It became quite apparent at around age nine that our eldest daughter would, at some stage in her near future, require orthodontic treatment. Without actually mentioning the dreaded “B” word (hint, rhymes with duck), those much-wished-for two front teeth were becoming far more prominent than what front teeth ought to be.
Subtle hints from grandparents on visits home like, “So, just out of curiosity, at what age do they put braces on in Hong Kong?” had us scheduling an appointment with the orthodontist, and so began our education in braces in the modern era.
Luckily for kids born post-2000, braces are not what they used to be. The very first pair was attached onto some unfortunate fellow back in the year 1900. Requiring the metal to be wrapped around the entire tooth and with thick wires holding it all in place, this pioneering technique of straightening wayward teeth was the brainchild of the father of orthodontics, Edward Angle. His patients were, quite literally, the original “metal mouths”.
Over the past 100-plus years, as technology improved, the brackets gradually became smaller and the wires thinner, resulting in the far more acceptable tooth bling we see today. Hong Kong orthodontist Dr Derek Baram says the addition of brightly coloured bands has made getting braces almost, if not completely, desirable.
“It’s been huge; we underestimated the effect the coloured bands would have,” he says. “It’s made braces fun and fashionable, and it put part of the treatment in the hands of the patient, where they can be involved in certain choices.”
So what is the most popular colour choice for young people? “Turquoise, for both boys and girls, because it provides good colour contrast with the tooth,” Dr Baram says. “It’s closely followed by bright pink.”
Dr Baram advises children have their first orthodontic check-up at seven or eight years old. Most will be told to come back in two or three years’ time, but the early check allows for faster intervention in those who require treatment before braces.
To expand or not to expand?
The most recent advancement in early treatment is the introduction of the expander. This small piece of metal sits permanently on the roof of the mouth, and is designed to spread the palate before the cartilage of the upper jaw fuses at around age ten.
Dr Baram estimates that up to 20 per cent of kids in Hong Kong who need braces will begin treatment with an expander or similar jaw-correcting device. “It’s particularly beneficial for children with moderate to severe crowding, and will reduce the need to remove teeth later on,” he says.
While not generally painful, expanders can be annoying. Food gets trapped underneath, speech can be affected and the device needs to be manually turned by the patient or parent.
How much will orthodontics set you back?
Expander: $20,000 – $30,000
Metal braces: $45,000 – $55,000
Ceramic braces: $55,000 – $65,000
Invisalign: $60,000 – $70,000
Braces behind the teeth: $80,000 – $100,000
What about Mum and Dad?
If you’re making regular trips to the orthodontist with your kids, you might start thinking about your own corrective treatments.
These days, up to 30 per cent of orthodontic patients are adults. Despite the increased cost, they almost always opt for the less visible form of braces, with Invisalign being the most popular choice.
Jack, aged ten, says his expander was uncomfortable at first, but he soon got used to it. “When you first hear about it, it sounds horrible and you think, There’s no way I want that, but once you get it in it’s no big deal,” he says.
Expanders are usually in for about six to nine months, and are followed up by a retainer or braces once all the adult teeth are in.
The lowdown on braces
Orthodontists now believe the optimum time for kids to get “braced up” is 12 or 13 years old. While braces can be put on at any age, the teeth will respond better before ages 16 to 18, when the jaw typically stops growing. Kids have softer bones and faster metabolisms than adults, and teeth will begin to move into line almost immediately after treatment starts.
But the main benefit of putting them on earlier is that it’s more socially acceptable – many of your child’s friends are likely to have braces on at that age as well. A quick survey at my daughter’s 13th birthday party revealed that ten of the 19 kids were wearing, or had worn, braces. With strength in numbers, it’s easier for kids to feel confident about the metal in their mouth and gives them plenty of friends to share their experiences with.
Recent studies have found up to a third of all kids wear braces in developed countries like the US and Australia. In Hong Kong, the figure varies: 13 per cent of local Chinese children will have braces, but that number jumps to 60 per cent within the expat community.
Will it hurt? It’s a legitimate question from those about to have metal permanently attached to their teeth. The answer? Yes, but only for a short while. Dr Baram says pain is typical for one or two days after the braces go on, and can be worse with the lower jaw. “When we move the teeth, it creates swelling in the ligaments,” he says. “We are basically creating an injury, before correcting it, and it can make the gums sore.” Anti-inflammatory medication or paracetamol will both help, and by day five the pain should be gone.
Initially, the braces can also scratch the inside of the lips. Patients are often given pots of wax to smooth over the irritating areas until the mouth adjusts.
Some people will also experience discomfort after each adjustment every four to six weeks, but it’s nothing compared to the initial soreness when they’re first installed.
The duration of treatment depends on the complexity of each case. Some simple corrective problems can be fixed in just six months, but most kids will have braces on for between one and a half to two years. This will certainly be the case if there are issues with overbite, underbite or a misalignment.
As well as the regular adjustments, there are some measures kids can take to ensure the process runs smoothly. Dr Baram says, first and foremost, kids need to keep their teeth and braces clean. “It can be a big problem when kids don’t clean their teeth enough, resulting in gum swelling and cavities,” he says. “Brushing two to three times a day after main meals is essential.” He also recommends the use of tiny brushes which can get underneath the wires, and floss picks specially designed for use with braces.
Kids are advised to avoid chewing gum and foods that are hard or sticky and can break the wires. Braces can also be damaged during contact sports, and participants should wear custom-made mouthguards for protection.
If braces are on the horizon, you may also want to think about which musical instruments your child plays. Instruments like the flute, trumpet and horn can be particularly harsh on wearers, who will need to use wax to avoid sore lips after practice.
In special circumstances, kids may opt for a different type of treatment which better suits their requirements.
What are the options?
While 80 per cent of teens have the traditional metal braces fitted, there are now several other options to be considered.
Ceramic braces are the same as metal ones, but the bracket comes in opaque white, making it less obvious on the tooth. On the flip side, they are more brittle and can be damaged more easily, and are more expensive.
Invisalign is another popular alternative. This treatment consists of a series of clear, removable teeth aligners, which are changed every couple of weeks. There are no wires or metal parts, but there are limits to what can be achieved compared to normal braces, and it is also more expensive.
The least visible orthodontics are braces that are fitted behind the teeth, as they can only be seen when the mouth is open wide. But they too have their downsides: typically considered the most uncomfortable, they are almost twice the price of regular wire braces.
Whichever option you choose, ensure you’ve discussed realistic expectations for results with the orthodontist. In some cases, modern technology can allow patients and parents to see the step-by-step transformation and final results on screen, before you’ve even started. It’s great motivation to have the end goal in mind when coping with the initial discomforts.
Any former wearer will tell you the most exciting time is when the braces come off. While the corrections will have been apparent for many months, there’s nothing like a shiny, metal-free, perfectly aligned smile to assure parents and kids alike that it was all worthwhile.
As for my daughter, the change has been nothing short of astounding. She now has a set of pearly whites a toothpaste model would be proud of, and will happily flash them at any camera pointed her way. And in the age of Instagram, Facebook and selfies, that’s a positive outcome!