Different braces have different functions. Your orthodontist has assessed and analysed your orthodontic problem to come up with the treatment plan that is customised to produce the best possible improvement for your bite. This sometimes involves wearing functional braces which act to bring about specific changes which fixed braces may not be very efficient at achieving. Treatment with functional braces is usually (but not always) followed (or occasionally preceded) by fixed brace treatment.

Regardless of the type of orthodontic treatment you are having, you should always continue to arrange six-monthly check-ups with your dentist.

Contact the practice as soon as possible for an emergency appointment and/or advice. Do not wait for your next scheduled appointment as this may delay your treatment, or may result in unwanted tooth movement. Very occasionally we may be able to order a new brace in your absence; or repair it if someone else brings in the damaged brace, the 3D moulds and plaster models. A charge is made for replacing damaged or lost braces. If you repeatedly damage or lose your brace, no progress will be made, and treatment may be stopped.

Many people wrongly believe that orthodontic braces lead to swelling of the gums, leave marks or stains on the teeth, or damage the enamel of teeth. This is not true. However, poor oral hygiene as a result of hurried or insufficient brushing of the teeth could cause these problems. Poor diet, sugary snacks and acidic drinks are also damaging to teeth. With fixed braces especially, failure to maintain excellent oral hygiene and a good healthy diet will cause gum disease and bleeding of the gums, tooth decay and marking/staining of the teeth around the brackets.

Root resorption is the shortening of the tooth root. It can occur with or without orthodontic appliances and it is very difficult to forecast susceptibility to this condition. Some orthodontic patients are predisposed to this problem whether it is hereditary or from previous trauma, while most are not. Very slight changes in root length are normal in orthodontic treatment and are usually insignificant; they cause no long term ill effects in a healthy mouth.

Very rarely and unpredictably there may be more serious changes and the longevity of the teeth involved may be affected. The incidence may increase with unnecessarily extended orthodontic treatment: that is why your cooperation during treatment is very important so that treatment can be completed on time. Depending on your orthodontic circumstances, your orthodontist may take additional radiographs (X-ray films) to check for root resorption during treatment.

Some patients suffer a blow or knock to their front teeth before or during orthodontic treatment. Regardless of how much damage is sustained or when the incident happened, traumatised teeth become predisposed to three possible conditions. These consequences are generally uncommon but should be considered before deciding to go ahead with orthodontic treatment:

1. Loss of vitality or degeneration of the nerve inside the tooth. The affected tooth may discolour and become painful. A root filling and later cosmetic work may be required to treat this problem. Loss of vitality is also more common in teeth with very large/deep fillings or crowns, or teeth which have severe gum problems.
2. ‘Root resorption’ or a shortening of the root of the tooth. The outcome and possible treatment depends on the degree of resorption, but the longevity of the affected tooth could seriously be affected.
3. ‘Ankylosis’ or the fusion or attachment of the tooth root to its surrounding bone. Normally a fibrous layer separates the root from jaw bone. An ankylosed tooth cannot be moved with orthodontic braces, and it may require removal, or surgery to move it into position.

A number of orthodontic appliances or braces are used in your treatment, and it is very important that you closely follow your orthodontist’s instructions regarding their use to avoid accidents. However, there is always some risk of injury with the use of appliances.

• Because your braces cover your teeth, a blow or knock to the mouth can scratch or cut the inside of your lips or cheeks. Be sure to wear a mouthguard when taking part in sports or physical activity.
• Loose or broken wires and brackets can also scratch or irritate your cheeks, gums or lips. Follow your orthodontist’s advice regarding the foods or habits to minimise the chances of such problems occurring. Dislodged or broken braces could also be swallowed or inhaled.
• Head Gear: you must follow your orthodontist’s instructions for safe and effective use of headgear to prevent facial injuries. Never wear your headgear when playing physical games or sports. Never remove your headgear in one go by taking out the facebow first and pulling the headgear over your head. Always remove the safety strap and the headgear straps before removing the metal facebow. Always remember to wear the white ‘safety strap’ with your headgear. Make sure the hooks on the ends of the inner arms of the facebow are correctly engaging at the back of the molar bands. In the past, there have been very rare reports of eye injuries occurring while wearing headgear. If this happens, treat it like a medical emergency. Go to your local hospital Accident & Emergency Department to see an eye specialist as soon as possible.

If any brace or part of brace is damaged or you feel is not functioning properly, you must contact your orthodontist so that it can be repaired or adjusted.

These can be dislodged while removing your braces; but usually this problem can easily be resolved by your dentist.

A very small minority of patients may need both orthodontic treatment and surgery to modify the size, shape or position of your jaws. As with all surgical procedures, the risks and complications of oral surgery is a possibility. These risks need to be discussed in detail with the surgeon if your orthodontist recommends surgery.

Occasionally problems may occur in the jaw joints (temporomandibular joints or TMJ) and associated facial muscles, causing joint pain, limited opening, muscle aches and joints noises (clicking). Earaches and headaches are sometimes related complaints. Multiple factors which may be difficult to pinpoint are usually responsible for these signs and symptoms. Orthodontic treatment is not a cause, but such problems may occur at the same time as treatment as a matter of coincidence.

Some of the most common causes of TMJ disorders are chronic muscle tension associated with clenching or grinding of the teeth, parafunctional habits such as nail or lip biting, or stressed jaw posture at work or during sleep. The symptoms may also originate from a joint disease, such as arthritis, or result after previous trauma, such as a blow to the face or sometimes from a whiplash type injury.

The severity of the symptoms may be affected by stress, tension, mood, emotional distress, insufficient sleep, poor diet and not drinking enough water. Neck and shoulder muscle tensions may be a major contributor by referring pain and tightness to the jaws and face. Severity of symptoms may be exaggerated by faulty function of the pain suppression system at various levels of the nervous system.

In the past, it was believed that an imperfect bite (malocclusion) and/or certain types of orthodontic treatment were possible causes of TMJ problems. However, extensive research has disproved this relationship. Bite problems that occur concurrently with TMJ disorders are most often the result of the problems rather than the cause of the problems.

TMJ disorders are musculoskeletal problems similar to aches and pains in other joints of the body. A TMJ problem is most often treated as a medical problem and not necessarily a dental problem. Treatment may require specialized care from other health professionals such as a TMJ specialist, physical therapist, and/or stress control specialist. These procedures are beyond the scope of the usual orthodontic treatment. Orthodontic treatment – in the same way that it does not cause TMJ problems – cannot guarantee a cure for TMJ disorders either.

Any TMJ signs or symptoms should be reported promptly to your orthodontist.

Orthodontic relapse is the tendency for teeth to return to their original positions after the completion of orthodontic treatment. Your orthodontist will use the optimum clinical techniques to minimise the chances of relapse. However, the main method of preventing relapse is wearing retainers after braces have been removed. You should follow your orthodontist’s advice about wearing retainers to prevent unwanted tooth movement after your treatment.