As orthodontist, we specialise in the correction of "malocclusions" or "bad bites". Many people have teeth that are crowded or crooked, some people have upper teeth that stick out and look unsightly. Orthodontic treatment can be used to straighten these teeth and improve appearance. Orthodontic treatment is always a change for the better regardless of your age. The biological process involved in tooth movement is the same in both adults and children. The health of your teeth, gums and supporting bone is the most important factor in determining the prospects for improving your smile. Modern tooth-coloured braces have encouraged adults in increasing numbers to take on treatment. However they are not suitable for all cases and most appropriate type of brace will be recommended after consultation.

The Initial Consultation involves a full examination of the teeth and the jaws is followed by X-rays, photographs and impressions (moulds) of the teeth. These pre-treatment records enable your orthodontist to make a correct assessment of your teeth, and devise a treatment plan to address any problems. In our clinic both dentofacial orthopaedics using custom made removable and functional appliances to modify the pattern of jaw growth and orthodontics using fixed appliances to correct dental irregularities are used to achieve the best result. Children under 18 years of age at the time of examination will be offered the treatment under the NHS. All treatment for adults is under private contract. The cost of treatment will depend on the severity of the problem.

Most types of orthodontic treatment require NHS approval. Approval usually takes about 3 weeks (very occasionally longer) to come through. In the meanwhile, please wait until we contact you so that arrangements can be made to begin your treatment. If you have been told by your orthodontist that some teeth need to be removed before the start of treatment, we will also remind you to contact your dentist for this to be done (a letter will have already been sent to your dentist).

Fitting braces does not hurt! Different patients require different types of brace. Some people, for example, need removable braces. These simply fit over the top teeth. Those patients who require fixed braces or train tracks will usually need 2 appointments to have their braces fitted. The first is a short preparatory appointment where little elastic rings are fitted between the back teeth. The second is a longer appointment to fit the fixed brace. (Occasionally, 4 appointments may be needed to fit some types of fixed braces). Your brace may be fitted by an orthodontist in our team other than your own orthodontist.

You are then usually seen about once every 6 weeks to have your braces checked and adjusted. Whilst every effort is made to accommodate your preferred appointment day and time, appointments during school holidays, and those at the end of the day or early morning are popular with most people, and we cannot guarantee that you will be able to get any particular day or time of the day. If the available appointment time is not suitable, your preferred appointment time may only be available 1 to 2 weeks later; and this may mean that the braces will be on for longer. Appointments may not be booked 2 or 3 visits in advance, as this would not be fair to other patients. Saturday appointments are generally reserved for new and private patients. You must continue to see your own dentist for check-ups.

We respectfully request those accompanying the patient (especially parents with other younger children) to remain in the waiting room while treatment is being carried out. We find that in this way, the clinic runs more smoothly without the orthodontists and their patients being distracted, and so without the treatment being compromised. It also means that our nurses are able to move about the clinic more freely, and do their job more effectively. If you would like to speak to the orthodontist at any stage, you are of course welcome to ask the receptionist to do so either before or after the visit.

This varies. Average treatment time is usually 14-18 months; but the duration of orthodontic treatment depends mainly on the type of case and on how well you look after your brace. Treatment always finishes sooner for those patients who have taken good care of their braces as advised by their orthodontist.

All patients wear retainers after their fixed braces have come off. Retainers are removable plates that hold the teeth, so that the teeth have a chance to settle in their new, corrected positions. They are worn for a few months full-time, and then for a few months night-time, then every other night, and so on until they are gradually phased out. Your orthodontist will continue to see you for another year, checking your retainers once every 3-6 months.

Jaw (or orthognathic) surgery involves the combined effort of the orthodontist and an oral surgeon. In some cases, the jaw bones are positioned in a way that makes it difficult, if not impossible, to obtain good results with orthodontics alone. The most common problems corrected with jaw surgery include a protruding upper jaw (which sometimes causes a “gummy smile”), a protruding lower jaw, or a recessed lower jaw. Dramatic improvements in facial features, as well as straight teeth, can be obtained when surgery is done in conjunction with orthodontic treatment.

Orthodontics is for adults too. Since the biological process in tooth movement is the same in both adults and children, you’re never too old to be at your best. Our oldest patient so far has been 72 years young! About 20% of our practice is adults, and the number is growing.

The rule of thumb is to see an orthodontist as soon as a possible problem is noticed. It’s a big advantage if we see younger patients for the first time at about age 7 or 8. This is the opportune time to begin a guidance program. Sometimes removal of baby teeth can prevent improper eruption of permanent teeth.

National Health treatment is free for children up to the age of 18. You will only be entitled to treatment under the NHS if your condition is serious. Minor problems may be classed as cosmetic and would therefore be charged privately

All examinations and treatment for adults over the age of 18 years will be offered on a private fee paying basis. Our fees vary according to the complexity and time involved with each case and type of braces (appliances). We offer several payment options to fit your budget. Your orthodontist will be happy to discuss these options with you at the initial consultation. Orthodontic treatment will make your smile look fabulous. Think about how a fabulous smile will improve your life.

In order that practice is run efficiently we request that patients keep to the appointed time. If you are unable to keep your appointment please let us know as soon as possible so that we can use the appointment for another patient on our waiting list. Failure to attend appointments or giving us less than 24 hours notice may result in discontinuation of the treatment and discharge from the clinic.

Whenever possible, please contact us about emergencies during normal surgery hours. If you need to be seen the same day, please get in touch as early in the day as possible. In case of emergency out of our opening hours, please call the NHS Direct on 0845 4647 or 02088671411. You can also visit the NHS Direct online: www.nhsdirect.nhs.uk

We want to provide the highest standard of care and we are sorry if you are not completely satisfied with the service you received. We hope we will be able to put things right. A formal complaint should be made in writing to the Practice Manager of our clinic. However, you can also send a copy of your letter to the PCT's complaints team: Hammersmith and Fulham Primary Care Trust Parsons Green Centre 5 – 7 Parsons Green London SW6 4UL call them on 020 8846 7964 fax them on 020 8846 7961 or email complaintsteam@hf-pct.nhs.uk

Your orthodontic records will remain confidential and secure. However from time to time we may need to release these to Hammersmith and Fulham PCT or The NHS Business Services Authority as part of our ongoing clinical review process. We will try to contact you before releasing your dental records to another organisation.