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Dental Impressions 

It is important that any dental treatment starts with accurate dental impressions known as dental moulds. This is usually required for many aspects of dental work, however it is essential to plan orthodontic treatment. These dental moulds are used for planning your treatment and also to fabricate the appliances that will be used to obtain the desired tooth movements.

They also  ensure that the treatment is done as efficiently as possible. There are many important factors that a dentist that specialises in orthodontics looks at when choosing how to take a dental impression, including:

1. Material selection
2. Tray design, and 
3. Oral tissue management. 

1.Materials. The most commonly used impression material for orthodontics is an addition-type silicone or polyvinyl siloxane referred to as PVS for short. PVS materials are stable and therefore are ideal for transportation and postage to the place of choice. PVS materials have excellent handling, flow, flexibility, and elastic recovery properties and are very comfortable for the patients. They also have a relatively short setting time, good tear resistance, and have no objectionable tastes and smells. 

2. Tray Design. The tray is the plastic vessel which is used to hold the PVS material and allow the clinician to conform it to your teeth and adapt it. This allows a precise copy and the selection of trays is important for accuracy of the impression, and also for your comfort. Trays should be rigid so as to not deform when taking the impression and perforated to retain the PVS in place once it is removed. Sometimes at 128 Harley Street Dental Suite we request custom trays which are needed at times as every individual has different sized-teeth and jaw shapes.  

3. Tissue management. Manipulation of the PVS is essential by your treating orthodontist to take an accurate copy of not only your teeth but the surrounding gums. This prevents injury to the tissues of the mouth during preparation and impression-taking. The procedure of taking impressions is done by first preparing the trays, cleaning the site, removing moisture, then syringing the impression material around the tooth, and seating the tray properly. An impression or dental mould with modern materials usually takes around 30 seconds to fully set.

Accurate dental impressions are a fairly common procedure. 

Nowadays scanners are also available for a digital copy of your teeth however the gold standard remains dental moulds and more modern scanners are continuously compared to this very well-known and established technique.

Your treatment journey starts here!

Dr Stefan Abela

Dr. Stefan Abela
BChD, MFDS, RCS Eng, MSc, MORTH RCS Ed, AHEA, FDS Orth RCS Ed

Stefan is a Consultant in Orthodontics at one of the most prestigious London teaching hospitals; Guy’s and St Thomas NHS Foundation Trust.

Stefan is also a specialist in Orthodontics and is registered on the General Dental Council (GDC) specialist list. Stefan qualified as a dental surgeon in 2003 and underwent further training in various specialties including restorative dentistry, paediatric dentistry, oral medicine and complex oral and maxillofacial surgery including the management of facial trauma.

http://128harleystreetdentalsuite.com/team/dr-stefan-abela/

Invisalign treatment is the process of sequentially wearing a series of clear, removable aligners that have been programmed and are custom-made for you personally to gradually straighten your teeth. This system uses No brackets and No wires, so are very different to conventional fixed braces also known as “train track braces”.

At 128 Harley Street Dental Suite a lot of people ask us what Invisalign is made of. The material that Invisalign is a specifically and a patented thermoplastic material called SmartTrack®.

The process starts by taking a copy of your teeth and once they are uploaded on the Invisalign digital system, your orthodontist can plan your individual tooth movements needed to create the smile you have been wanting.

The orthodontist will also make provisions to see you every 6-8 weeks to ensure that the progress is maintained as originally planned and if this is not the case, provisions are made to ensure progress is restarted. 

Clear aligners are much more discreet than normal fixed braces and allow you to remove them to be able to clean your teeth and gums and maintain them during the treatment duration.

The aligners are trimmed to cover your teeth only and there won’t be any coverage of the inside of your mouth nor will they cover part of the palate.

Tooth sizes, shapes and bites are very unique and the Invisalign treatment would be completely custom-made to your teeth and mouth.

If you are wondering whether Invisalign is a good option for you,  you must be aware that Invisalign is a good option for both teens and adults. Everyone leads a busy lifestyle and can take advantage of the flexibility of the system. 

Each aligner should be worn for 20 to 22 hours each day and the aligners changed as recommended by your orthodontist. 

Invisalign can be used to treat one jaw at a time or both depending on your needs.

At 128 Harley Street Dental Suite we recommend that you wash your aligners after use with lukewarm water and placing them in your dedicated container when not in use.

Following treatment, you will need to have a set of retainers made to prevent unwanted tooth movement as much as possible.

Dr Stefan Abela

Dr. Stefan Abela
BChD, MFDS, RCS Eng, MSc, MORTH RCS Ed, AHEA, FDS Orth RCS Ed

Stefan is a Consultant in Orthodontics at one of the most prestigious London teaching hospitals; Guy’s and St Thomas NHS Foundation Trust.

Stefan is also a specialist in Orthodontics and is registered on the General Dental Council (GDC) specialist list. Stefan qualified as a dental surgeon in 2003 and underwent further training in various specialties including restorative dentistry, paediatric dentistry, oral medicine and complex oral and maxillofacial surgery including the management of facial trauma.

http://128harleystreetdentalsuite.com/team/dr-stefan-abela/

Due to COVID-19, our orthodontist’s office is currently closed and all procedures have to be postponed and rescheduled for a later date. At 128 Harley Street we would have given you instructions and you may also contact us in case you have any difficulties. In case you are still wondering how to handle potential orthodontic issues at home, there are some steps that you can take to temporarily fix or alleviate any discomfort and ensure continuity of the progress achieved so far. We would still encourage you to get in touch in case you have any difficulties. In our specialty,  most issues can be handled with no untoward consequences.

During this time, make sure to stay in contact with your orthodontist, Dr Stefan about when we plan to reopen. The government gave us guidelines to reopen in June and is currently limited to treatment such as emergencies to start with. Normality is expected to return by July. We will remain available over the phone and email and we will be more than happy to answer any queries that you might have.

Supplies that you might come in handy!

With these accessories at hand, you will be prepared to handle the most common orthodontic issues

• Orthodontic relief also known as comfort wax
• Dental floss which is obtainable over the counter
• Disinfected tweezers
• Interproximal brushes such as TePe brushes
• Non-prescription pain reliever such as paracetamol or ibuprofen
• Topical Anaesthetic spray or ointments
• Salt mouth rinses in case you have mouth ulcers

Lost Elastomerics or ‘O-rings’

An elastomeric (coloured or not) sometimes referred to as “O” rings are the tiny rubber bands, that holds the orthodontic wire and forms the brace system. If a rubber o-ring came off partially, you may be able to put it back in place using disinfected tweezers. If a wire ligature came loose, simply remove it with the tweezers. In case this fine wire ligature is sticking out into the lip but is not loose, it may be bent back down with a Q-tip or pencil eraser to eliminate the irritation.

Discomfort or Pain

It’s normal to have some discomfort during orthodontic treatment as your teeth move however it should not last longer than a couple days. It should also be alleviated with pain killers such as paracetamol or ibuprofen. Rinsing your mouth with warm salt water by dissolving coarse salt in tepid water should also help with the discomfort.  If the discomfort lasts longer than a couple days, please do not hesitate to contact us.

Mouth Ulcers

Some patients are susceptible to episodes of mouth sores without braces. The braces do not cause them, however they may be precipitate or exacerbate the existing or new irritations even more.  The cheeks, lips or tongue are common areas where ulcers may appear. This is not an emergency but may be very uncomfortable especially until the ulcers heal. Prompt relief may be achieved by applying a small amount of topical anaesthetic which can be found over the counter such as Difflam^™  spray or Orabase protective paste, which are applied directly to the ulcerated surface using a cotton swab – reapply as needed.  If after a couple days the discomfort does not resolve, please do not hesitate to contact us to discuss this further.

Irritation in the Mouth

Sometimes braces can irritate the mouth or parts of the mouth, especially initially till your mouth are getting used to them and you are getting used to daily life wearing them. The wires come in different sizes and the initial ones are very small in size however tend to cause the most discomfort as you are least used to them. The best solution is to use a small amount of orthodontic relief wax makes an excellent cushion between the wire and the mouth usually in the cheek area. Simply pinch off a small piece and roll it into a ball the size of a small pea.  Flatten the ball and place it completely over the area of the braces causing irritation.  Wax can be purchased at any drug store if you are unable to get some from your orthodontist during this time. We have completely shut the practice and we are following the government guidelines as to when we can reopen safely.

Protruding Wire

The braces are active and when the teeth are moving, the end of a wire can elongate towards the back of the brace. This “growing wire” at the end can irritate the cheeks. It might be a good idea in such a case to use a  Q-tip or clean tweezer and try to push the wire so that you push it flat against the tooth. If the wire cannot be moved into a comfortable position, cover it with relief wax. This normally is provided to you in a tiny little box. You can select a very small sample, round it and press it against the end of the protruding wire so that the sharp end does not rub against your cheeks. This is very similar to the process described above.

Loose Braces or Bands

If the braces or bands have come loose in any way, please call us at 128 Harley Street Dental Suite so that your orthodontist can plan and prioritise your next appointment.

Running out of Elastic Bands

During this temporary closure due to the coronavirus pandemic, we suggest to give your mouth a “break” and stop using the elastic bands. This won’t compromise your treatment in any way but it will give us the time to catch up with your progress when we are able to meet again in person at the practice. We are hoping that normality is achieved in the next few weeks.

We would like to thank you for your understanding during these times and we will certainly be looking forward to welcoming you back in due course.

Dr Stefan Abela

Dr. Stefan Abela
BChD, MFDS, RCS Eng, MSc, MORTH RCS Ed, AHEA, FDS Orth RCS Ed

Stefan is a Consultant in Orthodontics at one of the most prestigious London teaching hospitals; Guy’s and St Thomas NHS Foundation Trust.

Stefan is also a specialist in Orthodontics and is registered on the General Dental Council (GDC) specialist list. Stefan qualified as a dental surgeon in 2003 and underwent further training in various specialties including restorative dentistry, paediatric dentistry, oral medicine and complex oral and maxillofacial surgery including the management of facial trauma.

http://128harleystreetdentalsuite.com/team/dr-stefan-abela/

We all know that in order to be exceptionally good at a particular job or task we need to focus exclusively on one thing. Inevitably, trying to be an expert in all things is just not possible. This blog post is dedicated to people looking for total satisfaction, total  orthodontics from a total specialist and seeks to explain why this is often the preferred option.

What is a specialist orthodontist?

Did you know that all orthodontists are also dentists but not all dentists or orthodontists?

An orthodontist is a dentist that has undertaken postgraduate Masters level education focusing totally on orthodontic treatments. They understand the biological processes involved in moving teeth, they understand the impact of moving teeth on biting and chewing. An orthodontist has total understanding of the potential problems and pitfalls that can occur when we try to move teeth and bone. A specialist orthodontist is a total expert in moving teeth!

Are braces worth it?

The question here is always to ask, what is it that you want to achieve with your teeth braces? Wherever possible the dental profession like to maintain the integrity of natural teeth, other ways to straighten teeth including veneers, bonding or dental crowns involve either covering your natural teeth or partial removal of natural tooth structure in order to accept a new dental crown or veneer.

Inevitably, there is then a junction between the restoration and the natural tooth and it’s this junction which can become the weak point, if it lets in even the tiniest amount of bacteria then it is possible for decay to take hold.

If you rely on total orthodontics rather than other restorative procedures then you maintain this tooth integrity and therefore have a higher chance of avoiding decay in years to come.

What determines the cost of dental braces?

The cost of braces is made up of a multitude of factors:

1. The premises in which you are seen – many practices have convenient locations in the heart of London, such as Harley Street, these premises have exceptionally high rental values which add to the cost of orthodontic treatment.
2. This skill and experience of your orthodontist – with any professional service, particularly a private orthodontic practice, you are paying for the knowledge and experience that has led your professional service provider to be able to deliver the highest quality treatment. Going to see a specialist that focuses totally on orthodontics means that:
   1. Treatment is right first  time.
   2. You get a wider range of orthodontic treatments.
   3. Treatment is tailored to your individual requirements around outcomes, treatment time, lifestyle and budget.
   4. You get the assurance that if things don’t go quite as planned your provider is able to work out the best remedial course of action, there is no need to refer you to a specialist to resolve the problem as they are a specialist themselves!
   5. Adults and children can both be seen saving you time if you wish to visit with your children.
3. The direct costs of running a practice, this typically includes:
   1. Support team, including reception, management and nurses
   2. Cross infection control – many practices have dedicated cross infection control areas behind the scenes.
   3. Consumables – many treatments involve the use of many consumables, including impressions etc
   4. Utilities of keeping the practice warm, let and powered
   5. Compulsory insurance/indemnity – this can very often run to many thousands of pounds per year.
   6. Registration with the General Dental Council.
4. Maintaining Continual Professional Development and additional training courses – this ensures you only ever receive the very best treatment.
5. The cost of the braces themselves – the raw materials for brackets, wires and purchasing of removable appliances such as Invisalign.

How long does orthodontics treatment take?

People often want to know how long it will take for braces to straighten their teeth, having a total orthodontic treatment can run from anywhere between 7 weeks and 2 years, this is sometimes why patients opt for more rapid teeth straightening treatments such as dental bonding or veneers, however we urge you to take caution with these treatments for the reasons mentioned above.

A good specialist in orthodontics will give you an idea of how long treatment will take and then plot your progress at each visit, this can then be tracked in software which allows you to see how far a long your treatment you have come at any given point.

It also allows your orthodontist to modify treatment if the teeth are not moving as initially planned.

Can I wear a removeable braces without consulting dentist?

There are a variety of online clubs which offer removable braces direct to the patient without seeing a dentist.

Buyer beware!

Here’s what to think about if you are considering purchasing orthodontics direct:

• A specialist orthodontist offers other treatments, not just a single type of orthodontic appliance. We don’t force you to have a simple appliance like you see on the Internet, you get a choice depending on your budget, ideal treatment time, lifestyle and clinical situation.
• A dentist can also repair fractured teeth improving the look of your overall smile.
• A dentist will offer follow-up reviews to ensure that your money hasn’t been wasted  and to ensure relapse doesn’t occur.
• You will have a dentist’s personal contact details to ensure you have no issues during treatment.
• An orthodontist will never send braces out in the post as they want to make sure that you have an accurate fit and that your tooth movement is predictable and measured.
• An orthodontist will ensure that both themselves and you, as the patient, are happy for signing off any treatment.

What happens if I’m not regular in my braces appointments?

One of the advantages of going to someone that specialises in total orthodontics is that you get the highest level of one-to-one care, so not coming to orthodontic appointments firstly means that you may be wasting your valuable money and not receiving the level of care that you would expect.

If your orthodontist doesn’t see you as often as they would like they are also not able to modify treatment accordingly. This can then impact both your results and the treatment time, meaning you may have to wear braces for much longer then you would ideally like.

Regular appointments will also have checks which you are not able to do at home, example brackets may have worked loose without you noticing. Loose bracket, if left could potentially harbour harmful bacteria underneath and lead to an increased risk of tooth decay. At your regular braces appointment your orthodontist will be able to spot the loose bracket and bond it back into place. Another problem with an unnoticed loose bracket is that it won’t be doing the job it is there to do and could therefore extend treatment times.

Summary

A total orthodontic treatment is a total investment in yourself and your smile. Visiting a specialist orthodontist gives you the assurance that you’ve got the most appropriate type of braces, offered with the highest level of skill and delivered to give you the ultimate smile.

Dr Stefan Abela

Dr. Stefan Abela
BChD, MFDS, RCS Eng, MSc, MORTH RCS Ed, AHEA, FDS Orth RCS Ed

Stefan is a Consultant in Orthodontics at one of the most prestigious London teaching hospitals; Guy’s and St Thomas NHS Foundation Trust.

Stefan is also a specialist in Orthodontics and is registered on the General Dental Council (GDC) specialist list. Stefan qualified as a dental surgeon in 2003 and underwent further training in various specialties including restorative dentistry, paediatric dentistry, oral medicine and complex oral and maxillofacial surgery including the management of facial trauma.

http://128harleystreetdentalsuite.com/team/dr-stefan-abela/

Many parents worry about their babies and/or children thumb sucking, is this a valid concern to have? Are there any problems with a child or baby sucking their thumb? In this blog post we take a look at some of these questions.

Baby keeping thumb in mouth – is this a problem?

There is a natural tendency for very young babies to feel comfort from having something in their mouth, this is why many babies can develop a habit of sucking a thumb or finger, in fact babies have been photographed and scanned doing this in the womb!

As babies begin to develop it, it is a normal developmental stage to begin oral exploration. The mouth is particularly sensitive and when babies put everyday objects in their mouth it allows them to begin to discover the textures and tastes of the world around them.

When babies put objects in their mouth it can also be a sign that the first  teeth are beginning to come through.

Is this a problem?

A baby that keeps their thumb in their mouth can be a problem as the constant pressure on the roof of the mouth, which is caused as the baby sucks, can begin to move the bone.

If this habit continues through into early, mid or even late childhood the bone will continue to move with this pressure. It’s a very similar process to orthodontics, orthodontic braces work by applying pressure to the tooth which moves them through the bone, when a baby sucks very hard the pressure is simply applied to the bone directly by their thumb.

This can end result in an anterior open bite where the front teeth don’t meet leading to dental work later on in life.

If your baby or child consistently sucks their thumb it may be worth considering providing an alternative appliance which allows them to soothe themselves without putting the pressure on the bone.

Toddlers fingers in mouth constantly – is this a problem?

This has the same effect as babies putting fingers and thumbs in their mouth, in and of itself it is not a problem however if the pressure on the roof of the mouth is such that the bone moves it can cause orthodontic problems later on in life.

If your toddler has teeth coming through then the pressure of the fingers in their mouth can move the baby teeth. As the baby teeth move the bone will also move which will in turn move the permanent teeth which are yet to come through.

If this habit continues swallowing and speech can also be affected as the bone moves in the oral environment.

How to fix overbite from thumb sucking

Many cases of overbite, including those caused by thumbsucking can be successfully treated using most types of braces including orthodontic fixed appliances (on the outside of the teeth), Invisalign^® or other type of clear aligners or braces on the inner aspect of the teeth; also known as lingual braces such as Win GmbH or Incognito™.

If you believe that your child has been sucking their thumb and moving the bone then it is recommended that you visit an orthodontist as early as possible, even as young as 5 years old. Early intervention orthodontics can help to assess the likelihood of problems developing later on in life and then help to prevent them throughout the developmental stages of your child and as they grow.

Management of thumb sucking

It is possible to help a child to stop sucking their thumb with 2 key areas:

• preventive therapy
• appliance therapy

Preventative therapy includes:

1. Painting the nails with a bitter or foul tasting liquid
2. Wearing a finger guards over the hands including gloves
3. Making the child where a thumb sucking guard
4. Putting the child into a long sleeved gown so they can’t get access to their thumbs or fingers
5. Age appropriate discussions and explanations with the child and positive re-inforcements such as a sticker chart

Appliance therapy includes:

1. Fixed appliances to break the habit by making the habit as difficult as possible to continue
2. Removeable appliances to break the habit by making the habit as difficult as possible to continue

Reference: Shetty RM, Shetty M, Shetty NS, Deoghare A. Three-Alarm System: Revisited to treat Thumb-sucking Habit. Int J Clin Pediatr Dent 2015;8(1):82-86

Do thumb guards work?

Yes.  They can work incredibly well to prevent thumbsucking so long as it is used in conjunction with other techniques. A child could get incredibly frustrated if they are unable to soothe themselves by sucking her thumb. This could lead to creation of other undesirable habits or they could move the habit to fingers which are not covered by the guard.

Positive reinforcement is recommended to ensure that each day or night that the child goes without sucking their thumb is recognised by the parent and that the child feels good about themselves and their achievements. A sticker chart can work really well for this to help the child assess their progress and be rewarded when they stop their finger and thumb sucking.

Should I use a pacifier (dummy) to replace a thumb

It is recommended that children do not have dummies beyond the age of about 4 or 5. if you feel you would like to switch your child over to using a pacifier instead of their thumb then it is recommended that an orthodontic dummy is used.

if a decision is made to replace thumb and finger sucking with a pacifier then it is recommended that an orthodontic pacifier/dummy is used.

These orthodontic dummies are shaped to prevent the excessive forces which are applied to the roof of the mouth during regular thumb sucking. However, they do not completely eliminate these forces so even orthodontic dummies should be used with caution.

Summary

Most orthodontists are agreed that thumbsucking, if it continues in to childhood can indeed cause long-term orthodontic problems for the children as they grow into adults. It is therefore recommended to try and break the thumbsuckers habit  as as soon as possible to avoid future problems.

Dr Stefan Abela

Dr. Stefan Abela
BChD, MFDS, RCS Eng, MSc, MORTH RCS Ed, AHEA, FDS Orth RCS Ed

Stefan is a Consultant in Orthodontics at one of the most prestigious London teaching hospitals; Guy’s and St Thomas NHS Foundation Trust.

Stefan is also a specialist in Orthodontics and is registered on the General Dental Council (GDC) specialist list. Stefan qualified as a dental surgeon in 2003 and underwent further training in various specialties including restorative dentistry, paediatric dentistry, oral medicine and complex oral and maxillofacial surgery including the management of facial trauma.

http://128harleystreetdentalsuite.com/team/dr-stefan-abela/

In a study in 2014 Bell and Kiebach observed that between 5% and 8% of children in the age group 3 to 12 years old had a crossbite. A further study conducted by Gungor et al in 2016 noticed up to 53.6% prevalence of crossbite in permanent dentition!

a normal dentition the top teeth in both the posterior and anterior regions will align on the outside of the lower teeth. In a crossbite situation the lower teeth will set on the outside (cheek side) of the top teeth.

The following video shows what the teeth look like with a posterior crossbite.

Crossbites can have dental or skeletal causes. If the cause is dental then it will just be the teeth which are in the wrong position, if the cause is skeletal this means that either the upper jaw is underdeveloped (superior retrusion) or the lower jaw is overdeveloped (Inferior protrusion), in short this means that either the upper jaw is too small or the lower jaw is too big.

Why should a crossbite be corrected?

Your jaw is an incredibly complex mechanism which effectively works as a ball and socket joint hinge, it is cleverly designed to hinge equally from both sides allowing us to chew in a circular motion rather than just up and down (like a crocodile!).

Because we have a joint on either side of our head this means we can hinge from either side and that circular movement can have central pivot point on either side of our head, depending on which way we are chewing. All of this means that the alignment of the teeth is incredibly important to maintain the integrity of not only the jaw joint itself but all of the supporting muscles.

If the teeth interfere with the movement of the jaw joint then this can result in headaches and pain. This pain can migrate down the head, face and neck as all of the muscles are interconnected.

A crossbite will more than likely mean that the teeth interfere with this smooth circular movement that the jaw would naturally like to undertake as it pivots around the jaw joint. Therefore correcting a crossbite will not only allow you to chew and eat more effectively but reduce the likelihood of headaches and additional muscle pain.

How can crossbites be corrected?

The key to correcting a crossbite is understanding the cause, is it dental or skeletal? Depending on the cause will likely effect the way your treatment is carried out. Simple dental crossbites may be able to be treated by your regular dentist using a treatment such as Invisalign however more serious crossbites or skeletal crossbites will more than likely need the skills of a specialist orthodontist and more advanced orthodontic braces.

Using palatal expansion to correct a crossbite

If your upper jaw is underdeveloped meaning that the teeth on the top are on the inside (tongue side) of your lower teeth then having the upper arch expanded will push the bone and top teeth further out therefore realigning all of your back teeth.

The simplest form of palatal expansion is an orthodontic appliance with a little screw on the inside. Each day the patient turns the screw a small amount (determined by the orthodontist), this puts the teeth and arch under constant pressure and gently pushes the bone and teeth further out.

The treatment is most commonly used in children during their developmental years as this then works in conjunction with their normal development and growth. Arch expansion can also be used in adults however it is often more uncomfortable and can take longer.

Once the expansion has been undertaken to correct the skeletal underdevelopment then further orthodontic treatments can be undertaken to move the teeth into the correct dental alignment.

Using a Quad Helix for correcting a crossbite

This type of orthodontic device has the same outcome as a regular palatal expander however it is fixed and cannot be removed by the patient. A couple of bands are attached to the molar teeth and then up to 4 active helix springs are used to widen the arch and therefore make room for crowded teeth or expand the arch to correct the crossbite.

Common questions and answers about correcting a crossbite

Can my orthodontist fix my crossbite underbite with braces?

Yes, a crossbite under bite can be corrected with orthodontic braces, more competent dentist with a special interest in orthodontics may be able to do this using Invisalign however more complex treatments are only available from specialist orthodontist.

How long will it take for braces to straighten my teeth?

It depends on exactly what type of treatment you require. Very often with a crossbite an arch expansion device is required to move the bone first.

A Quad Helix device will usually be worn for 3 to 6 months, after this time orthodontics may be used to correct the alignment of the teeth, this can take an additional 3 to 6 months depending on the orthodontic treatment used.

Is perfect teeth absolutely possible with braces?

This all depends upon your definition of perfection, however usually the answer is yes. This is another reason that a specialist orthodontist is one of the best people to visit for your orthodontic treatment. They will be able to give you a detailed analysis of the final result and let you know of any compromise before you begin treatment.

This is often achieved with detailed study models as well as digital imaging to give you an idea of the final result.

Do I need braces if I have a palate expander?

Usually you will require some form of braces after you have had a palatal expander. This is because the expander simply moves the bone and teeth to a further out position, more accurate orthodontic treatments are then required to move the teeth into the exact position required so that your the teeth meet together in the required manner.

What is the best age to get a palatal expander?

Treatment should ideally begin whilst your child is still growing, around the age of 10 is ideal. This then allows us to expand the arch during the growing process, it is much easier in children to expand and arch then it is with adults.

Dr Stefan Abela

Dr. Stefan Abela
BChD, MFDS, RCS Eng, MSc, MORTH RCS Ed, AHEA, FDS Orth RCS Ed

Stefan is a Consultant in Orthodontics at one of the most prestigious London teaching hospitals; Guy’s and St Thomas NHS Foundation Trust.

Stefan is also a specialist in Orthodontics and is registered on the General Dental Council (GDC) specialist list. Stefan qualified as a dental surgeon in 2003 and underwent further training in various specialties including restorative dentistry, paediatric dentistry, oral medicine and complex oral and maxillofacial surgery including the management of facial trauma.

http://128harleystreetdentalsuite.com/team/dr-stefan-abela/

We’ve noticed that many people are concerned about tooth decay during and after orthodontic treatments. We thought we’d take the time to go through some of the most common questions in our latest blog post.

Is it safe to get braces while having cavities?

Before having braces your orthodontist will want to ensure that you have a healthy mouth, this is particularly true if you have fixed orthodontics. If you have fixed braces fitted while having cavities then it can be extremely difficult to treat those cavities as tooth structure may need to be removed.

Orthodontics is therefore usually only carried out on a healthy mouth, free of gum disease and for patients with good oral hygiene. A good dentist or orthodontist can help you achieve this.

How can cavities be prevented while having braces on?

The best way to do this is to ensure you have good oral hygiene prior to beginning your orthodontic treatment. Our top tips on preventing cavities whilst wearing braces are:

1. Clean your teeth at least twice per day for 2 min each time with the fluoride toothpaste.
2. Keep dental plaque at bay by cleaning in between your teeth with superfloss or an interdental brush/stick.
3. Consider having a fluoride treatment at the dentist prior to having braces fitted.
4. Continue to visit your dentist, they can then ensure that any early tooth decay problems are noticed.
5. Let your dentist and orthodontist know any medical condition which you have, some conditions and treatments for those conditions can leave you more predisposed to dental cavities.
6. If your dentist or orthodontist are particularly concerned, you may have particular deep valleys (fissures) in the costs of your back teeth then these can be filled with dental sealants such as composite resin. These can drastically lower the chance of cavities developing.

What happens if you don’t brush teeth while you have braces?

A variety of things can happen:

1. The natural biofilm which is a sticky substance covering your teeth that everyone has will build up.
2. As the biofilm builds up it tends to harden and form dental plaque.
3. As the bacteria which hygienist plaque continue producing acid each time you eat or drink your teeth are subjected to attack.
4. As the acid erodes the outer surface of your tooth enamel, more bacteria find places to hide.
5. As the bacteria continue to produce the acid the dental cavity becomes larger and larger.
6. When the cavity reaches the softer, inner dentine the speed of the decay increases.
7. When the decay reaches the inner blood vessels and nerves of your tooth you will be in excruciating pain and need to see a dentist immediately.
8. If left untreated this can ultimately lead to tooth loss!

The good news is that all of this is largely preventable… Just clean your teeth whilst you have braces!

Can braces cause a tooth to die?

Braces put a reasonable amount of force on the tooth, however this is monitored carefully by your orthodontist so braces should not cause teeth to die.

Can braces cause abscesses?

No, braces cannot cause abscesses. Abscesses are caused by a deep infection underneath the gum of your tooth, typically this infection takes hold due to poor oral hygiene. Can you see a theme appearing here? Good oral hygiene is key to getting the best from your braces.

Does wearing a retainer cause cavities?

It’s not the wearing a retainer that could cause cavities, it’s not keeping a retainer clean that could cause cavities. You should clean your teeth at least twice per day with a fluoride toothpaste, making sure you clean in between your teeth with floss or a brush.

You should also clean your retainer. The same biofilm which you clean off of your teeth also sticks to a retainer. If it’s not removed at the same time as cleaning your teeth then the biofilm can simply be transferred back onto your teeth, effectively as though you haven’t cleaned your teeth in the first place!

This biofilm can then form into plaque which can harbour bacteria and causes the cavities.

Does straightening of teeth make them weak?

There is no evidence to suggest that orthodontic teeth straightening makes teeth weak, so long as you follow the advice of your dentist and orthodontist by cleaning your teeth then your teeth will not be weakened.

The only thing that is slightly weaker after orthodontics is the position of your teeth, they have a natural tendency to want to return to their initial positions, this is why wearing a retainer is important.

Are my teeth getting worse with braces?

The easiest way to determine this is to speak to your orthodontist. Most orthodontists uses tracking software on their practice computers to track progress, you should be able to see a percentage chart showing how far you are through treatment.

Why do teeth become yellow after wearing braces?

Teeth can look a little bit yellow after wearing braces for a couple of reasons:

• You may have found it a little more difficult to clean your teeth with fixed braces, a visit to the hygienist should restore then natural whiteness.
• There may be some bonding resin which the orthodontist used to stick the brackets to your teeth still on the outer surface of your teeth. Again, a visit to the hygienist can help to remove any of this difficult to see composite resin.
• Your orthodontist will have had to etch the surface of your teeth in order to bond on the brackets, this can leave the teeth a little bit rough and more likely to pick up stains. If this is the case a quick polish by a dentist or hygienist will restore your teeth and remove any yellowing.

What foods can I not eat with braces?

If you have braces you should avoid foods which are particularly sticky chewy, these can pull off the brackets which can reduce the effectiveness of your braces.

Particularly sticky foods can also be very difficult to clean after eating, this can then leave them stuck in between your teeth enabling the bacteria to start the process of tooth decay.

Dr Stefan Abela

Dr. Stefan Abela
BChD, MFDS, RCS Eng, MSc, MORTH RCS Ed, AHEA, FDS Orth RCS Ed

Stefan is a Consultant in Orthodontics at one of the most prestigious London teaching hospitals; Guy’s and St Thomas NHS Foundation Trust.

Stefan is also a specialist in Orthodontics and is registered on the General Dental Council (GDC) specialist list. Stefan qualified as a dental surgeon in 2003 and underwent further training in various specialties including restorative dentistry, paediatric dentistry, oral medicine and complex oral and maxillofacial surgery including the management of facial trauma.

http://128harleystreetdentalsuite.com/team/dr-stefan-abela/

As a specialist orthodontic practice we get to hear a wide range of questions asked by many of our patients, we thought we would collate some of the more interesting questions in a single blog post.

We’d also like to hear what you think, please do feel free to comment…

• Is it safe to get braces while having cavities?

The simple answer to this is no. Before you have any type of orthodontic brace your orthodontist will want to ensure that you have good dental health without any tooth decay. This for a  couple of reasons.

1. Tooth decay can be a sign of poor oral hygiene. If you have fixed braces then you need to ensure your oral hygiene is good to prevent further decay.
2. Tooth decay will only get worse if untreated. You will probably have your braces on for anything up to 2 years. In this time tooth decay will almost certainly get worse if left untreated. Treating the decay can be made extremely difficult if you have orthodontic braces fitted.

2. What is the difference between an orthodontist and a dentist?

All orthodontists are dentists first. However only 5% of dentists are orthodontists. An orthodontist will be registered with the General Dental Council GDC in the UK as a specialist. An orthodontist has undertaken Masters level training after their initial dental degree. Most specialist orthodontists are also registered with the British Orthodontic Society.

3. Can dental retainers correct slight shifting?

Let’s be very precise here. Strictly speaking a retainer is used AFTER orthodontic treatment to retain your teeth in their new position, a retainer is not active and does not move the teeth anywhere. However many people use the word ‘retainer’ to talk about an active orthodontic appliance. Slight shifting can be corrected with an active orthodontic appliance.

4. How to get orthodontic treatment without metal braces

Modern technology has seen the advent of a range of different orthodontic treatments without metal braces, these include tooth coloured braces (these working exactly the same way as traditional metal braces but are either ceramic or clear) and clear liners such as Invisalign. NHS orthodontic treatments we usually not include tooth coloured braces or clear orthodontics.

5. What is it like having an open bite and then getting braces?

If you have an open bite and then get braces this would usually be with a fixed appliance. An open bite is usually defined by the back teeth meeting but there being a gap at the front. Treatments can be extremely successful but usually more complex and so are often not available at a general dentist, you may find you need to see a specialist orthodontist.

6. How to know if my ortho braces are going well?

One of the best ways to know if your teeth straightening treatment is going well is to ask your orthodontist. During treatment you should have regular appointments, typically every six weeks although sometimes it may be more.

With some of the more modern orthodontic treatments such as Invisalign which use computer assisted design it possible to monitor progress based upon a 3-D computer animated modelling which was undertaken at the beginning of treatment.

Many orthodontists use a tracking system to be able to tell you how far through treatment you are, simply ask each time you go.

7. Should I get braces if I like my smile?

Not all braces are for cosmetic reasons. Sometimes patients find it difficult to eat and chew due to the position of their teeth, braces can help in this situation also.

Sometimes braces can also be used to move teeth to a more convenient location for other treatments such as a dental implant or a dental crown. Moving teeth like this is usually for health benefits making teeth easier to clean and maintain rather than for cosmetic options.

8. How do orthodontists plan a treatment?

Your orthodontist may take impressions at the beginning of treatment, these can then be used to plan treatments in advance. Teeth can be moved on these orthodontic models and final positions calculated.

Modern treatments such as Invisalign also use computer assisted design to plan treatments. Invisalign uses a patented system called a Clincheck, this produces a visualisation of your tooth movement from beginning to end of treatment. It allows you to see what you will look like after your orthodontics and is an excellent adjunct to the orthodontic planning process.

Unfortunately Invisalign is not available as an NHS treatment.

Orthodontists will also use their extensive knowledge and case history to be able to plan treatments. Ask to see previous cases which are similar to yours, a good orthodontist will have a book of before and after photographs which would show patients and how they treatment was planned and executed.

9. How to feel more confident with orthodontic braces?

If you are concerned about having orthodontic treatments don’t speak to your orthodontist and talk about discrete options. Tooth coloured braces or clear braces may often be available.

An alternative is to go completely the other way, many patients are nowadays asking for brightly coloured orthodontics and making them a fashion statement in themselves, very much like brightly coloured glasses!

The choice really is yours, only by having a full discussion with your orthodontist and being completely honest and open about what you want to achieve will ensure you get the best result you.

After all, having orthodontic treatments is often all about confidence in a new smile, so it’s equally important to feel confident throughout the process either by showing off your new braces or by having discreet or invisible options to keep things hidden.

10. How much do braces cost in the UK?

Orthodontic braces typically cost from £1495 for either the top or bottom. Simply considerations and questions to ask are:

• Are all appointments included in this fee?
• Will I have to pay an additional fee if treatment goes on longer than originally estimated?
• Do I have to pay for an initial consultation or is there a free consultation?
• Are retainers included in this free?
• If my braces break is a repair included in this free?

A quick thought about free consultations. Many practices say they offer these but are really just a quick free chat without any detailed clinical investigation. After a consultation you should ensure there is:

• An opportunity for you to have a detailed discussion with orthodontist about your concerns and requirements.
• A full treatment plan with all of your options carefully explained.
• A detailed pricing structure helping you decide which route to smiling confidently is best for you.

Dr Stefan Abela

Dr. Stefan Abela
BChD, MFDS, RCS Eng, MSc, MORTH RCS Ed, AHEA, FDS Orth RCS Ed

Stefan is a Consultant in Orthodontics at one of the most prestigious London teaching hospitals; Guy’s and St Thomas NHS Foundation Trust.

Stefan is also a specialist in Orthodontics and is registered on the General Dental Council (GDC) specialist list. Stefan qualified as a dental surgeon in 2003 and underwent further training in various specialties including restorative dentistry, paediatric dentistry, oral medicine and complex oral and maxillofacial surgery including the management of facial trauma.

http://128harleystreetdentalsuite.com/team/dr-stefan-abela/