If it seems like every second teenager – not to mention quite a few adults – has braces, you may be right. Braces are more popular than ever, with a variety of options marketed at different price points and lifestyles, including the new clear aligners such as Invisalign and lingual braces from Incognito.
Braces are used to fix a range of teeth and bite issues, but despite the marketing hype not all types of braces are suitable for everyone – certain problems will do better with some braces than others. Your orthodontist is best placed to determine what will and won't work for you.
We take a look at:
We also surveyed CHOICE members about their experiences with braces, using their observations to help compile our top tips when shopping for and wearing braces.
Types of braces
Brackets and wire
Conventional braces have come a long way since the metal train tracks of old. For one, the brackets (the bits that stick on your teeth) are smaller, can be made from stainless steel, titanium or ceramic, and can be silver, gold, clear or tooth-coloured. Stainless steel brackets are the most economical option.
The wires that ultimately pull the teeth into alignment are usually made from titanium alloy or stainless steel. Like the brackets, they also can be tooth-coloured, making them less obtrusive (and more expensive).
There are different systems for holding the wire: the most common system, the so-called fixed edgewise appliance, involves wire ties or small elastic bands – available in a rainbow of colour choices – which secure the wire within a slot on each bracket.
An alternative is a self-ligating brace, where the brackets have a channel accessed via a spring-loaded door – the wire travels through these channels. The brackets themselves are smaller and the appearance less obvious than the elastic band system, and they come in silver-coloured or clear versions. Proponents say that the reduced friction on the wire makes it work faster with fewer visits to the orthodontist, though these claims aren't backed up by scientific evidence.
Dr Mithran Goonewardene, spokesperson for Australian Society of Orthodontists, says there's little evidence that any one brand or system of fixed brace is better than another, and while computer-assisted braces technology shows promise, there's no high level evidence to support it yet. Ultimately, the efficiency and success of treatment comes down to the skill of the practitioner.
Clear aligners (Invisalign, ClearCorrect, ClearPath)
There are a few brands of clear aligners competing for market share in Australia, but Invisalign is probably the best known. Invisalign hit the market in 1999, targeting adults with the promise of teeth straightening without braces. According to the company, more than three million people around the world have started Invisalign treatment. It consists of a series of clear plastic moulds – think slimline mouthguards – which are worn for about 22 hours a day. Although only a small number of the 241 survey participants had used Invisalign, the majority spent more than $7000 on them, and it's likely conventional braces would be more economical.
Using 3D imaging of your teeth as they are at the beginning of treatment, a series of steps involving gradual movement of teeth towards the desired final result are computed, and moulds are made for each step. The number of steps depends on how much movement is required. You wear a set for about two weeks, then change to the next set, with each set moving your teeth slowly toward the desired effect. Attachment points – tooth-coloured plastic bumps on your teeth – may be added to help the aligners get a better grip, and 'buttons' to hold elastic bands may also be required.
The system offers a couple of key advantages over the traditional wire and brackets braces: they're almost unnoticeable to others and they can be removed for eating and cleaning teeth or even for a special occasion. Invisalign is best for mild to moderate problems with crowding and alignment, and for people who have previously worn braces but have suffered relapse through not wearing their retainer.
While the company claims they can treat most orthodontic issues, Dr Goonewardene explains that the results are unpredictable, especially for certain movements such as tooth rotation or vertical movement of teeth. More research is needed to see if the effects last as long as conventional braces.
Before going down the clear aligner route, ask yourself if you have the diligence required to look after them. This means wearing them at least 22 hours a day every day. It means taking them out for meals and drinks, then brushing and flossing teeth and cleaning the trays before putting the trays back in – possibly while you're out and about. You'll also need to look after them when you take them out – replacing a lost or damaged set is expensive.
"My dog ate an Invisalign set when I took them out for eating." (Giuseppe, Victoria)
Lingual braces (Incognito, Harmony)
The ultimate in non-obtrusive braces are lingual braces – braces attached to the inside surface of the teeth. All other things being equal, they are more expensive than braces on the outside of the tooth, and appointment time for adjustments is longer because it's more fiddly. The main drawbacks are that they're a little less efficient than external braces, it's harder to keep teeth clean, they irritate the tongue and they can affect speech (though that is temporary until you get used to them).
Fast fix (short-term orthodontics, FastBraces, Smilefast, Six Month Smiles)
Need a great smile in a hurry? There are brace systems which claim to work faster – and cheaper – than conventional braces, perhaps by virtue of "special" wires or brackets. These systems can be offered by general dentists rather than orthodontists.
Dr Goonewardene points out that they can help straighten the six front teeth – the so-called "social six" – but can't be used to fix problems with bite. That's fine if you only want straight teeth, but in that case, in the hands of a skilled practitioner, you could get similar and faster results with other products.
Other means of speeding up treatment are using devices that vibrate or use low-level light therapy to speed up the process of bone breakdown and reformation. Experts say they may work, but there's no good evidence yet.
Maintenance after orthodontic treatment
Once the braces are off, you'll most likely need to wear a retainer to maintain your beautiful new smile. It might be a fixed retainer, with a wire attached to the back of your teeth, or a removable retainer. If it's removable, you'll need to wear it full-time at first, then at night, perhaps dropping back to every other night or once a week.
In our survey, 85% of those who wore braces in the last 20 years were asked to wear a retainer post treatment. Most – but not all – of them wore them as instructed: 38% always, 43% often/most times.
"I wish I had known I would have to use the retainer for the rest of my life to prevent my teeth from reverting to the original position. I was led to believe that I would need the braces/retainer for two or three years, then would not need them at all." (Steve, ACT)
"My teeth have moved back a lot due to not wearing the retainer as instructed, but are still better than before braces." (Laura, NSW)
"Go to a dentist rather than an orthodontist if possible. Much cheaper!" (Margaret, NSW)
"Use a trained orthodontic specialist for orthodontic work, and use a dentist for general dental work." (Cathy, Queensland)
Orthodontists are specialist dentists who've undergone an additional three-year university degree in orthodontics where they learn how to diagnose, prevent and treat facial irregularities to correctly align teeth and jaws.
These days, more and more general dentists are offering orthodontic treatment. With systems such as clear aligners or some of the "social six" fast treatments apparently requiring less expertise than that of an orthodontist, it can be quite lucrative (the chief clinical instructor for Six Month Smiles calls his product "a gold mine for general dentists".) In addition, patients benefit from being able to use their trusted family dentist, have their regular dental needs attended to simultaneously, and perhaps save some money – as long as everything goes right.
Going to an orthodontist offers several key advantages:
- They are the experts in straightening teeth and correcting bite. This is what they've been trained in for three years, and what they do day in, day out. That depth of knowledge and experience cannot be matched by a general dentist.
- Successful treatment is contingent upon an accurate diagnosis and assessment of your teeth and jaw issues – knowledge and experience are critical for this.
- An orthodontist has many tools – systems of braces – at their disposal, and they can choose the best one for your situation, which may change during treatment depending on how your teeth respond. The tool your dentist uses may not be the best one – or even a good one – for your situation.
The example of clear aligners is case in point. Figures from Dental Protection Limited, the professional indemnity insurers covering most dental practitioners in Australia, indicate that 80–90% of malpractice claims due to clear aligners involved dentists rather than orthodontists.
Dr Goonewardene explains, "If we have 100 patients with exactly the same problem, there will be an incredible variation in the way they respond. Orthodontists can adapt the treatment to the response, and revise the treatment as it goes. This is impossible to teach in the general dental curriculum, or in a weekend orthodontics course."
- Check the practitioner's credentials – ask about their qualifications, experience and results for previous patients. You can look up a dental practitioner on the Australian Health Practitioner Regulation Agency website – it will tell you if they're an orthodontist (specialist dentist) or general dentist.
- Ask for personal recommendations for a practitioner from friends, family and parents at your child's school. You don't need a referral for an orthodontist.
- Cost and treatment times vary depending on the complexity of the case.
- Get a second or third opinion if you're not convinced about the diagnosis or treatment plan. The consultation may cost you $100 or more, but if you're spending thousands, it's important to be confident with the treatment.
- That quick, cheap fix might cause more problems later, requiring expensive undoing and more time in braces.
- What happens if you need to discontinue treatment – the practice closes down, or you move to a new city for example? Members of the Australia Society of Orthodontists are bound to a formula where payments are proportioned between the initiating orthodontist and a new orthodontist, so you won't bear the full cost twice.
- Check your health insurance rebate – you'll probably be surprised at how little is reimbursed.
- Look after your teeth. Follow instructions for brushing and flossing, and cleaning appliances; avoid sweet, sticky, hard foods and sugary drinks; keep up your regular periodontal appointments.
- Wear a mouthguard over your braces when playing contact sports and sports where you might inadvertently cop a blow to the face from a fall or object.
- Wear your retainer. Your teeth will continue to move throughout life, and without a retainer all the work from braces will come undone.
We surveyed CHOICE members to find out about their experiences with braces and other tooth realignment treatments. 2500 Voice Your Choice members were invited to participate in the survey. From the 379 members who responded, 241 were qualified to answer the survey. Thank you to all of you who took part.
Overall, most of the members seem happy with their braces treatment, and 90% said they felt the treatment was successful, that the condition of teeth has improved and teeth have become aligned.
In terms of experiences and what people should look out for, members mentioned doing research and being aware of what the treatment will be. Getting expert opinions from orthodontists (known or previously recommended), consulting more than one orthodontist, proper dental hygiene and care once the braces are in are also mentioned.