Braces, aligners and other options

Reviewed by Dr. Samar Fadavi, DDS

Short answer: Teeth can be straightened with traditional metal braces, tooth-coloured ceramic braces, clear aligners such as Invisalign, or, for small issues, retainers and other removable appliances. The right option depends on how complex the bite is, your age, how well you can wear a removable appliance, and how the teeth look and feel to you. An assessment with X-rays is the first step.

Why people straighten their teeth

Straight teeth are not only about appearance. Crowded teeth are harder to brush and floss, so plaque collects in tight corners and the risk of cavities and gum inflammation rises. A bite that does not meet evenly can wear some teeth faster than others, chip front teeth, and strain the jaw joints and muscles. Protruding front teeth are more likely to break in a fall or a sports injury. For many people, the reason is simpler: they want to feel confident when they smile, speak and eat in front of others.

Whatever the reason, the goal of treatment is a healthy bite that is comfortable, easy to clean and stable over time. This guide explains the main options for children, teens and adults, what each involves day to day, and how to choose. It is general information for families in Scarborough, the Danforth and East Toronto, not a substitute for an exam.

Common alignment problems

• Crowding. Not enough space in the jaw for all the teeth, so they overlap or twist.
• Spacing. Gaps between teeth, from small teeth, missing teeth or habits such as tongue thrusting.
• Overjet and overbite. Upper front teeth that stick out ahead of the lower teeth, or that cover too much of them vertically.
• Underbite. Lower front teeth that sit ahead of the upper teeth.
• Crossbite. Some upper teeth sit inside the lower teeth when you bite, on one side or at the front.
• Open bite. Front or side teeth that do not touch when the back teeth are together.
• Midline shift. The centre of the upper and lower front teeth do not line up.

Our guide to overbites and underbites explains bite problems in more detail.

Option 1: Traditional metal braces

Metal braces are small stainless steel brackets bonded to the front of each tooth and connected by a thin archwire. The wire is adjusted at regular visits, usually every four to eight weeks, and it slowly guides the teeth into new positions. Elastics, springs and other small attachments can be added to correct the bite between the upper and lower jaws.

Strengths: Metal braces can handle almost any kind of tooth movement, including severe crowding, large bite corrections and teeth that need to rotate or move up and down. Because they are fixed in place, they work around the clock without depending on the patient to wear them. Children and teens often like choosing coloured elastic ties.

Things to consider: They are visible. The first few days after placement and after each adjustment can feel sore, and the brackets may rub the inside of the lips and cheeks until the tissue adapts; orthodontic wax helps. Brushing and flossing take longer, and some foods need to be avoided.

Option 2: Ceramic (tooth-coloured) braces

Ceramic braces work the same way as metal braces, but the brackets are made of clear or tooth-coloured material that blends in with the teeth. Many people choose them because they are less noticeable in photos and at work.

Things to consider: Ceramic brackets are a little larger and can be more brittle than metal ones. The clear elastic ties can pick up stains from coffee, tea, curry or red wine between visits. They are usually used on the upper front teeth, where appearance matters most, and are a good middle ground for teens and adults who need the control of fixed braces.

Option 3: Clear aligners such as Invisalign

Clear aligners are a series of thin, removable plastic trays made from a digital scan of your teeth. Each set moves the teeth a small amount, and you switch to the next set every one to two weeks. Small tooth-coloured bumps called attachments are often bonded to some teeth to help the aligners grip and move them precisely.

Strengths: Aligners are nearly invisible, and because they come out, you can brush and floss normally and eat without food restrictions. There are no brackets or wires to rub the cheeks. Many adults with mild to moderate crowding, spacing or relapse after childhood braces are good candidates.

Things to consider: Aligners only work when they are worn, usually 20 to 22 hours a day. They must come out for eating and anything other than water, and teeth must be brushed before they go back in. Losing or forgetting trays slows progress. Some complex bite corrections still respond better to fixed braces. Learn more on our Invisalign and braces page.

Option 4: Retainers and removable appliances

For very small issues, such as a single tooth that has shifted after earlier treatment, a removable retainer with a spring or a short series of aligners may be enough. In growing children, removable or fixed appliances such as palatal expanders and space maintainers can widen a narrow upper jaw, correct a crossbite or hold space for adult teeth. These early steps can make later treatment simpler or, in some cases, unnecessary.

Option 5: Cosmetic alternatives for minor issues

When the bite is healthy and the concern is only the look of one or two teeth, cosmetic treatment may be an option. Bonding with tooth-coloured composite or porcelain veneers can close small gaps or mask a slightly rotated tooth. These options change the shape of the teeth rather than moving them, and they are not suitable when the bite itself needs correcting. Your dentist will explain the trade-offs honestly so you can compare.

Braces and aligners for children and teens

The Canadian and American orthodontic associations suggest an orthodontic check by about age seven. At that age, the first adult molars and front teeth have usually arrived, and problems with jaw growth, crossbites or crowding can be spotted early. Most children do not need treatment at seven; the check simply helps decide whether to watch and wait or to start an early phase.

Full braces or aligners are most commonly placed between about 11 and 14, once most adult teeth are in. At this stage the jaws are still growing, which can help some corrections. Teens who play contact sports should wear a mouthguard made to fit over braces. Family support matters: reminders about brushing, elastics and aligner wear make a real difference to how smoothly treatment goes.

Straightening teeth as an adult

It is never too late to move teeth, as long as the gums and bone supporting them are healthy. Adults now make up a large share of orthodontic patients. Some had braces as children and their teeth have shifted; others never had the chance. Before treatment, gum disease and cavities need to be treated and stable, because moving teeth through inflamed gums can make bone loss worse. Adults may also combine alignment with other dental work, for example moving teeth into better positions before a crown, bridge or implant.

Adult treatment can take a little longer than for teens because the bone is denser and no longer growing. Many adults prefer clear aligners or ceramic braces for work and social life.

How treatment is planned, step by step

1. Consultation and exam. The dentist looks at your teeth, gums, bite and jaw joints, and asks what bothers you most.
2. Records. X-rays, photos and a digital scan or impressions show the roots, bone and how the teeth fit together.
3. Treatment options. You hear which approaches suit your case, roughly how long each would take, and what is expected of you at home.
4. Preparation. Any cleanings, fillings or gum treatment are completed first.
5. Active treatment. Braces are placed or aligners are started, with regular check visits to track progress.
6. Retention. When teeth reach their new positions, retainers hold them there while the bone and gums settle.

If your case is complex, your dentist may refer you to an orthodontist and continue to provide your regular check-ups and cleanings during treatment.

Daily life with braces or aligners

Cleaning. Brush after meals with a soft brush and fluoride toothpaste, angling the bristles above and below the brackets. Floss daily with a floss threader, orthodontic floss or a water flosser. With aligners, brush and floss before putting the trays back in, and rinse the trays in cool water; hot water can warp them.

Food. With fixed braces, avoid hard, sticky and chewy foods such as hard candy, nuts, ice, caramel, toffee and gum, and cut crunchy foods like apples and carrots into small pieces. With aligners, remove the trays to eat, and avoid sipping sugary or acidic drinks while they are in, because the liquid is trapped against the teeth.

Comfort. Mild soreness for a few days after starting or adjusting is common. Soft foods and over-the-counter pain relievers taken as directed usually help. Orthodontic wax covers any bracket that rubs. A poking wire end can be pushed back gently with the eraser end of a pencil until it can be trimmed at the office.

Visits. Keep regular cleanings and check-ups during treatment. Plaque around brackets can leave white marks on the enamel if it is not kept under control.

Why retainers matter

Teeth have a natural tendency to drift back toward their old positions, and they continue to shift slowly throughout life. Retainers are what keep the result. Some are removable clear trays or wire-and-acrylic retainers worn at night; others are thin wires bonded behind the front teeth. Your dentist will explain how long and how often to wear them. Many people are advised to wear a removable retainer at night for the long run. Bring your retainer to check-ups so its fit can be checked, and replace it if it cracks or no longer fits.

Choosing between the options

• Complexity of the case. Large bite corrections and teeth that need significant rotation or vertical movement often favour fixed braces.
• Discipline with wear. Aligners suit people who will reliably wear them all day and remove them only to eat and clean.
• Appearance. Aligners and ceramic braces are less visible than metal.
• Lifestyle. Musicians who play wind instruments, athletes and people who speak for work may have preferences worth discussing.
• Gum and bone health. Gums must be healthy before any option starts.
• Coverage. Some insurance plans include orthodontic coverage, often with limits and age rules. Our team can help you understand what your plan includes and provide a written estimate at your visit.

What to avoid

• Do-it-yourself and mail-order straightening without an in-person exam. Moving teeth without X-rays and a check of the gums and bone can cause root damage, gum recession and bite problems.
• Skipping retainers. This is the most common reason straightened teeth move back.
• Wearing aligners less than advised. Treatment slows or stalls, and the trays stop fitting.
• Letting plaque build up around brackets. It can leave permanent white spots on the enamel.
• Chewing ice, pens or hard candy with braces, which can break brackets and wires.
• Delaying treatment of gum disease before or during alignment.

When to see a dentist

• Your child is around seven and has not had a bite check.
• Teeth are crowded, overlapping or hard to floss.
• Front teeth stick out, or the lower teeth sit ahead of the upper teeth.
• Your jaw clicks, aches or feels tired after chewing.
• Your teeth have shifted since earlier braces.
• A bracket or wire is broken, or an aligner no longer fits.

Our Invisalign and braces page explains how we assess and treat alignment, and our children’s dentistry page covers early bite checks for kids.

Questions about braces and other alignment options

Are clear aligners as effective as braces?

For many mild to moderate cases, aligners can achieve results similar to braces when they are worn as directed. Some complex bite corrections still respond better to fixed braces. Your dentist will tell you which applies to you.

How long does treatment take?

It varies with the case and the method. Minor corrections may take several months; full treatment often takes one to two years or more, followed by retainers.

Do braces hurt?

Most people feel pressure and mild soreness for a few days after placement and adjustments. It usually settles quickly with soft foods and over-the-counter pain relief taken as directed.

Can I get braces if I have crowns or missing teeth?

Often yes. Brackets can be bonded to many crowns, and moving teeth can open or close spaces before an implant or bridge. Your dentist will plan around existing work.

Is there an age limit for straightening teeth?

No. Healthy gums and bone matter more than age.

Will my teeth stay straight after treatment?

They stay in place as long as you wear your retainer as advised. Without one, teeth tend to drift.

Does insurance cover braces?

Some plans include orthodontic benefits. Coverage varies widely, so our team will review your plan with you and give you a written estimate at the visit.