Orthodontic FAQs

Common signs include crowded teeth, gaps, bite problems, teeth that are hard to clean, protruding front teeth, relapse after previous treatment, or a smile concern you want assessed. A clinician needs to review your teeth and bite before confirming whether treatment is suitable. A useful first check is to compare photos of your smile from the front and both sides, and to note whether any teeth overlap, stick out or fail to meet when you bite. Mild cases are often suited to aligners, while larger bite corrections are more often planned with fixed braces, so the right answer comes from an examination rather than from appearance alone.

Private orthodontic care usually does not require a referral. You can contact a practice directly or start with an online assessment. NHS orthodontic referral routes vary and are usually based on age, dental development and treatment need. Your regular dentist can still be a useful starting point, since they know your dental history and can flag gum or decay problems that need treating first. For NHS treatment the route normally runs through a dentist, who checks the Index of Orthodontic Treatment Need before referring you on to an NHS orthodontic service.

Ask what problem is being treated, which appliances are suitable, how long treatment may take, what is included in the fee, how refinements work, how emergencies are handled, and what retainer plan is needed after treatment. It also helps to ask who will carry out the treatment and whether they are on the General Dental Council specialist list for orthodontics, what happens if treatment takes longer than planned, and whether there is a written treatment plan and itemised fee before you commit.

An online consultation can give a useful starting point from photos and history, but it cannot replace records such as X-rays, scans, gum checks or a full clinical examination when those are needed. Photos cannot show the gum health under the teeth, the roots, decay between teeth or the way the jaws fit together, which is why a clinician will normally ask for X-rays or a scan before starting any treatment. Treat an online result as an indication of options and likely cost, to be confirmed in person.

Neither is automatically better. Fixed braces can be useful for complex tooth movements and bite correction, while clear aligners may suit patients who want a removable and less visible option. Suitability depends on the tooth movements needed and patient compliance. Braces stay in place for the whole of treatment, so they work whether or not the patient is consistent, while aligners are removed for eating and cleaning and only work if they are worn for around 20 to 22 hours a day. Cost, appearance, lifestyle and the specific movements needed usually decide which is the better fit.

Clear aligners can treat some crowding, especially mild to moderate cases, but severe crowding may need attachments, interproximal reduction, extractions, braces or specialist planning. As a rough guide, crowding that needs a few millimetres of space can often be managed by slightly widening the arch or polishing small amounts of enamel between teeth, while crowding that needs more space than that may call for extractions, which are usually planned with fixed braces. An orthodontist can measure the space needed from a scan.

Many spacing cases can be treated with braces or aligners, but the cause of the gap matters. Missing teeth, tooth size differences, gum health and bite relationships can change the plan. A gap between the upper front teeth, for example, can be linked to a low-attached frenum, and teeth that are small for the arch leave generalised spacing. Closed gaps have a tendency to reopen, so a retainer is an important part of the plan, and some patients are also offered tooth-coloured bonding to even out tooth widths.

Adults can usually have orthodontic treatment if their teeth, gums and bone support are healthy enough. Adult plans may need closer attention to gum health, existing dental work and long-term retention. Adult teeth move more slowly than a teenager's because the bone is denser and growth has finished, so treatment can take somewhat longer, and gum disease must be controlled before it starts. Many adults choose aligners or ceramic or lingual braces because they are less noticeable at work.

Clear aligners can suit some teenagers if they can wear them consistently and keep them safe. Braces may be more predictable where compliance, tooth eruption or complex movement is a concern. Aligners need to be taken out for meals and brushed after, and lost or broken trays delay treatment, so parents and clinicians usually look at how reliable the patient is before recommending them. For under-18s, NHS funded treatment is generally provided with fixed braces rather than aligners.

Private braces in the UK typically cost £1,500 to £8,000 for a full course, depending on the type: metal braces £1,500–£3,500, ceramic braces £2,000–£4,500 and lingual (hidden) braces £4,000–£8,000. The price also depends on case complexity, the practice's location and what the fee includes, so a quote should itemise records, appointments, refinements, emergencies and retainers. NHS braces are free for eligible under-18s.

Private clear aligners in the UK typically cost £1,500 to £5,500. Invisalign costs £2,500–£5,500 (Lite £2,500–£3,500, Moderate £3,200–£4,200, Comprehensive £4,000–£5,500 or more) and other aligner brands usually cost £1,500–£4,500. The price depends on case complexity, the number of aligners, refinements, the level of clinical supervision and retention, and a very low headline price may not include all clinical checks or refinements.

Yes. Most private practices ask for a deposit (typically 10–25%) and then equal monthly instalments over 12–24 months, often at 0% interest. On a 0% plan over 24 months with a 10% deposit, metal braces work out at about £56–£131 a month, ceramic braces £75–£169 and lingual braces £150–£300. Regulated finance can stretch to 24–60 months but may charge interest, so check the total payable, the missed-payment policy and whether retainers or refinements are included.

An initial private orthodontic consultation in the UK typically costs £0 to £200, and many practices offer it free. The fee varies with the length of the appointment, whether scans or X-rays are taken and whether a written treatment plan is included, so ask what it covers and whether it is deducted from the cost of treatment.

Private orthodontic treatment in central London typically costs 20–40% more than the UK average for equivalent treatment. As a guide, comprehensive fixed braces from a specialist orthodontist cost about £3,500–£6,500 in central London and the South East, £3,000–£5,000 in the South West and East of England, £2,500–£4,000 in the Midlands and South Wales, and £2,200–£3,800 in northern England, Scotland and Northern Ireland.

Usually not. Most standard UK dental insurance plans exclude orthodontic treatment or do not list it as a benefit. A smaller number of insurers and dental plans offer specialist orthodontic cover, but it typically has strict limits, waiting periods and exclusions, so read the policy wording and ask the insurer in writing whether fixed braces, clear aligners and retainers are covered.

NHS braces are free for eligible under-18s in England whose teeth meet the clinical need threshold (IOTN Dental Health Component grade 4 or 5, with grade 3 cases borderline), but waits can run to four years or more in some areas. Private braces are open to any age and any level of need, usually with appointments within weeks, and typically cost £1,500 to £8,000 or more depending on the appliance.

NHS orthodontic treatment is mainly for under-18s who meet clinical eligibility thresholds. Adults usually need private treatment unless there is a hospital-based clinical need. Adults whose bite problem is severe, such as one needing combined orthodontic and jaw surgery, may be seen in a hospital orthodontic department on an NHS referral from their dentist or specialist. For most adults who want straighter teeth, private treatment is the realistic route and is paid for as a fee for the course.

Waiting times vary by area, referral pathway and provider capacity. Eligibility is usually assessed before treatment starts, and not every child referred will qualify for NHS braces. It is normal for a child to be assessed first and then wait for treatment to start, because the best time is often when most adult teeth have come through, usually between about 11 and 14. Ask your dentist or the NHS service you were referred to for the current wait in your area.

Braces can cause pressure, tenderness or rubbing after fitting and adjustments. This usually settles, but severe pain, swelling, trauma or a broken appliance should be checked. Soreness is usually strongest for the first three to five days after fitting and after a wire change, and over-the-counter pain relief and soft food help. Orthodontic wax over a bracket that rubs the cheek or lip can ease ulcers, and rinsing with warm salt water helps small sore spots to heal.

Treatment time depends on the starting position, bite, appliance type, biology and appointment attendance. Many cases take months to a few years, but only a clinician can estimate your case. Fixed braces for a moderate case commonly run 12 to 24 months, and complex bite corrections can take longer, followed by retainers worn afterwards. Missed or rescheduled appointments, broken brackets and, for aligners, trays not being worn as directed are the usual reasons a course runs longer than the original estimate.

Contact your orthodontic provider for advice. Wax may help with rubbing, but broken brackets, loose wires, swelling, trauma or pain that does not settle should be checked promptly. A wire poking into the cheek can sometimes be covered with wax until you can be seen, and a loose bracket that is still attached to the wire can be left in place. Do not cut wires at home. Out-of-hours emergency arrangements differ between practices, so check what yours offers.

Yes. Teeth can move after treatment, so retainers are normally needed long term. Your clinician should explain whether fixed, removable or combined retainers are appropriate. Fixed retainers are thin wires bonded behind the front teeth and stay in place, while removable retainers are clear plastic trays or wire-and-acrylic plates worn mostly at night. Both need cleaning, and a fixed retainer that comes loose or a removable one that no longer fits should be looked at promptly.

Contact your provider quickly because teeth can move when retainers are not worn. A replacement may need a scan, impression or repair, depending on the retainer type. Do not try to bond a broken fixed retainer back on yourself, and avoid wearing a damaged removable one if it has sharp edges. If it will be a few days before you can be seen, ask whether the practice can offer interim advice or a quick-turnaround replacement.

Retention is usually considered lifelong. Most clinicians recommend full-time wear for several months after treatment, then switching to nights-only wear indefinitely. How quickly teeth move without retainers varies between individuals, so following your clinician's specific guidance is important. Teeth continue to shift slightly throughout life, including in people who never had braces, so the aim of long-term retainer wear is to stop the small movements that would otherwise undo the result. A fixed bonded retainer, if you have one, works around the clock without any effort.

Privately, a removable clear (Essix) retainer typically costs £80–£150 per arch, a Hawley retainer £150–£250 and a fixed bonded retainer £150–£350 per arch. Invisalign's Vivera retainers are usually £300–£500 for a set. A standard retainer is normally provided as part of NHS orthodontic treatment. Replacement retainers usually cost more than the originals if new impressions or a scan are required, and a lost fixed retainer needs a visit to be rebonded. Some practices include a first set of retainers in the treatment fee and charge only for replacements, so check what your quote covers.

The main types are fixed bonded retainers (a thin wire cemented behind the teeth, usually the lower front six), removable Essix retainers (a clear plastic tray similar in appearance to an aligner), removable Hawley retainers (a wire and acrylic plate), and combined approaches using both a fixed wire and a removable tray. Each has different maintenance requirements and longevity.

Tightness when putting a retainer back in after a period of non-wear usually means the teeth have moved. Do not force the retainer in. Contact your provider for advice before attempting to wear it, as forcing a tight retainer can damage the teeth or the appliance. Teeth can begin to move within days, and a retainer that was comfortable can feel tight after as little as a week of non-wear. Your clinician may advise wearing it full time for a short period to settle things, or may suggest a new retainer or a short course of aligners if the teeth have moved significantly.

Contact your provider as quickly as possible because teeth can begin to move within days without a retainer in place. Your clinician will advise on whether a replacement can be made from existing records or whether a new scan or impression is needed. The process depends on retainer type. Wearing a retainer that no longer fits comfortably is not advised, and a replacement made from old records can be inaccurate if teeth have moved since. If you cannot be seen straight away, ask for advice on interim wear and book the earliest available appointment.

Yes. The retention requirement is the same regardless of the appliance used for active treatment. Teeth have a natural tendency to move back towards their original position, so retainers are needed after any orthodontic treatment to hold the result. With aligners, the last set of trays is often followed by a clear removable retainer made from the final scan, and some practices also place a fixed retainer behind the lower front teeth. Which is used depends on how stable the final position is and how likely the patient is to wear a removable one consistently.

A virtual orthodontic assessment typically involves submitting a guided set of photos taken at home using a smartphone. A registered clinician reviews the photos and returns a recommendation or indicative quote. The process is designed to give patients a clear starting point before committing to an in-person appointment. Good lighting and a lip retractor or the back of a spoon help the front and side views show the teeth clearly, and the guidance in the process tells you which angles to take. The result is advice on likely treatment types and cost, and where a clinician spots something that needs an in-person examination, they will say so.

A virtual assessment is a useful starting point for gauging suitability and receiving an indicative quote, but it cannot replace a full clinical examination. An in-person appointment allows the clinician to take X-rays, check gum health, record your bite in detail, and assess factors that photos cannot capture. The two are complementary rather than interchangeable. In practice, the virtual step is most useful for deciding whether it is worth travelling to a practice at all, for getting a realistic price range to compare, and for arriving at the first appointment with your questions already prepared, while the in-person visit is what confirms the diagnosis and the plan.

Standard photo sets typically include a front view with a natural smile, a front view with teeth closed, a side view from the right with teeth closed, a side view from the left with teeth closed, an upper arch view taken from below, and a lower arch view taken from above. Some providers request additional photos depending on the specific concern.

Response times vary by provider, but most virtual orthodontic assessments are reviewed within one to three working days. The result is usually delivered by email or through the provider's platform, and typically includes an indicative quote, treatment options, or a recommendation to book an in-person appointment for more detailed records.

Virtual Consultant Online provides orthodontic practices with a photo-based remote patient intake system. Practices can send guided photo request links to prospective patients, review submissions, generate digital quotes, automate follow-up communications, track case acceptance, and access reporting on intake performance. The intake link works on a patient's phone with no app to download, and the clinical team sees the photos and answers in one place. Because quotes and follow-up messages are handled in the platform, a practice can see how many enquiries become booked consultations and where they drop out.

When a practice sends a photo request, the patient receives a link guiding them through capturing a standard set of orthodontic photos at home. The photos are submitted through the platform, the clinical team reviews them, and can respond with a quote or a triage outcome — all without requiring the patient to attend the practice first.

No. Virtual Consultant Online is designed to work alongside existing practice management software rather than replace it. The platform focuses on front-end patient acquisition and remote intake, covering the period from initial enquiry through to a confirmed treatment start, complementing the clinical and administrative workflows already in place. Appointments, clinical notes, imaging and billing continue to live in the practice's own software. What the platform adds is the pre-booking stage, a structured set of patient photos and answers that the team can review before the first appointment, so the first visit can start from a clearer picture.

Yes. Practices can register for a free trial to explore the platform before committing to a subscription. The trial gives access to core features including the guided photo intake workflow and quote generation tools, allowing the clinical team to assess the system before going live with patients. A trial is a practical way to see how a practice's patients respond to a photo request link and how much time the clinical team spends reviewing submissions. Practices should check the plan details on the pricing page before the trial ends so there are no surprises about what continues afterwards.

Practices can book a live demonstration through the Virtual Consultant Online website. A demonstration covers the full patient intake workflow, quote generation, follow-up automation, and reporting features, and can be tailored to the specific questions or workflow concerns of the practice team. It is helpful to bring a few realistic patient scenarios, such as a teenager's parent asking about NHS eligibility or an adult asking about aligners, so the team can see how the intake and quoting steps handle each.

Yes, in many cases. Missing teeth can actually create an opportunity — braces may be used to close the gap entirely, or to create or maintain space for an implant, bridge, or denture later. The treatment plan depends on why the tooth is missing, the size of the gap, the bite, and the patient's age. A combined approach involving an orthodontist and a restorative dentist is common when implants or prosthetics are planned after alignment.

You may notice early tooth movement within the first 4–8 weeks, but treatment to the final result typically takes 12–36 months depending on the complexity of the case, the appliance used, and how consistently appointments are kept. Clear aligner treatment for mild cases may finish in 6–9 months. Complex cases involving extractions, bite correction, or jaw discrepancies can take 2–3 years. Only a clinician assessing your specific records can give a realistic estimate.

Yes. Clear aligners including Invisalign Teen are designed specifically for teenagers and include compliance indicators and provision for erupting teeth. They can suit motivated teenagers who can maintain 20–22 hours of daily wear. Fixed braces — including tooth-coloured ceramic options — are also popular among teenagers who prefer a set-and-forget approach. The right choice depends on the case complexity, the teenager's compliance track record, and clinical assessment.

A Herbst appliance is a fixed functional appliance used to correct an overjet (protruding upper teeth or receding lower jaw) by holding the lower jaw forward during growth. It is typically used in growing patients — usually aged 10–14 — where repositioning the jaw through growth modification is possible. Unlike braces, which straighten teeth, the Herbst appliance modifies the jaw relationship. It is usually worn full-time for 12–18 months and is fixed to the upper and lower teeth, so it cannot be removed by the patient.

If orthodontic wax is unavailable, short-term alternatives include silicone putty (used by brace wearers as a moulded cushion over brackets), dental comfort strips (pre-formed silicone barriers), and sugar-free soft cheese or bread as a very temporary barrier in an emergency. These alternatives are stopgaps only — they do not fix the underlying bracket or wire issue. If a bracket is rubbing severely or a wire is poking, contact your orthodontic practice to arrange a repair rather than relying on wax indefinitely.

Yes — getting a second opinion before proceeding with significant orthodontic treatment is always reasonable, and is particularly advisable if the plan includes irreversible decisions such as tooth extractions, if you were not seen by a specialist orthodontist, if you have doubts about whether the recommended treatment is proportionate, or if the plan has not been explained to your satisfaction. Reasonable orthodontists expect patients to seek second opinions and will not be offended. A second opinion typically costs a consultation fee but can save you from unnecessary treatment or from committing to a plan that is not right for your situation.

For the most clinically authoritative second opinion on orthodontic treatment, see a specialist orthodontist — a dentist on the GDC Specialist Register for Orthodontics who has completed an additional three-year postgraduate training programme in orthodontics. You can verify whether a practitioner is a specialist at gdc-uk.org. A second opinion from another general dentist, or from a practitioner associated with the same practice or organisation as your first consultation, carries less independent weight.

It is not unusual for two orthodontists to recommend different approaches for the same patient — particularly on borderline decisions such as whether to extract teeth, which appliance to use, or whether treatment is needed at all. This reflects genuine clinical variation in orthodontic treatment planning. If you receive two significantly different opinions on a major decision, ask each orthodontist to explain specifically why they have reached their recommendation. The quality and completeness of the explanation — not just the conclusion — is often the most useful thing to compare.

To get a second opinion on your orthodontic treatment plan: request copies of your clinical records (X-rays, photographs, and any written treatment plan) from your first orthodontist — you are entitled to these; find a specialist orthodontist on the GDC Specialist Register in your area; book a consultation and provide your existing records to avoid repeating all initial tests; prepare a list of the specific questions or concerns you want addressed; and ask for a written summary of the second opinion if it differs significantly from the first. Virtual assessments from specialist orthodontists are also increasingly available and may provide a fast and accessible starting point.

Smile Visualisation is a tool built into Virtual Consultant that creates an illustrative before-and-after smile preview from a single photo. It is designed to help patients visualise how orthodontic treatment could transform their smile. The preview is a guide only and is not a clinical prediction, guaranteed result, or substitute for a professional assessment.

No. The preview is illustrative only — it gives you a visual sense of what treatment could achieve based on your photo, but it is not a diagnosis, clinical prediction, or guaranteed outcome. Individual results depend on case complexity, treatment type, duration, and compliance. Always consult a qualified orthodontist before making any treatment decisions.

Visit virtualconsultant.online/tools/smile-visualisation, enter your details and consent to image processing, then upload or capture a clear smile photo. Your illustrative before-and-after preview is then created within minutes. From there you can continue into the photo assessment journey to get a clinician-reviewed quote.

Yes. Your image is processed securely and is not permanently shared via public links. The public tool requires your details and consent before any image processing takes place — anonymous generation is not permitted. Secure patient flows use tokenised links to ensure images are only accessible to the intended recipient.

Smile Visualisation is controlled via the company settings panel. Administrators can enable the feature, choose whether to make the public tool available, enable secure patient link sending via SMS, and configure monthly usage limits and alert thresholds.

Admins can send a secure tokenised visualisation link directly from a patient record. The patient opens the link, uploads or captures a smile photo, confirms consent, and creates their preview. The original and preview images are then linked back to the patient record, and the full visualisation history is visible in the admin interface.

Planning in advance allows clinicians to review cases properly, make better decisions, and reduce time pressure during the appointment. This improves efficiency and patient experience.

Yes, provided the prescribing clinician has assessed the case and created a clear treatment plan in advance, and the therapist is working within their scope of practice.

By removing dependency on prescriber presence for every appointment, practices can increase capacity, improve scheduling flexibility, and utilise therapists more effectively.

Remote assessment enables structured data capture before the appointment, giving clinicians the information they need to plan cases earlier and reduce delays on the day.

It means collecting enough information before the appointment to understand patient intent, treatment interest, photo quality, readiness, and next-step suitability. This helps the practice prioritise stronger opportunities.

Virtual Consultant can guide patients through remote photo capture, collect pre-treatment information, ask configurable questions, present treatment or quote information, and help identify patients who are ready for the next step.

Early qualification protects chair time, reduces avoidable manual follow-up, and helps the team focus on patients who are more likely to proceed with treatment.

It can support better conversion by helping patients arrive more informed and giving the practice clearer insight into readiness before committing appointment time. Results vary depending on workflow, lead quality, and team follow-up.

Yes. A remote evaluation workflow can guide patients through photo submission before the first appointment, giving the practice useful clinical and commercial context earlier.

Yes. Practices can configure evaluation questions, workflows, and qualification steps around their own treatment mix, commercial priorities, and team processes.

By collecting key information and intent signals before the appointment, the practice can identify which patients are ready to proceed, which need nurturing, and which may not be suitable yet.

Remote consultations often fail when the workflow is too manual. Slow responses, poor photo quality, weak follow-up, generic quotes, and lack of engagement tracking can all reduce conversion.

A strong workflow should include guided photo capture, instant confirmations, automated reminders, clear lead stages, quote follow-up, and visibility over patient engagement.

Guided photo capture helps patients submit the right images in the right order, reducing unusable photos and avoiding delays caused by manual re-requests.

They can help because patients often want to compare treatment options, payment routes, and lifestyle fit. Offering clear choices can reduce friction and make it easier for patients to move forward.

Automation can send instant confirmations, reminders, quote follow-ups, and next-step prompts, keeping patients engaged without relying entirely on manual staff follow-up.

Practices should track photo uploads, quote views, email opens, clicks, reminder responses, and drop-off points so they can improve the patient journey and conversion rate.

Virtual Consultant supports guided photo capture, automated follow-up, multi-option quote workflows, lead engagement tracking, and smoother handover into the practice.

Practices can reduce chair time by moving early-stage tasks such as intake, photo capture, pre-treatment questions, quote engagement, and follow-up into a structured remote workflow.

No. Remote assessment supports earlier qualification and preparation. In-person care remains important for clinical checks, treatment starts, adjustments, and procedures that require chairside delivery.

Reducing unnecessary early-stage chair time frees clinical capacity for higher-value appointments, helps teams prioritise serious leads, and creates a more scalable consultation workflow.

Many patients value the convenience of completing early steps from home, especially photo submission, initial questions, and reviewing treatment options before attending the practice.

Patient details, guided photos, treatment goals, pre-treatment questions, quote review, reminders, and some follow-up steps can happen remotely before the first appointment.

Virtual Consultant supports remote evaluations, guided photo capture, lead qualification, quote workflows, automated follow-up, and engagement tracking so practices can prepare patients before they arrive.

No. The goal is to protect chair time for the moments where in-person care adds the most value, while moving admin-heavy or preparation-based steps earlier in the journey.

Virtual Consultant measures an average saving of 1.37 kg CO₂ per remote appointment compared to an in-person visit. This accounts for avoided patient travel only — additional savings come from reduced resource use at the practice.

The primary saving comes from eliminating patient travel. When patients don't need to drive to a clinic for routine checks, aligner reviews, or initial assessments, both the travel emissions and the practice's resource consumption (heating, lighting, sterilisation) are reduced.

At 1,000 remote appointments, the carbon saving reaches approximately 1.37 metric tons of CO₂ — equivalent to the emissions from driving a car for around 3,400 miles, according to the EPA Greenhouse Gas Equivalencies Calculator.

Many orthodontic appointments are well suited to remote delivery, including initial assessments, aligner progress reviews, treatment planning discussions, and follow-up consultations. In-person visits remain essential for fitting, adjustments, and certain clinical assessments.

Remote assessments save time, reduce travel stress, improve accessibility for patients in rural areas or with mobility challenges, and offer greater flexibility. For patients exploring orthodontic treatment, they also remove the need to travel just to find out whether treatment is suitable.