Asked Questions about Orthodontics
When would one need orthodontic treatment?
Teeth are important for chewing food properly, for good appearance and
for proper speech. If any one or more of these functions of teeth are
adversely affected due to irregular teeth and/or jaws, one would need
When teeth of the upper and the lower jaws do not meet properly with each
other grinding of food properly is impaired. This may cause indigestion
and related health problems.
When teeth are projecting out, lips are not closing normally, or teeth
are crowded and are spoiling the smile, one needs orthodontic treatment
for aesthetic reasons.
One may need orthodontic treatment to correct discrepancies in jaw size
and/or positions, which affect the facial appearance adversely. When the
jaws and/or teeth do not meet properly with each other, excessive forces
may be transmitted to some teeth leading to wearing out of the enamel
of the teeth. Excessive forces may also cause damage to the tooth supporting
structures like the gums and surrounding bone. This can cause weakening
and early loss of these teeth.
Irregular teeth can also cause difficulty in brushing thereby leading
to cavities and gum problems which may shorten the life of the affected
In rare cases irregularities like spacing in the front teeth can cause
speech problems and orthodontic treatment can improve the speech as well.
How important is orthodontic treatment?
In today's world good appearance and a good smile go a long way in making
a person feel confident and comfortable with one's self.
People with good looks and a pleasant smile are perceived well by others
and are treated favourably by them.
Good-looking children are subconsciously liked more by parents, teachers
and other adults.
Good-looking adults are more likely to get good jobs, more friends and
better life partners.
So, the value of orthodontic treatment cannot be overemphasized. It is
a question of a child's or an adult's future physical and psychological
When should a child go for an orthodontic consultation?
It is recommended that the first check up by an orthodontist should be
done by 6 years of age. If a dental or jaw problem is developing it can
be corrected as the child grows. If the teeth and the jaws are developing
normally then a regular check up should be done every six months to monitor
In case the lower jaw is growing excessively, it must be corrected at
the earliest because this condition becomes more difficult to treat as
the child grows. Some conditions can be treated later. Certain teeth irregularities
can be corrected earlier thereby preventing them from becoming more severe
and would need less time to treat later.
Up to what age can an adult be treated for orthodontic problems?
There is no upper age limit for treating an adult. Persons in their 40's
and 50's and even 60's can also be treated for orthodontic problems. The
deciding factors would be the condition of the teeth and the supporting
structures like gums and bone.
How much time is required for orthodontic treatment?
The duration of orthodontic treatment varies according to the condition
of the teeth and jaws at the beginning. On an average, treatment with
the fixed braces takes about 1 to 2 years in cases where all the permanent
teeth have erupted and there is minimal jaw discrepancy. The treatment
time has reduced now with the use of "Friction-Free Ties" developed by
us. We are able to complete treatment in a few months in some cases.
In growing children where jaw discrepancies have to be corrected it may
take 3 to 4 years. The treatment may be split into two phases. Jaw correction
is done in the first phase with one of the various growth modification
appliances at the orthodontist's disposal. In the second phase, fixed
braces are given to set the teeth in their proper positions.
How much would orthodontic treatment cost?
orthodontic problems need different treatment modalities and different
duration of treatment time. So the fees are decided according to the condition
to be treated. The treatment fees differ from patient to patient as their
conditions differ. The fees may vary from Rs.10,000/- for minor corrections
to Rs.50,000/- or more for the correction of severe irregularities. The
fees for treatment with clear and invisible braces may be between Rs.50,000/-
Is orthodontic treatment not very expensive?
It is a relative term. Orthodontic treatment costs so much because the
treatment goes on for a long duration. There are certain expenses incurred
to maintain a high level of sterilization of equipment and asepsis of
the clinic. The appliances used are expensive. Thus some amount is spent
for the patient himself/herself.
The fees are professional charges for the knowledge, experience and skill
of the orthodontist. Considering the long term, positive, physical and
psychological benefits of orthodontic treatment whatever spent on orthodontic
treatment should be considered as a sound investment.
What is the procedure followed for starting orthodontic treatment in your
In the first consultation the patient is examined and the condition of
the teeth, jaws, face and the function is assessed. History is taken to
know the patient's health condition. Then the patient and the parents
are explained about the treatment procedures with the help of computer
animations, photographs of treated cases, models etc. The patient is then
sent for special x-rays needed for diagnosis and treatment planning.
In the next appointment impressions are taken and the x-rays are collected
to study them.
The final treatment plan, expected duration of treatment, and fees etc.
are discussed in the next appointment. If the patient and parents are
agreeable for the treatment then appointments are fixed for starting the
When are permanent teeth extracted for orthodontic treatment?
One or more permanent teeth may have to be extracted in some cases to
create spaces in the upper and/or the lower arches. Extractions of permanent
teeth are not necessary in all the cases.
When the jaw and teeth sizes are normal the teeth can be set in their
proper positions without extractions.
When the jaws are small and the teeth are large the teeth get crowded
or proclined or both. In such cases extracting teeth creates the necessary
spaces to move the remaining teeth in the extraction spaces. This helps
in aligning and retracting teeth to more aesthetic positions.
When the jaws are large and teeth small, the teeth get spaced out. These
teeth can be aligned and spaces can be closed by orthodontic treatment
without any extractions.
Which permanent teeth are removed for orthodontic treatment?
The decision to extract or not to extract teeth and which teeth to extract
depends on a number of factors like the severity of the malocclusion,
amount of space required, the area of crowding, presence of any decayed
tooth/teeth or missing tooth/teeth, presence or absence of milk teeth,
jaw discrepancies, presence of impacted teeth, presence of extra (supernumerary)
teeth, amount of changes required in the facial appearance etc.
The orthodontist studies all the factors and charts out alternate treatment
plans and decides on the most favourable treatment plan and then decides
about extractions. Usually the first premolars are extracted but depending
on the case requirements second premolars, second molars, upper or lower
incisors and sometimes even canines may be extracted. The idea is to get
the best possible result aesthetically and functionally with a long-term
stability of the result.
Are extractions painful?
Extraction of teeth is not painful as the teeth are removed under local
anesthesia. The healing also is very quick because there is no infection
in the teeth and the jaws.
Does extracting teeth cause damage to the eyes or other parts of the body?
There is no evidence in scientific literature that extracting teeth weakens
or damages eyes or any other parts of the body.
In almost 6/7 out of 10 orthodontic cases teeth have to be extracted.
If there actually was any damage to any part of the body it would be known
and nobody would take orthodontic treatment.
Is orthodontic treatment very painful?
No. With better understanding of physiology of tooth movement and latest
Technology, pain during orthodontic treatment is kept to the minimum.
Initially when an appliance is given there is pressure on the teeth that
can cause some discomfort and pain. This can be minimized by timely medication
as prescribed by the orthodontist. There is NO constant pain or discomfort
during the entire duration of orthodontic treatment. When the appliance
is activated to exert pressure on the teeth the patient may experience
pain for a couple of days. This subsides on its own and is usually bearable.
If it is more, then the prescribed medicine can be taken to relieve the
What are the different kinds of appliances used for orthodontic treatment?
Depending on the condition of the patient the appliance or appliances
are selected. When there is a need for modifying growth one of the growth
modification appliances is given. This may be removable i.e. it can be
removed by the patient or fixed.
When the lower jaw is deficient or placed behind in relation to the upper
jaw either a bionator, activator, twin block may be given.
When the lower jaw is more prominent or growing excessively a chin cap
may be used.
Foe a deficient upper jaw a reverse pull head gear may be used. In case
of an excessively growing upper jaw a high pull, cervical pull or a combi
pull headgear may be given to the patient.
For setting the teeth properly usually fixed appliances are used which
are commonly known as "braces". These comprise of brackets, bands, tubes,
arch wires, elastics, power chains, pins, ligature wires, elastic modules
Usually the brackets used are of metal but aesthetic tooth-coloured (or
clear) brackets are also available which are not very visible in the mouth.
Certain conditions like cross bites, mild to moderate spacing can be treated
with removable appliances. Fixed appliances provide total control over
tooth movements so they are routinely used. Removable plates have a limited
use. Lingual or invisible braces are becoming more popular as more adults
are seeking orthodontic corrections to improve their smiles.
What care should be taken during orthodontic treatment?
Since the brackets of fixed appliance are glued to the teeth they can
get detached if anything hard hits them. So one has to avoid eating hard
things like toast, "chikki", "chakli", cookies, banana chips, corn cab
and such hard things. One must also avoid eating sticky things like "eclairs".
If the brackets keep coming out, wires keep breaking due to negligence
on the part of the patient the treatment takes longer time and the desired
result may not be achieved.
There are more chances of food collection around the brackets and under
the wires. This can cause cavities, bleeding gums and bad breath. It can
also cause permanent discoloration of teeth that would spoil the smile.
One must brush teeth with toothpaste after every meal to keep the teeth
clean and to avoid problems mentioned earlier.
What should one do if a part of the braces hurts?
If there is any sharp, projecting part of braces, cover it with orthodontic
relief wax or wet cotton pellet.
Call the doctors at the earliest and it would be taken care of at the
earliest. In case of pain, medication is prescribed to relieve it.
How stable are the treatment results?
The orthodontic treatment is planned and executed keeping optimal results
and long term stability of the results in mind.
Once the appliances are removed or discontinued retainers are given to
keep the teeth in their new positions.
Normally some settlement of teeth takes place in a few months. In some
cases long term retention is recommended to prevent teeth from relapse.
What are retainers?
Retainers are plates or wires given to prevent teeth from moving after
the orthodontic treatment is completed. The teeth have a tendency to shift
from their new positions as the bone supporting them is softer when the
braces are removed. Even after the bone gets back to normal there are
a number of forces acting on the teeth. A retainer supports the teeth
and keeps them in their desired positions.
There are two types of retainers, removable and fixed.
Removable retainers are plated which can be removed by the patient. They
have to be worn all the time except while brushing and eating. The duration
of wear of removable plates is gradually reduced over a period of time
after first six months of full time wear.
The fixed retainers are thin wires glued to the teeth on the inner surfaces
so that they are not visible at all. These can be kept in the mouth as
long as necessary.
How long does one need retainers?
The recent studies in the orthodontic literature suggest that it is better
to keep retainers for a long time. It is not possible to predict whose
teeth are likely to move after the retainers are discontinued. The orthodontist
would decide about the duration of the retainers for an individual based
on her/his condition of teeth and jaw structures.
Usually the retainers are worn at least for six months and are gradually
weaned off. In some cases longer retention may be necessary for the long
term stability of the results.
What is the role of the patient in successful outcome of the treatment?
The success or failure of orthodontic treatment very much depends upon
the patient's motivation and cooperation.
Once the appliance is given to the patient it is her/his responsibility
to take care of it and to follow the instructions given by the doctors.
If the patient does not take care and does not follow the instructions
the treatment result cannot be what is desired and planned for.
Can aesthetic treatment substitute for orthodontic treatment?
With orthodontic treatment one can shift the position of teeth in the
jawbones. The teeth can be moved from one place to another along with
their roots that are in the jawbones. This helps in taking protruded teeth
inside, aligning or straightening irregular teeth, opening or closing
the bite etc. Once the teeth are set correctly in the jaws they look better
and function better for a long time.
Cosmetic or aesthetic dentistry is a recently developed branch of dentistry
that deals with the shape, size and the colour of the teeth. It may be
useful in minor corrections of irregular teeth but it cannot substitute
for orthodontic treatment. And it does not give a long-term solution for
The aesthetic procedures may have to be repeated periodically. Some times
these procedures may be harmful to the teeth and gums.
In some cases, both orthodontic treatment and aesthetic procedures combined
would give the best possible results.
are Clear Ceramic Braces
braces are an aesthetic alternative for those who don't want their
braces to show as much. Clear braces move your teeth in exactly
the same way as metal braces do. Like metal braces, they are extremely
comfortable to wear and very efficient at moving teeth
consist of wires and clear, ceramic brackets. These brackets are
glued to the front of your teeth. The wires (one for each set of
teeth) are attached to the brackets with transparent, tiny elastics
called ligatures. Ceramic braces function just like traditional
braces: the wire is shaped into the ideal position of your teeth,
then threaded through the brackets. As the wires struggle to get
back to their original shape, they gradually pressure your teeth
into that shape as well. Your orthodontist will tighten the wires
every four to six weeks. You should see a nice, straight smile within
two or two and a half years (though this time period can be shorter
or longer, depending on the severity of your problem). Once your
braces come off, you will likely wear a retainer for six months
to a year, to keep your teeth from shifting and make sure your new
smile stays in place.
Braces can be
unpleasant at times. Initially, the brackets can irritate the back
of the lips (though you will get used to this being there within
a few days). They require special brushing and flossing techniques,
as food can collect around the brackets, causing bacteria buildup
and bad breath. They can also hurt at times, especially immediately
after wire-tightening visits to the orthodontist. This hurt, too,
will go away in a day or two. Keep an eye out for the many, many
people in the media and on the street who have worn braces—their
straight, beautiful, hard-earned smiles should motivate you to stick
to your treatment.
Is it required that my family dentist schedule my appointment with the
No, it is not. Many of our patients are referred by their family dentist,
yet many other patients take the initiative to schedule an examination
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2. At what age should I schedule an appointment for
an orthodontic screening?
The American Association of Orthodontists recommends an orthodontic
screening at age 7. By this age, several permanent teeth in most children
have erupted, allowing us to effectively evaluate your orthodontic condition.
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3. Will my teeth straighten out as they grow?
No, they will not. The space available for the front teeth does not
increase as you grow. In most people, after the permanent molars erupt,
the space available for the front teeth decreases with age.
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4. How do I schedule an appointment for an initial
If you or your child can potentially benefit from orthodontic treatment,
simply call our office.
We will be happy to schedule an appointment for you. When you call to
schedule your appointment, our front office staff will request some basic
information from you.
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5. What will happen at the initial examination appointment?
Upon arriving, each patient and parent will be seen by the staff and
doctor who will acclimate you to our office.
The doctor will then complete a brief, but thorough, exam.
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6. What will I learn from the initial examination?
There are five essential questions that we will cover during the
· Is there an orthodontic problem, and if so, what is it?
· What must be done to correct the problem?
· Will any teeth need to be removed?
· How long will the treatment take to complete?
· How much will the treatment cost?
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7. Will I need to have teeth extracted for braces?
Removing teeth is sometimes required to achieve the best orthodontic
result. Straight teeth and a balanced facial profile are the goal of orthodontics.
However, because new technology has provided advanced orthodontic procedures,
removing teeth is not always necessary for orthodontic treatment.
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8. How long will it take to complete treatment?
Treatment time obviously depends on each patient's specific orthodontic
problem. In general, treatment times range from 12 to 30 months. The "average"
time frame a person is in braces is approximately 22 months.
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10. How often will I have appointments?
Appointments are scheduled according to each patient's needs. Most
patients in braces will be seen every 4-6 weeks. If there are specific
situations that require more frequent monitoring, we will schedule appointments
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14. Can I return to school the day I receive my braces?
Yes. There is no reason to miss school because of an orthodontic
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15. Do you give shots?
No. Shots are not necessary in orthodontic treatment.
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16. Do you use recycled braces?
Absolutely not! It is our belief that each patient should be provided
with their own braces to achieve the best orthodontic result possible.
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17. Can I still play sports?
Yes. We recommend a mouth guard for all sports.
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18. Do I need to see my family dentist while in braces?
Yes! Regular checkups with your family dentist are important while
in braces. Your family dentist will determine the intervals between cleaning
appointments while you are in braces. We recommend 3-4 months.
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19. Are there foods I cannot eat while I have braces?
Yes. Once treatment begins, we will explain the complete instructions
and provide a comprehensive list of foods to avoid. Some of those foods
include: ice, hard candy, raw vegetables and all sticky foods (i.e. caramel
and taffy). You can avoid most emergency appointments to repair broken
or damaged braces by carefully following our instructions.
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20. How often should I brush my teeth while in braces?
Patients should brush their teeth at least four times each day - after
each meal and before going to bed. We will show each patient how to floss
their teeth with braces and may also provide a prescription for a special
fluoride, if necessary.
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22. Can orthodontic correction occur while a child
has baby teeth?
Yes. Some orthodontic problems are significant enough to require early
intervention. However, if a patient is not yet ready for treatment, we
will follow that patient's growth and development until the time is right
for treatment to begin.
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23. What is Phase One (early) Treatment?
Phase One treatment, if necessary, is usually initiated on children
between the ages of 7 and 10. Phase One treatment lasts about 12-21 months.
The primary objective for Phase One treatment is to address significant
problems to prevent them from becoming more severe and to improve self-esteem
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24. Will my child need full braces if he/she has
Phase One treatment?
It is best to assume that your child will need full braces even after
Phase One treatment. The period following Phase One treatment is called
the "resting period," during which growth and tooth eruption
are closely monitored. Throughout this period, parents and patients will
be kept informed of future treatment recommendations.
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25. Will my child need an expander?
At the completion of the initial examination, we will determine whether
a patient will need an expander.
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26. Is it too late to have braces if I am already
A surprising percentage of our patients are adults. In fact, 25 percent
of all orthodontic patients are adults. Health, happiness and self-esteem
are vitally important to adults. No patient is "too old" to
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27. Can I wear braces even though I have crowns and
Yes. A tooth with a crown will move just like a tooth with a simple
filling. When teeth are missing, orthodontic treatment will aid in the
alignment of the remaining teeth.
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28. Why should you choose an orthodontic specialist?
Teeth, and sometimes entire facial structures, are permanently changed
by orthodontic treatment. It is important that the treatment be appropriate
and properly completed. Orthodontic specialists have extensive and specialized
training that enables them to provide their patients with professional,
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should My Child be Evaluated?
your child develops an "open bite", or you are otherwise concerned
about the development of your child's teeth, no matter what the age, contact
us right away for a consult with Dr. Anshu.
Otherwise, children should be evaluated by the age of 6 for orthodontic
treatment. In the past, a child was 11 or 12 before brackets were actually
placed on the teeth to straighten them. This may still hold true in most
cases, but there are new techniques that can correct problems early, while
a child is still growing. This may eliminate the need for braces in the
future, or if the child does still need braces, the treatment will be
less complicated, usually shortening the period of time in braces.
is an Arch Expander?
Arch Expander is one example of orthodontic treatment available for younger
patients. Many times an arch expander can be used to create a proper alignment
of the arches so permanent teeth have room to erupt in a natural position.
The use of an arch expander will generally minimize or eliminate the need
for braces when the patient gets older.
are retainers, bonded brackets, arch wires and elastic bands that move
crowded or spaced teeth into a "normal" position for appearance,
prevention and function. Patients with poorly aligned teeth tend to have
much more tooth decay, gum disease and jaw joint problems. Recently invented
brackets and new techniques make orthodontic treatment faster and more
comfortable than ever.
do Braces work?
a period of time, teeth will shift if constant, gentle pressure is applied.
Brackets are bonded to the front surface of each tooth and wires are attached
to the brackets with elastic bands. The slight tension on the wire is
gently transferred to the bracket through the elastic band.
the teeth have been moved into proper position, a retainer is sometimes
used to keep the teeth in place until they have "settled". Retainers
can be fixed (bonded to the teeth) or removable.
Small, thin wire bonded to tongue side of teeth Adjustable retainer: Snaps
into place. Easily adjusted.
Covers teeth. Virtually invisible when in place.
Small, thin wire bonded to tongue side of teeth
retainer: Snaps into place.Easily adjusted.
retainer: Covers teeth. Virtually invisible when in place.
I have orthodontic treatment?
Many people have crowded or crooked teeth. Orthodontic treatment
will straighten the teeth or move them into a better position. This can
not only improve their appearance but also the way the teeth bite together,
while also making them easier to clean.
In some patients the
upper front teeth can stick out and look unsightly. These ‘prominent’
teeth are more likely to be damaged, but orthodontic treatment can move
them back into line. In others, the way the upper and lower jaws meet
can cause teeth to look unsightly and lead to an incorrect bite. Orthodontic
treatment may be able to correct both.
When the teeth don’t
meet correctly, this can put strain on the muscles of the jaw, causing
jaw and joint problems and in some cases headaches. Orthodontic treatment
can help you to bite more evenly and reduce the strain.
At what age
should I have orthodontic treatment?
Orthodontic treatment is generally best carried out in children,
but adults can have orthodontic treatment too – and more and more
are doing. Age is less important than having the proper number of teeth.
In children it may be necessary to wait for enough teeth to come through
before starting treatment.
Will I need to have teeth taken out to make room?
You may not have enough room for all your permanent teeth and
so it may be necessary to take out some permanent teeth to make space.
Your dentist will tell you whether this is the case. Sometimes space can
be created using other forms of treatment.
How is treatment carried out?
Orthodontic treatment can be done by many sorts of appliances,
which most people know as ‘braces’.
What is a removable appliance?
Simple treatment may be carried out with a removable appliance
(a plate that can be taken out to be cleaned). It has delicate wires and
springs attached, which move the teeth using gentle pressure.
What is a functional appliance?
It is sometimes possible to change the way the jaws grow, using
orthodontic appliances. These functional appliances use the power of your
jaw muscles and can help with certain types of problem.
What is a fixed appliance?
Often, teeth need to be guided more accurately than they can
be using a removable plate. So fixed appliances are used. These have brackets
and bands temporarily stuck to the teeth. A flexible wire joins all the
brackets and allows the teeth to be moved. It is not possible for the
patient to take the appliance out and so it is called a fixed appliance.
What are the brackets made of?
Fixed braces are not always made of metal. Plastic and ceramic
can be used, especially for adults.
What are elastics?
It may be necessary to attach delicate elastic bands to a fixed
brace to help move the teeth. Your orthodontist will tell you if you need
What happens when the teeth are in the right position?
When treatment is finished the teeth need to be held in position for a
time. This period is called retention, and the appliances that hold the
teeth in place are called retainers.
The retainers hold
newly straightened teeth in position while the surrounding gum and bone
settles. The retainers can be removable or fixed depending on the original
A retainer holds newly straightened teeth in place
How successful will it be?
Success depends on a partnership between the skills of the orthodontist,
and the enthusiasm and help of patient and parents. It is important to
attend regularly and carry out any instructions given by the orthodontist.
The success of the
treatment also depends on the commitment of the patient. For children’s
orthodontic treatment it is very important that the patient is as keen
as the parent.
damage my teeth?
Your teeth can be damaged if they are not properly looked after during
treatment. Appliances will not in themselves cause damage, but poor cleaning
and too many sugary drinks and snacks can cause permanent damage. Brackets,
wires and braces can trap food and cause more plaque than usual to build
up. So the teeth and appliance need to be cleaned very thoroughly.
Is orthodontic work permanent?
Even after retention, it is normal for minor tooth movements to happen
throughout life, so no permanent guarantee can be given. However, it is
unusual for teeth to alter enough to need further treatment.
How do I care for my brace and teeth?
It is important to continue to have your teeth checked by your dentist
while having orthodontic treatment. You also need to take extra care of
your teeth and mouth:
1 Clean your teeth
carefully every day, including between your teeth where you can. Appliances
are delicate and you need to make sure you clean them carefully so that
they do not break. Your dentist or hygienist will be able to show you
the special techniques to use depending on the appliance you are wearing.
2 Cut down on how
often you have sugary foods and drinks. Avoid ‘snacking’ on
foods or drinks containing sugars, and on fizzy drinks. Also, sticky and
hard foods may damage the delicate orthodontic appliances.
3 Brush your teeth twice a day with fluoride toothpaste and, if necessary,
use a mouthwash. Your dentist or hygienist may recommend a fluoride toothpaste
or application for you to use.