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Media and Parliamentary briefingApril 2000 ORTHODONTICSWhat is orthodontics?Orthodontics is concerned with the development and management of irregularities of theteeth, jaws and face. The most common orthodontic problems are crowding of teeth,impacted teeth (where a tooth cannot fully erupt because it is partially blocked by anothertooth) and protruding (sticking out) upper teeth.Who can provide advice about whether or not orthodontic treatment is necessary?The General Dental Practitioner (family dentist) will be able to provide initial advice, mayprovide treatment or will refer the patient to an orthodontist (specialist).Sometimes patients may feel they need orthodontic treatment. However, they will not receiveorthodontic treatment on the NHS unless it is clinically necessary or where it is unlikely towork. Orthodontic treatment is normally carried out in the early teens.How many people have orthodontic treatment?In the year ending March 1996, 452,041 children and 18,835 adults had orthodontictreatment done on the NHS. Most of the treatment is carried out in the General DentalServices by General Dental Practitioners or specialists.• The Office of Population Censuses and Surveys 1993 survey of Child Dental Health found that at the age of nine, 54% of children had a need for orthodontic treatment which was described as moderate to very great.• By age 15 this number had dropped to 34%.• About 25% of children will have orthodontic treatment at some stage in their life, having either extractions or an appliance or both.What is orthodontic treatment?The perception is that orthodontic treatment is solely cosmetic. This is not true. The aim oforthodontic treatment is to produce a healthy bite, straight teeth and an attractive smile. Aswell as improving a person’s confidence, straight teeth make cleaning easier which helps toprevent tooth decay and gum disease.Orthodontic treatment includes a range of procedures to correct the position of the teeth. Theseverity of the problem ranges from irregular teeth to severe abnormalities. One-third ofchildren at the age of 12 have a great, or very great need for treatment. Another one-third
have a moderate need for treatment. Increasingly the need for treatment is being assessed onan "index of treatment need" and therefore decisions are having to be made on who hasorthodontic treatment. Ideally orthodontic treatment should be carried out while jaws aregrowing. Orthodontic treatment is possible for adults and a limited amount is available on theNHS.As with all medical and dental treatment, there are benefits and risks. In orthodontics thebenefits of undergoing a course of treatment include:-• Improvement in facial appearance, resulting in improved self-esteem of the individual.• Improvement in the function of the teeth and jaws.• Reducing damage to prominent teeth and treatment of impacted teeth.• Improved resistance to dental disease.The risks associated with orthodontic treatment are:• In some patients, the roots of the teeth can become shorter.• Poor tooth cleaning may cause: a) permanent marks on the teeth b) tooth decay c) deterioration in gum condition.What are the main problems that require orthodontic treatment?• From the age of nine about 26% of children have crowded teeth.• 22% of children have protruding upper teeth.• 27% are cases where the upper and lower teeth do not meet properly.• Other examples include a protruding lower jaw or where a tooth cannot come through because another tooth has already developed and is blocking its path.Approximately one-third of children would benefit greatly from orthodontic treatment.How is orthodontic treatment carried out?• This is done with orthodontic appliances (braces) which can be removable or fixed.• An increasing proportion of treatment is being done with fixed appliances as this normally produces better results.• The average age for commencement of treatment is early teens although there is no maximum age.• Treatment takes around 2 years with appointments every 4 to 6 weeks for adjustment of appliances, although complicated treatment can take longer.• It is sometimes necessary to extract permanent teeth to create space.What are orthodontic appliances (braces)?There are several types:• A removable appliance has a plastic base (like a denture) which often clips onto the back teeth. It is normally worn for 24 hours a day and should only be taken out for cleaning. It needs to be tightened by a dentist about once a month.
• A fixed appliance has brackets which are cemented onto the teeth, and wires and elastic bands which move the teeth that are to be repositioned. It cannot be removed and needs careful but thorough cleaning by the patient and adjustment about every 6-8 weeks. The brackets are usually made from metal. Ceramic (tooth coloured) brackets are available but not under the NHS.• Head gear is sometimes used to compliment the treatment with fixed or removable appliances.• At the end of orthodontic treatment, retainers (fixed or removable) are normally used to hold the straight teeth in the correct position, usually for around a year.Pre-teen children are not normally treated but in certain circumstances are treated with aremovable appliance. Whatever appliance is fitted, a large degree of co-operation is neededfrom the patient. It is not sufficient for the dentist and parents to agree that treatment isnecessary. The patient must also have the motivation to complete the treatment as it usuallytakes between 18 months and two years.What are recent trends?The Office of Population Censuses and Surveys 1993 report on Child Dental Health foundthat over the last ten years fewer extractions were being done and that more fixed appliancework was being used.How is NHS orthodontic treatment provided?For those patients for whom orthodontic treatment is necessary following advice from theirGeneral Dental Practitioner, treatment can be provided through the following:• Some general dental practitioners offer orthodontic treatment in the same way as they offer other treatment such as fillings and examinations.• Dentists who limit their practice to orthodontics. These have greater experience and usually a higher qualification in orthodontics. They on the whole accept referrals from other dentists who do not offer orthodontics.• Community orthodontists often work at several centres making use of locally available community clinics.• Orthodontic departments at district hospitals and teaching hospitals. These accept referrals from dentists and other specialists and often deal with more complex cases. They are also available to give advice on the way in which a case should be treated if general dental practitioners are able to carry out the treatment themselves.Is it difficult for patients to get orthodontic treatment?Demand has increased and in recent years it has become more difficult to get orthodontictreatment. In the UK, the need and demand for orthodontic treatment exceeds the resourcesavailable to provide it. This has resulted in long waiting lists for both initial consultation andtreatment in many parts of the country. Compared with other countries with a national healthservice, such as Norway or Sweden, who have one orthodontist to every 25,000 of thepopulation, the UK has one orthodontist to every 100,000 of the population.
Why is this?The need and demand for orthodontic treatment continues to increase yet the number oforthodontists to provide the diagnosis and treatment has not kept pace. Not all dentists havethe necessary skills to be able to treat cases satisfactorily.• There must be equal access to high quality orthodontic treatment in all branches of the service throughout the country.What training do orthodontists need?It takes a minimum of three years to train a dentist to become a specialist orthodontist, andlonger to train a consultant. Competition for places on training programmes is extremely highand not all trainees are fully funded. In order to make high quality orthodontic care moreavailable, more specialists will need to be trained in future. The provision of part-time,flexible training programmes would increase the number of specialists being trained.• More postgraduate training is needed for dentists who wish to increase their expertise in orthodontics.• In recent years the number of university teachers of orthodontics has been reduced due to difficulties in recruitment and funding. Orthodontic specialists should be encouraged to become university teachers.• More fully funded training places for dental graduates wishing to become orthodontic specialists are required.
Are there charges for orthodontic treatment?• NHS treatment for children under18 years of age is free of all charges in all sectors.• Adults receiving treatment under the NHS would be charged up to the maximum patient’s charge which is currently £354.• There are no charges for NHS patients who receive advice and treatment within the Hospital Dental Service or Community Dental Service.• Some treatment is carried out privately.How should people look after their teeth during orthodontic treatment?While patients are having orthodontic treatment, it is vital that they continue to see theirGeneral Dental Practitioner for regular dental check-ups and have good oral hygiene. Thefollowing important rules should always be followed while undergoing treatment:• Brush thoroughly with a fluoride toothpaste at least twice a day.• Take care with diet particularly avoiding hard foods and all sweets to prevent damage to braces and tooth decay.• Be scrupulous about cleaning appliances.• Be careful when playing contact sports.• Keep dental appointments. Irregular attendance will prolong treatment and risk damage.What recent developments have there been in orthodontics?Specialist listsOn 1st July 1998, the law was changed to allow the General Dental Council (the regulatorybody for the dental profession) to hold a list of specialist dentists. A list of dentists offeringorthodontic treatment is available from the GDC, 37 Wimpole Street, London W1M 8DQ.Index of Orthodontic treatment Need (IOTN)An Index of Orthodontic Treatment Need (IOTN) has been developed. The most severeorthodontic problems fall into IOTN Grades 4 and 5 and the Children’s Dental Health Surveyfound that 38.5% of 12 year olds fall into one of these two categories.What are the fashions in orthodontic treatment?Multi-coloured bands (the rubber bands holding the stainless steel wire in place) areavailable on the NHS.Ceramic or tooth coloured brackets ( the clip which fits on the tooth to hold the wire) arenow available but generally not on the NHS. EndsFor press enquiries please contact the BDA’s Press and Parliamentary Department on 0207563 4580.