FAQ's


1. What is the earliest age for an appointment and treatment?
Usually the earliest age at which a child can have a meaningful orthodontic examination is about 8 years, although there are some exceptions if a problem is noticed by a parent or dental professional. Although some problems at this age need to be treated, it may be recommended that treatment be deferred until all the baby teeth have been lost and the permanent teeth have emerged, usually at 12 to 14 years. An early examination may reveal hidden problems or may outline future treatment that will be required. Back to top


2. Am I too old to have orthodontic treatment?
No! As long as you have healthy gums, there is no age-related reason why you should not have treatment. More than a quarter of our patients are adults and some are even in their 60s or 70s. Adult orthodontic treatment is in greater demand with the advent of various “aesthetic” types of braces including Clear Damon brackets, lingual appliances (braces on the inside of the teeth) and the almost invisible “Invisalign” clear appliances. Even if these less obvious options are not suitable, more and more adults are seeing the benefits of orthodontic treatment, which include straight, healthy teeth and greater self-esteem. Back to top


3. Is it necessary to have a referral to see an orthodontist?
No. Anyone can contact the practice by phone or e-mail for an appointment. Your school dental therapist or dentist may suggest contacting an orthodontist and may make a referral but this is not essential. Back to top


4. Will I need to have teeth extracted?
Some patients definitely do not need to have teeth removed; some patients may need to have teeth removed; and some patients definitely should have teeth removed! It all depends upon the problem.

Some treatments are started without the removal of teeth and when all of the teeth have been lined up, a reassessment is made. At this stage, teeth may still not be removed or it may now be very clear that teeth should be removed. In the latter case, the braces are simply adjusted, the teeth removed by the dentist and the braces continue to place the teeth in their correct positions within the jaws and relation to each other.

The usual reasons for the removal of teeth are to:
Relieve excessive crowding.
Correct a protrusion (buck teeth).
Improve an incorrect bite (for example. the lower teeth slightly forward of the uppers).
Move the upper and lower front teeth back in the face and jaws when they are both too far forward.
And overall, to improve the stability of the treatment result by placing the teeth safely within the limits of the gums and bones of the jaws.
Every patient is different and the decision to extract teeth is very carefully assessed for every patient by the specialist orthodontist on an individual basis. Back to top


5. Will extractions harm the shape of my face or weaken my jaws?
Not at all! If the treatment has been carried out by a specialist orthodontist, the movement of the teeth into their correct positions will be carefully monitored and controlled. In many cases, the removal of the teeth and the subsequent tooth movement can greatly enhance lip positions and posture. Many scientific papers have shown that the extraction of premolar teeth and competent treatment does not spoil faces or result in narrower smiles. As specialists, we are trained to assess faces as well as teeth and treat problems to obtain the best overall result. The removal of teeth is a serious matter and a specialist is best equipped and experienced in the subsequent tooth movement with braces.

The jaws are definitely not weakened by extractions as the spaces are completely filled by the movement of adjacent teeth and the bone reforms around them. Back to top


6. Why should I see a specialist orthodontist?
An orthodontist is a fully qualified dentist who has usually practiced as a dentist for some years before returning to university for post-graduate studies in orthodontics. The master’s degree or doctorate involves three years of full-time training at an accredited university, studying only orthodontics. This involves all aspects of orthodontic treatment from the simplest removable appliance treatment, through all types of fixed appliances and on to cleft-lip and -palate and skeletal deformities treatment. The university degree involves about 3,000 hours of study, a great deal of it on a one-to-one level with the teachers. The breadth and depth of the training is such that the qualified specialist orthodontist is most able to assess the best treatment for an individual. Back to top


7. Can dentists carry out orthodontic treatment?
Some general dentists carry out relatively minor orthodontic treatment with perfectly acceptable results. However, part of the problem is deciding when an orthodontic problem is minor or requires specialist assessment and treatment. What may seem to be a simple problem to a dentist may in fact be analysed as complex by an orthodontist.

It has to be remembered that dentists who do orthodontics also do fillings, crowns and bridges, implants, dentures, gum treatments, extractions, etc., etc. That is why they are called general dentists.

Orthodontists just do orthodontics. That is why they are called specialists.

The difficulty is not that non-specialists do not know enough orthodontics; the problem is when they do not know how much they do not know. Back to top


8. Do braces hurt?
When the braces are first fitted, the teeth are often sore, particularly when biting together, and the lips and cheeks may be rubbed by the braces. Taking some over-the-counter pain-killers, like paracetamol, will relieve the pain and the use of wax placed over the braces will assist with the rubbing. After about three to five days, this discomfort usually subsides. Patients very quickly adjust to the presence of the braces and for the most part forget that they are wearing them. Adjustments at each new appointment will usually cause some fresh discomfort but the initial stage is the most difficult. Back to top


9. Why do I have crooked teeth?
For most people, crooked teeth are an inherited pattern and parents will often say that their child has teeth just like theirs or another relative. Obviously facial shapes, jaw sizes and jaw relationships are inherited within families as are the sizes of teeth. Patterns of missing teeth or teeth that do not develop are highly inherited traits and even impacted teeth can run in families.

It has to be recognised that crowded teeth, irregular bites and imperfect jaw relationships affect the majority of the population and are perfectly normal.

Some malocclusions are acquired by the early loss of deciduous teeth or by the loss of permanent teeth by accidents, gum problems or decay. Persistent thumb or finger sucking can result in a protrusion or anterior openbite.

A persistent tongue or lip posture or activity may be associated with certain facial shapes but it is difficult to say which has caused the other. Back to top


10. What Is Functional Orthodontics?
This is a treatment modality that uses functional appliances or expanders to attempt to expand the jaws to correct crowding and the bite. It claims that by expansion, teeth do not ever have to be extracted. It further claims that the use of these removable appliances can make, in particular, the lower jaw predictably grow more than the patient’s inherited genetic potential. Over many years, it has been consistently scientifically shown to be thoroughly disproved. The idea that pieces of plastic and wire can reliably permanently and safely alter someone’s genetically inherited facial shape and growth has been well debunked by high quality scientific research. However, in a cooperative patient, functional appliances can certainly move the teeth and gain a considerable improvement in a protrusion and bite. Removable functional appliances do not change a person’s jaw relationship  by an  amount that makes any difference to treatment.


11. Will my teeth stay straight after treatment?
Yes, a high proportion of the original problem will remain stable. However, there are certain pre-treatment features of tooth positions that are well known to have a tendency to return or relapse, although to a lesser extent. Retainers are fitted to resist these adverse changes. Rotations of the front teeth and spaces between the front teeth have a tendency to relapse. Therefore, when a patient is close to completing their treatment with braces, very fine wires are bonded behind the four or six upper front teeth and six lower front teeth to maintain their alignment. These “flexi-wires” are not visible from the front and have a low profile so that patients become very used to them in two or three days and forget they are there except when brushing their teeth and flossing. It is hoped that patients will keep these wires intact for many, many years as the gums never forget! If the wires come loose or are broken, they must be repaired or replaced very promptly.

In addition to these retainers, patients are provided with an upper removable appliance which simply holds the teeth while the bones and gums settle to the new tooth positions. The removable retainer is worn full-time for some months and then for an extended period at night-time only. Patients who have had their upper back teeth expanded to correct a crossbite may he required to use the upper removable appliance part-time (say two nights per week), long-term.

It must be remembered that all parts of the body change with maturing and aging and the teeth are no exception. “Wrinkly skin, wrinkly teeth!” Back to top


12. How frequent are the appointments?
When you have fixed braces, you are seen about every six weeks. If a feature of your treatment needs extra monitoring, you may be seen more frequently. Patients with lingual appliances are seen 4 weekly and those with removable appliances 3-4 weekly. Back to top


13. How long does treatment take?
The “average” treatment time with braces is about 24 months. This varies greatly and depends upon the extent of the original problem, patient co-operation and individual response to treatment. Obviously, the more difficult cases take longer.

Some people’s teeth move more slowly than others and it is impossible to tell before treatment starts. This is particularly so with adults.

Lack of patient cooperation with treatment involving the breakage of braces, failing appointments, not wearing elastics and/or poor oral hygiene can very quickly add many months to treatment time.

Treatment with removable appliances for children who still have some deciduous teeth is usually limited to about nine months. When the appliance has corrected the problem, sometimes a retainer is required to maintain the achieved result. The retainer is a simpler form of a plate with no active components. It may be worn for only a few months at night or when the upper back teeth have been expanded, at nights only until the rest of the permanent teeth have emerged. It must be remembered that for a lot of these early treatments, more major treatment is required when the permanent teeth have emerged. In a small percentage of cases, the early treatment may be all that is required. Back to top


14. What cooperation with treatment is required of me?
When the braces are first fitted, clear instructions are given about how to look after your braces and teeth and gums. Throughout treatment you may be asked to wear elastic bands in a certain manner and over a certain time period. Basically, cooperation involves:

a)   Particular attention to regular and thorough toothbrushing and flossing. Maintain a healthy diet and restrict foods and drinks (e.g. sports drinks) that can cause tooth decay.
b)   The avoidance of hard, sticky and crunchy foods, which are likely to damage the orthodontic appliances.
c)   The wearing of elastic bands as directed.
d)   Daily checking of appliances for breakages which must be reported promptly to the practice. Do not wait until the next appointment. Back to top


15. What happens if I move to another town or go overseas while I still have braces on?
Your treatment can be transferred to another orthodontist, preferably one who uses the same appliances. Your records would be sent and your treatment fee would be assessed using an international formula, adjusting for the amount of treatment carried out and remaining. Back to top


16. Will my teeth straighten up as I grow older?
In general, no they will not. With continuing age, teeth tend to crowd up more and the overbite (vertical overlap of the front teeth) gets worse. In children, the space available for the emerging front teeth barely changes as they grow. The permanent teeth can look untidy as they emerge but may improve as they settle into place if there is room. From the mid-teens onward, teeth tend to be pushed back in the face and tend to crowd up even more. This is not necessarily associated with the development of the wisdom teeth as it even occurs when they are absent or removed.

An exception to this generalisation is an improvement that can be seen with the upper front teeth as the upper permanent canines emerge and line up. As these canines gradually move through the bone they can disturb the alignment of the upper lateral incisors. As the canines erupt through the gum the alignment of the incisors may well improve and if there are small spaces, these may close. Back to top


17. How does orthodontic treatment work?
The movement of teeth is a perfectly natural phenomenon — obviously mainly seen when teeth erupt into the mouth. The teeth achieve a natural position, being affected by forces from their developing roots, the size and shape of the bones of the jaws, the limits of the surrounding gums, the muscles of the tongue, lips and cheeks and from biting forces. “Outside” forces such as persistent thumb sucking can change the positions of the teeth. When all the various forces acting on the teeth are balanced, the teeth stop moving to a large extent but tooth movement certainly continues the teeth stop moving to a large extent but tooth movement certainly continues throughout life. Typically, lower front teeth crowd up in late teenage years even if they have been quite straight earlier and even if wisdom teeth are not present.

Orthodontic forces are usually quite light but are continuous or persistent and therefore the teeth gradually and slowly move according to the direction of the forces, guided by the braces. It must be recognised that when the braces are removed, the forces acting on the teeth include natural muscle forces, very similar to those acting before treatment started. It is very important that orthodontic treatment places the teeth within the comfort zone that was existing before treatment started, or place them in another position that will be stable in the long-term. The elasticity of the gums, continuing growth of the jaws and other factors continue to act on the teeth. Retainers are used to resist post-treatment movement of the teeth but it must be remembered that “all parts of the body change with aging and teeth are no exception. Back to top


18. Can I still play sport with braces on?
Yes, certainly. If you play any sport that would normally require you to wear a mouth guard then having braces is even more of a reason to use a mouth guard. Any sport that might involve a blow to the lips or teeth is an indication that a mouth guard should be worn. If you have a removable appliance, it should be removed for swimming (in case it is lost in the pool or the sea) and contact sports. The appliance should be kept in a mouth guard container. Back to top


19. Can I still play a musical instrument with braces?
Yes, although you will have to adjust to them at the start. Wax can be used to pad-out the braces on the front teeth and smooth the contours. Back to top


20. Do I need to see my General Dentist during orthodontic treatment?
It is essential that the dental examinations every six months are continued by your dentist throughout treatment. You should have a full dental check-up before braces are fitted and, particularly for adults, your gums should be checked by your dentist or possibly a specialist periodontist prior to and regularly during orthodontic treatment. Back to top


21. When my wisdom teeth erupt will they make my teeth go crooked again?
Scientific studies have shown that lower front teeth typically become more irregular, to a greater or lesser extent, in late teenage years. This occurs at about the same time that the wisdom teeth are erupting and it was thought that the irregularity was caused by this eruption. However, it has been shown that the irregularity of the lower front teeth occurs even in those people who do not develop lower wisdom teeth or who have had them removed much earlier. This potential for “late crowding” is why orthodontists strongly recommend that the lower front teeth are kept straight by the long-term use of a flexi-wire. The removal of the wisdom teeth is for general dental reasons relating to partial eruption or poor eruptive angles that could lead to future problems. Back to top


22. Is jaw joint pain caused by crooked teeth?
Jaw joint pain can be a complicated problem with several factors involved. While a patient with crooked teeth and jaw joint problems may achieve some relief when the teeth are eventually straightened, no orthodontist would guarantee this improvement from just orthodontic treatment. Many people with very crooked teeth have no jaw joint problems while people with perfect teeth can still have jaw joint problems.

Depending upon the extent of the problem, particularly when pain is involved, we would refer you to a specialist for an in-depth assessment. The pain can be due to a disease of the joint surfaces or it may have its origin in other parts of the head and neck. Stress and certain jaw movements particularly if habitual, can be important factors.

If you start to experience pain or clicking of your jaw joints during orthodontic treatment, it is very important that you report this to us promptly. Back to top


23. Does thumb-sucking damage the teeth?
Thumb-sucking is a natural response that can begin in babies as early as in utero. This is a normal part of the development of your child.

Often, thumb- or finger-sucking will not obviously alter the teeth. However, the teeth will move if the habit is persistent enough, strong enough and lasts for a long time (several years).

In particular, if the habit is persistent and lasts beyond the age of 5-6 years (when the permanent front teeth are emerging), orthodontic problems can develop. Typically, these are protruding upper front teeth (sometimes with the lower front teeth pushed back as well), an anterior openbite (a vertical gap between the upper and lower front teeth when biting together) and a posterior crossbite (the upper back teeth biting towards the inside of the lowers, instead of the other way round).

These features can alter chewing, swallowing and can even cause a lisp.

Usually, the habit gradually dies out, particularly when the child first goes to school. There are several methods of persuasion applicable at this age (see the link below) but the problem should not become a major issue causing distress for the child and family. If the child wishes to stop but finds the habit too difficult to break, there are orthodontic appliances of varying complexity that can assist. Sometimes just a visit to the orthodontist to assess the extent of the problem and explain the effects of the habit on the teeth can be enough. A very simple orthodontic plate which has acrylic covering the roof of the mouth is effective in helping the child to stop in a high proportion of cases.

More complex appliances are available but it is very important that the child does actually wish to stop the habit. A “thumb-crib” appliance can be cemented on the upper molars, which support a smooth wire grid, behind the upper front teeth to act as a physical barrier to the thumb and to act as a reminder to the child to take the thumb out of their mouth. The advantage of this appliance is that it is “glued” in place and cannot be removed by the patient.

Cessation of the habit may allow the teeth to naturally return to a satisfactory position that requires no further intervention. Some features resulting from the habit may require more treatment but it will be important that the habit has ceased fully before treatment can start as it may otherwise be wasted. Back to top
24. Are Fast Braces as good as traditional braces?
Following treatment with braces, the reality is that in most cases, the teeth will not stay perfectly straight unless they are retained forever. With Fast Braces, the stability is much worse. The hype about Fast Braces varies from over-inflated to out-right false. There is nothing new, better, revolutionary or extra fast about Fast Braces compared to the braces that orthodontists have been using for years now.

Fast Braces are simply short, incomplete treatments that don’t address some of the major issues that actually need orthodontic treatment. Fast Braces only do what orthodontists call “Initial Alignment”. This is just lining the teeth up in the first six months of treatment so that the much more major work of correcting the bite can be carried out in a controlled manner over the next twelve to eighteen months. The really hard part is getting the teeth to fit together in the correct position within the face, the jaws and the gums and making sure they work together correctly. But Fast Braces ignore all these important stages and only do the first six months and then remove the braces.  And hope.

Fast Braces are promoted by dentists who don’t have the orthodontists’ treatment aims of achieving a safe, good looking and long-term stable fit of the bite. You will note that no orthodontists in New Zealand use Fast Braces – perhaps the orthodontists know something that the dentists don’t?

There have been many advances in orthodontic technology in recent years. These include ‘self-ligating’ and ceramic brackets (attachments), ultra-flexible wires, scanning devices, digital X-Rays and photography and many more. However, biology has not changed. The biological principles of why teeth are in their positions, how teeth move in the bone, how and why they stay or move after braces are removed are the same as they’ve always been.

As for long term results of Fast Braces, they are no different from any other type of braces – poor or inappropriate treatment as above will be unstable and prone to relapse, and may cause gum and bite problems in the future.

It is a fact that we live in a much more ‘market-driven’ era. This has many benefits to us all but it is also accompanied by an upswing in ‘snake-oil’ sales people and ‘Buyer Beware’ applies very strongly.

If you are going to have orthodontic treatment, do it properly from the outset – see a registered specialist orthodontist. Only orthodontists have the specialist qualifications to practice orthodontics. Back to top
25. At what age is it recommended for children to get braces to straighten teeth?
Most children who have an orthodontic problem or will have in the future, should only be treated at the time the baby teeth have been lost and the permanent teeth (apart from wisdom teeth) are growing through. The usual age range for this is 12-14 years although there is great variability. However, there are a few orthodontic conditions that should be treated early, such as crossbites of the front or side teeth, teeth erupting incorrectly, extra teeth, a marked protrusion that is causing social problems (or, more rarely, has resulted in damage to the front teeth) and some other issues. Some dentists carry out extensive treatment for children (even as young as 5 or 6 years) who still have plenty of deciduous teeth. Removable plates are used, often for years, with expansive (and expensive) claims of the benefits of this early treatment. The scientific facts are different.

The evidence is that (apart from the few exceptions above) for most orthodontic patients, early treatment does NOT produce a more favourable skeletal (jaw) change, it does NOT eliminate the need for treatment at a later date, NOR does it reduce the need for extraction of permanent teeth. Early treatment neither leads to a better occlusal (bite) result, nor reduces the complexity of later treatment.  As a matter of fact, many early orthodontic treatments lead to a less favourable outcome because of patient (and parent) ‘burnout’. By the time patients have reached the stage of dental development \when they’re ready for the main treatment, they’ve all lost interest and had enough time already wearing orthodontic devices – and paying the bills!

For these reasons, orthodontists avoid inflicting early treatment on youngsters if possible, leaving the treatment until teenage years when the teeth and bite are fully developed and can be fixed in one straight-forward treatment. Again, only orthodontists have the specialist training to practise orthodontics. Back to top
26. Don't all dentists learn orthodontics at Dental School?
Yes, they do.  But it is not enough for them to diagnose and carry out the full and wide-ranging treatments that specialist orthodontists are trained to do.

The Heads of the Orthodontic Departments of all dental schools in Australia and New Zealand have stated that:
“The foundation knowledge gained in a general dental training program does not provide competency in comprehensive orthodontic diagnosis, planning or treatment.”

  “The postgraduate course in orthodontics prepares the specialist to firstly recognise malocclusion traits, develop a comprehensive diagnosis and evidence-based treatment plan based on the patient’s specific concerns and problems. Not all patients respond similarly to the mechanotherapy because of differences in physiology and growth patterns. The specialist is trained to recognise the individual responses to treatment procedures and is trained to modify the treatment plan in a timely fashion when required.” 

“This cannot be achieved in the undergraduate program or by distance education in the general practice environment.”*
The message from the Dental Schools (which train all the dentists so they really know) is very clear: 


See a specialist orthodontist. Why risk seeing someone who is not a specialist and not adequately trained to look after your child’s - or your - teeth and jaws.
 
*See the full statement at:
www.aso.org.au


 Back to top