Orthodontic service
This service is managed by Primary Care Services. The service is a referral service and all orthodontic patients must be registered with a general dentist. Within the Orthodontic Service there is Primary Care (Specialist Practice) and Secondary Care (Consultant at Nobles Hospital).
The Primary Care Orthodontist Service is a contracted service and is delivered by Regent Dental Care, Ridgeway Street, Douglas.
The Secondary Care Orthodontic Service held 1 week in 4 by a visiting Consultant.
Being referred
The general dentist will assess the patient to see if the patient would be eligible for NHS treatment by scoring their Index of Orthodontic Treatment Need (IOTN). The IOTN score is a rating system used to assess the eligibility for NHS treatment Orthodontic Treatment. NHS treatment is available for grade 4 and grade 5 cases for patients under the age of 18. NHS Orthodontic care isn't usually available for adults, however may be considered subject to approval on a case-by-case basis.
NHS treatment provided in the Orthodontic Department:
- Crowding - Correction of crowding and straightening of teeth
- Correction of Bite - Reverse Bite, Anterior Open Bite and Deep Traumatic Overbites
- Protruding Teeth - Reducing the chance of damage to prominent teeth
- Skeletal Jaw Treatment - Orthognathic Surgery
- Impacted Teeth
- Congenital Absence of Teeth - Hypodontia
- Complex Orthodontic Treatment
- Cleft Lip and Palate - North West Cleft Lip & Palate Managed Clinical Network
Triaging referrals
All referrals are triaged by the Consultant and then placed on to either the Primary Care pathway or the Secondary Care pathway, depending on the clinical information and the IOTN score given by the referring dentist.
Primary care pathway
Patients on this pathway will have an IOTN score of 4. They will be seen by the Specialist Practice for an initial assessment to check the IOTN given is correct. If the patient is eligible they are then placed into the correct priority group for their clinical need. These priority groups range from treatment starting within 3 months to waiting 12 + months.
Secondary care pathway
Patients on this pathway will have an IOTN score of 5. The visiting Consultant Orthodontist is on island generally one week a month. Once the referral has been accepted, the patient is placed into a priory group based on their clinical need and all new patients are sent a consultation appointment within 18 weeks.
Factors that can affect the wait time
- Awaiting eruption of permanent teeth
- Impeded eruption of a tooth/teeth
- Further adolescent skeletal growth – females grow until they are 15 years of age and males grow until they are 18 years of age, so there may be a clinical need to wait until patients are fully grown
Benefits of orthodontic treatment
The benefits of orthodontics are a pleasing smile and healthy teeth and gums but there are limitations. Excellent orthodontic results can be achieved with close co-operation between patient, parent and orthodontist. The following information is supplied routinely to anyone considering orthodontic treatment.
Treatments and appliances
It is the responsibility of the patient to look after and maintain their appliance whether that is a removable, functional or fixed appliance. Each time an appliance is damaged it can add time onto the overall treatment length. Most Orthodontic treatments take 18-24 months from the start of treatment. Patients are expected to attend the Orthodontist every 6-8 weeks for adjustments. If you are unable to attend an appointment please inform the provider as soon as possible. All orthodontic patients must see their own dentist for check-ups throughout their treatment.
Oral hygiene
When an appliance has been fitted, the patient must brush their teeth after every time they eat whether that is at home, school, friend’s house or on holiday. Maintaining a high level of oral hygiene is really important. If plaque is left on the teeth around the appliance it can lead to decalcification which is permanent damage.
Diet
During Orthodontic treatment all patients are advised to stick to a soft diet. Hard foods can cause damage and mean that the appliance is not working as it should. If the patient follows the correct diet, breakages will be less likely to occur. Patients must avoid certain foods like sweets, chocolate and fizzy drinks. This is to prevent decalcification.
If the oral hygiene or diet is not good enough, the orthodontist may consider taking your brace off to prevent further damage to your teeth. This can happen part way through treatment.
Orthognathic surgery
Skeletal Jaw Treatment is a combined treatment with Orthodontics and Orthognathic Surgery. This treatment is for patients with a skeletal discrepancy and is done once the patient has stopped growing. The Orthodontics is carried out on island with fixed appliances, and the Orthognathic Surgery is carried out at Aintree Hospital. Patients can expect to carry on with the fixed appliance therapy for 6 months post-surgery.
Broken braces
If you lose or damage your brace please contact the orthodontic service providing your treatment as soon as possible. Do not wait until your next appointment. If you are not wearing your brace, or it is not in the correct position, this affects your treatment hugely. If you follow the correct diet, breakages will be less likely to occur. However, some breakages cannot be avoided and must be reported as soon as possible. It is important that a brace is repaired fairly quickly, as a broken or distorted brace can delay treatment. If a brace breaks, becomes loose or is painful you should contact your orthodontic provider and one of the team will arrange an extra repair appointment.
Contact details
Primary Care Specialist Practice
Regent Dental Care,
16-18 Ridgeway Street,
Douglas,
IM1 1LS
Email: Reception-Ridgeway@regentdental.im
Telephone: +44 1624 618618
Secondary Care Consultant Service
Nobles Hospital
Email: ortho@gov.im
Telephone: +44 1624 685137
Retention with retainers
Once the active orthodontic treatment is complete, patients are fitted with retainers to retain the result, which must be worn as instructed by the Orthodontist. If the retainers are not worn then the teeth may move. Patients are kept under review for one year. If during this time the retainer breaks please contact your orthodontic provider but continue to wear the appliance, even if it has broken in to pieces. If the retainer is lost, there is a fee for a replacement but contact the orthodontist to arrange a replacement. Once the patient has reach the end of their retention phase, they are discharged from the service. Any replacement retainers after discharge would need to be arranged through their own dentist for the appropriate fee.
The British Orthodontic Society's website has more information about Orthodontic treatments.
