Too few NHS orthodontists mean parents face paying for their children's treatment, as Jane Hughes discovers.

We the British have been slow to appreciate the importance of good teeth, of straightening a bite or correcting a crooked smile or protruding teeth. Some orthodontists blame traditional British self-effacement and the feeling that appearance doesn't matter, combined with a lack of awareness about the dental health benefits of straight teeth. Certainly, until recently, few parents would have considered paying for such treatment privately.

The number of specialist orthodontists has increased, but there are still only around 1,000 in the UK. This is the worst ratio of orthodontists to 12-year-olds in Europe. With around a third of our children meeting NHS criteria for needing treatment, it's no wonder the British Orthodontic Society says there is a shortage of specialists. Interestingly, it's our children who are now driving the demand for straight teeth, according to Dr Neil Counihan, of Elleven Orthodontics.

“Children are bombarded with imagery and they don't want to look goofy,” he says. “The social stigma that used to surround braces has almost gone - they are now considered quite trendy and the effects on self-esteem can be life-changing.” This is backed up by research at the Royal London Dental Hospital which found that having bad teeth negatively affect teenagers' quality of life.

We, as parents are more aware that dealing with a bite problem where the teeth do not line up evenly, will improve overall dental health.

Today, most orthodontists will look at an individual's face and then decide where the teeth should be. Treatment is mainly by a variety of braces which exert gentle pressure to move the teeth. This is usually followed by a retainer, such as a thin plastic mould which fits over the teeth at night, or a thin wire behind the teeth. Some 211,860 new child patients needed braces in 2006 at a cost of around £80 million. Many have had to go on waiting lists for NHS treatment, so private treatment has grown, typically costing between £2,000 and £4,000.

Tracey Posner was caught out by the new NHS regulations, midway through her daughter Georgia's treatment. “Georgia was so self-conscious that I decided to take her for private treatment,” says Tracey. “It cost around £4,000 but I felt this was an investment in her future-and I was able to pay through an interest-free finance system.”

The most common brace is a fixed device, commonly referred to as “train tracks”, where brackets are bonded on to the teeth and connected by a wire. Over the years, these have become smaller, lighter and more flexible. Increasingly popular is the American Damon System, a low friction brace which uses a slide mechanism to hold the wire. It's more expensive but it significantly reduces treatment time.

Louise Rothwell's twins, Lucas and Michael both had protruding front teeth and, at 13 were fitted with Damon braces, costing £3500 each. “I was told they were not eligible for NHS treatment,” says Mrs Rothwell, “so we went to Dr Counihan and decided to go for Damon braces. Since both boys are rugby players, I wanted to cut down on treatment time.” Their new smiles say it all.