Oral Health›Dental visits and treatments

Braces and Clear Aligners: Your Options Explained

Fixed braces, removable appliances and clear aligners all move teeth, but they suit different problems. Here is how each works, who provides them, what regulators say about aligners sent by post, and why retainers matter.

Updated September 2026·By the OHA editorial team·9 min read·How we write
Key takeaways
  • Orthodontic treatment moves teeth to improve how they bite together and how they look.
  • Fixed braces stay on until treatment ends. Clear aligners are removable, but only work if worn 20 to 22 hours a day.
  • In the UK, braces are often free on the NHS for under-18s whose teeth meet an assessed level of need. Adults usually pay privately.
  • The UK dental regulator and orthodontic bodies in the US and Australia say a physical examination should come before treatment, including with aligners sent to your home.
  • Almost everyone needs a retainer afterwards, and many people are advised to wear one long term.

Orthodontics is the area of dentistry that deals with the position of the teeth and how they bite together, as the Better Health Channel (Victoria) explains. It adds that not all crooked teeth need treatment.

Why do people have orthodontic treatment?

The NHS says braces may be needed if your teeth are crowded or stick out, your upper and lower jaws do not meet properly (an overbite or underbite), you have large gaps, or the position of your teeth makes it hard to chew or keep them clean.

The American Dental Association calls a "bad bite" a malocclusion. The Better Health Channel says crooked teeth are harder to clean, which raises the risk of tooth decay and gum disease, and that front teeth that stick out are more likely to be injured in sport or a fall.

The NHS says braces are often recommended once all the adult teeth have come through, and the American Dental Association says treatment often begins between 8 and 14. Both say adults can have treatment too.

What types of appliance are there?

  • Fixed braces. Small brackets are glued to each tooth and joined by a wire that puts gentle pressure on the teeth (NHS). Brackets can be metal or tooth-coloured, and are sometimes placed behind the teeth (American Dental Association, Better Health Channel). The NHS says fixed metal braces are the type commonly used on the NHS, with adjustments every 6 to 8 weeks.
  • Removable appliances. Plates that can be taken out for cleaning (Oral Health Foundation). Functional appliances correct the bite in growing children (Better Health Channel).
  • Clear aligners. A series of custom-made clear plastic trays, each worn for a week or two before moving to the next (American Association of Orthodontists). You take them out to eat, drink and clean, but must wear them 20 to 22 hours a day (American Association of Orthodontists, Better Health Channel). Some treatments need small tooth-coloured attachments bonded to the teeth to help the aligners grip (Australian Society of Orthodontists).

Braces or aligners?

The American Association of Orthodontists says aligners may not work as predictably for severe bite problems, large rotations or large gaps, where fixed braces can be more precise, and that results depend on wearing them as instructed. The Australian Society of Orthodontists says aligners generally work best for minor to moderate problems. Aligners are easier to clean around, but can trap drinks and food against the teeth, raising the risk of decay (American Association of Orthodontists).

Sources give different treatment lengths: 1 to 2 years for an NHS fixed brace (NHS), 1 to 3 years (American Dental Association), and several months to about two and a half years (Oral Health Foundation).

Who provides orthodontic treatment?

UK. The NHS says a dentist who thinks a child needs braces will refer them to an orthodontist, a specialist in teeth and jaw problems, and that waiting lists can be long. The General Dental Council (GDC), the UK regulator, says remote aligner services fall within the legal definition of dentistry, so only GDC-registered dental professionals may provide them.

Australia. The Better Health Channel says treatment is provided by orthodontists and some dentists. The Australian Society of Orthodontists recommends a specialist orthodontist, who has a dental degree plus three years of full-time university orthodontic training, and says some other providers may have trained for only a couple of days. It suggests checking registration with the Australian Health Practitioner Regulation Agency (AHPRA).

US. The American Dental Association says your dentist or an orthodontist may provide treatment, depending on your dentist's experience and how complex your case is.

Views differ, so ask any provider about their training.

Can my child have braces on the NHS?

The NHS says braces are usually only free for under-18s who have a problem with their teeth. An orthodontist examines the teeth and decides on eligibility based on how they affect daily life, such as eating or cleaning.

The British Orthodontic Society says eligibility depends on age and on the Index of Orthodontic Treatment Need (IOTN), which has five grades from "no need" to "severe need". Grades 4 and 5 need treatment for health reasons. Grade 3 is borderline: NHS treatment is possible if the teeth also score 6 or more on an appearance scale judged against reference photographs.

Adults with severe problems may be treated in hospital orthodontic services (British Orthodontic Society). If your child is not eligible, the NHS suggests asking a dentist about alternatives or paying privately.

What about aligners sent to your home?

Direct-to-consumer aligners are arranged remotely and posted to you, often without an in-person visit.

  • UK. The GDC says there is currently no effective substitute for a physical clinical examination before orthodontic treatment. Its advice for the public warns that some conditions can make aligners unsafe and may be missed without an in-person check-up. It says you should know the full name of the dentist responsible, be able to contact them directly, and check they are registered.
  • US. The American Association of Orthodontists strongly discourages mail-order treatment, saying that without X-rays and an in-person examination it can cause potentially irreversible damage, such as tooth and gum loss. The American Dental Association lists bone loss, receding gums, bite problems and jaw pain among the risks.
  • Australia. The Australian Dental Association encourages people to get professional dental advice before cosmetic treatments or products promoted online, naming direct-to-consumer aligners among the trends it has seen. The Australian Society of Orthodontists says starting treatment without a physical examination by a specialist orthodontist risks irreversible damage to teeth and gums.

The Oral Health Foundation says teeth moved too quickly or into the wrong position can loosen, their roots can be damaged, and bone can be lost.

Why are retainers so important?

After treatment, teeth tend to drift back towards where they started (called relapse), and they can also shift with age. The British Orthodontic Society says almost every patient needs a retainer, and you should only start braces if you are happy to wear one. Retainers can be removable (a clear plastic tray, or a plate with a wire) or fixed, as a thin wire bonded behind the teeth.

Advice on how long differs. The British Orthodontic Society's leaflet says you will generally wear retainers every night for the first 12 months, then gradually less, to at least once a week long term. The Oral Health Foundation says day and night at first, then usually at night long term. The NHS says your orthodontist will tell you, so follow their instructions.

The British Orthodontic Society notes that NHS care covers 12 months of retention, after which retainer repairs and replacements are paid for privately. If a retainer breaks or is lost, contact your orthodontist promptly, as teeth can move without it.

Looking after your teeth during treatment

  • Brush with fluoride toothpaste, taking care around brackets and wires. Advice on how often varies: the NHS says morning, night and after meals, while the Oral Health Foundation says last thing at night and once more during the day.
  • Clean between your teeth and under the wire every day with interdental brushes (NHS, Oral Health Foundation). See cleaning between your teeth.
  • Cut down on sugary food and drinks, and avoid hard, crunchy or sticky foods and chewing gum, which can damage braces (NHS, Better Health Channel).
  • With aligners, the American Association of Orthodontists advises drinking only water while they are in, brushing before putting them back after eating, and keeping them in their case.
  • Keep having dental check-ups as well as orthodontic visits (NHS, Oral Health Foundation).

The Better Health Channel says orthodontic wax can cover parts of a brace that rub.

When to see a dentist
  • Your teeth are still painful more than a few days after braces are fitted or adjusted (NHS).
  • Your gums are very red, swollen or painful while you have braces (NHS).
  • Your braces are broken, or a retainer is broken or lost (NHS, British Orthodontic Society).
  • You are worried about your own or your child's bite. The Better Health Channel suggests talking to a dental practitioner.

Frequently asked questions

Am I too old for braces?

No. The NHS, the Better Health Channel and the American Dental Association all say adults can have orthodontic treatment. In the UK, adults usually pay privately.

Do braces hurt?

The NHS says teeth may be sore for a few days after braces are fitted, and the Oral Health Foundation says there may be mild discomfort after adjustments. Soft food and painkillers can help.

How long will I need to wear a retainer?

The British Orthodontic Society says the only way to keep teeth permanently straight is to wear a retainer part-time for life. Your orthodontist will tell you how often.

Sources

  1. Braces, NHS, accessed September 2026
  2. Is my patient eligible for NHS treatment?, British Orthodontic Society, accessed September 2026
  3. What is the IOTN?, British Orthodontic Society (archived patient page), accessed September 2026
  4. Quick reference guide to orthodontic assessment and treatment need (PDF), British Orthodontic Society, accessed September 2026
  5. Retainers, British Orthodontic Society, accessed September 2026
  6. Retainers: patient information leaflet (PDF), British Orthodontic Society, accessed September 2026
  7. Statement on direct-to-consumer orthodontic treatment, General Dental Council, accessed September 2026
  8. Aligners or braces sent directly to your home, General Dental Council, accessed September 2026
  9. Orthodontic treatment, Oral Health Foundation, accessed September 2026
  10. Why are DIY braces a concern?, Oral Health Foundation, accessed September 2026
  11. Orthodontic treatment, Better Health Channel, accessed September 2026
  12. Young Australians at risk of "falling through the cracks" on dental health, Australian Dental Association, accessed September 2026
  13. All about clear aligners, Australian Society of Orthodontists (Orthodontics Australia), accessed September 2026
  14. How to select an orthodontic provider, Australian Society of Orthodontists (Orthodontics Australia), accessed September 2026
  15. Potential risks associated with direct-to-consumer clear aligners, Australian Society of Orthodontists (Orthodontics Australia), accessed September 2026
  16. Braces, American Dental Association (MouthHealthy), accessed September 2026
  17. Do-it-yourself (DIY) dentistry, American Dental Association (MouthHealthy), accessed September 2026
  18. Clear aligner therapy, American Association of Orthodontists, accessed September 2026
  19. At-home orthodontics: cons and considerations, American Association of Orthodontists, accessed September 2026

This article is general information about oral health. It is not a diagnosis or a substitute for advice from a dentist or doctor who knows your situation. If you have pain, swelling, bleeding that does not settle, or a problem that is getting worse, see a dental professional. In an emergency, contact your local emergency service.

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