We provide orthodontic opinions mainly to general and community dental practitioners and less commonly to medical practitioners.
We liaise with specialist orthodontic practitioners in primary care and with hospital consultants including consultants in oral and maxillofacial surgery, restorative dentistry, paediatric dentistry, paediatrics, plastic surgery and ENT.
We provide second opinions for concerned patients at the request of dental and medical practitioners or consultant colleagues.
This service is now centralised at The James Cook University Hospital in Middlesbrough and the Friarage Hospital in Northallerton. We provide treatment within the hospital department for:
Patients with the greatest need for treatment on dental health grounds
The additional training of consultant orthodontists means that the department is able to treat malocclusions of the greatest severity and technical treatment complexity. These are usually identified from the nationally accepted “index of orthodontic treatment need” (IOTN).
Interdisciplinary treatments
The hospital environment, in particular the close working arrangements with oral and maxillofacial surgery provides the ideal situation for managing interdisciplinary treatments.
Examples of such problems will be unerupted teeth, unerupted displaced and malformed teeth and the effects of trauma and pathology on the developing jaws of children and young adults.
We treat in conjunction with oral and maxillofacial surgeons severe skeletal problems by means of combined orthodontic and surgical treatment approaches. We have a particular role in treating patients with clefts of the lip and palate as part of the cleft team with plastic surgeons, oral and maxillofacial surgeons, ENT surgeons, speech therapists and paediatric dentists.
We also treat in conjunction with general practitioners those problems which need combined orthodontic treatment and replacement of congenitally absent teeth or the restoration of more normal form to abnormally shaped teeth.
Milder malocclusions
These would normally be treated within primary care rather than the hospital service although some cases will be accepted for treatment when this is required for training of specialists or primary care dentists.
Retention
Teeth can change their position throughout life and minor changes will occur post treatment. It is our endeavour, for most patients, to leave the teeth in positions that will be reasonably stable once the supporting tissues have reorganised.
The consensus in the speciality is that this takes a year. We, therefore, recommend that at the end of the active phase of treatment with orthodontic appliances retainers (passive less visible braces) are worn for a year.
We are unable to continue supervising retainers beyond this period. Some patients may be concerned about the risk of minor changes occurring and may wish to continue wearing retainers for a longer period. Such continued care and monitoring would need to be provided by the patients primary care dentist under a private arrangement as such prolonged retention is not normally provided by the NHS.
A similar situation applies to those few individuals for whom aligned and stable positions of the teeth are not achievable by treatments that are reasonably acceptable. In such cases life long retention may be needed to maintain a functional and aesthetic result.