The British Orthodontic Society (“BOS”) is a charity registered with the Charity Commission, whose aims are to promote the study and practice of orthodontics, to maintain and improve professional standards in orthodontics as well as to encourage research and education in orthodontics. We have a wide range of members including Specialist Orthodontists, Dentists, Academics, Researchers and NHS Consultants. The role of the British Orthodontic Society is to promote the highest quality standard of care throughout the UK for patients. This statement has been compiled by the BOS to help navigate some of the claims that are made about orthodontics, so you can find the best treatment for you or your child. More general information can be found elsewhere on the BOS website – https://bos.org.uk/  

Orthodontic treatment is very popular in the UK. Around 200,000 young people undergo NHS-funded orthodontic treatment annually and there is an increase in the number of adults choosing to have private treatment. 

Extraction-based treatment 

Sometimes, in an overcrowded mouth, it is impossible to accommodate all the teeth in the upper and lower dental arches in the best position. Therefore, your orthodontist or dentist may need to extract teeth in order to achieve the best possible result. Extractions should never be undertaken lightly and extensive planning and experience will go into making that decision, working in conjunction with you as the patient. When extractions are recommended, it is because they are in the best interests of the patient and necessary for a good result to be obtained. 

The NHS Business Services Authority, the organisation which monitors dental activity in NHS primary care, says that around 25% of young people have extractions prior to wearing fixed braces. The advice will differ from patient to patient but in some cases, treatments involving extractions can increase the chances of a stable result in the long term. 

It may be possible, when there is crowding, to avoid extractions. For example, in certain circumstances your orthodontist or dentist may advise you that it is possible to create space to relieve crowding by expanding the dental arches to accommodate the teeth. However, this is not always feasible and is not always the best approach but it will depend on the circumstances. Another recommendation by your orthodontist or dentist may be to remove a very thin sliver of enamel from the sides of the teeth to create some space, but this is not possible or effective for all patients, particularly if there is a lot of crowding. Because we are all individuals, there is no advice or guidance that the BOS can give that will apply to all patients. An assessment undertaken, in person, by an orthodontist or a dentist with orthodontic training, is essential to know what is most appropriate. 

Misleading claims 

As a result of increased marketing and social media, many claims are made about brace-wearing. During the last two years, the Advertising Standards Authority has upheld cases where websites were making unsubstantiated claims about orthodontic treatment. The BOS has made a video to help patients embarking on treatment to make the right choices: 

https://bos.org.uk/patients/treatments/orthodontics-for-adults/  

The BOS advocates that you proceed with caution and seek alternative advice, if you are told that a recommended orthodontic treatment or approach will do any of the following: 

• Cause your child’s cheekbones to rise or their jaws to change significantly in position – such changes may occur naturally as part of a child’s development but the BOS is not aware of this ever being achieved as part of orthodontic treatment
• Cure or cause jaw joint problems – there is no evidence for this
• Improve speech – there is no evidence for this
• Improve breathing – there is no evidence for this
• Improve your child’s intelligence – this is completely incorrect and there is no evidence those patients with crooked teeth or sleep apnoea are less intelligent than others.

Any claims set out above should cause concern as to date, BOS is unaware of any scientific evidence to support these claims. 

Your orthodontist or dentist should provide you with a written document called a treatment plan and explain to you why they are recommending a particular approach and highlight any associated risks. In such instances, if there is any doubt in your mind, a second, independent opinion from an orthodontist or a dentist with orthodontic training can provide the perspective that is needed. Your clinician should support you in securing a second opinion so that you can be sure you are choosing the best treatment for your needs. 

Straightening teeth without braces or changing the shape of your face  

The justification for the use of traditional braces is supported by a body of sound scientific evidence and large numbers of patient studies by expert orthodontists in the United Kingdom and worldwide who have tried and tested the techniques and deemed them safe for patients. This is not the case with some alternative methods that have been advocated. As part of its charitable aims, the BOS funds research into orthodontics and is always willing to consider alternative views outside those of traditional orthodontics provided that these are backed by scientific evidence. We welcome independent thinkers and innovation in orthodontics but all views must always be supported by clinical evidence of the highest quality. 

We see no scientific evidence whatsoever to suggest that patients can change the shape of their face or improve their intelligence by undertaking orthodontic treatment. We always put patients first and we are concerned to ensure that patients are not misled into believing that you can change the shape of your face by chewing or holding teeth and the tongue in a closed position or indeed making any kind of facial movements. There are no independent studies or scientific evidence to support this claim. For further consideration of the issues in this topic, please access the American Association of Orthodontics white paper on sleep apnoea and airways – https://www2.aaoinfo.org/wp-content/uploads/2019/03/sleep-apnea-white-paper-amended-March-2019.pdf  

In summary: 

• In some patients, extractions are the only way to achieve a good long-term result. 
• Patients should be wary of exaggerated claims about orthodontic treatments. 
• There is no guidance that can apply to all patients. 
• If in doubt, seek a second opinion.