Q&A with orthodontist Dr Anton Bass
Q. MetalSian: When I was younger I had a removable brace when at primary school, and a type of train track (with open/close doors, not elastic bands) at secondary. I went on to wear my retainers for longer than was suggested to me, every night for over a year, then cut down wearing them one or two nights a week until they broke.
My teeth now, however, have moved and seem to be even worse than before I had the braces.
To me it seems completely pointless to have gone through the years of wearing braces, then following the instructions of my orthodontist, for my teeth to look almost worse now than they did before I started treatment.
To rectify this problem would it mean having to have even more braces? And is there any way to guarantee the teeth not moving back? Or could I even complain to my original orthodontist?
A. Anton Bass: As I said to Drummersma, one of life’s certainties is that teeth will progressively shift and become crooked, whether someone has had braces or not.
The only way I can guarantee the teeth not moving after orthodontic treatment is for my patients to wear retainers for life. However, once my patients have been out of braces for a couple of years, the retainer usually only needs to be worn one night a month. Fixed retainers are also available, which are small wires fitted behind the teeth out of sight, I almost always fit a lower fixed retainer.
If you would like to bring your teeth back to their former glory, the only way is with braces again. These days there are many subtle, almost invisible and removable options instead of the traditional fixed-metal type.
Q. HettySpaghetti: I’m 38 and I have extremely crooked teeth. They’re very hard to clean. I had shocking dentists as a kid, which now reduces me to a gibbering wreck when I go to the dentist. I have recently booked my first dentist appointment in years. Is there anything they can do to straighten my teeth that won’t cost silly money?
A. Anton Bass: Firstly, you need to keep in mind that a visit to the orthodontist is a very different experience from a visit to the general dentist, and that there are none of those familiar sights and smells you remember from your childhood. Secondly, there are many options available for straightening your teeth – from nearly invisible removable braces to fixed ones, some more cost-effective than others.
However, the options which are possible for you depends on the severity of the problems and how much you would like done, I always tailor my treatment to individual needs. It is best that you start with an orthodontic consultation to explore all your options.
Q. Xstargirl: When I was younger the dentist referred me to the orthodontist as one of my teeth was growing sideways. But due to mistakes, I never got it looked at. I still only have the milk tooth where the errant tooth should be, should I get this looked at now, or is it too late?
Also, I have a very small jaw and very large upper front teeth in particular, and they have overlapped considerably since my early teens. Can this be corrected now, and if so would it be available on the NHS as it’s considered “cosmetic” work?
A. Anton Bass: I would strongly advise that you have this errant tooth assessed, it is probably too late to encourage it to grow into your mouth, but there is risk that it could be growing ectopically and causing damage to the roots of teeth and other structures.
With regards to your orthodontic treatment, which is a separate issue, It is unlikely that this could be carried out in an NHS practice, however, treatment may be available at a teaching hospital.
Your priority is to have the errant tooth looked at by your general dentist, he may need to refer you to have it removed. At the same time seek advice about local dental teaching hospitals for orthodontic treatment.
Q. Meala: I have protruding front teeth and hate my smile. I have a large overbite and have two natural bite positions. As a teenager my orthodontist used fixed braces to move my bite back but the overbite is back, and worse than ever.
I have plucked up courage and have seen two orthodontists who advise that the only option is fixed braces for one year, jaw surgery and then more braces. Is there any alternative? I am wary of surgery but also depressed by the state of my teeth.
A. Anton Bass: Unfortunately, your teeth have relapsed since your orthodontic treatment as a teenager, which is likely due to continued growth of your jaws, which can’t be controlled, even with retainers. It certainly sounds like you are very bothered by your teeth and smile, which is reason enough to do something about it.
It is difficult to advise on alternatives as I haven’t assessed your case, but if two orthodontists have both advised on surgery, this is probably considered the best option to give you the results you would like. It may help to meet the potential surgeon (if you haven’t already) to discuss the procedure and put your mind at rest. I always advise this for my patients and they are usually much happier after.
The alternative treatments may be just to straighten the teeth without changing the jaw positions, however this will be a compromise and you will continue to have two natural bite positions. This is a very important decision, which you have to make for yourself by weighing the relative risks of the surgery and the gains from having your teeth and jaws corrected.