Orthodontic treatment straightens or moves teeth to improve the way they look and how they work. Well-aligned teeth are easier to clean, which can reduce the risk of tooth decay and gum disease. Treatment can also improve confidence and self-esteem.
The most common form of orthodontic treatment for straightening teeth uses fixed braces — brackets bonded to the front of the teeth with a wire running through them. Removable clear aligners are an alternative option (see our separate leaflet).
Who needs orthodontic treatment?
Orthodontic treatment can help with a wide range of problems, including:
Crowded or overlapping teeth
Widely spaced teeth
An overbite (upper front teeth biting too far over the lower teeth)
An underbite (lower teeth sitting in front of upper teeth)
A crossbite (upper and lower teeth not lining up correctly at the side)
An open bite (upper and lower front teeth not meeting)
The IOTN (Index of Orthodontic Treatment Need) is a scoring system used in the UK to assess how great the need for orthodontic treatment is. It has two components: the Dental Health Component (DHC), which scores the severity of the orthodontic problem, and the Aesthetic Component (AC). NHS orthodontic treatment is generally only available to children and young people with a significant need — typically IOTN DHC grade 4 or 5, and the higher end of grade 3 (sub-grades 3d and above). Adults are not routinely eligible for NHS orthodontics and adult orthodontic treatment is typically carried out privately.
What does treatment involve?
The process of orthodontic treatment typically follows these stages:
Assessment — X-rays, photographs, and impressions or digital scans of your teeth. A treatment plan is designed specifically for you.
Preparatory treatment — any decay or gum disease must be treated before braces are placed. Some extractions may be necessary to create space.
Fitting the braces — brackets are bonded to each tooth and a wire is threaded through them. This appointment takes about an hour and is not painful, though teeth may ache for a few days afterwards.
Regular adjustment appointments — every 6–8 weeks, the wire is adjusted to continue moving the teeth. Each adjustment may cause mild aching for a day or two.
Debond — once tooth movement is complete, the brackets are removed and the teeth are cleaned.
Retention — retainers are essential to hold the teeth in their new positions. This phase is lifelong. Without retention, teeth will drift back (relapse) over time.
How long does treatment take?
Treatment length varies considerably depending on the complexity of the case. As a general guide:
Simple alignment cases: 6–12 months
Moderate cases: 12–18 months
Complex cases: 18–30 months or more
Missing appointments or not wearing removable retainers as directed can significantly extend treatment time.
Risks and possible complications
Common (affect more than 1 in 10 people):
Soreness and aching after each adjustment, typically lasting 2–5 days
Mouth ulcers or irritation from brackets and wires, especially in the first few weeks
Difficulty eating hard or sticky foods during treatment
Uncommon (affect about 1 in 10 to 1 in 100 people):
White spot lesions (decalcification) — if oral hygiene is poor during treatment, permanent white marks can form on the teeth where brackets were. These can be permanent. This is one of the most important risks to understand.
Root resorption — the roots of some teeth can shorten slightly. This is usually minor and clinically insignificant.
Relapse — teeth can move back after treatment if retainers are not worn as directed
Rare (affect fewer than 1 in 100 people):
Significant root shortening affecting the long-term prognosis of a tooth
Jaw joint (TMJ) symptoms — though research has not established orthodontic treatment as a direct cause
Oral hygiene during treatment
Keeping your teeth clean during orthodontic treatment is critical. Braces create many additional surfaces where plaque can collect:
Brush after every meal — carry a travel toothbrush and toothpaste
Use a small-headed toothbrush and angle it under the wire and around each bracket
Use interdental brushes to clean between brackets
Floss daily using a floss threader or orthodontic floss
Use fluoride mouthwash daily to protect enamel
Avoid sugary food and drinks between meals
Attend your regular dentist and hygienist appointments during treatment — your orthodontist checks the teeth are moving correctly, but your dentist monitors for decay and gum problems
Questions to ask your dentist or orthodontist
How complex is my case and what treatment approach do you recommend?
How long do you expect treatment to take?
Will I need any teeth removed before treatment starts?
What retainers will I have at the end — removable or fixed, or both?
What are the consequences if I choose not to have orthodontic treatment?
This leaflet is for general information only and does not replace professional dental advice. It is intended to support — not replace — the discussion with your dentist about your individual options, risks, and treatment plan. Treatment outcomes vary between patients depending on individual circumstances. Your dentist will confirm exact fees and what is suitable for your specific circumstances before you agree to any treatment.
References
Aligned with guidance from: FGDP(UK), British Orthodontic Society, NICE, SDCEP.