Child Orthodontics

Orthodontic Treatment under the NHS

Children under the age of 18 could be eligible for orthodontic treatment under the NHS, if they have been assessed as having a clear clinical need for treatment.

  • A system know as Index of Orthodontic Treatment Need (IOTN) is used as a means of assessing whether orthodontic treatment is required and can therefore be provided under NHS general dental services (GDS).
  • Eligibility for NHS can usually take between 6 to 12 weeks to confirm and sometimes, there is a waiting list for NHS orthodontic treatment.
  • Patient considered to have less severe irregularities of their teeth will not be eligible for funding under the NHS. However, all patients can still benefit from an increased range of treatments, carried out under our private treatment options.

If you would like an assessment for treatment under the NHS for your child or teen, please ask your dentist for a referral to M-Brace.

Functional appliances

A functional appliance (eg. the Twin Block) is a type of brace to correct a “Class II” problem, which are a group of bite problems where the top teeth bite in front of the lower teeth. Functional appliances may be either fixed or removable.

Removable functional appliances are the most popular treatment in the U.K.

The more common removable functional appliances are made from separate upper and lower parts, which interlock placing the lower jaw in a more advanced position. Other types of functional appliance are made from just one piece, although these may adapt slightly less well to the teeth. Correction of prominent top teeth (Class II problem) is not straightforward and relies on co-operation from you or your child.

To address both Class II problems and crooked teeth may require the use of both a functional appliance, followed by fixed braces, or less commonly use of functional and fixed braces at the same time. The indications for each approach depends on the specific problem so it’s best your child comes in for an assessment.

Much debate and controversy has surrounded the mode of action of functional braces. It appears that functional braces primarily tip teeth, moving top teeth backwards and lower teeth forwards. Reliable research suggests that the position and length of the lower jaw is governed by our genetic make-up. Therefore, while growth of the lower jaw may be altered in the short-term by a functional brace, it appears that in the long-term no significant difference in jaw position is likely to occur. Nevertheless, by virtue of moving the teeth, changes in lip position may occur with the upper lip covering the top teeth more fully.
Not necessarily. Obviously, treatment will not work if the appliance is not worn sufficiently well. In addition, there are a group of patients who do not respond particularly well to functional braces. Unfortunately, it is very difficult to predict which patients will respond to treatment. Functional appliances are believed to be most successful prior to or during the adolescent growth spurt. This typically occurs between the ages of 11 and 14 in boys and 10 to 13 in girls. Nevertheless, treatment may be suggested at an earlier or later stage in certain circumstances.
Class II problems may be treated in a variety of ways. If Class II correction fails, a variety of options exist. Consideration may be given to using an alternative device or approach to correct the Class II including:
  • Headgear
  • Extractions
  • Jaw surgery
The indications for these approaches vary and is based on the specific problem. In certain instances it may be advisable to accept the residual problem before considering treatment if desired at a later date. Jaw surgery is generally deferred until 17 years and above.
Treatment in this age group is regarded as ‘early treatment’ in the U.K. although this practice is routine in many countries. Research has demonstrated that functional appliance therapy commenced at an early stage is no more effective but is less efficient than treatment commenced at 10 to 14 years. In certain circumstances, however, particularly if children are the subject of teasing in relation to dental appearance, early treatment may be recommended.
Treatment time varies based on how severe the problem is. However, most of the work with this brace is usually completed in 9 to 12 months. After this a period of nights only wear may be advised to maintain the improvement. However, progression to a second phase of treatment with a train track brace may be recommended immediately.
The number of hours per day that you are expected to wear the brace will be explained to you. For the treatment to work it is important you follow these instructions. However, most functional appliances are worn on a full-time or near full-time basis. With the correct number of hours of wear you may find the improvement in the position of your teeth can be quite dramatic.

Conventional Fixed Appliances

  • Fixed appliances are the most commonly used appliances and are able to produce very precise tooth movement to achieve ideal results.
  • Treatment with fixed appliances usually starts once all the adult teeth have erupted and usually lasts for 18-24 months. All fixed appliance treatment is followed by retention.
  • Many different brands of fixed appliance are available, which can be very confusing for patients, but they all essentially perform the same function.
  • Manufacturers may claim that their products produce more superior results than others. Care must be taken in accepting such claims as often they are not substantiated by scientific evidence. Below are described the main types of fixed appliances: metal fixed appliances and tooth-coloured fixed appliances.

Metal fixed appliances

  • These are the most common form of appliance used in children and are often also termed ‘train tracks’. They are most commonly made from stainless steel and attached onto the teeth using tooth coloured filling material (composite resin). Care has to be taken eating hard foods as the attachment can easily be broken leading to a disruption in treatment. An orthodontic wire (archwire) is tied (or ligated) into the bracket using coloured elastic rings which can discolour in-between visits.
  • These elastics can be silver coloured to blend in which the appliance or brightly coloured. As treatment progresses the orthodontist will progress to thicker wires which can place greater forces onto the teeth. Some patients term this process as ‘tightening’ the appliance. Appliances can easily be removed at the end of treatment leaving the teeth intact.

Ceramic or tooth-coloured fixed appliances

  • Rather than using stainless steel, the attachments may be made from a hard ceramic material to blend in with the tooth colour. The orthodontic wires can also be tooth coloured to help improve the appearance further.
  • Ceramic fixed appliances can be as effective as conventional fixed appliances at achieving tooth movement. Sometimes they are not recommended for the lower teeth, if the bite is deep, because the hard material can damage the opposing teeth that contact the attachments. Ceramic appliances are slightly more difficult to remove than conventional fixed appliances, however, they are unlikely to damage healthy teeth in most cases.
  • These appliances offer a more aesthetic appearance as they are made of clear materials and you can almost hide the fact that you are wearing a brace, therefore they are visually less prominent and blend in with the natural colour of the teeth. They offer a good aesthetic solution while getting great results.
  • Tooth-coloured fixed braces are only available on a private basis.

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