Dental professionals maintain an ethical code of practice around communicating honestly, and seeking fully informed consent throughout treatment, which should be clearly and carefully planned. This is important, as managing patient expectations can be challenging.
When adult patients do express dissatisfaction with orthodontic treatment, it is chiefly due to treatment either not meeting a desired aesthetic outcome, or frustration with slow progress. Patients can also express discontent when they feel communication is lacking.[i] It is therefore very important – as the British Orthodontic Society (BOS) states – that objective-setting is realistic, and agreed between the patient and practitioner; and that all aims of treatment are clearly documented.[ii]
Complex cases – for example, those that include severe crowding – require especially thorough assessment and treatment planning. Complicating factors associated with crowding, such as difficulties accessing periodontal areas to maintain adequate hygiene, may prolong the total treatment time and negatively affect the final outcome.[iii]
Patient compliance plays a very important role in the success of treatment. Any underlying conditions affecting periodontal health must be addressed before considering orthodontic treatment. The necessity for the very precise and gradual treatment in patients with crowding and compromised periodontal health can lead to a lengthier process than may be expected. Candour and clarity are, therefore, vital in managing expectations.[iv]
The statistics
In a 2023 survey conducted by the BOC, over 76% of orthodontists reported an increase in adult patients seeking orthodontic treatment over the last three years. 83% of these were aged between 26 and 55. 65% of orthodontists cited increased virtual team-working as a factor, and 38% claimed their adult patients are influenced by celebrities.[v] Almost 45% of people in the UK have a degree of dental crowding which is the most common reason for adults to seek orthodontic treatment.[vi]
Fixed braces are offered as a treatment by 97% of orthodontists, and are the most popular system used to treat adults.[vii] Fixed braces are sometimes more effective than other options such as aligners in producing adequate occlusal contacts, controlling teeth torque, and retention. During post-retention time, patients treated with clear aligners relapsed more than those treated with fixed braces.[viii]
Lingual braces are offered by about 10% of British orthodontists,[ix] and have the advantage of being less visible than traditional fixed braces. However, this treatment is less comfortable, and requires more chair time, is more technically challenging, and is more costly than traditional fixed braces.[x]
Clear aligners are an increasingly popular alternative to fixed braces, and have an 80-90% success rate for mild to moderate tooth movements.[xi] They can be an effective alternative to traditional braces, but the expense in production, dependency on patient cooperation, and the inability to treat certain malocclusions limit their effectiveness and suitability in some cases.[xii]
When surveyed, an alarming 88% of dental professionals expressed a concern that their patients might seek direct-to-consumer (DTC) orthodontic treatment.[xiii] It goes without saying that without the supervision of a trained professional, complications are a far greater risk for patients seeking home treatment. Commonly reported adverse events include occlusal problems, pain, sensitivity, and periodontal disease, and some are irreversible.[xiv]
Relapse and associated problems
Orthodontically treated teeth are at high risk of relapse within the first 2 years following treatment.[xv]Movement back towards the original malocclusion may occur as a result of periodontal, gingival, occlusal and – in children and adolescents – normal growth-related factors.
Because it is not possible to predict who may be affected by relapse, clinicians advise long-term retention for all. This can be a significant commitment for patients, and so retention and the potential for relapse must form a key part of the informed consent process prior to commencing the procedure.[xvi]
Maximising comfort
Orthodontic treatment can be uncomfortable, and in some cases, patients requiring treatment using fixed braces may suffer from discomfort for longer than those undergoing other treatments. Pain has a negative effect on patients’ compliance as well as oral hygiene, and is a major reason for discontinuance of orthodontic treatment.[xvii] Pressure after adjustments can be painful whatever the choice of treatment, but fixed appliances can additionally cause soreness due to the appliance making contact with delicate soft tissues in the mouth.
Analgesics can assist with the aches and pains of orthodontic treatment, and orthodontic wax is a fantastic remedy for pain from chafing. Orthodontic Relief Wax from Kemdent® is a pleasant, minty-tasting, soft, gum protector for patients with fixed braces that can be used in a pinch to cover brackets and protruding wires with a smooth surface. Kemdent® Relief Wax is also conveniently packaged in 100% recyclable and planet-friendly, sustainable materials
Before undertaking any treatment, it is important that patients truly understand what each stage of treatment entails, how long it may last, what complications might occur and what behaviour is necessary to optimise success. Making sure patients are well-informed and comfortable can go far in ensuring the happiest of outcomes for both patient and practitioner.
For more information about the leading solutions available from Kemdent, please visit
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[i] Briggs, L. Complaints and claims: time for straight talking. Dentistry.com. May 2023. Available at: https://dentistry.co.uk/2023/05/16/complaints-and-claims-time-for-straight-talking/. Accessed April 2024
[ii] British Orthodontic Society. Professional Standards for Orthodontic Practice. 2014. Available at: https://www.bos.org.uk/wp-content/uploads/2022/09/Orthodontic-Standards-Document-Final.pdf. Accessed April 2024
[iii] Bhatia S. Managing a case of crowding with associated severe periodontitis. Med J Armed Forces India. 2018 Jan;74(1):78-81. doi: 10.1016/j.mjafi.2015.08.007. Epub 2015 Dec 2. PMID: 29386738; PMCID: PMC5771775.
[iv] Bhatia S. Managing a case of crowding with associated severe periodontitis. Med J Armed Forces India. 2018 Jan;74(1):78-81. doi: 10.1016/j.mjafi.2015.08.007. Epub 2015 Dec 2. PMID: 29386738; PMCID: PMC5771775.
[v] British Orthodontic Society. New stats from The British Orthodontic Society reveal online working triggers a rise in adults seeking tooth straightening treatment. August 2023. Available at: https://bos.org.uk/news/new-stats-from-the-british-orthodontic-society-reveal-online-working-triggers-a-rise-in-adults-seeking-tooth-straightening-treatment/ Accessed April 2024
[vi] British Orthodontic Society. Orthodontics for Adults the why, how, where and who. https://www.bos.org.uk/wp-content/uploads/2022/03/BOSSpecialistLeaflet.pdf Accessed April 2024.
[vii] Increase in adults seeking orthodontic treatment. Br Dent J 228, 908 (2020). https://doi.org/10.1038/s41415-020-1815-0
[viii] Ke Y, Zhu Y, Zhu M. A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health. 2019 Jan 23;19(1):24. doi: 10.1186/s12903-018-0695-z. PMID: 30674307; PMCID: PMC6343314.
[ix] Lingual Braces. British Orthodontic Society. Available at: https://bos.org.uk/lingual/#:~:text=About%2010%25%20of%20the%20UK’s,and%20the%20number%20is%20growing. Accessed April 2024.
[x] Huh HH, Chaudhry K, Stevens R, Subramani K. Practice of lingual orthodontics and practitioners’ opinion and experience with lingual braces in the United States. J Clin Exp Dent. 2021 Aug 1;13(8):e789-e794. doi: 10.4317/jced.58328. PMID: 34512918; PMCID: PMC8412811.
[xi] AlMogbel A. Clear Aligner Therapy: Up to date review article. J Orthod Sci. 2023 Sep 4;12:37. doi: 10.4103/jos.jos_30_23. PMID: 37881665; PMCID: PMC10597356.
[xii] Tamer İ, Öztaş E, Marşan G. Orthodontic Treatment with Clear Aligners and The Scientific Reality Behind Their Marketing: A Literature Review. Turk J Orthod. 2019 Dec 1;32(4):241-246. doi: 10.5152/TurkJOrthod.2019.18083. PMID: 32110470; PMCID: PMC7018497.
[xiii] https://bos.org.uk/news/new-stats-from-the-british-orthodontic-society-reveal-online-working-triggers-a-rise-in-adults-seeking-tooth-straightening-treatment/
[xiv] Belgal P, Mhay S, Patel V, Nalliah RP. Adverse Events Related to Direct-To-Consumer Sequential Aligners-A Study of the MAUDE Database. Dent J (Basel). 2023 Jul 17;11(7):174. doi: 10.3390/dj11070174. PMID: 37504239; PMCID: PMC10378056.
[xv] Khalil R, Walladbegi J, Westerlund A. Effects of fixed retainers on gingival recession – a 10-year retrospective study. Acta Odontol Scand. 2023 Apr;81(3):211-215. doi: 10.1080/00016357.2022.2118164. Epub 2022 Sep 6. PMID: 36067134.
[xvi] Littlewood SJ, Kandasamy S, Huang G. Retention and relapse in clinical practice. Aust Dent J. 2017 Mar;62 Suppl 1:51-57. doi: 10.1111/adj.12475. PMID: 28297088.
[xvii] White DW, Julien KC, Jacob H, Campbell PM, Buschang PH. Discomfort associated with Invisalign and traditional brackets: A randomized, prospective trial. Angle Orthod. 2017 Nov;87(6):801-808. doi: 10.2319/091416-687.1. Epub 2017 Jul 28. PMID: 28753032; PMCID: PMC8317568.
