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 (pacifier) 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 dentist about your child's bite at dental check-ups; general information about children is on the children's dentistry page.

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 ceramic and metal brackets failed in the first year. One found more failures with ceramic brackets⁶, the other more with metal ones⁷. A review concluded that ceramic brackets may lead to more enamel fractures, particularly when they are removed⁸. Much of that evidence is from the laboratory, and no rate is known. In a 1990 laboratory test, ceramic brackets wore away more enamel than metal brackets from the teeth they rubbed against⁹. The test had no patients and gives no rate. Ask your treating dentist whether ceramic brackets suit your bite.
• Lingual braces. The brackets are glued to the back surface of the teeth and cannot be seen from outside. With lingual braces, tongue soreness has been reported clearly more often than with braces on the front of the teeth. Cheek and lip soreness has been reported less often. One review¹⁰ and another review published after it¹¹ both reached this conclusion. The earlier review found no meaningful difference in overall pain¹⁰ in the first months. The later one concluded that people with lingual braces have more pain¹¹, mostly because of tongue soreness. Changes in speech are much more common¹⁰ 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 braces¹²; 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 similar¹³ with the two methods; the certainty of this evidence is low. More detail is on the clear aligner treatment page.
• 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 saved¹⁴. 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. Throughout that time, fixed braces need adjustment appointments at set intervals. 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 week¹⁵.
• White spots (early decay). While fixed braces are on, plaque builds up around the brackets. A review of white spots in orthodontic patients pooled 44 studies on new spots: they developed during treatment in about 34 in every 100 patients¹⁶. The same review reported that about 55 in every 100 orthodontic patients had white spots, counting all spots found, not only new ones. In people who had not had treatment, the figure was about 29 in every 100¹⁶. These two 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 back¹⁷ 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 raise¹⁸ 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 your treating dentist.
• Long treatment and regular check-ups. Treatment takes months, often years, and needs you to come to adjustment appointments regularly.
• 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. Such a tooth may need further treatment while wearing braces¹⁹.
• 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 (acetaminophen), 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 braces¹⁹. 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, not only where food gets caught. Ask your dentist which small brush or floss to use.
• Alongside your orthodontic check-ups, keep having regular check-ups with your dentist. 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, could last 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 teeth¹⁹ 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 better¹⁷ 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 retainer¹⁹. 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. He notes that 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, not our own figures. 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.

Treatment in Antalya is provided by our clinic.

Orthodontics is one of the nine dental specialties set by law in Turkey²⁷. Ask who will plan your treatment, who will fit the braces and who will carry out the adjustments, and what their titles are. You can find our dentists' titles on the Our dentists page.

If any of these happens, contact your treating dentist or your dentist at home.

• Pain that lasts more than a few days¹⁹ 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 treatment²⁸. 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 help²⁸. Do not wait for a dental appointment or for the clinic's reply. Go to the nearest emergency department or call the emergency number where you are (112 if you are in Turkey).

• Swelling that makes it hard to breathe, speak or swallow
• Swelling that spreads to the eye or the neck²⁹
• 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 home

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 where you live. 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. So before you decide, the practical question is who will carry out those appointments.

Who carries out the adjustments?

There are two ways. You come back to Antalya for the adjustment appointments, or a dentist or orthodontist near your home takes over after the brackets are fitted. Repeated trips over many months need to fit your work, your family and your budget. A dentist or orthodontist at home 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. Agree the arrangement before the brackets are fitted, and have it in writing. It should say who carries out the adjustments, roughly how often, and what happens if one is missed.

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

The examination comes first

The UK dental regulator, the GDC, states that some interactions between dentists and patients can be provided safely and effectively 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 examination³⁰. 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 where you live remains an option.

Your dentist at home

Talk to your own dentist before you go. They need to know the plan, and you keep seeing them for check-ups during treatment (see daily care above). 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, and for the aftercare plan in writing. A dentist or orthodontist at home 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 imaging³¹.

The retention phase also happens at home. A fixed retainer wire can come loose, and a removable retainer can break or stop fitting (see above). Agree who checks and repairs the retainer where you live.

Problems after you return are usually first seen by a dentist where you live. A dentist at home may not take over braces fitted abroad. Before you travel, ask the health service or your insurer in the country where you live what they would cover.

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 one³². These intervals assume no pain, swelling or bleeding at the treated site. The authors note that the research is limited and comes mainly from military aviation. The intervals are a starting point for the dentist's decision, not clearance to fly. Ask the clinic when you can fly after the brackets are fitted.

Questions to ask before you commit. Ask these before treatment abroad, and ask for the answers in writing:

1. Who will carry out my treatment, and what are their qualifications?
2. Are you regulated by a professional body and registered with it?
3. Is the work guaranteed, are the terms in writing, and for how long do they apply?
4. What aftercare do you provide, and who can I contact after the treatment?
5. If there are complications, who pays for further treatment, extra flights and the hotel?
6. Do you have a complaints system, and can I see a copy?

The full list of questions to ask before treatment abroad is on our page about dental treatment abroad.

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.