What is orthodontics?
Orthodontics is a branch of dentistry which is concerned with the growth and development of the teeth and jaws.
As such, most orthodontic patients are children and young adults. Orthodontic treatment can be considered to straighten crowded teeth, impacted teeth (teeth which have not come through) and correct the bite – generally this is termed “malocclusion”.
Orthodontics and impacted teeth
Adult teeth can develop in the incorrect position or be displaced during their formation if trauma is suffered to the baby teeth.
When this happens, it may be possible to uncover the tooth with a small operation (with our colleagues in oral and maxillofacial surgery) and then move the tooth into the correct position using braces.
Orthodontics and malformed or missing teeth
Sometimes adult teeth develop abnormally meaning that they have an unusual shape or structure. They could also be completely missing (hypodontia).
Orthodontists are often asked to provide advice to children and young people’s dentists when teeth are malformed and not likely to last for a lifetime.
In cases where teeth are missing, patients may be seen by the orthodontist in conjunction with children and young people’s dentists and restorative dentists to plan their care and decide whether to use braces to close spaces where teeth are missing or open spaces and place teeth in the ideal position for to allow placement of prosthetic (false) teeth at a later date.
Orthodontics and jaw surgery
Some children and adults have a discrepancy between the size of their jaws which subsequently has an effect on their bite and facial appearance.
If this is identified at an early stage then the orthodontist can monitor the growth of the jaws and try to correct the jaw relationship using braces when a child is growing.
Patients who have a large discrepancy in the position and size of the jaws often need to wait until they are an adult in order to undergo correction of their bite. In these cases the orthodontist works closely with the oral and maxillofacial surgeons to correct the position of the jaws and the bite with a combination of braces and jaw surgery.
Orthodontics and cleft lip and palate
A cleft of the lip and/or palate is the most common craniofacial birth malformation and affects one in 700 live births.
Children who are born with a cleft of the lip and/or palate are cared for by multiple different specialists including plastic surgeons, orthodontists, oral and maxillofacial surgeons, children and young people’s dentists and speech and language therapists throughout their childhood.
The orthodontic department works closely with the Northern Cleft Lip and Palate Service (based in Newcastle) to provide orthodontic treatment locally for children and young adults born with a cleft of the lip or palate to facilitate bone grafting, alignment of the teeth and correction of their bite.
Who gets orthodontic treatment?
Patients who are referred to the orthodontic department by their dentist are seen and assessed by one of our Orthodontic team under the supervision of an orthodontic consultant or by the consultant themselves.
Usually patients who are accepted for treatment are under 18 years of age but some adults may be accepted for treatment if they are suitable for teaching and training of our registrars or if their treatment is very complex and/or requires input from our oral and maxillofacial surgery colleagues.
Patients are assessed for their suitability for orthodontic treatment using the Index of orthodontic treatment need (IOTN).
The IOTN is a nationally approved scale used to determine which patients are eligible for orthodontic treatment funded by the NHS and is graded from one to five with grade one being no need for orthodontic treatment and grade five being a very great need for orthodontic treatment.
At present, patients who are graded as one and two are not eligible for orthodontic treatment which is funded by the NHS.
Patients who are graded four and five will be eligible for orthodontic treatment providing that they have a suitable standard of oral hygiene and healthy teeth.
Those who are deemed to have a borderline need for treatment (grade three) may receive orthodontic treatment depending on the aesthetic appearance of the teeth and whether the benefits of orthodontic treatment outweigh the risks involved.
Generally, patients with the most severe malocclusions (grade four or five) are accepted for treatment within our department; however, on occasion some milder cases may be accepted for treatment if they are a suitable teaching case for our registrars.
The department also works with the Northern Cleft Lip and Palate Service (based in Newcastle) to provide orthodontic treatment locally for children and young adults born with a cleft of the lip or palate.
What does orthodontic treatment involve?
Orthodontic treatment can be carried out using a removable or fixed brace and, in many cases, a combination of both. Once the treatment is complete and the braces are removed, patients are provided with retainers (removable braces) to keep the teeth in their new position.
Usually orthodontic treatment takes approximately two years with visits every six to eight weeks for adjustments to be made to the braces. Depending on the complexity of the treatment, some treatment will take less time and some treatment will be longer and the orthodontist will advise you of this prior to the start of treatment.
What are the risks involved in orthodontic treatment?
One of the main risks of orthodontic treatment is tooth decay. Fixed braces make it more difficult to keep the teeth clean and therefore increase the risk of tooth decay.
This risk can be minimised by restricting dietary intake of sugars (sweets, juices, fizzy drinks) and maintaining excellent oral hygiene – your orthodontist will provide you with advice as to how to achieve this.
If plaque is not removed adequately from the teeth, inflammation of the gums can occur resulting in red, swollen gums and gum disease. Maintaining excellent oral hygiene will prevent this from happening.
A side effect of moving teeth with braces is that the roots of the teeth (the part of the tooth beneath the gum) will get shorter.
This is a normal process and in most patients it is to a minimal extent. Some patients are at greater risk of root shortening and your orthodontist will advise you of this.
For most people, the teeth may try to move back towards their original position following orthodontic treatment, this is known as relapse.
At the end of orthodontic treatment you will be provided with retainers which we recommend that you wear every night for one year and then alternate nights long-term to maintain the position of your teeth and prevent relapse.
If you do not wear your retainers and your teeth move, you will not be provided with further orthodontic treatment to correct them.
Loss of vitality / need for root canal treatment
Occasionally, the nerve inside the tooth becomes inflamed or irritated during orthodontic treatment and this can cause the nerve inside the tooth to die off.
If this was to happen, your dentist would need to provide you with a root canal treatment.
Generally, this is a rare occurrence but it can be more common if you have had previous damage to a tooth for example during an accident or fall from a bicycle.
Where are appointments held?
Orthodontic appointments take place at The James Cook University Hospital, Middlesbrough (the department is located on the main corridor between the south entrance and Costa Coffee) and the Friarage Hospital, Northallerton (main outpatients).
When are appointments?
Appointments are between 9am and 4.30pm Monday to Friday. As most of the patients that we treat are of school age, it is likely that patients will have to miss school to attend some appointments. Whilst after school appointments are available, they are popular and therefore it will not always be possible to accommodate patients outside of school hours.
The orthodontic team consists of four consultant orthodontists who plan and oversee patient care.
In addition to the four consultants, we have one specialist orthodontist who works with us and a number of speciality dentists who have an interest in orthodontics.
The department is also involved in specialty training.
Our orthodontic consultants can be contacted via their secretary on 01642 854305.Children’s dental surgery – first outpatient appointment leaflet