New Patients FAQs

What is orthodontics?

Orthodontics is a branch of dentistry concerned with the development and management of irregularities and abnormalities of the teeth, jaws and face. The technical term for these problems is "malocclusion" which means "bad bite".

What causes orthodontic problems (malocclusions)?

Most malocclusions are inherited, but some are acquired. Inherited problems include crowding of teeth, too much space between teeth, extra or missing teeth, and a wide variety of other irregularities of the jaws, teeth and face.

Acquired malocclusions can be caused by trauma, (accidents), thumb, finger or dummy sucking, dental disease or premature loss of primary (baby) or permanent teeth.

Both inherited and acquired malocclusions affect both the alignment of teeth and also facial development and appearance.

Why is orthodontic treatment important?

Crooked and crowded teeth are hard to clean and maintain. However, in most cases, the main benefit of orthodontic treatment is aesthetic. Research has shown that people with attractive smiles are viewed as having better self-esteem and being more successful.

Why see a specialist orthodontist?

Orthodontists undergo a rigorous 3 year Masters degree that involves thorough training in all aspects of orthodontic treatment involving treatment planning, dealing with complex cases that involve multidisciplinary treatment with other specialists, facial deformities and cleft palate management, combined orthodontics and facial surgery, and of course all aspects of orthodontic treatment.

An orthodontist is registered with The Dental Council of New Zealand as a dental specialist. Orthodontists have their own special organisation, the New Zealand Association of Orthodontists (NZAO) who arranges courses and conferences. They have very high standards in accreditation of members, and requirements for ongoing education.

Andrew Lush, Andrew Marriott and other staff members attend conferences and courses in New Zealand and overseas regularly, so you can be sure that you are receiving the most up to date treatment given the latest technology and knowledge.

Can dentists do orthodontic treatment?

Many general dentists perform minor orthodontic treatment or simple cases, sometimes with support and guidance from a specialist orthodontist. They attend short courses to update their undergraduate dental training in orthodontics.

There are some dentists who perform alternative orthodontic treatment (sometimes called functional orthodontics) who advocate treatment goals that are unrealistic or excessive health benefits that are not supported by the current best research in orthodontics.

Do teeth always need to be extracted for orthodontic treatment?

Definitely not!!! A lot of people are surprised at how we treat a lot of our complex cases without taking teeth out. A recent practice survey showed that we start between 65 and 70% of cases without the extraction of teeth. A decision about the type of treatment given is made in consultation with the patient after a rigorous examination of records and cost/ risk/ benefit analysis.

The reason teeth need to be extracted are for excessive protrusion, so the teeth can be brought back in the face, or for excessive crowding, where there is not enough room for the teeth to fit in. Generally, most people end up with the same biting surface or more when teeth are extracted and there is often room for the wisdom teeth to erupt later in life, saving costly and painful extractions.

Some alternative practitioners claim that all treatment can be performed without the extraction of teeth or make excessive claims about the ability to "grow jaws", or make unsupported claims about extractions "caving in" faces. In misdiagnosed cases, these often end up with unsightly or unstable results (We don't like having to fix these cases up at a later date).

Do I need a referral to attend an orthodontist?

School Dental Therapists and Dentists are trained to refer cases appropriately to an orthodontist, and can give guidance or recommendations. However, you can ring to ask questions or make an appointment without a referral.

Do extractions harm the shape of my face?

There have been media reports in the past claiming that extractions can cause damage to the appearance of faces. This is unsupported by years of research. In fact, in appropriate extraction cases (such as buck teeth), the patients are perceived as being far more attractive at the end of treatment.

We always take the patients profile into consideration when planning treatment. Inappropriate extractions may cause problems, but as specialists we are trained to evaluate and treat cases to gain the best possible result. We have some very good scientific review articles on the subject if you wish to see them.

Is it better to start treatment early?

In many cases problems are best sorted out when all the adult teeth are through (age 10-14). However, we like to see children when they are around 7-9 years old. There are a couple of reasons for this:

1. Certain problems are best sorted out at this stage. For example; very prominent teeth can lead to teasing at school and the teeth are more likely to be damaged during sport and play. We can use an appliance at this young age to harness any available growth to improve the facial appearance.

2. Other problems that are best treated early include children who have some of the upper teeth trapped inside the lower teeth (at the back or front of the mouth), and those with very mild irregularities of the teeth. Intervention at an early age will almost certainly make any later treatment easier and more successful. In a small proportion of cases, it may eliminate the need for future treatment entirely.

3. At 8 years of age, it is possible to predict, with a reasonable degree of precision, the future orthodontic needs of an individual. This does give time to prepare financially for treatment.

Can adults get orthodontic treatment?

Orthodontic treatment is possible as an adult, and more adults are getting treatment. As long as the supporting gums are healthy the teeth can be moved with little risk of damage at any age. Certain types of problems can not be corrected in the absence of childhood growth.

Do braces hurt?

There is normally some tenderness after the braces are placed, and after some adjustments. However, the wires and forces used in modern orthodontics are much gentler than those used in the past resulting in less discomfort and less frequent adjustments.

What happens if I move away?

Orthodontic treatment is not suited to those who do not have a set base. However, if you move while braces are placed, the New Zealand Association of Orthodontists has a transfer scheme. This uses a set formula, so if you transfer to another member, the fee charged at the time of transfer is set as a percentage of the treatment completed.

Are there different types of braces?

There are several types of braces to choose from. We have traditional braces, clear braces, self-ligating braces (which have a small latch in the brace to hold the wire in) and clear braces. We also have braces for the front teeth shaped like stars, rugby balls, flowers and love hearts.

Do I have to keep my teeth clean?

Yes, definitely. We make sure that oral hygiene is up to the high level required before treatment can start. After all, we don't want to take the braces off and have marked teeth under them. We have a hygienist who all patients see when the braces are placed.

We give an initial supply of cleaning instruments to use, and monitor oral hygiene at each appointment. Some patients have to revisit the hygienist if their hygiene is not up to the mark. In some cases we remove the braces earlier than we normally would like if oral hygiene is a problem.

What are functional appliances?

Most functional appliances are a variety of removable "plates" that use forces that come from muscles and soft tissues of the face to move teeth. This is different to "braces" which are bonded to the teeth and use forces from springs or elastics to slide teeth along wires that run through slots in the braces.

Functional appliances have been the source of some controversy because it is claimed that they can make jaws grow (especially the lower jaw) and/or enlarge the jaws enough to make extraction of the adult teeth unnecessary and improve the top to bottom jaw relationship. Unfortunately these claims have been thoroughly disproved by quality scientific research over many years. We use functional appliance treatment to treat certain types of bites in the appropriate situation. However, they are not a cure all appliance for all problems.

What is functional orthodontics?

Functional orthodontics is alternative therapy that claims that teeth do not need to be extracted and that jaws can be expanded to grow. It promotes the use of functional appliances or expanders in nearly all cases. They promote the false hope of making jaws grow to fit teeth in. Unfortunately this has been proved time again by research to have little or no effect. Nothing we would see would change our mind about the exaggerated claims made by these alternative practitioners. It is often promoted by general dentists who have undergone short courses in the theory of functional orthodontics.