Braces Treatment

When braces may be considered

• Teeth that are crooked because there is not enough room for them in the jaw.
• Gaps between teeth.
• Lower teeth that close in front of the upper teeth, a crossbite, or front teeth that do not touch when the mouth is closed.
• Upper front teeth that sit well in front of the lower teeth (increased overjet). This is not only about appearance. In observational studies, children with an overjet over 5 mm had 1.81 to 2.43 times the odds² of injuring their front teeth, by age group. This is an odds ratio; it does not mean twice as many injuries.

Orthodontic treatment is not only for children; it is also done in adults.

Early treatment in children

Some children's upper front teeth stick out noticeably. In these children, early treatment with a functional appliance, started between the ages of 7 and 11, reduced new injuries to the front teeth. In a Cochrane review, about 30 in every 100 children who waited until adolescence reported a new injury. In the early-treatment group, it was about 19 in 100³. This comparison included 332 children, and the quality of the evidence was moderate.

According to the same review, early treatment of prominent upper front teeth has not been shown to have any other advantage. Once both groups had finished treatment, the final overjet and the way the jaws related to each other did not differ meaningfully. Early treatment is a two-phase approach: after the first phase in childhood, a second course of treatment may still be needed later.

A long-lasting thumb-sucking or dummy habit is linked to bite problems, and the risk rises the longer it goes on⁴. But it is not the only cause; genetics, injuries and losing teeth early or late can also play a part⁵. We cannot give a specific age for a first orthodontic assessment on this page. Ask your child's dentist about their bite at dental check-ups. In England, if a dentist thinks a child needs braces, they refer the child to an orthodontist⁶. The orthodontist decides whether the child is eligible for braces on the NHS (see the options below).

When something else is discussed first

• Decay or gum disease. The state of your teeth and gums is assessed at an examination before treatment. If there is decay or gum disease, how it will be dealt with before orthodontic treatment starts is discussed. This page does not explain how orthodontic treatment is planned for adults with gum disease. General information is on the gum disease page.
• When the problem lies in the position of the jaw bones. In adolescents, functional appliances reduced overjet by about 4.62 to 5.46 mm compared with no treatment³. These results come from small studies, and the quality of the evidence is low. There is no source showing that these appliances guide jaw growth in adults. In people who have stopped growing, adding jaw surgery to orthodontic treatment may be discussed for some jaw mismatches. We cannot say on this page when this is needed; your treating dentist explains the options after the examination.
• Only a small gap, or a shape problem in a single tooth. Sometimes a shorter route, such as adding composite to the tooth (composite bonding), can also be discussed.

• Not having treatment. If crowding or a gap is only about appearance, not having treatment is also an option. A marked overjet, however, especially in children, is linked to a higher chance of injuring the front teeth (above).
• Fixed braces with metal brackets. The brackets are glued to the front surface of the teeth and stay in the mouth throughout treatment; you cannot take them out.
• Ceramic (tooth-coloured) brackets. They work in the same way as metal brackets and are less noticeable. Two clinical studies compared how often ceramic⁷ and metal brackets⁸ failed in the first year, and they disagree. A review concluded that ceramic brackets may lead to more enamel fractures, particularly when they are removed⁹. Much of that evidence is from the laboratory, and no rate is known. One old laboratory study found that ceramic brackets wore away more enamel from opposing teeth¹⁰, but it had no patients. Ask your treating dentist whether ceramic brackets suit your bite. More on ceramic braces.
• Lingual braces. The brackets are glued to the back surface of the teeth and cannot be seen from outside. Studies of lingual braces mostly followed patients for about the first three months. In them, tongue soreness was reported clearly more often than with braces on the front of the teeth. Cheek and lip soreness has been reported less often. One review¹¹ and another review published after it¹² both reached this conclusion. No meaningful difference was found in overall pain in the first months. Changes in speech are much more common¹¹ with lingual braces.
• Clear aligners. Clear trays that you take out and put back in yourself, replaced one after another. One review pooled 11 studies in adults (887 patients). Three studies in that review scored how the teeth were lined up and how they met at the end of treatment. In those, the result with aligners was weaker than with fixed braces¹³; the quality of the evidence is moderate. A newer review of 15 studies found better results with fixed braces in cases where teeth had to be taken out. In cases without extractions, no clear difference was found¹. For mild to moderate crowding, treatment time was found to be similar¹⁴ with the two methods; the certainty of this evidence is low. More detail is on the clear aligner treatment page.
• Braces in the UK. Braces are also provided by dentists and orthodontists in the UK. On the NHS in England, braces are usually only free for people under 18 who have a problem with their teeth⁶. An orthodontist decides who is eligible. Adults usually pay for braces privately. Only a dentist on the GDC's specialist list may use the title specialist in the UK (see who carries out the treatment, below).
• Closing a gap at home with elastic bands is not an option. In one published case, an elastic band used by an 8-year-old child slipped under the gum. More than 75 per cent of the bone holding the teeth was lost, and two front teeth could not be saved¹⁵. This is a single case, not a rate.

How long treatment takes depends on the state of your teeth, how severe the problem is and which appliance is chosen. According to the patient information page of the American Dental Association (ADA), most people are in treatment for one to three years⁵. This range comes from general patient information, not from research. For braces offered on the NHS, the NHS says a fixed brace usually stays in place for 1 to 2 years⁶. Throughout that time, fixed braces need adjustment appointments at set intervals. For its own patients, the NHS describes an appointment every 6 to 8 weeks⁶ to adjust the braces. That describes NHS care, not this clinic's interval. Your treating dentist tells you the likely length of your treatment and how often you will need appointments after the examination.

On this page, "your treating dentist" means the dentist who plans and supervises your braces. Whether that dentist is an orthodontist is a question to ask (see who carries out the treatment, below).

Risks and disadvantages

• Pain and tenderness. When braces are first fitted or adjusted, your teeth can feel tender and under pressure for a few days. In studies of the first week, pain was usually at its highest in the first 24 to 48 hours and eased within about a week¹⁶.
• White spots (early decay). While fixed braces are on, plaque builds up around the brackets. In an analysis of orthodontic patients, based on 44 studies, new white spots developed during treatment in about 34 in every 100 patients¹⁷. The same review reported white spots in about 55 in every 100 orthodontic patients. In people who had not had treatment, the figure was about 29 in every 100¹⁷. The 55 and 29 figures come from different groups of studies. The longer treatment lasted, the more common the spots were. These figures come from published studies, not from our own records, and they are not a personal risk estimate. This is why careful brushing and cutting down on sugary food and drinks are recommended.
• Teeth shifting after treatment. After orthodontic treatment ends, teeth tend to move back¹⁸ towards where they started. This is why the retention phase is part of treatment (below).
• Tongue soreness and speech changes with lingual braces. These side effects are described above, in the options section.
• Gum recession. Orthodontic treatment, poor oral hygiene and thin gums are listed among the factors that may raise¹⁹ the risk of the gums pulling back. This is an expert opinion and does not give a rate. Where the gum shows no disease, the same paper considers monitoring the area the appropriate approach.
• Loose brackets and poking wires. A bracket can come away from the tooth, or the end of a wire can poke into your cheek. If this happens, contact the clinic or the dentist who looks after your braces (see below).
• Long treatment and regular check-ups. Treatment takes months, often years, and needs you to come to adjustment appointments regularly. If you live in the UK, this is the main practical question (see below).
• A front tooth that was knocked in the past. Before braces are fitted, tell your treating dentist if a front tooth has ever been knocked or damaged. According to the NHS, such a tooth may need further treatment while wearing braces⁶.
• Other possible side effects. Other side effects, such as shortening of the tooth roots during treatment (root resorption), can also happen. We cannot say on this page how often they happen; ask your dentist at the examination.

Benefits

• The aim is to line the teeth up more evenly, improve the bite and close gaps. How far this is achieved varies; your treating dentist explains what is realistic for you.
• In children whose upper front teeth stick out noticeably, early treatment reduced new injuries to the front teeth (above).

If you have pain

• Over-the-counter painkillers reduced orthodontic pain compared with taking no medicine. This result comes from a Cochrane review covering 32 studies; the quality of the evidence is moderate²⁰. When anti-inflammatory painkillers (NSAIDs, such as ibuprofen) were compared with paracetamol, no clear difference was found; the quality of that comparison's evidence is low. Follow the instructions on the pack; if you are not sure, ask your pharmacist or doctor.
• Non-drug methods such as chewing gum, bite wafers and vibration devices have not been shown²¹ to reduce orthodontic pain. The evidence on this is of very low quality.
• In the first days, soft foods may be easier to chew.

Eating and drinking

• Avoiding chewing gum during fixed braces treatment is recommended; gum can stick to the braces⁶. It is also best to avoid hard, crunchy and sticky foods.
• Cut down on sugary food and drinks; sugar can lead to plaque building up⁵ around the brackets.

Cleaning

• Brush your teeth twice a day with fluoride toothpaste; take care around the brackets and along the gumline.
• Clean between the teeth and under the wires every day, not only where food gets caught. The NHS advises using an interdental brush⁶ for this; ask your treating dentist which size to use.
• Alongside your orthodontic appointments, keep having regular check-ups with your own dentist in the UK. How often you need them is set according to your risk of decay and gum disease²².

Speech

In a review that looked at all kinds of orthodontic appliances, most changes in speech cleared up within a few weeks²³. A lisp on the 's' sound, however, sometimes lasted more than 3 months. The evidence in this review is of low quality.

When treatment ends, teeth tend to move back towards where they started. A retainer is used to hold the teeth⁶ in their new position.

• Which retainer? There are fixed wires glued behind the teeth and removable retainers. A Cochrane review covering 47 studies has not shown any one of them to be clearly better¹⁸ at keeping teeth straight. Each has pros and cons in terms of breakages, comfort and the gums; the certainty of the evidence is low or very low.
• For how long? Your treating dentist decides how long you wear the retainer⁶. According to a UK opinion piece, the British Orthodontic Society (BOS) has given patients the message that retainers should be worn for life²⁴. The author of the piece, a dentist, argues that research does not support this general advice. In his view, most retention studies lasted 6 to 24 months²⁴. There is no evidence-based fixed length of time, and no retention method has been shown to hold teeth completely still for life.
• A fixed retainer wire can come loose. In studies, bond failure with multistrand twisted wires has been reported at between 12 and 50 per cent²⁵. This is not a single rate but the lowest and highest values reported in different studies; the quality of the evidence is low.
• A gap between the front teeth can open again. A small retrospective study followed 30 patients whose gap between the two upper central incisors had been closed. On average 5 to 6 years after retention stopped, the gap had reopened in 6 in every 10 patients²⁶. The reopening averaged 0.49 mm across the whole group and 0.78 mm in the patients whose gap reopened²⁶. This rate does not apply to other gaps between teeth. Gaps between the central incisors and the teeth next to them (the lateral incisors) reopened less often.
• Who looks after the retainer in the UK? Retention goes on after you are back home. Agree before the brackets are fitted who checks the retainer in the UK and who repairs or replaces it if it breaks or stops fitting. Ask whether that is part of your plan. More on retainers: retainers.

Your treatment is provided by our clinic in Antalya, Turkey. The appointments in Antalya are carried out by the clinic's dentists. On this page, "we" means that clinic.

Orthodontics is one of the nine dental specialties set by law in Turkey²⁷. Turkish law ties the specialist title to a specialist certificate²⁷, issued and registered by the Ministry of Health²⁸. In the UK, a dentist may call themselves a specialist only if they are on the GDC's specialist list²⁹. A dentist does not have to be on the list²⁹ to provide orthodontic treatment, but only those on it may use the title.

If you are comparing with a UK orthodontist, compare like with like. Ask who will plan your treatment, who will fit the braces and who will carry out the adjustments. Ask what their titles are, where they qualified, and whether the dentist planning your braces holds a Ministry-registered specialist certificate in orthodontics. Ask for the answers in writing.

Contact your treating dentist, or the dentist who looks after your braces in the UK, if you notice any of these.

• Pain that lasts more than a few days⁶ after braces are fitted or adjusted
• A bracket that has come off a tooth, or the end of a wire poking into your cheek or tongue
• A fixed retainer wire that feels loose or has broken
• A removable retainer that no longer fits or has broken
• White spots around the brackets, or gums that bleed or are swollen
• A knock to the front teeth during or after treatment

If you think you have a dental abscess, do not wait; an abscess does not go away on its own and needs urgent dental treatment³⁰. In England, the NHS advises asking for an urgent dentist appointment. If you have no dentist or cannot get an emergency appointment, get help from NHS 111³⁰. If you have swelling in your face or jaw, or a fever, get seen the same day by a dentist where you are.

Emergencies. The following need urgent medical help³⁰. Do not wait for a dental appointment or for the clinic's reply. In the UK, call 999 or go to A&E. In Turkey, the emergency number is 112.

• Swelling that makes it hard to breathe, speak or swallow
• Swelling around your eye or in your neck³¹
• Swelling or pain in the eye, or sudden problems with your sight
• A lot of swelling inside your mouth
• Difficulty opening your mouth

Before you fly home

Know who will carry out your next adjustment, where and when. Make sure you have written care instructions, your treatment record and a way to reach the clinic.

Once you are back in the UK

If a bracket comes off or a wire pokes, write to the clinic and send photographs. See the dentist or orthodontist who looks after your braces in the UK for anything that needs someone to look in your mouth. In the emergencies above, do not wait for a reply.

Braces are not a one-trip treatment. After the brackets are fitted, the wires are changed or adjusted at set intervals until treatment ends. Then the braces are taken off and a retainer is fitted. For its own patients, the NHS describes an adjustment appointment every 6 to 8 weeks⁶. So before you decide, the practical question is who will carry out each appointment, and where.

Two ways to arrange it

There are two ways, and a plan may combine them. You come back to Antalya for the adjustment appointments. Or a dentist or orthodontist near your home in the UK takes over after the brackets are fitted. Repeated trips over many months need to fit your work, your family and your budget. For a child, they also need to fit around school.

A UK dentist or orthodontist has to agree to take over treatment in progress, and some may not want to. They may also want to change the plan or the appliance. Adults usually pay for braces privately in the UK (see the options above). So ask a UK practice in advance whether it would take over, and on what terms.

If a UK dentist does take part, agree what they are asked to do. The GDC states that when a dentist relies on another professional's examination, the responsibility for that judgement rests wholly with the prescribing dentist³². The GDC wrote this for dentists on its UK register. For your plan, it means asking which dentist is responsible for it at each stage.

Between appointments

Photographs you send can show the clinic a loose bracket or a wire that pokes. But a loose bracket is repaired, and a wire changed or adjusted, at an appointment. Ask before the brackets are fitted who repairs a loose bracket or a broken wire between trips, and who pays for it.

What to agree in writing

Agree the arrangement before the brackets are fitted, and have it in writing. Before you start, ask:

1. Who carries out each adjustment, and where?
2. Roughly how often are the adjustments, and how many trips to Antalya does the plan include?
3. What happens if an appointment is missed?
4. Who repairs a loose bracket or a broken wire between appointments, and who pays?
5. Who takes the braces off and fits the retainer, and where?

If you are considering clear aligners instead, ask the same questions about their check-ups; see clear aligner treatment.

The examination comes first

The UK dental regulator, the GDC, states that some contact between dentist and patient can take place at a distance. For other stages of care, however, a face-to-face appointment or a physical examination is needed for patient safety. For orthodontics, the GDC says there is currently no effective substitute for a physical clinical examination³². This is the view of a UK regulator, not a binding rule in Turkey. Before you book, you receive a written preliminary plan based on the photographs and any X-rays you send. It sets out the appointments and how many days the first trip needs. It is not a diagnosis: the examination confirms or changes it, and with it the days and the cost. If it changes, you receive the revised plan in writing before treatment starts. You can take time to decide, and you can say no, or ask to stop, at any stage. Having braces with a dentist or orthodontist in the UK remains an option.

Flying. We have found no guidance that sets a waiting time before flying after braces are fitted or adjusted. A 2023 review of flying after dental treatment does give times for tooth extraction, which matters if teeth are taken out to make room. It suggests waiting 24 to 48 hours after a simple extraction and 72 hours after a surgical one³³. These times apply only if there is no pain, swelling or bleeding where the tooth was taken out. The authors note that the research is limited and comes mainly from military aviation. Ask the clinic when you can fly after the brackets are fitted.

Your own dentist

The General Dental Council suggests talking to your own dentist³⁴ before you go. They need to know the plan, and you keep seeing them for check-ups during treatment (see daily care above). The NHS lists exchanging medical records and arranging aftercare back home³⁵ among the things to consider before treatment abroad.

Ask for a written record: the appliance and brackets used, the stage your treatment has reached and the wires in place. Ask too for copies of your X-rays, scans and photographs. A dentist or orthodontist in the UK needs it to continue treatment or repair the braces. In Turkey, the health tourism regulation entitles international patients to an itemised bill. On request, they also get free copies of the records of the materials used, the tests and the imaging³⁶.

What the NHS does and does not do

In England and Wales, an NHS dental provider may accept you for a course of treatment, not only an urgent appointment. If it does, it provides clinically necessary treatment within its NHS services, with your consent³⁷. That does not mean an NHS practice will take over braces fitted abroad. The free repair or replacement an NHS practice can give for its own work does not apply to work done elsewhere. The NHS also states that it is not liable for negligence or failure of treatment³⁵ when you have treatment abroad. On the NHS England routes that fund planned treatment abroad, you cannot get reimbursement for dental treatment³⁸.

The NHS guidance quoted on this page is for England, and for England and Wales where stated. Scotland and Northern Ireland have their own NHS rules, which we have not checked. Elsewhere in the UK, ask your own dentist how the rules apply to you.

Travel insurance

The NHS notes that most travel insurance policies will not cover you for planned treatment abroad³⁵, so you may need specialist cover. Ask your insurer before you book whether anything linked to your treatment is covered, such as a complication or an extra trip.

The General Dental Council lists questions to ask before treatment abroad³⁴. Below is our selection: what this page can answer today, and what to ask for in writing.

1. Who will carry out my treatment, and what are their qualifications? The treatment is provided by our clinic in Antalya, Turkey. Ask for the name of the dentist who will plan your braces and of each dentist who will adjust them. Ask where they qualified and what their title is (see who carries out the treatment, above).
2. Will they speak English, or will there be a translator? Ask who will explain the plan, the consent form and the care instructions to you in English.
3. Are you regulated by a professional body and registered with it? In Turkey, a health facility needs an authorisation certificate³⁶ from the Ministry of Health to treat international patients. Authorised facilities appear in a register the Ministry publishes³⁹, so you can check it yourself. The authorisation belongs to the facility, not to the dentist, and it says nothing about the result of your treatment. Ask for the treating dentist's own registration details as well. See health tourism authorisation.
4. How many times have you done this treatment, and what are your complication rates? The figures on this page come from published studies, not from the clinic's own results. Ask for the clinic's figures in writing, and how they were collected.
5. Is the work guaranteed, are the terms in writing, and for how long do they apply? This page makes no guarantee. Ask for the clinic's written terms for braces: missed or extra adjustments, loose brackets, the retainer, and what happens if teeth move back after treatment.
6. What aftercare do you provide, and who can I contact after the treatment? Your written plan should name who to contact, how, and who carries out each adjustment (see above).
7. If there are complications, who pays for further treatment, extra flights and the hotel? Ask for the answer in writing before you commit. Ask too what you would pay, and what is refunded, if the examination in Antalya shows that braces do not suit you.
8. Do you have insurance to cover this treatment? In Turkey a facility treating international patients must take out complication insurance for surgical and interventional procedures carried out in an operating theatre³⁶. That does not by itself tell you whether your treatment is covered, so ask which procedures in your plan, if any, fall under it. Ask too, in writing, whether the clinic or the treating dentist holds insurance for complications or errors, what it covers and whom it protects.
9. Do you have a complaints system, and can I see a copy? Ask for it before treatment. The GDC says it cannot resolve complaints or help with refunds⁴⁰; its investigations concern the dentists on its own register. Turkish regulation makes the facility responsible for complications and medical malpractice arising after the health service it provided³⁶.

If the braces are for your child, ask whether the clinic treats under-18s who live in the UK. Ask how a parent gives consent. A child under 18 may be able to have braces free on the NHS, so ask your own dentist first.

The NHS names warning signs to think about before booking any treatment abroad. They are a hard sell, a lack of information, pressure to make a quick decision, no discussion of possible complications, and no mention of aftercare³⁸. Apply them to this clinic too.

This page does not show prices. A treatment plan is prepared for you after an examination. The main factors that shape it are:

• The appliance chosen: metal or ceramic brackets, lingual braces or clear aligners
• How severe the problem is and the likely length of treatment
• Extra procedures, such as taking teeth out, or fillings or gum treatment before orthodontic treatment
• The number of adjustment appointments, and how many of them are in Antalya
• The retainer after treatment and its check-ups

Ask for the plan in writing. It should say what is included, and especially whether the adjustments, the retainer and its check-ups are included. Ask too who pays for further treatment and extra travel if there is a complication.

If you are comparing with a quote from a UK practice, compare what each one includes, item by item. Add the cost of your own trips for adjustment appointments, and of any UK appointments your plan relies on.