Teenagers

Why this stage works well

Between roughly eleven and fifteen, most patients have their permanent teeth through and still have growth left. Bone turnover is quicker than in adults, so teeth move more readily. Where the jaws relate poorly to each other, remaining growth can be directed rather than merely compensated for. And a teenager is generally at an age where the treatment can be handed to them as their responsibility, which matters more than any hardware choice.

The appliance question

Most teenagers do best in fixed braces. The reason is not that aligners cannot work but that fixed appliances do not require anything to be remembered. Aligner treatment demands twenty to twenty-two hours a day of wear from someone who is also managing school, sport and a social life, and partial wear produces a partial result at best.

Where visibility is the sticking point — and for some teenagers it is genuinely the difference between treating now and refusing — ceramic brackets answer most of it while keeping the compliance advantage. Colours answer a surprising amount of the rest.

What decides the finish date

Two things, both in the patient's hands: elastic wear and keeping the appliance intact. A case estimated at eighteen months finishes at eighteen months when elastics are worn as prescribed and brackets are not broken every few weeks. The same case can drift past two years when they are not, and that is nearly always what has happened when a friend's treatment seemed to go on forever.

For parents

• Give them ownership of the timeline rather than supervising it. The finish date moves with their behaviour, and they respond to that better than to reminders.
• Keep elastics in three places: school bag, bedside, pocket.
• Buy an orthodontic mouthguard before the season, not after the first incident.
• Watch hygiene without policing it. White marks are permanent and they are the complication teenagers most often create for themselves.
• Schedule adjustment visits early in the term rather than around exams.