Dental braces: types, treatment time, discomfort and retainers

Dental braces (also called orthodontic treatment) are used to correct the position of the teeth and, in a growing child, to guide the growth of the jaws. This guide sums up, in simple words, what is taught in the university diploma (D.U.) in orthodontics and in the reference textbooks (Boileau, Bassigny). It is here to inform you; it does not replace an examination: every case is different.

What do braces correct?

The courses describe four families of problems: the skeletal bases (the jaws themselves), the alveolar processes (the bone that holds the teeth), the relationship between the two dental arches when you bite together, and the position of the teeth (crowding, gaps, rotated or impacted teeth).

The aim is not only cosmetic. The goals listed by Boileau, in order: remove the causes, achieve a functional bite, a balance between the teeth and the gums, a pleasing face and smile, and then a stable result. One example of a functional benefit: upper front teeth that stick out by more than 3 mm roughly double the risk of breaking them in a fall.

Not treating can also be a valid choice, for a while or for good: a small asymmetry with no consequences is normal. And in adults, whose growth is over, braces alone cannot correct a large mismatch between the jaws; surgery may then be discussed in severe cases.

At what age should you see a dentist?

In children

According to the D.U. courses, there is no minimum age for a first consultation, as long as it does not automatically lead to treatment. An early examination makes it possible to keep an eye on things, and to step in at the right time if needed.

Treatment in children is called interceptive: simple, as short as possible (in principle 12 months at most) and aimed at one problem. The ideal time is often the end of the mixed dentition (when baby teeth and adult teeth are both present), with some exceptions treated earlier, such as certain Class III cases (lower jaw too far forward) and crossbites. A few examples:

• Habits: children are rarely asked to stop sucking their thumb before age 6 to 7, and always gently, without blame or punishment.
• Mouth breathing: a check-up with an ENT doctor, then retraining.
• An upper jaw that is too narrow: an expansion appliance can widen it in children and teenagers.
• Early loss of a baby tooth: a space maintainer fitted as soon as the tooth is removed.

In adults

Age alone does not stop you from having braces. Teeth move more slowly after 16 to 17, but according to the reference textbooks it is no harder at 50 or 60 than at 20 or 25 if your gums are healthy. This is the key condition: moving teeth in inflamed gums leads to loss of support. Gum disease must have been stable for six months before starting, then checked every two months during treatment. In adults, the retention phase also lasts longer.

Types of dental braces

Fixed braces ("brackets")

This is the most common type: small attachments (brackets) bonded to the teeth, joined by a wire that is changed over the course of the visits. The brackets are either metal or tooth-coloured (ceramic). According to the courses, the drawbacks of ceramic braces are that they can break, are harder to remove and can wear down the opposite teeth.

Lingual braces

Lingual braces are bonded to the inner side of the teeth, so they cannot be seen. Discomfort is greatest during the first 48 hours, and getting used to them takes 4 days to a week; your tongue and speech may be affected at first.

Elastics: what are they for?

The coloured elastics that many teenagers choose are there to hold the wire in each bracket. Other elastics, hooked between the upper and lower teeth, help correct the relationship between the two arches: these ones must be changed at least once a day. They are quick to put on, but they lose strength and trap dental plaque, so they need careful brushing.

Clear aligners (orthodontic trays)

A series of clear plastic trays; each one moves the teeth a little. According to Boileau, each tray moves the teeth by 0.25 mm at most and is worn for about 15 days, 22 hours out of 24. They are suitable for mild to moderate crowding and some moderate mismatches between the arches; some movements remain difficult (large rotations, closing extraction spaces, intrusion). Not wearing them enough is their main contraindication. They are also an option if you have a proven allergy to metals. See the detailed guide: clear aligners.

Removable appliances

You can take these out yourself: for example the expansion plate with a screw, which slowly widens a child's dental arch, or the retainer plates used after treatment. Their success depends on wearing them regularly.

Functional and orthopaedic appliances

These act on the growth of the jaws in children and teenagers:

• The activator: a removable appliance that brings the lower jaw forward. Its effect on the growth of the lower jaw is still debated; the textbooks warn against any promise of "gaining" length.
• The Herbst appliance: fixed, worn for about 6 to 8 months; a good part of its effect is temporary.
• The face mask: for some Class III cases, 12 to 14 hours a day; cooperation is essential.
• Headgear: at least 14 hours a day, for 6 months to a year.
• The rapid palatal expander, an expansion appliance: it opens the suture in the middle of the palate in children and teenagers.

What about "silicone braces"?

This term often refers to soft silicone trays, presented as "trainers" for the tongue and lips in children. They are not one-size-fits-all appliances: whether they help depends on the problem, and only an examination can tell whether they have a role. Night guards for tooth grinding (bruxism) are a different device: they protect the teeth but do not move them.

The steps of treatment

1. Examination and records: questions, and an examination of the face, mouth and functions. The minimum set of records taught includes 9 photos (4 of the face, 5 of the mouth), impressions, a panoramic X-ray and a side X-ray of the skull (cephalometric X-ray). This X-ray helps with decisions, but it "never replaces the clinical examination".
2. The treatment plan: you should receive an explanation of the diagnosis, the plan and the alternatives, the hygiene required, the appointments, the tests, the length of treatment and the cost. For adults, the plan is given in writing, with time to think it over.
3. The active phase: aligning and levelling the teeth, then corrections (closing spaces, relationship between the arches), then finishing, which takes about three months before the braces are removed.
4. Retention: just as important as the treatment itself (see below).

How long do braces take?

There is no "standard" length: it depends on the problem, your age, the appliance and your cooperation. Some benchmarks given by the sources:

Treatment can be done in two stages (one phase as a child, then fixed braces later): the second phase is then shorter, but the total length is longer.

Pain, discomfort and side effects

Every treatment has possible side effects; knowing them helps you avoid them:

• Pain: mostly in the hours after the braces are fitted or adjusted, peaking at around 24 hours, and worse when chewing. If a bracket or wire rubs on your cheek or lip, a small ball of orthodontic wax pressed onto it brings relief until your appointment; tell the team about any wire that pokes.
• White spots and tooth decay: braces trap plaque. A review of 14 studies found new white spot lesions in 45.8% of patients during treatment with fixed braces (Sundararaj et al., 2015, PubMed). Fluoride-releasing adhesives and a daily fluoride mouthwash reduce this loss of minerals. Cavities are treated before the braces are fitted.
• Root resorption: a shortening of the tip of the root, which is irreversible, with many causes (heredity, age, root shape, an old injury, the forces applied). The dental practitioner monitors it with X-rays and may pause treatment if it appears.
• The gums: inflammation caused by braces normally goes away. Where the gum is thin, gum recession is possible. Braces worsen existing gum disease, but do not cause it.
• Allergies: to nickel, chromium, resins or latex. Tell the team about any known allergy.
• The jaw joint: a meta-analysis cited in the courses (Kim, 2002) found no more jaw joint problems after treatment; braces alone do not cause, prevent or treat them.
• Relapse: the teeth partly moving back towards where they started. This is why retention is needed.

Hygiene: keeping your braces clean

• Brush your teeth and braces carefully every day with a fluoride toothpaste, using the method the team shows you.
• Aligners and removable appliances: clean them every day as instructed, and keep them in their case when you are not wearing them.
• Use a fluoride mouthwash every day if you are advised to.
• If you wear elastics between your jaws, change them at least once a day.
• Come to your appointments: poor hygiene and repeated missed visits can lead to treatment being stopped, and you are told this from the start.

Retention: keeping the result

After the braces come off, the tissues around the teeth need time to reorganise. This is where retention comes in:

• The rule taught in the D.U.: a thin wire bonded behind the front teeth, for at least two years and at most five years, sometimes with a removable plate for the upper teeth.
• Boileau suggests a removable alternative: three months day and night, then nine months at night only, so one year in total, and longer in some cases.
• In adults, retention can last a very long time, even for life, and is reviewed regularly.

Dental arches also change naturally with age (they narrow between 13 and 45), and the lower teeth can become crowded again even with a retainer. This is not a failure of treatment; it should be explained before you start.

What about the price?

This guide does not give any prices: the cost depends on the case, the appliance and the length of treatment, and each dental practitioner sets their own. It is part of the information you should receive before starting, along with the plan and its alternatives.

In practice

1. Don't wait for an obvious problem before having your child examined: there is no minimum age for a first examination.
2. Ask for an explanation of the diagnosis, the plan, the alternatives, the estimated length, the cost and the hygiene required.
3. Mention any allergy, gum disease or past injury to your teeth.
4. Wear removable appliances, aligners and elastics as prescribed.
5. Look after your hygiene every day and come to the appointments and X-rays you are asked to.
6. Don't neglect retention after the braces come off.

Frequently asked questions

What is the best age for braces?

There is no single best age. A child's first examination can take place at any age, and the timing of treatment depends on the problem: some cases are treated early, many at the end of the mixed dentition or later. In adults, braces are still possible if the gums are healthy.

Are clear aligners better than braces?

Neither better nor worse in absolute terms: each has its uses and its limits. Aligners suit some mild to moderate cases and must be worn 22 hours a day; some movements remain difficult. The examination is what helps you choose.

Do braces hurt?

Discomfort or pain usually appears in the hours after the braces are fitted or adjusted, peaking at around 24 hours, and is worse when chewing. Tell the team about any unusual or lasting pain.

Can teeth move after treatment?

Yes, partly: that is why retention exists. Even with it, the dental arches change naturally with age. Following the retention instructions is the best way to keep the result.

How much do braces cost?

It depends on the case, the appliance and the length of treatment, and each dental practitioner sets their own fees. Ask for the full cost before starting: it is information you are entitled to.