Your Guide to Orthodontic Treatment
What to expect from treatment with fixed braces: what it involves, how long it takes, the risks, and how to keep your teeth clean.
What is orthodontic treatment?
Orthodontic treatment straightens or moves teeth. It improves how they look and how they work. Straight teeth are easier to clean. This can lower the risk of tooth decay and gum disease. Treatment can also improve confidence and self-esteem.
Fixed braces are the most common way to straighten teeth. Small brackets are glued to the front of the teeth, with a wire running through them. Removable clear aligners are another option. Your dental team can give you a separate leaflet about them.
Who needs orthodontic treatment?
Orthodontic treatment can help with many problems, including:
- Crowded or overlapping teeth
- Teeth with wide gaps between them
- An overbite (upper front teeth biting too far over the lower teeth)
- An underbite (lower teeth sitting in front of the upper teeth)
- A crossbite (upper and lower teeth not lining up properly at the side)
- An open bite (upper and lower front teeth not meeting)
In the UK, a scoring system called the IOTN (Index of Orthodontic Treatment Need) shows how much a person needs treatment. It has two parts. The Dental Health Component (DHC) scores how severe the problem is. The other part is the Aesthetic Component (AC).
On the NHS, orthodontic treatment is usually available for under-18s whose need scores Dental Health Component 4 or 5 on the Index of Orthodontic Treatment Need (IOTN), or 3 with an aesthetic score of 6 or more. Your dental team or orthodontist will check this. Adults do not usually get NHS orthodontic treatment. Adult treatment is usually done privately.
What does treatment involve?
Treatment usually follows these stages:
- Assessment. X-rays, photos, and moulds or digital scans of your teeth. A treatment plan is made just for you.
- Treatment beforehand. Any decay or gum disease must be treated before braces are fitted. You may need some teeth taken out to make space.
- Fitting the braces. Brackets are glued to each tooth, and a wire is threaded through them. This takes about an hour and does not hurt. Your teeth may ache for a few days afterwards.
- Regular adjustments. Every 6–8 weeks, the wire is adjusted to keep moving the teeth. Each adjustment may cause a mild ache for a day or two.
- Taking the braces off (debond). When the teeth have finished moving, the brackets are removed and the teeth are cleaned.
- Retainers (retention). Retainers are essential to hold the teeth in their new places. This stage is lifelong. Without retainers, teeth will drift back over time (relapse).
How long does treatment take?
How long treatment takes depends a lot on how complex your case is. As a rough guide:
- Simple straightening: 6–12 months
- Moderate cases: 12–18 months
- Complex cases: 18–30 months or more
Missing appointments, or not wearing removable retainers as advised, can make treatment take much longer.
Risks and possible problems
Common (affect more than 1 in 10 people):
- Soreness and aching after each adjustment. This usually lasts 2–5 days.
- Mouth ulcers or rubbing from brackets and wires, mainly in the first few weeks
- Difficulty eating hard or sticky foods during treatment
- White spot lesions (decalcification). With fixed braces, about 1 in 3 people develop new white marks on their teeth during treatment. These appear around where the brackets were. The risk is much higher if teeth are not kept clean, or if you often have sugary food and drinks. These marks can be permanent. This is one of the most important risks to understand.
- Mild root shortening. All brace treatment causes small changes to the roots of the teeth. This is usually minor and does not matter for the health of the tooth.
- Relapse (teeth moving back after treatment). Some movement over the years is normal. Relapse is very likely if you do not wear your retainers as advised.
Rare (affect fewer than 1 in 100 people):
- Significant root shortening that affects how long a tooth is likely to last
- Jaw joint (TMJ) symptoms. Research has not shown that brace treatment directly causes these.
Keeping your teeth clean during treatment
Keeping your teeth clean during treatment is vital. Braces create many extra places where plaque can build up:
- Brush after every meal. Carry a travel toothbrush and toothpaste.
- Use a small-headed toothbrush. Angle it under the wire and around each bracket.
- Use small brushes (interdental brushes) to clean between brackets.
- Floss every day using a floss threader or special brace floss (orthodontic floss).
- Use a fluoride mouthwash every day to protect your enamel.
- Avoid sugary food and drinks between meals.
- Keep going to your usual dentist and hygienist appointments during treatment. Your orthodontist checks that the teeth are moving correctly. Your dental team checks for decay and gum problems.
Questions to ask your dental team or orthodontist
- How complex is my case, and what treatment do you suggest?
- How long do you expect treatment to take?
- Will I need any teeth taken out before treatment starts?
- What retainers will I have at the end: removable, fixed or both?
- What could happen 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 dental team about your individual options, risks, and treatment plan. Treatment outcomes vary between patients depending on individual circumstances. Your dental team will confirm exact fees and what is suitable for your specific circumstances before you agree to any treatment.
Sources
- Orthodontic treatment: frequently asked questions. British Orthodontic Society.
- Treatment and brace types. British Orthodontic Society.
- Braces. NHS website (nhs.uk), reviewed June 2026.
Links checked 18 October 2026.
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