Fixed Braces & Brace Care

Most patients require the use of fixed orthodontic appliances (‘train tracks’) to have really straight teeth, and achieve the best possible improvement of their smile. Small precisely designed metal or ceramic buttons called brackets are stuck/bonded to each tooth. Sometimes metal rings called bands are also fitted around the back/molar teeth. The brackets are then connected to each other using a thin metal wire, called an archwire. The wire is held in place with small elastic rings called modules, or with very thin wires called ligatures. Modules come in a variety of colours to customise your brace. The wires are adjusted at regular intervals to straighten the teeth and correct the bite.

Modern brackets are quite small, and they cover a relatively smaller area of each tooth, making braces more attractive than they used to be. With fixed braces, there is no plastic in the roof of the mouth. This means speech is unaffected and the flavour of food can be enjoyed fully.

As the appliance cannot be removed, it acts full-time, and so it is very effective. Fixed braces are very good at achieving fine detail, and making the smile look really perfect!

Fixed appliances, by definition, cannot be removed by the patient. The simplest way to think of each bracket is as a handle with which it is possible to control each tooth individually and precisely. The brackets are highly sophisticated as every tooth has its own bracket design engineered to achieve correct position and angle of axis.

As we have already mentioned, in the early part of treatment, a thin archwire is fitted to link up all the brackets. Because the teeth are irregular, the wire has to bend up and down or in and out between the teeth. This is the clever bit: the wire, a bi-product of NASA research, has perfect shape memory and will gradually return to its original shape, bringing the teeth with it.

As treatment progresses, stiffer wires are fitted and these act as a monorail. At this time, tiny springs and elastics are also used to guide the teeth in the desired directions.

Fixed braces are not very good at major alterations to the bite. For this, other appliances are used either before or at the same time as the fixed braces. Examples include changing the relationship of the jaws with a functional/orthopaedic appliance, or moving the upper teeth back to improve bite with headgear. Very occasionally specialist surgery needs to be used in conjunction with brace treatment to achieve the ideal result.

Depending on your treatment, fixed braces in London can be fitted either in a single appointment or over several appointments.

Sometimes small blue elastic rings called ‘separators’ are fitted between your back teeth a few days before your braces are fitted. This is to enable the fitting of ‘bands’ around the molar teeth. Bands are like rings that fit around the back teeth. Not everybody needs to have bands as part of their fixed braces.

You may need to stick to a softer diet only for the first few days of having your braces if your teeth feel a little tender. After that you should generally be able to eat normally.

Having said that, we recommend that you totally avoid certain foods to avoid damage to your teeth or your braces. These include sticky, chewy or hard sweets (such as toffee, boiled sweets and wine gums). Avoid:

• Chewing gum or bubble gum. Do not bite directly into very hard food with your teeth.
• Keep your consumption of fizzy cola drinks to a minimum, and generally keep these to meal times.
• Cut up harder fruit and vegetables (e.g. crisp apples, carrots) into smaller pieces before eating them. Be very careful with crusty bread, nuts, spare ribs, corn on the cob and stones in fruit.
• Above all think about what you eat and be careful.

Fitting your fixed braces will not hurt: they are simply glued to your teeth. No injections are required, and you certainly do not need to go to sleep for fixed braces to be fitted!

For the first 4-5 days after your appliances have been fitted, and for a day or two each time they are adjusted, you may experience some discomfort and slight toothache. Your teeth may feel loose and quite tender. Regular pain-killers that you normally would take can easily take care of this discomfort.

Parts of the brace may rub on your lips, cheeks or tongue. You will be provided with orthodontic wax to help cushion the soft tissues away from the bothersome parts of your braces. You may also notice increased saliva flow, and a minor temporary effect on your speech. These issues are normal, and soon you’ll get used to wearing your brace and your speech will go back to normal.

Biting your fingernails may result in damage to your brace. Do not touch, play with, or pick at your brace. Do not bite pens or touch your braces with them. Do not use your teeth as DIY or household tools! The more you look after your braces, the sooner your treatment will be completed.

If despite all your careful attention part of the brace becomes dislodged or damaged, contact the practice as soon as possible so that an appointment can be arranged either to repair the brace or to relieve any discomfort. Damage to your braces can prolong treatment. If appliances are repeatedly damaged and no progress is being made, treatment may have to be terminated.