Orthodontists estimate that 1 in 5 children need braces treatment to correct bite problems, although up to 75% of children will benefit from having treatment to straighten teeth and improve the shape of their face. The decision to embark on a few years of treatment needs careful consideration as it involves patients understanding their treatment expectations, financial cost involved and the need to find a qualified orthodontic specialist.


1. Recommended age for braces treatment.


When most people think of dental braces, they think of teenagers. The reason for this is because the response to orthodontic treatment is most predictable during the teenage years. During early adolescence, the average teenager would have completed the transition to their permanent teeth, while the jaw bone is still growing and relatively mouldable. Most of them would also have a routine lifestyle, which enables them to attend regular monthly reviews with their orthodontist. All these culminates in a faster treatment time and greater degrees of improvement during treatment.


2. There is no age limit for braces treatment.


Developed countries like Singapore have a very large number of adults with braces. In fact, almost half of the orthodontic patients in some practices are adults. This trend has been increasing over the years as orthodontic treatment become more socially acceptable, affordable (adult patients usually pay for themselves) and with the introduction of “invisible braces”. While most adults seek aesthetic improvement, an increasing number are choosing orthodontic treatment to facilitate other types of dental treatment (example, localize space for the replacement of a missing tooth) or to make routine personal care at home easier. The treatment plan for an adult often differs from a teenager’s, as the orthodontist would have to take into account the existing dental and gum condition, overall health, soft tissue support of the lips and cheek, lifestyle as well as expectations of the adult patient.


3. Timing of your child’s first visit.


Your child will benefit from a visit with an orthodontist when the baby teeth is starting to change over to the permanent set, usually at 6 to 7 years old. The most common reason for crooked teeth is due to a lack of space and disruption in the pattern of permanent teeth eruption. Teeth that are erupted into a poor positions may affect the child’s bite and result in uneven jaw or facial growth.


Early diagnosis and intervention (when needed) often prevents a ‘full blown’ presentation of the developing problem and in some cases may even eliminate the need for future braces treatment. The window of opportunity for intervention is relatively short and depends significantly on parental awareness.


4. Biting well is important for long term health.


Dental braces treatment accomplishes much more than just straight teeth. Your orthodontist will assess the way your upper and lower teeth meet when you close your mouth, the position of your teeth in relation to your lip and tongue, the health of your gums and jaw joints, areas that trap food, the way you speak and breathe, besides the alignment of your teeth. Orthodontists understand that patients who request for straight teeth often expect to be able to use them for a long time to come.


5. An Orthodontist has a lot more training.


Orthodontists are dentists that have additional years of training in teeth movement, facial growth, smile aesthetics and jaw function. They are accredited by the Dental Specialist Accreditation Board of Singapore to ensure that patients have access to a high quality of orthodontic care and are in safe hands.


Does this mean that a general dentist should never do braces? The answer unfortunately is not so straightforward. Some dentists may have taken short courses to learn about teeth movement and render simple orthodontic treatment. Perhaps it is a good idea to ask your dentist how many orthodontic patients has he treated in the past year as well as how complicated your case is. Take heed that teeth movement will in most instances change the way you bite and affect the function of your jaw joint. Most patients would not relish the thought of spending more of their hard earned savings for remedial treatment with an orthodontist should things go awry. Another way of looking at this is would you get brain surgery from a surgeon who only operated on brains occasionally?


6. Get a second opinion, or maybe even a third.


Since it may not be easy to make a decision, consider getting a second opinion or maybe even a third, before going ahead with treatment. This is especially so if your proposed plan involves teeth extraction, jaw surgery or has been deemed to be complicated. There are many ways to move teeth, and different orthodontists may favour different approaches. You need to know your options and the “right decision” will hinge on your comfort level with the attending orthodontist, your immediate and long term expectations of treatment as well as what you can afford.


Allowing the orthodontist to take photos, x-rays and moulds of your teeth gives him more information to formulate your treatment plan. It will also allow him to make a better estimate of the total treatment cost, duration of treatment and conduct treatment outcome simulations (where appropriate). If you are not ready to proceed for the above, your orthodontist will still be able to provide you with an intelligent guess of what needs to be done, the different types of braces available, the likelihood of teeth extractions, rough duration of treatment and approximate cost.


7. The type of braces used is not a predictor of success.


Many adult patients go to an orthodontist, hoping that they can get “invisible braces”. In reality, only some are suitable candidates for such a treatment. Similarly, a lot of parents hope that their child can be treated without the need for teeth extractions by using “self-locking brackets”, although only about half of the local teenage population can be treated adequately without teeth extractions.


Orthodontic treatment success depend on the type of teeth movement needed, the amount of space available and time needed to effect teeth movement. No one system is perfect and each system will have its own pros and cons. If you have your heart set on a particular system, ask your orthodontist on his opinion. You will need to allow him to speak his mind and be open to making joint decisions so that he can help make things work for you.


Manufacturers of orthodontic devices and appliances spend a lot of money on advertising and marketing to potential patients. Yes, that’s you. While any improvement in comfort, handling and appearance is much appreciated by both patients and orthodontists, it’s not the device that make the difference, it’s the technique and experience of the orthodontist who is treating you!


8. Cost of braces treatment in Singapore.


The average cost of dental braces treatment is between $4,000 and $7,000, depending on your condition and the experience of the orthodontist you are seeing. Most insurers do not cover the cost of orthodontic treatment for cosmetic reasons, although some dental plans may offer partial coverage for treatment due to health related reasons. In most instances, dental braces treatment does not qualify for subsidy at public hospitals and clinics, nor is it payable using your Medisave account. In a nutshell, the cost of dental braces treatment is fairly similar across both public and private clinics within Singapore due to the above reasons and the small geographic area.


9. Know the total cost of treatment.


Some clinics offer an easy payment plan to help manage the cost of treatment, allowing for a down payment of about $1,000 to $2,000, with the balance paid via a monthly instalment plan. Prior to starting braces treatment, your orthodontist will draw up a treatment plan and counsel you on the total cost of treatment. He will share with you important details, such as the cost of orthodontic records, the need for other dental treatment (example, extractions of teeth), the terms of payment and whether retainers are included in your treatment cost. If you should encounter sudden, unexpected financial difficulties during treatment, talk to your orthodontist or his office manager about working out new terms with you. Most orthodontists would very much like to complete your treatment as long as everyone involved is committed to making things work.


10. Grow roots.


In an ideal scenario, both you and your orthodontist would be able to complete the treatment together. Sometimes however we may need to relocate due to personal reasons or work. Inform your orthodontist at the very first instance, so that a mutual decision can be made. Depending on your treatment progress, your orthodontist may offer to complete your treatment early (where possible) or make adjustments to your remaining payments to facilitate your transfer to the care of another colleague.


Once you are in your new location, you will need to scout for a new orthodontist. You can help smoothen the transition by giving the receiving orthodontist permission to access your previous records, taken by your previous orthodontist. Alternatively, you can request for the records yourself and pass it to the receiving orthodontist on your first visit with him.


There is usually no discount for transfer patients as the receiving orthodontist will need to try to understand what has been done and take over the responsibility of finishing the treatment as planned. In some situations, it can be more complicated for the receiving orthodontist to finish your treatment as he may have preferred a different approach to your treatment. Be prepared to pay more than you have initially provided for in the event of a need for a transfer.


 11. You control the treatment time.


How long will you be wearing braces? The average treatment time is eighteen months for teenagers and two years for adults. Some easy (and cheap) ways of beating the clock is to ensure that you keep your teeth and braces clean by proper brushing after each meal, avoiding breakages by eating sensibly, keeping appointments and complying with your orthodontist’s instructions. While this may seem like a long time, it often go by faster than we realize when treatment goes smoothly.


There are other methods for moving teeth faster, but as in all things, look before you leap! Some adjunctive procedures can complete teeth movement in half the usual time. Unfortunately, the procedure involves gum and bone surgery around the roots of the teeth (which is likely to be uncomfortable and increases the risk of complications) to accomplish its goals. Another method incorporates the use of a vibrating device to stimulate the supporting bone of the teeth to remodel faster. While short term studies show no side-effects with its use, there is also little evidence to show that it actually works to makes treatment significantly faster. The device does not come cheap and at the time of writing has not been approved for patient use by the local regulatory authorities.


12. Stay clean.


Spending time, effort and money on your teeth only makes sense if you are willing to care for them well, during and after treatment. Your ability to keep clean during treatment reduces the likelihood of teeth decay, avoids bad breath, allows your treatment to progress faster and ensures a well groomed appearance. While this may seem troublesome, getting into the habit of brushing after meals is easy if you keep an extra dental kit at your workplace or in your school bag. The kit should contain a toothbrush, interdental brush and travel sized tube of toothpaste. Keeping snacks and beverages to meal times also helps to reduce the need for repeated brushing throughout the day.


Start by brushing at a 45° angle toward the base of the brackets from the top and bottom. Use a small interdental brush or oral irrigator (example, Philips Airfloss, Waterpik) to clean the nooks and crannies in between the brackets which lie under the archwire. Finish up with your usual way of brushing for the areas without braces. Patients using Invisalign or retainers would be able to brush normally as these devices are removable.


13. No pain, no gain!


Teeth movement hurts! While putting on the braces is painless, most patients will experience some tenderness of their teeth that last a few days after every tightening appointment. Patients on invisalign treatment should also expect similar discomfort after fitting on a new tray. Some patients may experience some mouth sores due to the proximity of the brackets to the lips, tongue and cheek during the first few weeks after placement. Taking simple painkillers, using ulcer gels or sucking on ice can help reduce the discomfort and help provide temporary relieve. Your orthodontist would also coach you on how to protect your lips from the brackets, using orthodontic wax. If your teeth feels especially tender to bite on, cut or dice your food into smaller pieces and eat using small mouthfuls. Most patients get seasoned to the presence of the brackets by the first month and may even “forget” about them after a while.


14. Hypersensitivity reactions.


It is important to share known allergies with your orthodontist. A high percentage of women (up to 17% in some studies) and a lower number of men (up to 3% in similar studies) are allergic to Nickel, a common metal found in orthodontic brackets and archwires. Latex examination gloves and elastics used during braces treatment, which comes into close contact with your skin, is another known allergen. The incidence of latex allergy is fortunately low, at approximately 1% of the general population. Recently, there have also been several reports of allergic reactions associated with the material used in the fabrication of “invisible braces” trays.


Mild allergic reactions may manifest as a persistent skin itch, redness, increased or decreased gland secretions, nausea, burning sensation and/or soft tissue swelling adjacent to the irritant material. Severe allergic reactions, although rare, can cause potentially life threatening breathing complications. Always discuss your concerns with your attending orthodontist as allergic reactions can occur suddenly during treatment. Your prompt response will ensure that appropriate precautions can be taken and alternative treatment plans explored.


15. Retention is KEY.


Approximately 3 out of every 10 patients will experienced a very stable result. In other words, they can cheat by not wearing their retainers as instructed, avoid going back to their orthodontist, and yet not experience any unwanted teeth movement. That also means that 70% of orthodontic patients will be prone to experience some degree of unwanted teeth movement after orthodontic treatment, phenomenon termed as “Relapse”. Unfortunately, there is no simple test at present that can tell which group you belong to. Most orthodontists will advised you to be prepared to wear your retainers forever until they can ascertain your risk of relapse after several years of observation.


Ahem, forever, are you serious? Well, it really depends on you. Remember, the retainers act as a safeguard to protect the time, effort and money that you have put into your smile. The first 6 to 12 months after treatment completion often involves full day retainer wear, including sleeping. It can be removed for eating, brushing and when playing contact sports. Your orthodontist will monitor the alignment of your teeth and the way you bite during this period and make recommendations to switch to night wear, when sleeping, if he is satisfied with how your teeth is settling.


16. Types of retainers.


The retention phase start when your braces come off. Your orthodontist will take an impression of your newly aligned teeth and provide you with a set of retainers. There are a few different type of retainers, each with its own pros and cons.


An Essix retainer is a clear plastic retainer that looks like an Invisalign tray. It is removable, comfortable, transparent, and does not alter normal speech. The disadvantage is that it may need to be replaced yearly due to wear and tear.


A Hawley retainer is made of plastic and metal wires. It looks like a denture without teeth. The plastic fits behind your teeth, while the metal wire wraps around the front part of your teeth. It is durable, removable, allows your upper and lower teeth to meet naturally and your orthodontist can make minor adjustments to its fit. The disadvantage is that it is less comfortable and may affect normal speech. 


A Bonded fixed retainer is made by affixing a metal wire on the back surface of your front teeth using tooth coloured dental filling material. It is very lifestyle friendly, comfortable and does not affect speech. The disadvantage is that it is not removable, thereby interfering with routine brushing and flossing. You will likely need more frequent cleaning visits with your dentist if you choose to use a fixed retainer. 


Like most thing in life, there is no such thing as a perfect retainer. You, together with your orthodontist, will have to decide on the type that suits your lifestyle and expectations the most so that you can wear it as instructed.


17. Caring for your retainers.


Caring for your retainers is important to keep it clean and free from deposits. Like your teeth, you can brush your retainers with a toothbrush and toothpaste. Soaking them in cleaning solutions like RetainerBrite for 30 minutes every day will help dissolve stubborn deposits and kill germs. Avoid using hot water or soaking them in antiseptic mouth rinses as it may damage or discolour your retainers. 


18. Don’t spend more than you have to.


Patients who do not comply with their retainer wear run the risk of having their teeth move out of position. It is not uncommon for young adults to seek retreatment after such an occurrence. Do be reminded that there is no frequent flyer discount for retreatment.


Keep your retainers safe by using a retainer box when you are not wearing them. One way to lose them quick is by wrapping it in tissue paper when eating out. It will eventually result in the retainers being accidentally thrown away or left behind. Storing it in your pocket or bag increases its risk of breakage. A new retainer cost between $200 and $300, so take good care of it!


Should you lose or break your retainers, inform your orthodontist IMMEDIATELY! Quick action is needed to ensure that a new dental impression can be taken to fabricate a replacement set. Preventing unwanted teeth movement is of course way easier (and cheaper too!) than retreatment.