Orthodontics

Orthodontics Services

Philip Friel Advanced Dentistry provide a orthodontics service to patients throughout Glasgow, Edinburgh and Cental Scotland.

Orthodontics, the branch of dentistry concerned with the growth of the teeth, jaws and face, is in high demand.

According to the British Orthodontic Society (www.bos.org.uk) almost one million people in the UK started having orthodontics in 2011 and more adults than ever before want treatment.

Why? Orthodontic treatment is about making the best of your teeth; it's about improving the harmony of your mouth and jaws. Once you can bite together correctly, you can eat more comfortably and care for your teeth and gums more easily. And your smile will benefit immensely!

Our clinic has two specialist orhtodontists in our team - Andrew McGregor and Imran Shafi.

With the help of the British Orthodontic Society, one of our clinic's specialist orthodontists Andrew McGregor (UK qualified - see Our Team for more details - and General Dental Council registered: 80505) presents some key information which can help patients make informed choices about the topic.

To achieve the status of specialist Andrew undertook six years of full time post graduate training and was required to pass professional examinations.

Like most orthodontic specialists, he treats only orthodontic patients and is therefore best placed to give optimal care and treatment.

Here are some of the most common reasons for and benefits from seeking orthodontic treatment:

  • Protruding upper front teeth – one of the most common dental problems
  • Crowding – a narrow jaw may mean there is not enough room for your teeth, resulting in crowding. Conversely, some patients have significant gaps between their teeth.
  • Asymmetry – particularly when the centre lines of the upper and lower front teeth do not match, perhaps because the teeth have drifted or the position of the jaw has shifted.
  • A deep bite – when your upper teeth cover the lower teeth too much
  • A reverse bite – when your upper teeth bite inside the lower teeth
  • An open bite – when your front teeth remain apart when your back teeth meet; the tongue is often still visible between the upper and lower front teeth.
  • Impacted teeth – in some patients, secondary teeth come through in the wrong position or do not erupt at all. Orthodontic treatment can help bring these teeth into the correct position.
  • Reducing the likelihood of damage to prominent teeth
  • Enhancing facial aesthetics
  • Accommodating impacted, unerupted or displaced teeth
  • Preparation for advanced dental treatment, such as crowns, bridges or dental implants
  • Reversing the drifting of the teeth in older patients who have suffered from advanced gum disease

Let’s now look into the treatment and how our clinic will look after our patients.

Every patient needs tailor-made treatment, planned by the orthodontist and agreed with you, the patient.

In order to decide what treatment is required for you, we will need to carry out a full assessment of your face and teeth which is likely to include x-rays, impressions (moulds of the teeth) and photographs.

Treatment can take 6-24 months so it is important you are happy from the outset with what is recommended.

Let’s look now at the types of brace which may be recommended.

A fixed brace – this is the most common type of brace today. Brackets are glued onto the teeth and linked by wires. The wires exert gentle pressure to move the teeth into a new position. The brackets can be metal or ceramic (tooth coloured). We use state of the art Innovation self-ligating brackets as standard.

A removable brace – this is sometimes used for correcting a simple problem, such as moving a single tooth or expanding the dental arch.

It has a plastic baseplate with wires and springs attached. Removable braces need to be worn all the time except for cleaning or sport.

Functional appliances – these are used to harness the growth of the jaws and improve way the upper and lower teeth meet. There are several designs all of which fit on to both the upper and lower teeth and hold the lower jaw forward. They are mostly removable but should be worn as near to full-time as possible

Aligners – Aligners are thin clear flexible plastic ‘mouthguards’ which fit closely over the teeth. A series of these appliances is used to obtain incremental changes to correct the teeth according to a treatment plan developed by the orthodontist.

Because they are unobtrusive, aligner appliances are ideally suited to adult patients whose life-style or work commitments make it difficult for them to wear conventional appliances.

A proper orthodontic assessment, diagnosis and treatment plan is essential to successful aligner treatment, as with any other form of orthodontics.

Aligners need to be worn full-time, day and night except for meal times. Aligner treatments tend to take longer than conventional braces to achieve the same effect. It is important to seek an opinion from an orthodontic specialist who will be able to give authoritative advice on the options.

Lingual Appliances – Lingual braces are cemented on the inside of the teeth, next to the tongue and therefore cannot be seen. We use two lingual systems; one for minor tooth correction which works in around six months and one for moderate to severe problems which takes 12-24 months.

An example of a lingual appliance fixed behind the upper teeth

The advantages over aligners are that you are not required to take them in and out for eating, cleaning etc and they give the orthodontist more control over tooth movement which leads often to a better, faster result.

Retainers – at the end of treatment, all patients should wear retainers to hold their teeth in the new position. These can be removable or fixed and are an important part of treatment.

Orthodontic Risks & Benefits
While patients are right in recognising the functional and aesthetic benefits of healthy teeth and a pleasing smile, you should also be aware that orthodontic treatment can present limitations and potential risks.

These are seldom enough, however, to avoid treatment, but should be considered in making the decision to undergo orthodontic treatment.

Orthodontic treatment usually proceeds as planned; however, response to treatment and results cannot be guaranteed as each patient is individual.

BENEFITS
Orthodontics plays an important role in improving overall oral health and the treatment helps create balance and harmony between the teeth and face for a beautiful, healthy smile.

Correctly aligned teeth are easier to brush, and thereby may decrease the tendency to decay, or to develop diseases of the gum and supporting bone.

Because of the individual conditions present and the limitations of treatment imposed by nature, each specific benefit may not be attainable for every patient. The unknown factor in any orthodontic correction is the treatment response and cooperation of the patient during orthodontic treatment.

RISKS
All forms of medical and dental treatment, including orthodontics, have some risks and limitations. Fortunately, in orthodontics complications are infrequent and when they do occur they are usually of minor consequence. Nevertheless, they should be considered when making the decision to undergo orthodontic treatment. The major risks involved in orthodontic treatment may include, but are not limited to:

DECALCIFICATION: (Permanent enamel markings) Tooth decay, gum disease, and permanent markings (decalcification) on the teeth can occur if orthodontic patients consume foods or drinks containing excessive sugar and/or acid (eg, sweets, fizzy drinks, diluting juice, etc). This tooth scarring also occurs if patients do not brush their teeth frequently and properly. These same problems can occur without orthodontic treatment, but the risk is greater to an individual wearing braces.

ROOT SHORTENING: In some patients the length of the roots may be shortened during orthodontic treatment. Some patients are prone to this happening, some are not. Usually this does not have significant consequences, but on occasion it may become a threat to the longevity of the teeth involved. Previous trauma to teeth, nail biting or even pen chewing may exacerbate root shortening.

GOOD ORAL HYGIENE: Periodontal health (health of the bone and gums which support the teeth) may be affected by orthodontic tooth movement if there is already a pre-existing condition, but also may occur in some rare cases where a condition does not appear to exist. In general, orthodontic treatment lessens the possibility of tooth loss or gum infection due to misalignment of the teeth or jaws. Periodontal disease (inflammation of the gums and loss of supporting bone) can occur if plaque is not removed daily with good oral hygiene.

RELAPSE TENDENCY: Teeth may have a tendency to change their positions after orthodontic treatment. This usually is only a minor change and faithful wearing of retainers as instructed should help reduce this tendency. Throughout life the bite can change adversely from various causes, such as: eruption of wisdom teeth, growth and/or maturational changes, mouth breathing, playing of musical instruments and other oral habits, all of which may be out of the control of the orthodontist.

JAW JOINT PROBLEMS: Occasionally problems may occur in the patient's jaw joints, i.e. temporomandibular joints (TMJ), causing joint pain, headaches or ear problems. These problems may occur with or without orthodontic treatment and may worsen, improve, or stay the same during orthodontic treatment.

LOSS OF TOOTH VITALITY: Sometimes a tooth may have been traumatized by a previous accident or a tooth may have large fillings, which can cause damage to the nerve of the tooth. Orthodontic tooth movement may in some cases aggravate this condition and in rare instances may lead to loss of vitality and possible root canal treatment.

POST-ADJUSTMENT PAIN: After adjustment of your brace, tenderness should be expected, and the period of tenderness or sensitivity varies with each patient and the procedure performed. Typical post-adjustment tenderness may last 24 to 48 hours. Please inform the clinic of any unusual symptoms, broken or loose appliances, as soon as they are noted. We can then tackle these issues as soon as possible.

UNFAVOURABLE GROWTH: Atypical formation of teeth, or insufficient or abnormal changes in the growth of the jaws may limit our ability to achieve the desired result. If growth becomes disproportionate during or after treatment the bite may change, requiring additional treatments or, in some cases, surgery. Growth disharmony and unusual tooth formations are biological processes beyond the orthodontist’s control. Growth changes that occur after orthodontic treatment may alter the quality of treatment results.

TREATMENT TlME: The total time required to complete treatment may exceed the original estimate. Excessive or deficient bone growth, poor cooperation in wearing the appliance(s) the required hours per day, poor oral hygiene, broken appliances and missed appointments can lengthen the treatment time and affect the quality of the end results.

ADJUNCTIVE DENTAL CARE: Due to the wide variation in the size and shape of teeth, achievement of the most ideal result (for example, complete closure of excessive space) may require restorative dental treatment (in addition to orthodontic care). The most common types of treatment are cosmetic bonding (white fillings as “build ups”), crown and bridge restorative dental care and/or periodontal therapy.

PERFECTION IS THE GOAL: In dealing with human beings and problems of growth and development, genetics and patient cooperation, achieving perfection is not always possible. Orthodontics is an art, not an exact science; therefore, a functionally and aesthetically adequate result, not 100% perfection, must be acceptable. Your comments in regard to your expectations prior to, during and after orthodontic treatment will help us understand your concerns.

We ask that all our patients should please keep us regularly informed of your feelings, concerns and results that do not meet expectations.
Use and Care of Your Retainer

These are instructions about the use and care of your retainers that you will have fitted at the end of your course of orthodontic treatment.

Please read this carefully and if there is anything that you are unsure about, please ask, we are here to help you.

Your braces have moved your teeth into their straightened position by slowly moving them through the bone of your jaws. It will now take many months for the bone to remodel to this new position and during this time it is important to stop the teeth moving back towards their original position.

Your retainers are designed to hold your teeth in their straightened position and must be worn at night times only. If you do not wear your retainers your teeth will move.

When your retainers are not being worn you must keep them in a rigid box to prevent them from being damaged.

Your retainers should be cleaned carefully with a toothbrush and soaked in a special cleaner such as 'Retainer Brite'. They should NOT be placed in hot water or disinfectant, nor cleaned with toothpaste.

Your retainers MUST be checked by your orthodontist. It is important that you bring your retainers to all appointments.

If you lose or damage your retainers, you must contact the Practice immediately (during normal working hours). You will be charged for replacements.

Your orthodontic treatment has taken a considerable amount of both your and their time and it is your responsibility to wear and take care of your retainers.

Fixed Orthodontic Appliances
These are general guidelines for patients being treated with fixed orthodontic appliances.
If you have any queries please ask, we are here to help you.

Fixed appliances consist of metal or ceramic brackets glued to the front or back of teeth. These components are connected by a horseshoe-shaped archwire. The brackets and bands are not removed until the end of treatment, however, certain components of the appliance (such as the archwire) may be changed during treatment.

You may experience a small amount of discomfort when the appliance is first fitted and after each adjustment appointment. This will normally settle after a few days, but mild pain killers such as paracetamol may be helpful.

The metal attachments themselves can irritate the inside of the lips and cheeks and are particularly noticeable when first fitted. You may need to apply some soft wax over the surface of the brackets or bands to prevent discomfort.

It is essential that you keep your appliance and teeth clean. If plaque and food debris are allowed to collect around the appliance staining and discolouration of the enamel and tooth decay can occur. A diet high in sugar is likely to make this worse, therefore sweets and sugary drinks (such as cola and lemonade) should be avoided as much as possible.

Your appliance is very delicate and easily damaged. Hard or sticky food such as toffees and chewing gum must be avoided altogether. Any other foods which are part of your normal diet but which would require hard chewing should be cut into small, manageable pieces.

Breakages are less likely to happen if you follow the instructions above. If you break your appliance please telephone us during normal working hours so that arrangements can be made to repair it. When you attend for routine appointments, please tell us immediately if you suspect that part of your appliance has become loose or damaged.

In the later stages of treatment elastic bands may be placed on your appliances (usually connecting the upper and lower braces) to help move your teeth into the correct position. You will be shown how to place these yourself. Elastics are an essential part of treatment and must be worn as instructed. Normally this should be full time, although they must be taken off when cleaning your teeth. Once you have been given elastics to wear, assume that you will need to wear them until the end of treatment, or until you are instructed otherwise.

Normal sports mouthguards cannot be worn with fixed appliances, however, special mouthguards can be provided if you need them. Please ask for further details of cost.

Removable Orthodontic Appliances
These are general guidelines for patients being treated with removable orthodontic appliances.
If you have any queries please ask, we are here to help you.

Removable appliances may be used by themselves, or in conjunction with other appliances (such as those fixed to the teeth) to assist with the progress of treatment.
You should normally wear your appliance full time (day and night) unless you are given specific instructions to the contrary.

You may find it difficult to speak clearly when you first start wearing your appliance. This is quite normal and you will find that you gradually become used to talking with your appliance in place.

It is important to keep both the appliance and your teeth thoroughly clean. The appliance itself does not damage the teeth, but if plaque and food debris is allowed to collect around it, decay may start. Too much sugar (especially in fizzy drinks) is likely to make this worse, therefore sugary foods and snacks should be avoided as much as possible.

The appliance should always be taken out for cleaning. Use a toothbrush and toothpaste but be careful.

It is also advisable to remove your appliance for any sports or games (including swimming) where it may become dislodged accidentally. Put it somewhere safe.

Always insert and remove your appliance using your fingers. Never bite it into place as this is likely to break it. When it is in position, leave it there and do not be tempted to 'play' with it with your tongue, as this may also damage your appliance.

If you break your appliance please telephone us during normal working hours so that arrangements can be made to repair it. Appliances are repaired at a technical laboratory and this may take a little time. Patients must attend in person so that the fit of the appliance can be checked before and after the repair.