No need to be down in the mouth

EATING sandwiches and watching Ian Lund's dental horror movie at the same time is probably not a good idea. The plate of sandwiches thoughtfully provided by the specialist Darlington dentist at the start of this interview were largely untouched at the end of his short video presentation.

Ian, who has practised in South Durham since 1998, likes to show non-dentists the kind of challenge he has to deal with on a regular basis.

Of course, in an ideal world, everyone develops perfect, regular teeth during childhood and ends up with a dazzling even smile. In reality, a significant minority of children reach their early teens with a mouthful of problems. These are not the usual dental decay problems - dealt with by mainstream dentists in the usual way - but Mother Nature getting the plot slightly wrong.

Ian, 41, who has been fascinated by the specialism of orthodontics - corrective dentistry - since he was at dental school, explains that the most common problem is 'crowding', when upstart premolars fill in the gaps which will eventually be needed by pointed canine teeth.

This often means that youngsters present with what appear to be two recessed 'fangs' set back into the upper gum, with no room for them to descend.

"The most common complaint is about canine teeth, which are the last to come through in children. We often find that other teeth have 'stolen' the space which should be occupied by the canine teeth on both sides of the mouth," says Ian. "With the crowding of teeth there is simply not enough space to fit them all in. We can reduce the number of teeth but, if we can, we will use a variety of appliances to correct the problem."

The other main problem, which can often occur at the same time as crowding, involves a mis-match between the upper and lower jaws, resulting in a recessed lower jaw or a projecting lower jaw.

In the most severe cases Ian will refer the patient to specialist surgeons at the nearby Darlington Memorial Hospital, but milder forms of the problem can be corrected by fitting appliances which train the patient's jaw to develop in the right direction.

As one of a handful of orthodontists in the region, Ian gets NHS referrals from other dentists, usually from South Durham and the Dales, but a shortage of people practising the specialism means there is a waiting list of around 12 months for NHS patients at Ian's practice. Many parents of teenagers in need of dental correction are not prepared to wait that long and there is a steady stream of private patients.

While Ian is fascinated by the challenge of each young patient, he gets a particular buzz out of helping them. "When they walk in on the first day they are often very quiet and won't smile," says Ian. "You find that their self-esteem is low and they don't want you to see their teeth."

After a successful course of treatment, the difference can be remarkable.

"It often transforms people's personality. It can make them much more confident and outgoing, which is important when you are a teenager."

So how does he perform these minor miracles? Ian explains that in a living, evolving mouth it is possible to train teeth to grow in a particular way by providing sustained pressure using a variety of appliances, including braces, springs, wires and harnesses.

Some youngsters flatly refuse to have braces and prefer to put up with extractions - while others, and this is increasingly common, clamour for trendy coloured braces, usually because their friends have already got them.

In the old days, metal braces used to be welded to metal bands fixed around teeth, a process which was time-consuming and expensive.

But in recent years orthodontists have been able to take advantage of increasingly sophisticated techniques, which allow brackets to be 'super-glued' to the front surface of teeth, and have seen the introduction of much finer gauge wire.

"The glues are made up of composite resins. You condition the surface of the tooth and then cure it in a similar way to the way fillings are now fixed in place," says Ian.

Other improvements have seen the development of white-coloured wire and pearl-coloured silica brackets which are less visible in a patient's mouth. "These appliances are popular with patients, particularly with adults who are often not prepared to wear metal braces," says Ian.

New methods of securing braces are coming in all the time and a recent development is the so-called 'invisible brace', a 'lingual appliance' which fits snugly behind the teeth rather than in the conventional position on the outside surface. "It does feel odd for the first couple of months but people get used to it," says Ian.

Model and actress Kelly Brook recently wore this type of invisible brace during a stint presenting a breakfast television show. And megastar Hollywood actor Tom Cruise has also had 'invisible' ceramic tooth brackets made for braces.

As technology develops, the next step is a tight-fitting, see-through plastic brace known as a 'positioner'. The idea is that a patient has a mould made of their upper or lower teeth and a dummy is cast in a dental laboratory.

By manipulating the model, a series of slightly different moulds can be produced. If they are worn in strict rotation they can help to 'train' teeth to move into the desired position in the mouth.

"The great thing about this approach is that it has low visibility. It is also removable, although patients still have to wear it for at least 20 hours a day," says Ian.

This new approach has gone down very well with the practice's private adult patients.

While Ian keeps himself very busy dealing with mainly adolescent patients he wonders whether Britons will ever take to adult orthodontics in the way the Americans have.

"In the US one in two adults has had orthodontic treatment. In the UK that figure is one in a thousand. That is really something to think about, isn't it?"

l Falchion Orthodontics, 67 Woodland Road, Darlington (01325) 381540