Dental Surgery Hove
Dental Surgery East Grinstead

01342 313886

01273 711507

Patient Information:

Removable Orthopaedic Appliances

We have already stressed the need for co-operation. Beyond this there are some pointers that can be very helpful.

Cleaning: Both the appliances and the teeth must be cleaned regularly. There are brace soaking cleaners which work quite well used on a daily basis to clean the appliances. However, an electric toothbrush is the best method to clean the appliances. Be Careful. Do not bend any of the wires while brushing the appliance.

The teeth should be brushed twice a day with a fluoride containing toothpaste. Flossing is also important in preventing cavities from forming in between the teeth. If brushing is impossible, taking water and swishing it around the mouth is the next best way to clean the teeth.

Wearing: All appliances should be worn full time unless otherwise instructed by the dentist. Exceptions can be for eating and cleaning. Some appliances are best removed during contact sports. The dentist should be consulted and will advise regarding each individual situation.

Lost Appliances: Most removable appliances are lost as a result of the patient removing them for eating. The dentist will supply an appliance box with your name and address. If, however, the appliances are not place into the box they can easily be lost. The appliance should never be wrapped in a tissue or napkin as they can be easily mistaken as rubbish and lost forever. Appliances are no different than eye-glasses. They must be properly cared for.

A second major cause of loss is the household dog. Dogs love the smell and taste of an appliance after it has been in the patient’s mouth. They will chew on it or even bury it much like they would a bone. Keep the appliance and the box well out of reach of the family pet.

If an appliance is lost or destroyed, the dentist will pass the expense of replacement on to the patient or parent. Appliance therapy is not overly expensive if patients and parents are responsible.


Fixed Appliances

The most important fact to remember about fixed appliance therapy is hygiene. If the patient does not keep the appliance clean, either decay or a change in tooth colour will result around the braces. The patient must brush after every meal, being careful to clean around each individual tooth. Inter-proximal brushes (like tiny bottle brushes) must be used between each bracket at least twice a day. A fluoride mouthwash is also recommended.

If these rules are observed, no damage will occur to the teeth or gums as a result of orthodontic therapy.

A second major factor in appliance care is diet. Orthodontic appliances are very delicate and can be easily damaged by improper diet. Sticky foods such as chewing gum and sweets must be avoided. In addition, hard items such as nuts, apples and crisps can break the appliance away from the tooth. Common sense dictates that careful attention to eating habits can speed treatment and reduce the cost of orthodontic therapy.

If elastics are required as part of the therapy, they should be worn exactly as requested by the dentist. All elastics bands should be exchanged for new ones every twelve hours. When the elastic supply becomes low, please contact your dentist for an additional supply.


Careful what you eat!


  • Sweets
  • Toffees
  • Chewing Gum


  • Nuts
  • Apples
  • Crisps


  • Fizzy drinks
  • Fruit juices

Healthy Tips:

Drink plenty of Water and avoid snacking between meals.



There are a number of different kinds of retainers. The dentist will select the particular type of retainer that is best suited for each patient. No matter what type of retainer is used, it is extremely important that it be worn according to the dentist’s recommendations. Everyone has too much invested in the treatment to let a few careless months spoil the results.

Don’t forget that “triangle of success“.


Some further small print of the pros and cons:

Orthopaedic treatment for TMJ problems is not considered the mainstream approach in the UK.

Root resorption, which is progressive shortening of the roots, may occur as a result of any treatment involving the wearing of appliances.

Loss of tooth vitality (where the nerve within the tooth dies) can occur with orthopaedic/orthodontic treatment although it is usually related to a large cavity, filling or traumas to the tooth.

Unfavourable growth during the treatment e. e. strong lower jaw forward growth, can affect the treatment outcome.

TMJ (jaw joint) problems can arise during treatment but often the treatment we use actually helps TMJ problems.

Enamel reduction and some tooth reshaping may be required to correct crowding.

Tooth size discrepancy and minor spacing can occur if teeth are very small or not symmetrical. This may require some bonded restoration.

The majority of treatment times can vary from six to twenty four months, although there may be some interval between the orthopaedic and orthodontic phases. Your dentist will give you some idea of the approximate treatment time for your proposed treatment.

Relapse can happen very quickly, especially if retainers are not worn correctly. Some minor relapse can occur even with good co-operation.

Orthopaedic/Orthodontic treatment for TMD (jaw joint problems) can and has been a successful method for treating patients. However there is as yet no evidence-based research to support its use, in preference to any other form of treatment for TMD.



It is the goal of everyone concerned to create beautiful smiles, beautiful faces and teeth that will last a lifetime. The time and expense that is required to attain this goal is a nominal investment compared to a lifetime of rewards.


Common Questions

As with anything that is new and unfamiliar, many questions always arise. The following are the most common. If you do not find an answer to your question be sure to ask the dentist. The more you understand about the treatment, the better it will progress.

What is orthodontic treatment?

Orthodontic treatment is a way of straightening or moving teeth, to improve the appearance of the teeth and how they work. It can also help to look after them long term health of the teeth, gums and jaw joints, by spreading the biting pressure on all the teeth.

Why should I have orthodontic treatment?

Many people have crowded or crooked teeth. Orthodontic treatment will straighten the teeth or move them into a better position. This cannot only improve their appearance but also the way that the teeth bite together, while also making them easier to clean.

In some patients the upper front teeth can stick out and look unsightly. These prominent teeth are more likely to be damaged but orthodontic treatment can move them back into line. In others the way that the upper and lower jaws meet can cause teeth to look unsightly and lead to an incorrect bite. Orthodontic treatment may correct both.

When teeth do not meet correctly, this can put strain on the muscles of the jaw and joint problems and in some cases headaches. Orthodontic treatment can help you bite more evenly to reduce the strain.

What caused the problem in the first place?

No one knows the exact cause of every orthodontic problem. Some causes are very evident, such as thumb sucking. Most are much more complex. However, the old cliché that the patient inherited dad’s teeth and mother’s jaw is simply not correct.

At what age should I have orthodontic treatment?

Orthodontic treatment is generally best carried out in children, but adults can have orthodontic treatment – and more and more are doing so. Age is less important than having the proper number of teeth. In children it may be necessary to wait for enough teeth to come through before starting treatment.

Who carries out orthodontics?

Any dentist may carry out orthodontic treatment. Or the dentist may send the patient to a specialist who has extra qualifications. The specialist may be in a practice or in a hospital department, and is called an orthodontist.

How do I go about getting orthodontic treatment?

The first thing that you need to do is to go along to your own dentist and get his or her advice. Your dentist will know whether you need treatment and can begin to plan the next stage to proceed.

What does it involve?

The most important thing is to have a full examination. This will usually involve looking at the teeth, taking x-rays and making plaster models of your teeth.

Your dentist or orthodontist will them discuss what treatment is possible. Once you want to go ahead, the treatment can begin as soon as you have enough permanent teeth.

Will I need to have teeth taken out to make room?

You may not have enough room for all of your permanent teeth so it may be necessary to create space by using Orthopeadic- orthodontic treatment to create space. We do not believe in removing teeth to create more room, but in some severe cases it is necessary.

How is treatment carried out?

Orthodontic treatment can be done by many sorts of appliances, which most people know as braces.

How long will it take?

The length of treatment depends on how severe the problem is and may take anything from a few months to two and a half years. Most people can be treated within two years.

How many visits will it take?

Orthodontic appliances usually need adjusting every 4-8 weeks. Your orthodontist will tell you how often your appliance will need adjusting.

Will it hurt?

All appliances may feel strange to begin with and can cause discomfort if the problem doesn’t go away the orthodontist may be able to carry out adjustments to help. Teeth are usually uncomfortable immediately after adjustment but this will eventually settle.

How successful will it be?

Success depends on partnership between the skills of the orthodontist and the enthusiasm and help of the patient (and in some cases parents.) It is important to attend regularly and carry out any instructions given by the orthodontist.

The success of the treatment also depends on the commitment of the patient. For children’s orthodontics it is very important that the child is as keen as the parent.

Even after retention, it is normal for minor tooth movements to happen throughout life, so no permanent guarantee can be given. However it is unusual for teeth to alter enough to need further treatment.

How much does orthodontic treatment cost?

Once your case has been assessed and your treatment options explained to you, you will be able to decide which appliances would be both suitable for your needs and which would work for you. Once the orthodontic system has been chosen the orthodontist will give you a detailed treatment plan with a breakdown of cost for your treatment as each patient’s orthodontic case is priced differently depending on the appliances that need to be used.

What is a removable appliance?

Simple treatment may be carried out with a removable appliance ( a plate that can be taken out to be cleaned) It has delicate wires and springs attached, which move teeth using gentle pressure.

What is a functional appliance?

It is sometimes possible to change the way that jaws grow, using orthodontic appliances. These functional appliances use the power of your jaw muscles and can help with certain types of problem.

What is a fixed appliance?

Often teeth need to be guided more accurately than they can be using a removable plate, so fixed appliances are used. These have brackets and bands temporarily stuck to the teeth. A flexible wire joins all of the brackets and allows the teeth to be moved. It is not possible for the patient to take the appliance out, so it is called a fixed appliance.

What are the brackets made of?

Fixed braces are not always made of metal. Plastic and ceramic can be used, especially for adults. You cannot generally get these braces on the NHS but they are offered as a private treatment option.

What are "Invisible Braces"?

They are tough clear plastic aligners (moulds) that are used to straighten teeth. Several sets of specifically moulded, slightly different aligners are made for each patient. Each set is worn for two weeks before being replaced with the next one. They are made of clear plastic, so they are invisible. This means that no one can see that you are straightening your teeth.

The aligners should be worn for around 22 to 23 hours a day for the best results. They can be easily removed for eating and drinking, brushing and flossing. You need to have all of your adult teeth before you can have this treatment.

What is headgear?

As well as an appliance it is sometimes necessary to wear headgear. You usually only need to wear the head gear in the evening or at night, if you do not wear it in the way that you have been told, your front teeth will stick out at the end of the treatment.

What are elastics?

It may be necessary to attach delicate elastic bands to a fixed brace to help move the teeth. Your orthodontist or dentist will let you know if you need elastics.

What will happen when your teeth are in the correct position?

When the treatment is finished the teeth need to be held in position for a time. This period is called retention, and the appliances that hold the teeth in place are called retainers.

The retainers hold newly straightened teeth in position while surrounding gum and bone settles. The retainers can be removable or fixed depending on the original problem.

Can orthodontics damage my teeth?

Your teeth can be damaged if they are not properly looked after during the treatment. Appliances themselves will not damage, but poor cleaning and too sugary drinks and snacks can cause permanent damage. Brackets wires and braces can trap food and cause permanent damage. Brackets, wires and braces trap food and cause more plaque than usual to build up. So the teeth and appliance need to be cleaned very thoroughly.

How do I care for my brace and teeth?

It is very important to continue having your teeth checked by your dentist which having orthodontic treatment. You also need to take extra care of your teeth and mouth.

Clean your teeth carefully every day, including in between your teeth, where you can. Appliances are delicate and you need to make sure that you clean them carefully so that they do not break. Your dentist or hygienist will be able to show you the special techniques to use depending on the appliance that you are wearing.

Cut down on how often you have sugary foods and drinks. Avoid snacking on foods containing high levels of sugar. Sticky hard foods must be avoided as they can damage the delicate orthodontic appliances.

Brush your teeth twice a day with fluoride toothpaste and if necessary use a mouthwash. Your dentist or hygienist may recommend a fluoride toothpaste or application for you to use. Look at products carrying the British Dental Health Foundations accreditation logo. This shows that the product has been checked and approved by a panel of experts and does what it says on the packet.

Why do my child’s teeth look so large?

The teeth do not change in size once they are formed. In a normal relationship the face and jaws grow fast enough to accommodate the erupting permanent teeth. It is when this balance becomes disrupted that orthodontic problems start to occur.

Are teeth ever too large for the patient’s mouth?

Yes. However, this is not a common occurrence. Incidentally, the teeth can also be too small for the patients face and jaw.

Is early treatment always best?

Not necessarily. If the patient’s problem is growth related then it is certainly wise to begin therapy early. The majority of problems fall into this category. However, if the problem is simply, “crooked teeth”, the dentist may advise you to delay treatment until all of the permanent teeth have developed.

Can my child be treated with only removable appliances?

Not usually. Sometimes all of the permanent teeth will correctly align themselves following orthopaedic therapy. However, everyone should be prepared to complete the second phase of treatment that is orthodontic therapy using fixed braces.

What happens if the appliance is broken or lost?

Notify your dentist immediately.

Do children "talk funny" with an appliance in their mouth?

Only for a short period of time. The speech pattern will quickly adapt to the appliance when it is worn full time.

When can my child take the appliance out?

Only when eating and brushing. There are certain exceptions such as singing in a choir. These should be discussed with the dentist. There are also certain malocclusions where it is best to wear the appliance while eating as this speeds up the treatment.

For further details about our services or to book an appointment please contact us:

East Grinstead Practice

138 Holtye Road, East Grinstead, West Sussex RH19 3EA

01342 313886

Hove Practice

51-53 Church Road, HOVE, BN3 2BD

01273 711507