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 known 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 treatments can take between 6 to 12 weeks to receive confirmation, and there may be an even longer waiting list for assessment before that time.
Patients considered to have less severe dental irregularities will not be eligible for funding under the NHS. However all patients, including children and teenagers, can still benefit from an extensive range of treatments available through our private treatment options.

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

Functional appliances

A functional appliance is a type of fixed or removable brace used to correct a ‘Class II’ problem. This means the top teeth are prominent as they bite in front of the lower teeth causing an overbite. Correction of prominent top teeth is one of the most frequent orthodontic treatments requested.

Removable functional appliances are a widely used treatment in the UK and are made from separate upper and lower parts which interlock so that the lower jaw can be moved to a more advanced position; these are called ‘Twin Blocks’. Other types of functional appliances are made from single pieces and may adapt slightly less well to the teeth.

Where patients have Class II overbite problems as well crooked teeth, their treatment may require either using a functional appliance followed by fixed braces, or functional and fixed appliances at the same time, although this is less common. Each approach depends on the specific problem which we can determine when your child comes in for an assessment.

Will a functional appliance change the shape of my face?

Much debate and controversy has surrounded the use of functional braces as it appears that functional braces move the top teeth backwards and lower teeth forwards. Research suggests that the position and length of the lower jaw is governed by genetic make-up, so that 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.

How successful are functional appliances?

Treatment will be most effective if the functional appliances are worn correctly. As with any treatment, there are some patients who do not respond particularly well to functional braces but it is difficult to predict which patients these will be. However, functional appliances are believed to be most successful prior to, or during, the adolescent growth spurt which typically occurs between the ages of 11 and 14 in boys, and between 10 and 13 in girls. In certain circumstances, it may be suggested that treatment is started at an earlier or later age.

If treatment is unsuccessful, how can the problem be addressed?

Class II problems may be treated in a variety of ways and if a treatment is not successful then a variety of alternative options exist that include:

Headgear
Extractions
Jaw surgery

The indications for these approaches vary and is based on addressing the specific problem relating to that patient. In some cases, it may be better to accept the residual problem before considering treatment, or even postponing further treatment completely; for example, should jaw surgery be required, this will generally not be carried until the patient is 17 years or older.

Is there any benefit in using functional appliances before ten years of age?

Although this practice is routine in many countries around the world, treatment in this age group is regarded as ‘early treatment’ in the UK. Research has shown that functional appliance therapy started at an early stage is not any more effective, and it can be less efficient than treatment started at 10 to 14 years old. However, early treatment may be recommended, especially where children may be at risk of teasing in relation to their dental appearance.

How long will treatment take with a functional appliance?

Treatment times will vary based on the extent of corrections needed and it may be necessary to follow with a period of wearing conventional, fixed metal and wire braces. However, most of the work with functional appliances is usually completed in 9 to 12 months, with a period of nights only wear to maintain the improvement.

How many hours do I need to wear the appliance each day?

Most functional appliances are worn on a full-time or near full-time basis, and when worn for the correct amount of time you may find the improvement in the position of your teeth is quite dramatic.
The number of hours per day varies for everyone and based on what treatment is needed, and this will be explained clearly to you.

Conventional Fixed Appliances

Fixed appliances are able to produce very precise tooth movements to provide the desired results and are the most commonly used treatment for children and teenagers.
Treatment with fixed appliances usually starts once all their adult teeth have erupted and usually lasts for 18-24 months.
All fixed appliance treatment is followed by retention (a removable retainer used during the final stages of alignment).
Some manufacturers may claim their products offer more superior results than their competitors but this is not substantiated by scientific evidence.

Metal fixed appliances

These are the most common form of appliance used for children and are often called ‘train tracks’. They are usually made from stainless steel and attached onto the teeth using tooth coloured resin
Care has to be taken when eating hard foods as the attachment can easily be broken leading to a disruption in treatment.
An orthodontic wire is tied into the bracket using coloured elastic bands. These elastics can be silver coloured to blend in with the appliance or come in a variety of different colours – you can even use a different colour on each bracket!
As treatment progresses the orthodontist will progress to thicker wires which can place greater forces onto the teeth. At the end of the treatment the fixed appliances can easily be removed leaving the teeth intact, although there will be a requirement to wear a removal retainer for a while afterwards.

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 can be 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 discreet solution 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 appliances for your child are available on a private basis and we will be pleased to provide you with an overview of costs and detailed payment plans.