Specialists from National Dental Centre Singapore (SingHealth) answers your questions on braces and retainers.
When it comes to teeth straightening options, should you go for traditional metal braces, clear ceramic braces or aligners?
Your dentist or orthodontist will be the best person to help you with your decision.
Your orthodontic journey begins when your braces or appliances are issued but it doesn’t end when they are removed.
Teeth have a tendency to move back into their original positions or relapse. As a result, a retention phase is necessary after the removal of braces. Retainers will be issued to ensure that they remain straight long after treatment.
Specialists from National Dental Centre Singapore (NDCS), a member of the
SingHealth group, answer your questions and more in this 'Ask the Specialist' Q&A forum.
This 'Ask the Specialist' forum has closed. Thank you for your interest and participation.
Scroll down the page to see all questions and answers submitted on this topic.
FAQs on braces and retainers
Question by J****
There are metal braces and ceramic braces, then there is also Invisalign (are there other options of braces that I’ve left out?) I have the following questions:
How do I go about choosing what’s best for me? Besides cost, what other factors should I bear in mind?
Is there a "best" choice among all these? And is there a "best" time/age to have them fitted?
What is the estimated average duration that I need to wear for each? Is it about 2 years for all?
What are the disadvantages of each?
Is there one that has proven more effective than the rest?
Thank you for your advice.
Answer by
Dr Qian Li, Consultant, Department of Orthodontics
Hi J****,
In essence, different patients are suited for different types of braces based on individual needs.
Metal braces and ceramic braces follow the same mechanical principles and produce identical results and effectiveness. Clear aligners are only suitable for specific cases, and can be less effective in correcting certain types of malocclusion.
The disadvantage of metal braces is that it is the most visible type of braces. Brushing and maintaining oral hygiene is also more challenging with fixed appliances (metal and ceramic braces). While clear aligners are removable when brushing and allow for easier maintenance of oral hygiene, they are also less effective in treating complex malocclusion. When using clear aligners, a high degree of compliance is required, and it needs to be removed when eating and brushing.
When it comes to treatment duration, the average duration for extraction cases is about 2 years, while non-extraction cases can be significantly shorter. Treatment duration varies between patients and depends on complexity of treatment, age, root length of teeth, bone density, rate of turnover of bone structure, etc. The choice of different types of braces has less of an impact.
Determining the best choice of orthodontic treatment involves identifying the option that best fits the individual’s unique preferences, priorities and treatment needs.
Most of the time, visibility of one’s braces is the strongest factor patients consider when choosing alternatives to metal braces. If you like to choose colors every month and don’t mind the traditional appearance of having braces on, then metal braces is usually the most cost-effective option.
Question by C****
Hi Dr,
Apart from correcting the gap between teeth and teeth protrusion, what are other reasons or benefits for getting braces? Will it last? Apart from braces, are there other ways correct teeth gap and teeth protrusion? Thanks.
Answer by
Dr Qian Li, Consultant, Department of Orthodontics
Hi C****,
Closing spaces and correction of protruding teeth are just two of the many indications of braces. I’ll state some of the common areas where braces can be recommended:
Correct crowding (crooked teeth)
Correct deep overbite (excessive overlap of teeth sometimes resulting in trauma to gum health of upper teeth)
Correct anterior open bite (front teeth cannot touch)
Correct posterior cross bites
Correct impacted teeth
Correct anterior cross bite (reverse bite / under bite)
Combined braces and jaw surgery to correct jaw discrepancy
Growth modification for short upper jaw or short lower jaw
This list is not exhaustive, but shows the wide range of occlusal problems that braces can correct. Braces do not just improve the smile, they can also improve functions or prevent future development of dental problems.
Question by C****
I’ve been going back and forth about whether to get braces for quite a while after hearing from others who done it that:
It can be quite painful especially when you get mouth ulcers from the metal wire cutting your gums, chewing can cause pain too (my pain tolerance isn’t very high)
I heard that there are instances, teeth may need to be removed for braces, is it true? Under what circumstances?
Even after wearing braces, once it is removed, your teeth can go out of place again, is it true?
What do you think is the best option for me, based on what I’ve shared? Thank you.
Answer by
Dr Qian Li, Consultant, Department of Orthodontics
Hi C****,
Most patients get used to the roughness of braces and wires after one to two months. Most are also able to eat normally after the first month of having braces on. Some adult patients are more prone to have ulcers and discomfort from braces than others. We advise a soft diet during the initial stage of braces treatment, and teach patients how to use wax and ulcer cream to relief discomfort from ulcers.
Extractions are recommended when there is crowding and lack of space for all teeth to fit within the patient’s jaws. Space created by extractions will be used to correct crowding (crooked teeth) or to reduce protrusion of teeth. Your orthodontist will discuss with you whether extractions are beneficial to your braces treatment.
Teeth tends to return to their original positions after removal of braces. That is why retainers must be worn after braces treatment for an adequate duration.
It is recommended to see an orthodontist for an initial assessment. During your visit, the orthodontist can advise on whether you will need extractions and what kind of discomfort you will likely experience during your treatment.
Question by A****
Hi Dr, my 7+ year old daughter has misaligned teeth and a slightly protruding upper jaw. Will wearing braces correct it? Is there a minimum recommended age for wearing braces? Is it better to wear braces at a younger age than later – does it mean a shorter wearing time but will it last to adult age? Having wisdom teeth will ruin the alignment, correct, what can be done then? Thank you for your advice.
Answer by
Dr Qian Li, Consultant, Department of Orthodontics
Hi A****,
Braces usually can be deferred until the age of 12 or older in most people, when baby teeth have all been replaced by adult teeth. However, some kids will require early braces at a younger age to correct problems that cannot be delayed further.
Alignment of teeth for aesthetic purpose is usually done after most permanent teeth have erupted. At the age of 7+, most adult teeth have not yet erupted, and it is too early to correct misalignment in most cases.
Jaw growth issues usually require early treatment and are best done between the ages of 9 to 12. Some patients will benefit from growth modification during this period, to help maximise the growth potential of the upper or lower jaw.
Severe protrusion of upper teeth may also require early correction at times to reduce risk of trauma and injury to the upper teeth.
Your daughter will most likely not require standard braces now, but may benefit from interceptive orthodontic treatment in the form of growth modification or removable appliances. It is a good idea to visit an orthodontist for an assessment.
Wearing braces during teenage years, compared to delaying until adult age, usually translates to faster treatment time, and less discomfort experienced during treatment. Wisdom teeth are not proven to ruin the alignment of teeth. As long as patient is compliant with retainer wear after braces, wisdom teeth removal is usually a separate decision from retention of braces alignment.
Question by M****
Hi Dr, I have the following questions:
How early can braces be put on a child?
Are a child’s crooked teeth due to genetics?
Is it possible to just wear retainers instead of braces? If yes, is it as effective and are there downsides to this?
Does getting braces cost about S$5K these days? Is this a reasonable amount I can expect to pay?
Your advice is much appreciated.
Answer by
Dr Qian Li, Consultant, Department of Orthodontics
Hi M****,
Braces usually can be deferred until the age of 12 or older in most people, when baby teeth have all been replaced by adult teeth. However, some kids will require early braces at a younger age to correct problems that cannot be delayed further.
Jaw growth issues usually require early treatment and are best done between the ages of 9 to 12. Some patients will benefit from growth modification during this time window, to help maximise growth potential of upper or lower jaw. Severe protrusion of upper teeth may also require early correction at times to reduce risk of trauma and injury to the upper teeth. It is a good idea to visit an orthodontist for an assessment.
The size of teeth and size of jaws in a child are affected by genetics. This in turn will play a part in the severity of a child’s crooked teeth. However other environmental factors such as thumb sucking habit, early loss of baby teeth, injury to teeth, missing teeth, all contribute to development of malocclusions as well. Even twins, who are genetically very similar, can have different presentation of crooked teeth.
Retainers are designed to retain the existing positions of teeth and not to move teeth. Clear aligners appear identical to retainers, but is designed to correct teeth alignment. Different brands of clear aligners have different limitations and effectiveness. There are some types of malocclusions that are not suitable for clear aligner treatment. An orthodontist can advise you whether you are suitable for clear aligner treatment.
The cost of braces varies for each individual. It depends on the complexity of your malocclusion, the type of braces you choose, and whether you are seeing a braces specialist (orthodontist). Some patients who have very mild crooked teeth may only require partial braces on several teeth and consequently the cost of treatment can be much lower.
Overall treatment cost of upper and lower comprehensive traditional metal braces in government hospitals is typically less than $5,000. Financial counselling can be done after you’ve visited an orthodontist to receive a more precise quotation.
Question by R**
Hi Dr, I had metal braces done 20 years ago and the procedure was like this – had to wear for about 2 years with monthly tightening of the wires. Then, after braces removal, had to wear retainers for about 6 months. Are the procedure and techniques still the same today? Thanks.
Answer by
Dr Qian Li, Consultant, Department of Orthodontics
Hi R**,
Traditional metal braces treatment has not changed very significantly from 20 years ago. Newer material technology allows for gentler wires and lower forces, which may translate to less discomfort experienced during initial stages of treatment. Newer ceramic materials for porcelain braces may also have better resistance to staining and fractures. However, overall treatment duration, fundamental principles of tooth movement, and the need for retainer wear has not changed.
Improvements in computer-aided design and manufacturing, intra-oral scanning and material science have allowed clear aligners to correct more types of malocclusions. Clear aligner treatment does not involve monthly tightening of wires and can be a lot more aesthetically pleasing. However, it demands a higher level of patient compliance in ensuring adequate hours of wear and has its own advantages and limitations.
Even though technology provided us with more choices, the biological principles and the need for an experienced clinician to co-manage the risks remain the same.
Question by F*****
Hi Dr, my wife is a foreigner staying in Singapore under Long Term Visit Pass Plus (LTVP+). She wants to put on dental braces to correct the alignment of her teeth. I have questions regarding dental braces and theay are as follows:
How much is the cost of each type of dental braces?
Is subsidy available for her if she does it with a government dental institution? If yes, what is the procedure to apply for it?
What are the different types of braces?
She is 26+ years old. Can she still put on dental braces?
Are fixed braces or removable aligners better?
Kindly advise on the above questions. Thank you.
Answer by Dr Qian Li, Consultant, Department of Orthodontics
Hi F*****,
Here are the answers to your questions:
How much is the cost of each type of dental braces?
Comprehensive two-arch (upper and lower) orthodontic treatment for non-residents range from $3800-$7000+. The cost varies due to differences in complexity of treatment, seniority of clinician, and types of appliance. After the first consultation visit, the orthodontist will advise you on the most suitable orthodontic treatment appliance that meets your individual needs, and arrange financial counselling for you during that visit.
Is subsidy available for her if she does it with a government dental institution? If yes, what is the procedure to apply for it?
There is no subsidy available for orthodontic treatment in any government dental institution. Patients with suitable indications may be referred to NDCS orthodontic residency programme, where cost of treatment may be lower.
What are the different types of braces?
The main types of braces for adults include conventional metal fixed appliance, ceramic fixed appliance, and clear aligners.
She is 26+ years old. Can she still put on dental braces?
Yes she can. I have several 60+ year old patients having orthodontic treatment as well. There are limitations and special considerations for older adults embarking on orthodontic treatment. Your wife is definitely not too old to get dental braces.
Are fixed braces or removable aligners better?
There are advantages and disadvantages of each system. Clear aligners have better aesthetics, and greater ease of maintaining oral hygiene. However clear aligners greatly depend on compliance and discipline from the patient in ensuring 20-22 hours daily wear. There are some types of malocclusions that clear aligners are unable to effectively correct. An orthodontist can examine your wife’s malocclusion and advise which is a more suitable option.
Question by b*****
Hi Dr Choo,
I have finished with my braces 8 years ago and have been wearing retainers ever since. However, my teeth would start to shift significantly even after 2 days of not wearing my retainers. By significant, I mean that the next time I wear my retainers it would feel quite tight. Was wondering if this is normal? Thank you!
Answer by Dr Johanna Choo, Senior Consultant, Department of Orthodontics
It is normal to feel some degree of tightness when replacing retainers at night. In general, retainers should be worn every night indefinitely for at least 8 hours. Some cases tend to relapse (shift) more than others and require extended wear. Growth and age related changes can affect tooth movement and mobility and may also cause relapse. If you experience significant shifting during the day, I would advise making an appointment with your orthodontist to check your teeth and your retainer.
Question by r*****
I'm 59 years old. I can feel that my front incisors are still protruding outwards more and more each year. What can be done to prevent further movement or correct them? Thank you.
Answer by Dr Johanna Choo, Senior Consultant, Department of Orthodontics
It is advisable to visit your dentist/orthodontist for a check up so that he/she can determine the cause of this worsening protrusion. If you have had braces before, relapse may be a cause of progressive protrusion. Age-related bone changes and/or gum disease can also cause teeth to drift and protrude. A retainer may be an option to prevent further protrusion but that will depend on your dental history, your bite and the health of your teeth.
Question by D********
Hi, my girl is 14 this year. She has overcrowding teeth especially at the lower front teeth. Would like to check whether is 14 a good time to consider straightening her teeth? If so, can advise which type is more suitable for her age as I understand now there are metal braces, ceramic braces as well as aligner. Appreciate your advice. Thank you.
Answer by Dr Johanna Choo, Senior Consultant, Department of Orthodontics
In general, 14 is a good age to start braces. Conventional braces are made of high-quality stainless steel and are fixed to the teeth. Ceramic braces are similar; they are less visible but are more brittle and costly. Aligners are removable braces. They are also more aesthetically pleasing than metal braces and also costlier.
Besides aesthetics and budget, discipline is also a factor to consider. Aligners need to be worn at least 23 hours a day. If one set is not worn as often as they should, then the treatment may be compromised. Ceramic braces and aligners may not be suitable for all cases so it is advisable to consult your orthodontist to see if these are feasible options.
Question by I**
I was advised to remove a total of 4 premolars on the top and bottom arches of my teeth as they are overcrowded. Is it possible to only braces for one arch? I am mainly concerned with the aesthetics for only one of my arches. Alternatively, is expanding the dental arches a viable solution instead of removing premolars? I previously assumed I will not need to remove any more teeth after gaining extra space from my 4 removed wisdom teeth.
Thank you very much!
Answer by Dr Johanna Choo, Senior Consultant, Department of Orthodontics
In general, moderate/severe overcrowding of teeth requires extraction. Expansion can provide some space for teeth to align but only in mild crowding cases. The wisdom teeth are at the back of the mouth and as they are quite ‘far’ from the site of crowding, removal does not provide space for alignment. Braces and extractions will change your bite and both upper and lower braces are usually required to re-adjust the bite effectively.
Question by B***********
I have been wearing my retainer since I took out my braces 3 years ago. May I ask how often do I have to change my retainer? I am not sure if I should purchase a new set of retainer. Thank you Dr Choo!
Answer by Dr Johanna Choo, Senior Consultant, Department of Orthodontics
Retainers do not usually have to be changed unless they are broken or do not fit well. If you have been using your retainers consistently and they are intact, you should be able to continue using them. Remember to follow the care instructions that your orthodontist gave you to prolong the life of your retainers. It is advisable to visit your orthodontist if there are any doubts regarding the fit of your retainers.
Question by g***********
Must retainers be soaked in water daily when not used during the day?
Answer by Dr Johanna Choo, Senior Consultant, Department of Orthodontics
Retainers can be soaked in water during the day. Alternatively, if you choose to store them in the box, remember to first clean them thoroughly and keep the box away from heat.
Question by e*******
I have been on retainers 24hours for almost 1 year. But my teeth shifted even though i have been wearing it. Is there any way to make it straight again? Btw its hawley retainers.
Answer by Dr Johanna Choo, Senior Consultant, Department of Orthodontics
Retention is a necessary part of an orthodontic treatment to prevent the straightened teeth from shifting back to its original position - this is known as relapse. Relapse can occur as a result of forces from the fibres around the teeth which tend to pull the teeth back into their pre-braces positions. Lip and tongue pressures can also cause the teeth to shift out of alignment.
Hawley retainers do not lock the set of teeth in one position as they allow teeth to move naturally towards each other. A process that is necessary to allow better function of teeth, this is termed as settling, it is a desired outcome after braces treatment for teeth to come together more after braces are removed. If the teeth have only shifted a little, new retainers that actively move the teeth may be able to move the teeth back into position. However, if the teeth have shifted a lot, other measures may be needed to re-straighten the teeth again. To get better assessment we advise you to visit an Orthodontist for a review.
Follow-up question by e*****
Thanks for the reply.
I have another question, is there a difference in the different types of retainers, eg. Hawleys/ clear retainers.
Do they affect the teeth in any way? or is one better than the other?
Answer by Department of Orthodontics, National Dental Centre Singapore
Retainers can be categorised into fixed or removable. Fixed retainer is a wire that is glued onto the backs of your teeth to prevent teeth from shifting. Removable retainers include Hawley retainers and clear retainers. Out of the different types of retainers, fixed retainers works the best in preventing teeth from shifting as it is there all the time. However, it has its disadvantages; it is difficult to clean and traps more plaque. Sometimes the glue that holds the wire in place dislodges and the teeth can still shift out of position.
Hawley retainers and clear retainers are different in their designs, but both work to prevent teeth from shifting out of position. Hawley retainers generally allow the teeth to settle faster, meaning the teeth do not have a layer of plastic that blocks the teeth from touching each other so it allows the teeth to shift towards each other more after braces are removed.
Clear retainers have a layer of plastic between the teeth when the patient is wearing both upper and lower retainers. The layer of plastic blocks the teeth from shifting towards each other more. However, since clear retainers are worn only at night after some time, natural teeth settling still takes place. During the day when the patient is not wearing the retainers, the teeth are no longer blocked by the plastic and can shift towards each other just like with the Hawley retainers.
Settling is an important part after braces treatment as it allows the teeth to function more optimally as it touches each other more after being released from the braces. Hawley retainers are built with an adjustable wire. While, clear retainers’ shape is fixed. Both function to keep extraction spaces closed. There is some research to suggest that clear retainers are better at preventing teeth that were rotated from shifting out of place. However, there is also research to show that even with fixed retainers; rotated teeth may still shift out of position. I would say that your orthodontist would be able to recommend the best type of retainers based on what your teeth was like before braces treatment.
Question by e*****
Hi is there any age limit to consider putting on braces?
Answer by Department of Orthodontics, National Dental Centre Singapore
A lot of people think that braces are meant for younger people. However, teeth with a healthy gum support can be moved at any age. The main limitation is not age but the support of the teeth. If your teeth have good bone support and healthy gums, braces treatment can be an option at any age. Do consult your orthodontist who may be able to ascertain if you are a suitable candidate for braces.
Question by c******
Dear Doctors, when I was young, my parents couldn’t afford to get me braces. In recent months, I’ve been to a few dentists in my neighbourhood to find out the cost of getting braces done, and frankly, they’re exorbitant ($9k onwards without tooth extraction). How much would it cost for an adult to get braces done in NDCS (including all consultations and extractions) and is any part of it medisave claimable? Also, what is the waiting period?
Answer by Department of Orthodontics, National Dental Centre Singapore
You are definitely not alone in your experience. Braces treatment is considered elective treatment and can be delayed until an appropriate time for each individual. Braces treatment in NDCS is estimated to range from $2000-$5000 depending on the complexity as well as the type of braces used. Braces treatment is considered elective and hence not Medisave claimable. Waiting time to the first consultation is usually within a few days to a few weeks.
Question by b****
Hi Drs, between metal, lingual and ceramic braces, which are most effective, require the least amount of time and don’t affect your speech too badly? I do a lot of trainings for a living and am already in my late 30s. I don’t want to use metal braces because they don’t look so good, but I also heard that they’re effective.
Answer by Dr Elaine Tan, Head & Senior Consultant, Department of Orthodontics
Answered by
Dr Elaine Tan, Head & Senior Consultant from the Department of Orthodontics, National Dental Centre Singapore
It is indeed a major decision to select a suitable brace that doesn’t affect your work. Metal, lingual and ceramic braces are all fixed appliances, this means they are fixed and stuck permanently onto your teeth throughout the course of treatment. These fixed braces are all equally effective in moving teeth but may cause some discomfort as the lips and cheeks could rub against the braces, to cause ulceration, etc.
Lingual braces are attached on the inside of the teeth. Even though they are not visible, the tongue will frequently come in contact with the braces and you will take some time to re-adjust back to your usual speech.
Removable braces like clear aligners on the other hand, can be removed during the course of treatment e.g. while you are eating or brushing teeth, or even for important functions. In addition, removable clear aligners are effective in moving teeth and are more comfortable in the mouth compared to fixed braces. They are also aesthetically more appealing than the rest as there are no metal wires used. However, for more complex tooth movement, fixed braces may prove as a more effective treatment option.
It is advisable for you to seek a consultation with an orthodontist to find out what sort of braces is most suited for your case.
Question by d********
Dear Drs, I take both my parents to their heart appointments and I hear their doctors advise them to keep their teeth clean. My parents have misaligned and a few missing teeth now that they’re in their 60s. I’m concerned that as I grow older, and if I don’t get braces done, that I may develop heart problems too. Are my concerns misplaced? Will braces help me prevent heart disease?
Answer by Dr Elaine Tan, Head & Senior Consultant, Department of Orthodontics
Dear d********, your concern is justifiable. Braces will not prevent heart disease. From scientific studies, it has been proven that cardiovascular heart disease is linked to gum (periodontal) disease. Improved gum condition has been shown to improve the cardiovascular heart disease. This is possibly why the heart doctors advised your parents to keep their teeth clean so that their heart conditions can be maintained.
Braces can indeed align your teeth and make cleaning easier, improving oral health. However, if the straightened teeth aren’t cleaned well, there is still a risk for gum disease. We have also seen patients who are able to keep their teeth clean with crooked teeth.
Question by s*****
Hi Doctors, I am considering putting on braces. I heard that people who with braces should eat soft foods such as porridge, oatmeal etc. What foods and drinks should I avoid? Also, does wearing braces promote weight loss? Thank you for your time.
Answer by Dr Elaine Tan, Head & Senior Consultant, Department of Orthodontics
We generally advise our patients to start with soft diet like what you mentioned as it can be rather sore during the first few weeks of initial placement of braces. However, as the treatment progresses and patients are more used to the initial discomfort with every adjustment visit, they can pretty much resume to their normal diet. However, we strongly advise against eating hard, crunchy food like nuts, ice cubes, crabs, etc. Apples should also be cut into bite sized before eating rather than munching off a whole apple on its own. This is to prevent patients from biting off the braces during eating of these foods.
Lastly, braces do not promote weight loss. In some people, they lose weight after putting on braces as they eat less due to the discomfort, but there are people who put on weight during braces treatment as they turn to other high calorie food like ice cream, sugary drinks etc. Weight loss should be done through diet and exercise.
Question by p************
Dear doctors, I have some crooked teeth and a slight under bite. My dentist suggested that I should put on braces for 2-3 years, thereafter I have to continue to wear retainers for the rest of my life. Is it true that my teeth will start to shift if I don’t wear my retainers? After removing my braces, how often should I replace the retainers and go back for reviews? Thank you!
Answer by Dr Elaine Tan, Head & Senior Consultant, Department of Orthodontics
Dear p************, great question! Yes it is true that teeth will start to shift if you don’t wear your retainers. In the first year after removal of braces, the teeth have a high tendency to shift back to the original position. Thereafter, teeth will still continue to shift throughout life, hence we always recommend a life-time wear of retainers.
After removal of braces, the retainers can usually last you for quite a number of years. There is also a fixed retainer you can consider, which is a metal wire that is stuck to the back of your teeth. The review visits depends on your orthodontist. We usually review our patients in the first 6 months, and yearly after removal of braces.
Question by c******
I have a friend who was supposed to take off his braces years ago, but just didn’t show up to his appointment. He thinks people with braces look cute/endearing and I guess he wants to prolong wearing braces because of this! I personally feel it’s really unhygienic because it’s so easy for food can get stuck in there. To think that he could actually just take it off already! What can I say to him to advise him? Thanks.
Answer by Dr Elaine Tan, Head & Senior Consultant, Department of Orthodontics
Dear c******, your concern for your friend is indeed warranted. It is not good to prolong wearing of braces when it is time to remove them. This is because without close monitoring of the braces by the dentist, your friend may not be aware that the braces could be loose and that might pose risk of ingestion. When the braces are no longer stuck to the teeth, the teeth may start to move and become crooked again.
You are also right that it is unhygienic to prolong braces as bacteria can get trapped around the braces and result in discolouration of the teeth around the braces or worse tooth decay may happen.
After braces are removed, we will put patients on retainers to retain the straightened position. If your friend likes the metal wire, he could request for a metal Hawley retainer so that the metal wire can still be seen. The retainer can also be removed for cleaning and when patient brushes teeth and eat. This makes it more hygienic for the patient.
Question by M********
Hi my upper and lower jaw does not match, does braces help or surgery need to be done?
Answer by Department of Orthodontics, National Dental Centre Singapore
Hi M********, not many people are aware that the problem with their bite may be due to their jaw positions. This means the upper jaw is too far behind the lower jaw or vice-verse. These are just some of the more common presentation, other jaw malpositioning are also present. Braces are meant to be stuck on teeth, and its purpose is to move teeth, not to adjust the jaws. In mild cases, braces may be possible to fit the teeth according to the mismatched jaws. This is known as the camouflage treatment, which means we change the teeth position to camouflage the jaw position. However, sometimes the degree of discrepancy between the upper and lower jaw may be too wide and jaw surgery is warranted to correct the jaw position and braces is also needed to ensure the teeth fit properly in the corrected jaw position.
Question by T**********
Hi doctors, I recently put on braces, and I started having ulcers on my gums. Is that normal?
Answer by Department of Orthodontics, National Dental Centre Singapore
Having ulcers sometime after putting on braces is a normal occurrence. Hooks on braces that will be used for rubber bands during braces treatment as well as the braces wire may chaff against your cheeks to cause ulcerations. You may also accidentally bite your cheeks or lips with the braces as you are not used to the braces yet. One way is to roll a small ball of orthodontic wax and stick it on the part that is chaffing. It should soften the sharp edges and make it more comfortable. However if the ulcer does not heal but worsens, do visit your orthodontist who may need to adjust the braces to make it more comfortable.
Question by S***********
Hi, from my previous visits to the specialist, understand that I need to extract 4 teeth before the braces can be put on. is there anything that can be done to shorten the period between the tooth extraction and putting of braces? Thanks.
Answer by Department of Orthodontics, National Dental Centre Singapore
Extractions are often necessary in braces treatment. Sometimes your orthodontist may extract teeth on different visits for healing to take place and to lessen any discomfort. Your orthodontist may also need to use certain auxiliaries to help in your treatment and these require a few more visits before the final putting on of the braces. You may wish to explain to your orthodontist the time commitments you have in mind to plan out a viable treatment plan.
Question by T**
I've been on braces for 5 years & it's going nowhere. My dentist recently told me that he needs to refer me to see a specialist/Orthodontist. Why are general dentists allowed to provide Orthodontic treatment in the first place & why did my dentist not referred me to see an Orthodontist to begin with?
Answer by Department of Orthodontics, National Dental Centre Singapore
Sounds like you need to see an orthodontist for a consultation. You can see an orthodontist of your choice to go through your treatment history and discuss possible options.
Question by F*****
Hi Doctors, I have 2 pre-molars removed (each side) on my upper jaw due to root canal decay. I am wondering if i could do without more teeth extractions on lower jaw as I do not want to lose good teeth unnecessarily because of braces. Is there a way to file up some teeth to create space so that I can do braces w/o teeth extraction?
Answer by Department of Orthodontics, National Dental Centre Singapore
Extractions are sometimes a necessary part of orthodontic treatment and also part of an overall treatment plan when teeth are lost due to decay.
Sometimes there may also be crowding present in the lower arch that warrants extractions in the lower jaw in order for the upper and lower teeth to fit properly. Interproximal reduction otherwise known as filing of the teeth does create some space that may help with the crowding, however there is a limit to how much interproximal reduction can be done.
On average each tooth can only be filed down a maximum of 0.5mm otherwise it will be detrimental to the health of the tooth. If interproximal reduction is not enough to solve the amount of crowding, extractions will be warranted. Extractions in the lower arch may also be necessary to achieve proper relationship with the upper teeth in order to have a good bite. To get a better assessment, it is best to consult an orthodontist for an evaluation.
Follow-up question by F*****
Thank you for your reply.
Regarding extractions, can i assume that it will always be 1 tooth on each side (in this case for lower jaws) and would it always be the corelating teeth top and bottom to be removed in order for a good bite ?
Answer by Dr Elaine Tan, Head & Senior Consultant, Department of Orthodontics
The American Association of Orthodontists recommends that each child should have a check-up with an orthodontist no later than 7 years of age. You can bring your girl in for a consultation with an orthodontist to check if she is ready for braces. Usually we will wait for baby teeth to be replaced before starting braces. However, sometimes the permanent tooth maybe missing, resulting in non-replacement of the baby tooth, or the child may need some interceptive treatment before the baby teeth are completely replaced. It is best to bring your girl to consult an orthodontist now
Question by j****
I have bruxism since at young age and my teeth has shifted causing bad misalignment and some gaps. I have fair bit of saliva spewing when I speak the past recent 6 months and I have chewing and biting problem. Also has difficulty pronouncing certain words or letters.
What is the best treatment for me? My mental health is affected as well.
Answer by Department of Orthodontics, National Dental Centre Singapore
Bruxism is the subconscious state of grinding or clenching your teeth when you sleep at night and it tends to wear your teeth over time. Bruxism is often associated with worn teeth and some people may get jaw joint aches and pains from sore muscles after a night of grinding and clenching. It sounds like you would need an assessment from a TMJ (temporomandibular joint) specialist who will be able to advice the treatment options after a clinical assessment.
Question by S******
Dear Doctors, i have not been wearing my retainers for few months, and previously was only wear occasionally at night. Now that my teeth has shifted abit and my retainers are getting very tight and hard to fit. Should i be doing a new set of retainers or i can just do re-adjustment? By the way, is it safe to do retainers or adjustments during early stages of pregnancy? This is my main concern as sometimes after readjustment, the retainers will be very tight and will tend to cause headache, not sure will it affect nerves or anything? Previously i'm under a subsidized patient under NDC but since i have complete my braces many years back, if i go back for readjustment, i will be considered as private rate right? Thanks for your advice in advance.
Answer by Department of Orthodontics, National Dental Centre Singapore
When your retainers feel tight, it means that the teeth are no longer in the same position where the retainers were first fabricated. Re-adjusting the retainers may not fully correct it, but it may help to maintain its position. If it is so tight that it gives you a headache, it may mean that there is too much force on the teeth. It is best to check with an orthodontist for advice on the other treatment options e.g. fabricating new retainers or a short phase of braces again. As retainers are a removable appliance, it will not cause any adverse side effects even if you are pregnant.
If you were a previous patient with NDCS and wish to have your retainers checked under subsidised rates, simply visit a polyclinic to get a referral letter to explain the reasons for revisiting.
Question by S********
My daughter is 3 years old and she has slight underbite problem. It does not affect her speech and eating. I was told that I should still bring her for braces /dental correction eventhough it is mild becuase it may slowly affect her appearance. Is that true? Given her young age and may not be able to understand fully and cooperate, when will it be a best time to bring her to see a doctor? And will the braces cause any discomfort? Thank you!
Answer by Department of Orthodontics, National Dental Centre Singapore
What is commonly known as an “underbite”, is also known as a reverse overjet. This means that the upper teeth lie behind the lower teeth when she bites together, this gives the appearance that the lower jaw is protruding more than the upper jaw. Most of the time, it is due to the upper jaw being too far behind and trapped by the lower jaw.
As she is only 3 years old, and it is not affecting her speech and eating, it may be better to wait till she is about 5-6 years old to bring her to see an orthodontist for an evaluation. At that age, she may be able to understand and cooperate better. Early treatment of an underbite has its benefits as the upper jaw is young and the joints holding the upper jaw is still soft and malleable to orthodontic treatment.
Question by b**
Dear Dr, My 6 year old boy has an overbite. His primary teeth are all still intact. What are the factors that I should take into consideration if i would like to get him fitted for braces? Also why is the estimated cost for pediatric braces? Thank you.
Answer by Department of Orthodontics, National Dental Centre Singapore
At 6 years old, it is likely that he still has most of his milk teeth in his mouth and they are still in a state of transition to adult teeth. Reasons to treat protruding front teeth early around this age would be to reduce the risk of injury to his front teeth and will help if the child is being teased in school for his “bunny” teeth resulting in low self-esteem.
However, large- scale research studies conducted show that treating children with protruding front teeth early does not mean that he will not need orthodontic treatment at a later age. The difference between treating a child early and if the treatment were to be delayed is also small. It is always best to bring your child to an orthodontist for a clinical assessment to know if he or she needs any form of treatment early.
Question by E*******
Hello Dr, My upper teeth used to be really straight while my bottom teeth is quite crooked, but there was once i was really annoyed by my bottom set of teeth, so i pushed with my tongue everyday so i can make it more aligned.. i pushed till my gums felt "weak" and my teeth were "moving", until now my upper teeth got "pushed" because i overpushed my bottom teeth, so when i clench or just close normally it will affect my upper set of teeth. I bought this teeth aligner on taobao long time ago, i tried using it, it felt like it would work because my gums felt like it was loose but i don't use it anymore because i dont want to worsen the situation now. I was thinking of having the Veneers(?) instead of braces, but i worry my bottom teeth is too crooked. Also,is it possible if i were to wear braces for my bottom teeth only?
Answer by Department of Orthodontics, National Dental Centre Singapore
Teeth lie in a zone of equilibrium held in bone by periodontal ligaments as well as a zone where the forces from the lips and tongue are balanced. Constant forces placed on teeth disturb this equilibrium and does result in teeth movement as seen in some patients who have a habit of sucking on their thumb or thrusting their tongue between their front teeth. Uncontrolled forces placed on the teeth can result in uncontrolled movement of the teeth that may be damaging. It is best for you to have an assessment with an orthodontist who will ascertain the health of your teeth and gums to offer you the best treatment options that will be tailored to your needs.
Question by t*****
Dear Doctors,
My girl is now 12 years old and has some crooked teeth. I am planning to let her start braces treatment, but she still has 1 more baby teeth not replaced yet. Do I have to wait till all her adult teeth is out before we start her on braces? For children her age, what type of fixed braces are recommended? Thank you.
Answer by Dr Elaine Tan, Head & Senior Consultant, Department of Orthodontics
The American Association of Orthodontists recommends that each child should have a check-up with an orthodontist no later than 7 years of age. You can bring your girl in for a consultation with an orthodontist to check if she is ready for braces. Usually we will wait for baby teeth to be replaced before starting braces. However, sometimes the permanent tooth maybe missing, resulting in non-replacement of the baby tooth, or the child may need some interceptive treatment before the baby teeth are completely replaced. It is best to bring your girl to consult an orthodontist now
Question by M*****
Dear Dr, I had my orthodontic treatment done 30 years ago. There is a slight relapse and like to know more about if I do the treatment again. I am now age 63. I had one dead tooth after the treatment. Did a root canal on this tooth.
My questions are :
What will be the cost of the treatment ?
Will I have another dead tooth from the moving ?
Will there be complication for my age ?
Anything that I have to take into consideration ?
Answer by Dr Elaine Tan, Head & Senior Consultant, Department of Orthodontics
Thank you for your great questions! No one is ever too old for braces!
The cost of treatment will range from $2200- $6000 depending on the complexity of the case.
One of the risks for orthodontic treatment is loss of vitality of the tooth. However, this usually happens on tooth that was previously traumatized before, or have been moved a long distance. If you have a slight relapse and your teeth is just slightly crooked and do not need much movement, then the risk of having a dead tooth will be reduced.
The risks from braces treatment are the same at any age. However, we will need to examine your gums and bone support to see if they are in a healthy condition for braces treatment. Also, in older patients, there may be more discomfort and treatment time may also take slightly longer as the bone supporting the teeth may be harder and lighter forces are used to reduce the discomfort from braces treatment.
You can also consider other more aesthetic appliances like clear aligners so that it does not disrupt your daily functions. It will be good for you to seek a consultation with an orthodontist to assess your suitability for braces treatment and discuss the various treatment options available for your case.
Ref: I23
