Orthodontic questions

1. How can I get to see you ... ?

We accept NHS child patients (under 16 years) on referral from another Dentist.

These days, the rules are not as formal as they were - adults and private patients can refer themselves and we look forward to hearing from you.

Back to Top

2. Is there a wait to be seen ... ?

For private patients, there is no wait - you can book in immediately.
We look forward to seeing you and to explaining whatever options may exist for your Orthodontic treatment.

Please note that children seen privately, whose parents then request NHS treatment, will be transferred back onto the NHS waiting list.

For patients who wish to be seen within the NHS, we regret that there will be a delay in receiving your initial consultation appointment.
Our NHS new patient waiting list is currently around 6 months long.

But, good news:-

A recent waiting list initiative has dramatically reduced our waiing times (which were formerly much longer) and they are continuing to fall.

We hope to get down to just a few months before long.

See our waiting list policy.

Back to Top

3. What will happen on my first visit ... ?

Nothing scary! 

It's all really simple and nothing hurts.

We will probably take a digital X-ray picture and this will be followed by a consultation, during which you will be asked for your views about any orthodontic problem you may have.

No treatment is provided on your first visit, so don't worry!

Back to Top

4. Can I have a coloured Brace ... ?

Certainly - coloured braces have become very fashionable in recent years. We allow you to choose  colours for your brace, at certain times during treatment, if you are looking after it well.

The brace on the right was coloured for an RAF cadet - red, white and blue!

5. Will I have to have teeth taken out ...?

Far fewer teeth are being extracted these days than formerly.

In particular, our Arch Development Technique and the Damon Appliance System have made dental extractions unnecessary in many cases.

However, some Orthodontic treatments, especially for the correction of protruding teeth, do involve extractions.

If these are required, your own dentist will carry them out. We do not take teeth out at Chapel Road.

We are very fond of non extraction, arch development treatment at Chapel Road. However, this is not suitable for everyone - you have to be in the mixed dentition (still with some baby teeth) and it is a private treatment.

However, the Damon appliance can be used at any age. 

Back to Top

6. Can I have after school appointments ... ?

Now, this is a difficult one!

Private patients can be seen on our evening sessions (normally on a Monday) up to 8.30 pm or at any other time of their choosing.

NHS patients need to appreciate that their appointments will usually be in school time.
Do remember that you will only be attending once a month and appointments do not last long.
We try to vary appointment times to cause minimum disruption to schooling. If this is a problem, we suggest you schedule your visits into free periods or sport.
In order to be fair to all concerned, we do have to prevent a few people from hogging all the late appointments and we do not allow advanced block booking.
We are sorry if this sounds unduly severe in this age of "customer care" but you wouldn't believe what a difficult problem this is - 1500 patients under active treatment and they've all "got to come after school"! - who'd be a receptionist!

7. I'm over 18 - am I too old to get my teeth straightened ... ?

You are never too old to have your teeth straightened. We have many patients in their 20's, 30's and 40's and many a good deal older.

Some of my favourite patients have been in their 60's.

At Chapel Road, we have a long history of treating adults, with great success.

All patients over 17 years of age are seen privately.

For more info. see Adult Treatment.

8. Do you take NHS patients ...?

Each year we see around 1,800 new patients, funded by the NHS and we fit over 750 NHS fixed braces. 

So I suppose the answer is yes!

A considerable and increasing part of our work is by private contract but we look forward to seeing you, however you choose to come!

Back to Top

9. Is there a difference between Private and NHS treatment ...?

Yes there is.

Given that NHS fees are relatively low , there are many treatments that we cannot offer within the NHS, for financial reasons. A good example of this is modern non extraction treatment, which is considerably more sophisticated than the extraction based therapies it replaces.

At Chapel Road, we offer an NHS service of surprisingly high quality for routine cases in children and this is very well received by our NHS patients.

There are the obvious differences, like evening appointments, a wider selection of braces and more clinical time for your appointments for private patients.

This picture shows the difference in appearance between a tooth coloured, aesthetic brace (top teeth) and the standard metal appliance (bottom teeth). The white "aesthetic Braces" are available only to private patients.

The Damon System and InOvationC braces are the most advanced, most gentle and quickest braces available.

These are used routinely on our private patients.

Damon System Braces

The Damon System offers outstanding facial results, usually without the need for extractions. A relatively new breakthrough – Damon braces are fast, fixed orthodontic braces using low friction mechanics – which not only results in quicker treatment times but lighter forces and more comfortable treatment. With the Damon System, patients benefit from fewer visits to the practice and 4-6 months less in their treatment time.

In-Ovation C is simply the most aesthetic appliance currently available.

Back to Top

10. How much does Private treatment cost ...?

Probably not as much as you might think.

The initial assessment costs £98 and this includes all x-rays and treatment planning.

There are a range of fees, depending on the treatment required. 

We offer interest free credit via Medenta Finance.

All our private fees are fixed and cover all treatment required, irrespective of how long it might take.

For full details see our private fees page.

Back to Top

11. Where are you ...?

We are situated right in the middle of Bexleyheath - near the main shopping centre of the London Borough of Bexley.

For detailed instructions on how to find us, see the "Location" page, in "Our Practice".

Back to Top

12. When are you open ...?

We are open Monday to Friday, 8am to 4pm.

We open late on Mondays, until 8pm, for private patients and have private clinics on some Saturday mornings.

Back to Top

13. Does having a brace hurt ...?

I think the honest answer to this is "not much - usually". 

There are several different types of braces and numerous different types of patients (!) and everyone's experience differs.

At least 60% of our patients report no discomfort at all after the fitting of their fixed braces, 30% report some tenderness and around 10% had significant problems.

Every now and again, a patient says that the first few days were painful but this is not very common. It is usually nothing that your favorite pain killer can't cure and in any case, the discomfort will only last for a few days.

Don't let this put you off - it shouldn't be a problem.

Back to Top

14. What happens when I have my fixed brace put on ...?

It's surprisingly simple.

You will have two appointments :-

The first is a really quick one - just a few minutes to put some small, plastic, separators in-between your back teeth. These very slightly ease the back teeth apart so that it is simple to put the metal bands on at the next visit.

The second appointment is a day later. At this visit, the metal bands and brackets are glued onto your teeth and the fine wires placed in them. During this procedure there is no drilling, no needles and no pain - it's really easy, don't worry!

 All you have to do is lie still on one of our comfortable dental chairs and it's all done in no time.

Back to Top

15. Can I wear a gum shield with my brace ...?

Normal gum shields will not fit over a brace. 

The teeth are moving and the appliance is too bulky to allow even a proper custom-made gum shield to be of any use.

At Chapel Road we sell special gum shields designed specifically to fit onto or over your brace - ask the nurse for details.

Back to Top

16. Does having a brace taken off hurt ...?

Absolutely not.

Don't take any notice of all those "friends" who tell you otherwise.

Modern fixed braces come off really easily without damaging the teeth and it really doesn't hurt!

Back to Top

17. I don't want a brace but Mum says I've got to have one. What happens ...?

Don't worry. Nothing is going to happen until you're absolutely sure you want treatment too.

At Chapel Road we have a very clear policy for this quite common situation.

At your appointment, all the various possibilities will be discussed with you and your parents.

The first option is always to do nothing and if that is what you really want, after considering all the facts, then that is how it will be!

They are your teeth and your views are the most important. You are the one who has to wear and look after the braces and we need your full and enthusiastic cooperation, otherwise it just won't work.

Back to Top

18. Can I use an electric toothbrush with my brace ...?

Yes, certainly.

Electric toothbrushes are very useful tools indeed. Of course, you do have to use it thoroughly and get all the plaque off, or it is no use at all. 

Back to Top

19. How important is it to keep my teeth clean with a brace ...?

It's really important!

As a matter of fact, just about the only time we ever see damage to the teeth caused during Orthodontic treatment is when it is due to bad tooth brushing.

Just to prove the point, I've included a photo of the teeth of a notoriously bad tooth brusher, taken just after he had his brace removed. This photo is quite a few years old. These days we'd never let it get this bad. Click on the picture to see a larger image and note how many months of bad oral hygiene have done terrible damage to the teeth and gums.

In fact, our oral hygiene standards are so high, that patients have to demonstrate that they are maintaining an absolutely immaculate standard of oral care before we will even consider treating them.

If you don't clean your teeth much, don't bother coming along - there's no point!

Back to Top

20. What are "elastics" and will I have to have them ...?

About 60% of our patients will need to wear small elastic bands with their brace.

These are given to you in a small packet and you are instructed as to how to put them on and off - it's easy!

To show you what they do, I've put here a couple of pictures taken from case 2 .

You can see that between these two photos, good wear of the elastics moved Hannah's lower teeth backwards, relative to the uppers.

Back to Top

21. Why are my child's teeth so crowded ...? 

This is a question which has fascinated me for many years and so I will take a few lines to answer it - bear with me!

Dental malocclusion (crowded and twisted teeth) is a modern dental plague. It has only existed, to any noticeable extent, since the industrial revolution.

If you had been growing up a few hundred years ago, your teeth would have been naturally straight.

A little while ago, I had the chance to examine many Neolithic skulls, from "The Tomb of the Eagles", Orkney.

These skulls were all about 5,000 years old and to the eye of an Orthodontist, there was one quite extraordinary thing about them - they almost all had perfectly straight teeth! 
Similar findings can be seen in skulls from  excavations of an Elizabethan church vault in Spitalfields, London.

Yet numerous recent surveys have shown that about 60% of modern children need orthodontic treatment for crowded and crooked teeth.

Why the difference? After all, we are genetically identical to both Neolithic and Elizabethan people.

I believe the answer is very simple - diet and air pollution.

Human jaws are designed to work hard, grinding and chewing at rough, semi-prepared food. Burger and mash just isn't the same!

Developing jaws, that are not exercised much, do not grow as large or as strong as they were designed to. Because of this, the teeth become crowded.

Air pollution, which never existed until recently, irritates the air passages, causing asthma (another uniquely modern complaint) and mouth breathing. This, in turn, leads to the developing jaw being held open and therefore growing downwards, rather than forwards. This gives rise to that other classic type of malocclusion - the "goofy look", with a recessive lower jaw.

So that is why it happens. Sadly there is nothing much we can do about this - I can't see children being keen to give up their burger buns for coarse, stone ground, unleavened bread - nor are we going to stop driving cars. 

This does, however, help to explain why non extraction / arch development treatment works so well. In allowing the jaws to grow to their full potential, space is created for the teeth to grow naturally straight, without needing to take out any teeth.

Back to Top

22. I've got a problem with my brace - what should I do?

Breakages can happen, even to the best of patients so don't worry.

General dental emergencies such as broken teeth, toothache, etc. should be directed towards your family dentist.

I've broken my fixed brace

Fixed braces are normally quite robust - they have to be to withstand the hammering that they get in the mouth!

However, from time to time, a component may break. Usually it's a bracket that has come unstuck from a tooth, an elastic that's come off or a wire that's broken.

This is not normally cause to panic - just give us a call and we will arrange a convenient time for you to come in to have the breakage fixed

The breakage should be repaired as soon as conveniently possible in order to keep up the forward progress of your treatment.

If you are not in any pain, there is no need to call us outside normal office hours - just ring at the start of the next working day.
We are open at 8am Monday to Friday.

There's a wire at the back of my fixed brace that's digging into my cheek

Sometimes a small length of wire can start to protrude from the back of the brace - this can be quite sore.

If this is a nuisance, call us - we will see you very soon and trim away the small bit of wire that's causing the problem - easy and quick to do!

Back to Top

23. I hear you don't like tongue studs - is that right?

Yes, that's correct.

We are strongly opposed to all forms of oral and facial piercing.

Any piercing of the body's outer defences against infection is dangerous and ill advised, especially in the mouth.

There have been many reported cases of severe infections associated with tongue piercing and several fatalities.

It would be hard to think of a more foolish thing to do to your body.

Back to Top

24.  Can I have white brackets with my NHS fixed brace...?

Unfortunately, the answer is no.

White (aesthetic) brackets are not approved for use in state funded (NHS) treatment in the UK.

At present, this type of appliance is therefore only available to private patients.

The photo on the right shows the difference in appearance between the aesthetic brace and a standard stainless steel appliance.

It's worth pointing out that they both do exactly the same job - one just looks better than the other, which is why we us aesthetic brackets in all our adult cases.

For examples of white brackets in action, see case 1 and case 3.

Back to Top

25.  Do you do "Invisalign" or "Lingual Orthodontics"....?

Invisible Braces (Aligners) have become popular in recent years, as they are aesthetically superb and therefore particularly suited to adult treatment.

At Chapel Road Orthodontics we use the Orthocaps system which is a newer, German version of the familiar Invisalign / Clearstep type of appliance.

Lingual appliances are stuck to the inside of the teeth and are therefore not visible.

However, in my view, they are fundamentally flawed - the patient's speech is badly affected and they are difficult to adjust and often very traumatic to the tongue.

They are also very difficult to use where the patient has a deep bite on the front teeth, as the lower teeth keep biting on the brackets behind the upper incisors.

I first saw lingual appliances in the early 80's, while training at the Royal Dental Hospital, London - a colleague elected to have them for her own personal treatment and I was dismayed by the fuss and bother that ensued.

At Chapel Road, we use the better, quicker and more effective (and still hardly visible) tooth coloured, fixed appliance system or Orthocaps.

Back to Top

26.  My Child sucks her thumb - how can I stop her ...?

Thumb sucking is a common habit in young children, which normally ceases by 3 or 4 years of age.
When the habit persists, it can lead to severe distortion of the growing jaws, with the upper front teeth being pushed forward and the lower incisors being distorted backwards.

Fortunately, there is a simple solution for thumb or finger sucking habit - the “reminder plate”.

The reminder plate is a simple, stress free removable appliance, which is worn full time for a month. Thumb sucking will always cease, provided that a child wants to break the habit and wears the appliance as directed.

The effect of this simple device can be remarkable.

Where the thumb was holding the teeth apart, they will improve rapidly once the habit has ceased, if the patient is still young.
 

These photos were taken only 8 months apart - note how stopping the habit has allowed the teeth to grow together naturally.

We are able to provide reminder plates for a very reasonable £110 - this includes the cost of 3 visits (impression, fitting and subsequent review) as well as the cost of the plate. The repair of any reasonable breakage within a few months following the fitting of the appliance is also covered.

If you would like your child to have a reminder plate, please contact the receptionist and an appointment will be given for the necessary impression to be taken and the plate will be fitted 1 week later.

A deposit is payable at the impression visit, with the balance on fitting.

It's appropriate here to put in a good word for dummies - those wonderful little devices that soothe our tiny friends - give a baby a dummy and he'll rarely become a thumb sucker and you'll get a good night's sleep!

Back to Top

27.  Is there a reduction for two ... ?

  "I have two daughters who I would like you to see urgently.
   Is there a reduction in the private assessment fee for two?"

Yes there is.

Because you will be bringing them both together, we charge less than double the standard fee - ask for details.

You may also like to know that, if it comes to private treatment being required, a substantial reduction in the treatment fee is usually given for a second child in the same family.

Back to Top

28. Do you use Fixed Retainers ... ?
 

Yes we do and with increasing frequency.

When you've had your teeth straightened, the last thing you want is to see them move. That's what "Retention" is for - to hold your teeth straight following treatment.

Traditionally, removable retainers have been used.

These are worn at night, in bed and are completely effective as long as this goes on.

For many cases, these are adequate.

Where teeth have been twisted or spaced before treatment, fixed retainers are preferable.

These are small pieces of very finely braided stainless steel wire, that are fixed to the inside of the teeth and are left in place permanently.

Provided they are kept clean, they cause no problems - after a while you forget they're there.

This is a standard type of fixed retainer for the lower front teeth.

Two upper fixed retainers holding previously rotated and spaced upper canines.

Back to Top