Does my child need braces? And how to take care of them

We all want our beautiful smiles to be framed by beautiful teeth, but sometimes that requires a little help. HCF Orthodontist Dr Frank Tan answers your FAQs about kids’ braces, including the types of braces that are now available.

Being told “you need braces” is something many kids – and parents – might not want to hear. But these days, there are many more options than there used to be and braces can be a worthwhile investment in your child’s future health and happiness.

We asked HCF Specialist Orthodontist Dr Frank Tan for his tips on the how, why and when of getting braces for your child.

Why might my child need braces?

Dr Frank Tan: One reason is if there’s a functional issue, for example the way they bite isn’t right. Typically there’s ‘excessive overjet’, when the top teeth are too far forwards and they can’t get their lips together comfortably, or an ‘underbite’, when the upper front teeth bite behind the lower ones, causing enamel wear of the upper teeth. These can generally be identified at a young age, before the problem becomes too severe.

Braces also make the mouth less crowded and the teeth easier to keep clean. But often it’s simply for cosmetic reasons. Most parents today are educated about the possibilities, and often want their children to have straight, good-looking teeth.

Are there any factors that make needing braces more likely?

Dr Tan: Yes, there are a few factors that can lead to crowding of teeth and misaligned jaws, and that includes thumb-sucking. But genetics have a big part to play. Jaw size and shape is inherited, and if there isn’t enough room this can lead to overcrowding and crooked teeth. If you had problems with overcrowding in your mouth as a teen, then it’s likely your kids will, too. 

At what age should parents start to think about braces for their kids?

Dr Tan: If you asked me when a child should have an orthodontic assessment, I’d say at 7 or 8 years old. By this age, the orthodontist will be able to see if there are any developing problems. But it’s usually not necessary to start treatment or get braces straightaway. It just means we can diagnose potential problems and recommend the best time to begin treatment.

What are the different types of braces and what are they for?

Dr Tan: There are 4 main types of braces. All the different types do basically the same job. It’s like a car – you can choose the make and model but they all get you there.

• Metal braces are the most common, and the most noticeable. They consist of metal brackets attached to the front of the teeth, connected with a thin metal wire that is adjusted at regular intervals. You can get them with coloured modules, which is popular with teens.
• Ceramic braces work in the same way as metal braces, but have tooth-coloured or clear brackets, so they’re more subtle in appearance.
• Lingual braces go on the inside of the teeth, so you can’t see them. They’re right next to the tongue, so they take a bit of getting used to. They’re a bit more complicated to make, which can make them more expensive.
• Clear aligners, like Invisalign, use a series of clear plastic aligners that are custom-made to fit your teeth and ease your teeth into a new position. They're removable so the wearer has to be quite disciplined about their use.

The choice depends on things like the age of the patient. For example, teenagers may prefer coloured braces but older patients like them to be less visible.

What can I expect when I see an orthodontist for the first time?

Dr Tan: The first consultation usually has a few steps:

1. The orthodontist will have a chat to find out the concerns and expectations of the child and the parents. It could be a small concern such as a gap between teeth or it could be mouth crowding or a speech issue.
2. They’ll assess the different elements – the jaw, the teeth, the lips – and how the different elements relate to one another.
3. The orthodontist will suggest treatment options, give an approximate cost for each one, and see if the patient wants to go ahead.
4. If the parent and patient want to proceed, they’ll take some records – X-rays, photographs and maybe scans – and arrange another appointment to commence treatment.

About 80% of children won’t need tooth extractions before getting braces fitted, but a few will need to take this into consideration.

Does getting braces hurt?

Dr Tan: I always joke with patients that when you have the braces put on, it’s like supergluing something onto your teeth. That’s basically what we do. We use a special adhesive to fix the braces in place. The actual procedure in the chair doesn’t hurt at all. And there are no needles!

Braces can feel a little tight when they first go on, and there may be some soreness that night or over the next 2 or 3 days. The level of discomfort really depends on the tolerance levels of the patient. I suggest taking some Panadol or Nurofen as necessary. Later on, when we do the 6-weekly adjustment, usually the discomfort is less. You don’t get continuous pain because the teeth don’t move continuously, they move intermittently, so every now and then it might be a little sore.

How should I look after my kid’s teeth when they have braces?

Dr Tan: Oral hygiene is always important and even more so with braces, as pieces of food and plaque get trapped in them. Kids with braces should be encouraged to brush after every meal. Flossing is also important. It can be tricky to floss with braces but you can buy floss threaders designed especially for teeth with braces, and interdental brushing with special brushes will get into the gaps. In general, they should avoid foods that put extra pressure on the teeth such as apples and raw carrots, crunchy food like chips and nuts, and of course chewy lollies and caramels.

How much do braces cost?

Dr Tan: The fee for braces can vary quite a lot depending on your treatment program. An average 18-month treatment plan could cost anywhere between $3,500 and $10,000. That will usually include everything from the first fitting through the 6-week adjustment visits to the removal of the braces and follow-up appointments.

Many orthodontists offer payment plans to help you spread the cost. If you have private health cover that includes extras for orthodontic treatments that will obviously help. Speak to your health insurance provider about how much can be claimed.

What about braces for adults? Is it a trickier process?

Dr Tan: It’s like building a house – if the foundations aren’t good, you can’t change them. When you’re young, it’s much easier to manipulate the jaw. A child has a small lower jaw and an orthodontist can bring the chin forwards relatively easily. Once you’re finished growing, it’s much harder to bring the jaw forwards, so you instead have to push the top teeth back. This can have an adverse effect on your profile as it makes the nose and chin more prominent. Also, there are likely to be other complications in adult patients that can compromise the treatment, such as gum conditions.

From a social perspective, I think it’s good to get your braces underway by your mid-teens, so it’s done by the time you leave school. You can start university or go to that job interview feeling confident with your straight teeth.

With adults, there are always limitations. But with younger patients, it’s easier to achieve the best results.

Top 5 takeaways on kids’ braces

1. It’s best to start the consultation process early, ideally at age 7 or 8.
2. When you have braces avoid hard foods and sticky lollies.
3. You can still play sports and musical instruments with braces.
4. Lots of orthodontists offer a payment plan to help spread out the cost.
5. Kids with braces should try to brush their teeth after every meal.

Words by Sara Mulcahy & Frank Tan
First published March 2022