How long will I wear my braces?

A question I hear daily is "when can I get my braces off?". My normal answer is "when the treatment is finished!".

Of course I do try to estimate treatment time during the planning stages and be realistic about this, and in most cases I get it about right or slightly over-estimate. But it still doesn't stop the question being asked.

At the beginning of treatment teeth appear to move quickly. Towards the end of treatment the teeth can appear generally straight, and the changes will be mush smaller. Sometimes these can seem unnecessary to the patient, like getting that tooth 'just so' or trying to correct the bite. Patients often wonder why I'm spending time correcting something they are not concerned about.

Take the teenager I saw yesterday. His teeth look fabulous, they're straight and he's very happy with them. I'm concerned because the bite isn't correct, in his case the side teeth don't meet evenly and he doesn't have an obvious place to bite. I prescribed elastics to improve this, he'll need to wear them all the time to get the result, and this is the only thing that's left to correct, so if he wears the elastics well I'll be able to finish treatment in a few months. He wasn't exactly enamoured about wearing elastics, both for the appearance and the comfort of them and asked if he really needed them, after all, he's happy with the appearance now.

I find this a bit difficult as I think people perceive that I'm fiddling with the teeth for the sake of it and they won't get a real benefit, they'd rather finish treatment. It is certainly the detailing of the last few visits that makes a difference between a good result and a great result. Naturally I want to get the best result I can, at the end of the day I am the judge of my own treatments and I have high standards. But there's often more to it than that. Take the 'wrong bite' situation. Getting a good bite where the side teeth interlock nicely helps with long term stability, that's the teeth staying where I've put them. It prevents uneven wear on the teeth and puts less stress on the jaw joint and jaw muscles, which might cause problems later.

Will he wear his elastics enough? I'm not sure, but he's been informed why it's important and I hope he will successfully complete treatment. I really don't prescribe elastics (or any other form of treatment) for a joke, they are necessary in some cases, so please listen to your orthodontist and follow their advice, and ultimately, trust that all they are trying to do is get the best possible result. Isn't that worth a few extra months wearing braces?

Smile Awards 2012

The Smile Awards were held last week and for the third year in a row I'm delighted to have brought home a Highly Commended certificate, this time for 'Best Aesthetic Practice'.

Like many other industries and professions the dental industry has several awards ceremonies throughout the year, and dentists and practices are using these as a method of both team building within the practice and a way of promoting themselves to their clients. The other awards focus on things like marketing, teamwork or practice appearance, but the Smile Awards are the only ones to focus on clinical excellence. The categories cover the many ways of improving a patient's smile, whether this is through the use of white fillings, tooth whitening, crowns and implants or orthodontic treatment. Dentists submit photographs and a writeup of the case, which are judges anonymously by a panel of dentists and specialists.

The 'Best Aesthetic Practice' is a new category, to recognise a practice which provides aesthetic dentistry (which can encompass any type of dentistry which improves the appearance of someone's smile). I submitted a portfolio all about the practice, including photographs, testimonials, financial details, our branding and our staff.

The awards were held at the Landmark Hotel in Marylebone, London. I travelled down with Carly-Ann and Angela, its great to be able to dress up and enjoy a night out, we're more used to spending working time together. Here we are at the drinks reception.

The Landmark is a beautiful five-star hotel, with a large central atrium decorated with palm trees. It reminds me of a rhiad in Marrakesh, but on a much larger scale. The dinner was held in the grand ballroom and was delicious! Its always great to meet friends and colleagues and I'd arranged to sit with my friend and colleague John Scholey and his team, it was great to catch up and have a bit of banter!

After dinner the awards were announced, with the judges stressing the high standard of entries and how both the number and quality of entries had increased over the last few years. Sadly neither my fixed braces case nor my removable braces case picked up a prize in their categories. However John won the fixed braces and another orthodontist who qualified the same time as me, Darsh Patel, won the removable category. Although they showed before and after pictures on a large screen for all the shortlisted entries it wasn't possible to really tell why certain cases had won, but there were certainly some impressive smile transformations.

The last award to be announced was for Best Aesthetic Practice. Originally this was to be a regional award, but all nine practices were judged together. Having checked out the opposition beforehand (of course!) I really didn't think we had a chance in this, so it was a fantastic surprise to be announced as joint runner up and to be awarded Highly Commended along with a Harley Street practice, which shows a Yorkshire practice can really cut it with the big London practices!

Of course we had to have a little celebration...

The night didn't end there, Carly-Ann and Angela strutted their stuff on the dance floor and I enjoyed chatting with colleagues, some I'd met before and some I hadn't. It was great to finally meet some faces who I've been in touch with via Twitter, I'm pleased to say we got on just as well in real life as we do online! it was clear that everyone had real enthusiasm for their own branch of dentistry. We even got filmed for a promotional video, though I'll need to review it carefully before I post the link!

Back in Yorkshire I've had time to reflect and for this to really sink in. I've worked really hard over the last six years to make this practice a success. Many said it couldn't be done without an NHS contract. It has been tough at times, particularly when the recession hit as orthodontics is a 'luxury' item, but many dentists have found that cosmetic treatment is still a growing area, we all need to feel good after all.

I couldn't have done this alone, and I really have to say a big big 'Thank You' to my husband Jack Cooke and his business partner Richard Moon. Jack and I started on the road to our own practices when we bought the property in 2005, and I still share facilites and staff with their practice Ashby Dental. Their rebrand and redecoration last year prompted my own rebrand and together we've both introduced treatment coordinators (Carly-Ann and Angela) who've really helped to grow our businesses. At the risk of this becoming an Oscar acceptance speech I should also thank Chris Barrow for his business coaching excellence since 2005, all the dentists who refer patients to me, and my patients, especially those who recommend us to their friends. And of course my family, not just Jack but my children and my parents-in-law who often help out with childcare.

This isn't the end though, I plan to keep improving Wetherby Orthodontics and making many more patients happy with their new smiles. Its not all about awards, in fact my patients are far more important. I am confident of giving my patients great service and great treatment, awards are just an extra way of recognising this.

I hate dental impressions

If you've had orthodontics, a gumshield or bleaching tray made, or a crown you've probably had a dental impression. It seems to be one of the least liked dental procedures, and yet it is a very simple one that doesn't require drills, injections or anything else usually percieved as scary. My patients have at least two sets of these, one at the beginning and one at the end of treatment, the purpose being to take a copy or print of the teeth. This is cast in plaster in the laboratory so we have a permanent 3D record of the teeth and if needed braces can be custom-made.

Impressions are taken using a tray which fits over the teeth. This is filled with a substance called alginate which turns from jelly-like to a firmer rubbery consistency in a few minutes. Most people don't like the texture, but some people have a pronounced reaction which casues them to gag or feel sick if the impression material is near the back of the mouth. It is this and the lack of control over the situation that causes people to dislike impressions, or even have a phobia of them.

Luckily, taking impressions is relatively quick and there are things which both the dentist and the patient can do to make it a less fearful experience.

First of all, do tell your dentist that you are worried about the process or have had problems in the past as there are steps the dentist can take.

• Warm water. Mixing the alginate with warmer water makes it set quicker (remember your chemistry, heat speeds up chemical reactions)
• Thick mix. Mixing the alginate fairly thickly helps it set, stops it running backwards and is more comfortable to the patient.
• Less impression material. I make sure to avoid loading too much material into the tray, as long as it won't affect the quality of the impression I need.
• Talking! I talk to my patients while it is setting to distract them.
• Apron and bowl. I give my patients a bowl and tissues, its better for them to dribble into a bowl than to try to swallow! Its also reassuring for patients who think they might be sick that they have a bowl in front of them.

Then there are the things you can do while you're having the impression. I talk my patients through this if they're worried, and remind them while the impression is setting.

• Breathe! Don't forget to breathe, but it really helps to concentrate on breathing slowly and through your nose, not your mouth.
• Stay calm. Ok, easier said than done, but do try to stay as calm as possible.
• Dribble! See above, you will salivate a bit but its better to dribble than try to swallow.
• Sit forwards. I prefer to take my impressions with my patients seated upright, then ask them to tilt their head down so their chin is on their chest. Some dentists prefer to have the patient lying down, this can also work very well, even though it seems a little backwards!
• Distract yourself. Think about something completely different, wiggle your toes, sing a song or imagine you're on beach!

Yesterday I removed the braces for a 14 year old girl, Lauren. Although she'd reached the end of her treatment she wasn't at all excited as she was very worried about the impressions and scared she'd be sick. She almost refused the impressions, which would not have been a good idea as I needed them to make retainers. I talked her through what we were going to do using the techniques above and did a 'dry run' with an empty tray and no alginate. She did great, the first one passed without incident and she told me she'd sung 'Baa Baa Black Sheep' in her head, but needed another song for the second one. I suggested 'Twinkle Twinkle', and in the end I did the singing! We all ended up laughing and I hope she went away pleased to have got over her fear of impressions and less worried for the next time she needs them.

In 22 years of being a dental student and dentist I can only think of three times a patient has actually vomited during impressions, and those were when I had no warning of a possible problem. None of those have been since I'd had my own practice, I've taken thousands of impressions so I'm pretty good at it now. I always find its never as bad as people fear, think positively and you'll be amazed.

Groupon? Not for me!

A few weeks ago I had a phone call. "Hello its Mark from Groupon, wishing you a very Happy New Year. And by the way, we've got a front page offer you might be interested in." I politely wished him a Happy New Year but declined his offer and asked not to be called again.

"Why?" you might cry, especially if you love Groupon or any of the similar discount voucher sites, in fact you may even have seen offers for for treatment such as tooth whitening or Invisalign.

I did write a really long blog post about the ethics of offering discounts on dental and medical treatment and why the figures don't stack up, and why it might work for businesses like restaurants and beauty salons where they can sell additional items or gain from repeat business.

I've deleted because I think the sort of clients I treat can see that and understand that and don't need it spelling out. There are certain brands you wouldn't expect to see on a discount site, like BMW or Porsche, Armani or Prada, The Ivy or The Manoir Aux Quat'Saisons. If these brands did start offering huge discounts it cheapens the brand, makes it less exclusive, just think what happened to Burberry a few years ago when the products suddenly became just that bit too popular.

So perhaps I'm going a bit far comparing myself to luxury brands, I certainly don't want to make myself and my treatments seem elitist, but much as some people will save up for that certain car, item of clothing or special meal many of my clients are seeing orthodontic treatment as an affordable luxury that will make them feel good about themselves. The true value is not in the cost but in how it makes you feel. Much as a Skoda will transport you, a coat from Primark will keep you warm, or a meal from Pizza Express will fill you up, that cheap braces offer may straighten your teeth, but will you get the same experience, the thing to treasure, to talk about, to make you feel good?

So, please don't ask me for special offers. I don't artificially inflate my prices so I can't offer discounts as this is a business and my livelihood, as well as my passion. I don't even mind if you 'window shop' a bit, by all means visit that practice offering a cheap deal, but come visit me too before you decide.

(If you still don't understand, read about the cupcake disaster, concerns from the ASA and OFT, the problems of time-limited medical offers and the General Dental Council's view of discount offers.)

New Year's Resolutions

Have you made a New Year's Resolution? The start of a new year always seems a good time to start or regain good habits. I'm sure many will have some sort of resolution to improve themselves, whether it be a diet, giving up smoking or being more organised.

I'm not one for resolutions myself, though I have promised myself I will spend more time doing the jobs I keep putting off as I'm an excellent procrastinator, so I suppose that's a sort of resolution!

How about a resolution that's easy to keep, will make you feel better about yourself, and will make other's feel better too? You might think that doesn't exist, but how about if you resolve to smile more? The simple act of smiling will instantly make you feel better and will make other people smile back. It's a universal language that you can use to communicate with anybody, friends, family or strangers. There's even research that suggests smiling will relieve stress, boost your immune system, lower your blood pressure and make you look younger. Have a look at this list of 10 reasons to smile.

*Edit* The same day I published this blog the Guardian wrote this article about how smiling is now fashionable! No longer do cover models on magazine's have sullen faces, they are showing their teeth in big smiles! Not just models, Kate Middleton is at it too (yes, her again!). I particularly like the final paragraph "Still, on the plus side, this is a fashion you can wear for free (memo: must book dentist appointment), and that suits me."

If you don't feel like smiling ask yourself why. Many of my clients tell me they always keep their lips closed when smiling, hide their mouth behind their hand and avoid being photographed. Are your teeth stopping you smiling? Perhaps 2012 is the year to do something about this?

Why not make your New Year's Resolution to find out what can be done to improve your smile? Simply call your dentist or orthodontist for a consultation. Many people think they are beyond help but there is always something that can be done and often it's not as difficult as you might think. If you're unsure about the difference orthodontics can make take a look at our 12 Smiles of Christmas to see some of our transformations over the last year. If you'd like a similar consultation please just get in touch and arrange a consultation or a complimentary visit with our treatment coordinator, and by New Year 2013 you could have a completely different smile!

The Duchess and the French orthodontist

On Saturday the Daily Telegraph carried this article about the Duchess of Cambridge and how 'pioneering' French orthodontist Didier Fillion has used 'micro-rotations' of the teeth to produce 'harmonious asymmetry' and give her a natural look, according to Dr Fillion's friend Bernard Touati.

I do think the Duchess has a lovely smile, I'm so pleased she hasn't gone down the route of porcelain veneers and instead chose orthodontics to help her, but I do have a few problems with the way this article portrays what she has had done. Let's leave aside for now the breach of patient confidentiality (it's NOT ok to tell your friends about your clients) and read between the lines of the article.

Harmonious asymmetry
I don't see much that's asymmetric about Kate's teeth. I'm sure if you used an accurate measuring device you'd be able to pick up small differences, but it's what the eye sees that counts. I'm not sure why an orthodontist would deliberately aim to leave asymmetry but there will always be some imperfections when the natural teeth are kept. The only way to get that perfectly even, perfectly white 'American' smile is with porcelain veneers, and even with that type of treatment a natural look can still be achieved if wished.

Micro-rotations
If something is 'micro' then are we able to detect it? I would never claim to be able to align teeth perfectly, I can get close to perfect, but perfect does not exist. There will always be 'micro-rotations' (see above!)

Lingual braces
There is little information to tell us what Kate actually had done to her teeth. This is not the first article to suggest she has had treatment by Dr Fillion, who could be called a dental pioneer in lingual braces. Lingual braces are like traditional fixed braces but attached to the back of the teeth (tongue side=lingual). Put them on the back and nobody can see them. Dr Fillion runs a respected course in lingual orthodontics in Paris and has developed his own system called Orapix. However, there are orthodontists all over the UK using lingual braces and it is growing in popularity amongst orthodontists and clients who'd like straighter teeth but prefer discreet braces.
I've been using the technique for five years and about 20% of my adult clients now choose lingual braces. As an orthodontist it is a challenging technique but I now feel comfortable using it and look forward to seeing my lingual clients. Almost anyone who is suitable for standard fixed braces is suitable for lingual braces, though they require a bit more time to get used to and cost more.
Take a look at the British Lingual Orthodontic Society website (you'll see Didier Fillion is the president) for more information and to find an orthodontist near you, or have a look at my own website. You don't need to be a princess or travel to London or Paris to get a smile like Kate's.

We may never know exactly what the Duchess has had done with her teeth but they do look lovely, straight yet natural. You can certainly be sure we will be seeing a lot more of her smile!

Some you lose

Its not often that I have a 'failure' to report, but one has happened this week.

A lady in her 60's asked me to improve her crooked lower teeth. Together we decided the best option would be to remove one lower front tooth to create space and fit a ceramic fixed brace to straighten the teeth and close the space. As with everyone I treat we discussed the possible problems she could face especially discomfort during treatment. Everyone will experience some level of discomfort, from either achy teeth or the braces rubbing on the inside of the lips, but this is usually temporary. For most people it takes 1-2 weeks to get used to wearing braces, but it does vary a lot.

Mrs H came to see me several times with areas of rubbing or soreness and in most cases I could help by suggesting orthodontic products or trimming sharp ends. However this week she has decided it is all too much and asked to have the braces removed. We discussed a few options but finishing treatment now was the final decision so she is now very relieved to be free of her braces, even though she does now have a small gap at the front.

Of course, I'm disappointed that it hasn't worked out for her, but this is only the second time in 6 years as an orthodontist that I have had to end treatment for these reasons. I think this shows that for most people the discomfort is temporary and can be tolerated for the end result. My mission is to make people happy, and if wearing braces is having the opposite effect then I'm not being very effective in my mission! I will always try and work with my patients for the best outcome, and this means taking every case separately and listening to their needs.