Sir, orthodontic patients undergoing active treatment require regular monitoring with adjustments made to appliances over the course of treatment. The inability to do this during this time raises serious concern regarding the detrimental effects this may have on this group of patients' oral health, the provision of treatment and subsequent orthodontic patient management.

In the immediate to short term, patients may experience several orthodontic emergencies such as broken brackets, retainers, sharp wires and loose auxiliaries. These breakages may lead to discomfort, intra oral trauma and undesirable tooth movements including possible relapse in the case of a broken retainer. Following orthodontic triage, most emergencies are being managed with telephone advice and direction towards the British Orthodontic Society website which has excellent advice and video tutorials on home repairs.1

In the medium term there is concern with regards to the oral health of orthodontic patients currently in active treatment. Orthodontic treatment increases the patient's risk of developing decalcification, caries and gingivitis. However, with excellent oral hygiene and dietary control of sugar intake, these risks are reduced. Without regular reinforcement and review, patient motivation and compliance may be compromised with detrimental effects. For some patients it may be prudent to discontinue orthodontic treatment as a result.2 Additionally, some patients may choose to terminate treatment due to the uncertainties surrounding COVID-19.

Anchorage is the resistance to unwanted tooth movement and is an important consideration in orthodontic treatment planning with respect to space requirements. There are several methods available to an orthodontist to alter the anchorage balance, for which the extraction pattern is one. Anchorage loss results from unwanted tooth movements.3 It is possible that during this period unwanted tooth movement and space loss occurs which may compromise the final orthodontic result or lead to extended treatment times.

Without routine dental appointments taking place, general dental practitioners are not able to carry out orthodontic assessments and subsequently refer patients for orthodontic treatment. Timely orthodontic referrals are essential for the management of patients that require interceptive treatment, treatment with functional appliances and those with impacted teeth or pathology, eg root resorption.4 It is also possible that during this time patients that may have been eligible for treatment on the NHS turn 18 years of age, which means they no longer qualify for treatment. It is essential that we are aware of these possible consequences and consider strategies to manage them when practice resumes.