Here are the answers to
some common questions about fixed appliances and wearing them.
What are fixed braces?
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!
How do fixed braces work?
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.
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.
What are the limitations of fixed
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.
How are fixed braces fitted?
- Depending on your
treatment, fixed braces 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
- Before braces are
fitted, your teeth are cleaned and conditioned.
- For those who need bands
special glue is used to stick them to the teeth.
- Brackets are
square-shaped metal or ceramic components that are glued to the teeth.
- The fitting of fixed
braces is completed by connecting the bands and/or brackets with a thin
piece of wire that is held in place using small elastics called modules.
These come in different colours to make the wearing of braces more fun.
Will it hurt?
- 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.
- Parts of the brace may
rub on your lips, cheeks or tongue. You may also notice increased saliva
flow, and a minor temporary effect on your speech. This is normal, and
soon you’ll get used to wearing your brace and your speech will go back
- Stick to a softer diet
for the first few days.
- If necessary, you may
wish to take mild painkillers such the ones you would normally take for
headaches. Please read the instructions on the packet regarding how much
you should take.
- We will supply you with
some orthodontic wax. If any part of the brace is rubbing against your
lips or cheeks, tear off a small piece of wax, roll it into a small
pea-sized ball between your fingers, and gently mould this over any part
of the brace that feels sharp. This acts as a cushion, keeping your lip
or cheek away from the brace components.
- If you continue to have
discomfort beyond the first few days, contact the practice so that an
emergency appointment can be arranged as soon as possible to adjust your
Do I need to modify my diet?
- 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
- 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.
What else can damage my brace?
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.
What do I do if my brace is
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
How do I keep my teeth
and fixed braces clean?
- We will provide you with
a free pack containing what you need to look after your braces. From now
on you will need to spend more time cleaning your teeth. Neglect will
cause swelling and bleeding of your gums, tooth decay and
marking/staining of the teeth around the brackets.
- Brush after each meal.
- Make sure the gum
margins are also brushed even if they bleed when you brush them.
- Change the brush every
- Use the interdental
toothbrush supplied for getting in between the brace components and the
- Use the fluoride
treatment we provide regularly.
- It may also be useful to
use disclosing tablets occasionally to check that you are removing all
the plaque from your teeth.
How long will treatment take?
This usually takes anywhere between 9-24 months but can vary according to
how severe your case is. Failed and cancelled appointments or repeated
breakages of the brace will add to the overall treatment time.
Will I need to wear retainers?
Once the active phase of your treatment has been finished, it will be
necessary to wear a retainer. This may be removable or it may be fixed
behind your front teeth. The length of time this has to be worn can vary.
How often will I need an
You will need regular appointments during treatment for the brace to be
Do I still need to see my regular
Yes. It will be important you still have check-ups with your regular
dentist throughout orthodontic treatment so that your teeth can be checked
Do I need a mouthguard for
We will provide you with a mouthguard free of charge. Wear your mouthguard
for any sport or activity where accidents may cause damage to your teeth.
What if I play a musical
If you play a wind instrument, then fixed braces may initially make things
more difficult. You will need to discuss this with your music teacher.
What do I do in an emergency?
If your fixed braces become damaged, or a component is digging in your
lips or cheeks, or if you are concerned that the fixed braces are
continuing to be uncomfortable or troublesome beyond what is normally
expected for the first few days, then telephone the
practice for advice and/or an emergency
appointment. Where possible, do not try and adjust the appliances
yourself, as this may damage them.