Orthodontics is a Greek word that literally means ‘to straighten teeth’. It is a type of dental treatment that aims to improve the appearance, position and function of crooked or abnormally arranged teeth.
Orthodontics uses mechanical devices, such as a brace, over a certain period of time (usually 18 months to two years) to correct the position of the teeth.
Healthcare professionals who specialise in orthodontics are known as orthodontists. They usually work in dental surgeries or specialist hospital units.
Who needs orthodontics?
Sometimes, a child’s teeth and jaw do not develop in the normal way. The medical term for teeth that are out of position is malocclusion.
Some cases of malocclusion occur for no obvious reason. Other cases are the result of certain behaviours, such as frequent thumb sucking, or an injury to the teeth or bones of the face.
Many cases of malocclusion do not pose serious health concerns. However, if malocclusion is not corrected during the teenage years, it may affect the appearance of the teeth and the shape of the face. This could cause psychological and emotional problems, such as lack of self-confidence, anxiety and depression.
More severe cases of malocclusion can affect the functioning ability of the teeth, mouth and jaw. For example, it can make it difficult for a person to eat food; cleaning the teeth may be harder and the teeth may be vulnerable to damage.
Malocclusion is much more common than most people think. For example, a recent study carried out in England found that around a third of 12 year olds would benefit from some degree of orthodontic treatment.
See Orthodontics - why it is used for more information.
Orthodontics on the NHS
Orthodontic treatment is only available free-of-charge on the NHS for young people who:
- are under 18 years old
- have a clear clinical need for treatment
NHS orthodontic care is not usually available for adults but may be approved on a case-by-case basis if the functional needs are great (see box, left).
A rating system, known as the Index of Orthodontic Treatment Need (IOTN), is used to assess the need and eligibility of individual cases. The IOTN consists of five grades, which are outlined below.
Grade 1
Grade 1 is used to describe almost perfect teeth.
Grade 2
Grade 2 is for minor irregularities with the teeth, such as:
- slightly protruding upper teeth
- slightly irregular teeth
- the position of the upper and lower teeth is not entirely symmetrical, such as a mild overbite or underbite, but this does not interfere with the normal function of the teeth
Grade 3
Grade 3 is for more marked irregularities with the teeth that do not usually need treatment for health reasons. For example:
- upper front teeth that protrude 4mm less than normal
- the upper teeth are slightly out of position which only interferes with normal function to a minor degree (less than 2mm)
- irregularly positioned teeth that are 4mm or less out of line
- the back teeth do not touch each other when the mouth is closed (this is known as an open bite)
- the lower teeth are overlapped by the upper teeth (this is known as a deep bite), but this does not interfere with normal function
Grade 4
Grade 4 is for severe irregularities with the teeth that need treatment for health reasons. For example:
- upper front teeth that protrude more than 6mm
- the position of the upper and lower teeth is more than 2mm out of their normal location in terms of symmetry and is interfering with normal function
- lower front teeth protrude in front of the upper teeth by more than 3.5mm
- irregularly positioned teeth that are more than 4mm out of line
- deep bite that interferes with normal function
Grade 5
Grade 5 is for severe dental health problems, such as:
- when teeth are unable to come through into the mouth due to an obstruction, crowding, additional teeth or any other cause
- a large number of missing teeth
- upper front teeth that protrude by more than 9mm
- the normal development of the skull and/or jaw has been disrupted, e.g. by a cleft lip and palate (a birth defect where there is a split in the roof of the mouth, the top lip or both)
The British Orthodontic Society’s website has more information about the Index of Orthodontic Treatment Need (IOTN).
NHS treatment is available for grade 4 and grade 5 cases. Grade 3 cases are usually judged on a case-by-case basis. Treatment may be made available if the appearance of a person’s teeth is particularly unattractive.
In some parts of the country there are currently not enough trained NHS orthodontists to meet patient demand. This means that even if your child qualifies for NHS orthodontic treatment, there may be a long waiting list before treatment becomes available.
Depending on your local primary care trust (PCT), the waiting time for orthodontic treatment can range from six months to two years.
Private treatment
If you or your child is having orthodontic treatment for purely cosmetic reasons (or you do not want to wait for NHS treatment), you will have to pay for private treatment.
Private orthodontic treatment is widely available but it can be quite expensive. The British Orthodontic Society (BOS) states that fees can vary from £2,000 to £6,000, depending on the complexity of treatment and the type of appliances that are used. However, in very complex cases, the cost of treatment may be even higher.
The BOS has an online service that you can use to find orthodontic treatment in your area. You may either be referred for treatment by your dentist or you can seek treatment directly (self-referral).
