Orthodontic questions

1. How do I find an Orthodontist... ?

Like all Medical or Dental specialists, Orthodontists accept patients on referral from a colleague. Your family dentist will recommend an appropriate practice - ask for his or her advice.
If you have a particular request, let your dentist know and he or she will write to a specialist of your choice. 

Back to Top

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

For private patients, there is no wait - you can book in immediately a referral is received and the charge for the initial consultation is £98. This is fully inclusive of all radiographs and any other procedures that are necessary.

A private consultation, in the first instance, does not commit you to private treatment - many children transfer to NHS treatment after the private consultation. Please note that patients seen privately, who then opt for NHS treatment, will be transferred back onto the NHS waiting list.

For patients who wish to be seen, free of charge, within the NHS, we regret that there will be a delay in receiving your initial consultation appointment.
Our practice is heavily oversubscribed with new patients and, inevitably, a queue has built up.
See our waiting list policy.
Our NHS new patient waiting list is currently around 30 months long and grows constantly.
We are sorry that this is the case but in recent years demand for our service (both private and NHS) has increased incessantly - there really is nothing that we can reasonably do about it.

Since the government's reforms of NHS dentistry in April 2006, our NHS contract is for a fixed number of cases per year - we are not able to see more, thus further contributing to the waiting time for new patients.

Back to Top

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

Nothing scary! 
It's all really simple and nothing hurts.

We will have a look at you , take an X-Ray and have a chat - easy!

Be reassured that Orthodontist don't give injections, so no need to worry about that.

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 ...?

Many Orthodontic treatments, especially for crowding or protruding teeth, do involve the extraction of permanent teeth.

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 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.

For more details of this, see non extraction treatment.

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 pm and some Saturday mornings or at any other time of their choosing.

NHS patients must appreciate that after school appointments are very few in number and 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 and 30'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.

Adult patients are seen privately and white braces (like the one on the right) used for all cases.

For more info. see Adult Treatment.

8. Do you take NHS patients ...?

Each year we see around 1,500 new patients funded by the NHS and we fit over 500 NHS fixed braces. 

So I suppose the answer is yes!

A considerable and increasing part of our work is by private contract but we are happy to see you, however you choose to come!

Back to Top

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

Yes there is.

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

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

At Chapel Road, we offer an NHS service of high quality for routine cases in children.

There are treatments that we do not feel able to offer within the NHS . A good example of this is non extraction treatment, which is more sophisticated than the extraction based therapies it replaces.

Due to the conditions of our NHS contract, treatment for all patients of 18 or over is private.

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. 

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 "Find Us" page.

Back to Top

12. When are you open ...?

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

We open late on Mondays, until 8.00 pm, 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 broken my brace - what should I do?

Breakages can happen, even to the best of patients.

Don't panic - read carefully the advice on our Emergencies page.

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.

Because of this, we decline to see patients with oral piercings. - new patients please note!

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"....?

No, we don't and as you might expect, there are good reasons for this.

In recent years there has been a rise in the number of companies promoting "invisible gum-shield type appliances" e.g. Invisalign, Clearstep etc.

These are essentially a series of plastic gum shields, designed to be worn sequentially and thus move teeth

Like many other UK Orthodontists, some years ago, I was invited to become "Invisalign certified", thus enabling me to provide the Invisalign appliance system of removable aligners.

However, I declined the invitation.

I first saw this system of gum shield-like appliances in 1998, at the annual conference of the American Association of Orthodontists in Denver, Colorado and was not impressed.

It struck me as an inaccurate, difficult and unreliable way to straighten teeth - the fixed appliances we use are, in my opinion, far more capable, reliable and technically advanced.

I wouldn't use them on my own children, so they're not good enough for my patients either.
 

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

However, they too are fundamentally flawed - the patient's speech is badly affected and they are appallingly 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.

So, despite the possible aesthetic benefits of these two systems, at Chapel Road, we stick to the better, quicker and more effective (and still hardly visible) tooth coloured, fixed appliance system.

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 of £10.00 is payable at the impression visit, with the balance of £100 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.

If you are bringing them both together, there will be a considerable reduction in the second assessment fee.

You may also like to know that, if it comes to private treatment being required, a discount on the treatment fee (typically 20%) 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

29. Can I have my teeth whitened ... ?
 

Yes you can.

We offer a professional, safe and effective tooth whitening service.

The procedure is simple and effective.

At your first visit you will have impressions taken for special trays to be made.

These are fitted the next week and the whitening material provided.

The trays are worn for two hours a day for one month, following which there should be a noticeable lightening of the teeth as measured on our before and after digital photos.

Simple, effective and only £495.

An ideal way to finish your Orthodontic treatment.

Contact reception for an appointment.

Back to Top