The number of adults who got orthodontic treatment is up nearly 40% since 1996, but adults face challenges that many teens do not, like an urgency to get potential gum ailments under control before they get braces.
Braces used to be just for teens.
Growing numbers of adults are having orthodontic treatments, hoping to achieve the perfect smile and bite. And more dentists are offering their grown-up patients appliances designed to be more discreet than traditional metal braces, including clear aligners, porcelain braces and back-of-the-teeth lingual orthodontics.
While the principles of straightening teeth are pretty much the same at any age, dental experts say adults should be aware of possible complications. Decades of dental work, including crowns, root canals and cavity fillings, can make it harder for the orthodontist to get the desired result in an older patient. And because the mouth of an adult has finished growing, correcting the teeth might, more often than in adolescents, require oral surgery in addition to braces.
Patients seeking orthodontic treatment are getting older, they are greatly influenced by social media, esthetics and appearance, they more conscious of their oral health, they are healthier, their dental health is better, and they’re interested in having their teeth last the rest of their life.
There isn’t yet strong evidence, however, to assure whether orthodontic treatment helps teeth last longer. Studies haven’t been able to prove that having straight teeth makes it easier to keep them clean and in better periodontal health but it has been shown recently by an study done at University of Washington by Dr. María Nart that teeth aren’t getting worst after orthodontic treatment. Still, people who have had orthodontic work may take more pride in their teeth and, after making a major investment, want to take better care of them. Their motivation for oral hygiene increases.
More than 1.2 million adults in the U.S. received orthodontic treatment in 2012, the most recent numbers available from the American Association of Orthodontists. That is up 39% from 1996. By comparison, about 4.65 million orthodontic procedures were performed for patients age 17 and younger in 2012, up 32% in the same period.
You’re Not a Kid Anymore
What adults should know before getting braces
- Orthodontic work can be more complex in adults than teens because of crowns, cavity fillings and other past treatments.
- Braces might not resolve some problems in adults because, unlike teens, the face has stopped growing. Surgery might be needed to fix problems like crossbite.
- Adults are more prone to gum disease than teens. It’s important to resolve any gum issues before having orthodontic work and to be attentive to hygiene while wearing braces.
- Treating adults in some cases may take longer than adolescents. Doctors sometimes apply less pressure with adults because of greater sensitivity to pain.
- Clear aligners, popular because they are less visible, are considered an option for less complicated oral problems.
Treatment costs for adults typically range from $4,800 to $7,135, a little higher than the $4,685 to $6,500 range for adolescents, according to an American Dental Association survey of dental fees from 2013.
The main difference between treating adults and adolescents is that the jaws of young people are still growing, which can be helpful in treatment. If a patient’s upper teeth stick out a lot we can hold back the growth of the upper jaw while the lower jaw grows and then facial balance will come.
Not so with adults, whose bone and facial structure are fixed. For example, to correct a crossbite in an adult, when the upper teeth bite inside the lower teeth, usually requires changing the size or shape of the jaws surgically to get them to fit correctly.
Another tactic when patients have stopped growing: Orthodontists might insert small titanium screws into the bone to use as anchors to pull teeth in the desired direction.
Adults must also make sure to clear up any gum and periodontal disease before getting braces, or risk additional bone and soft tissue loss or tooth loss. Children and teens are less prone to gum disease than adults. Orthodontic treatment is only possible if the gums and the bone are healthy and stable.
In some cases adults need orthodontic treatment before having other dental work done, such as teeth restorations or implants. In order for the restorations to be aesthetic and function well sometimes the spaces and crowding of the teeth have to be corrected and that would involve getting braces.
There doesn’t seem to be an upward age limit for getting braces, as long as the gums and bone are healthy. Harold Walter, who is 87 years old, had his braces removed last week. “I had one tooth that was protruding and I was fearful that I might have to get it pulled out,” he said. The Wichita, Kan., resident, who wore the braces for less than a year, said his teeth now “feel great and they look great.”
Surprisingly, studies have found that teeth of men and women today tend to be more crooked than those of people who lived centuries ago. Diet is probably a contributing factor, experts say. One theory is that modern civilizations have evolved to use the jaw less in chewing food so our jaw size may be decreasing relative to our teeth. Another theory is that when unprocessed and hard foods were the main diet there was less teeth crowding because the teeth would be worn down, leading to more space.
Nearly a third of adults getting braces had them when they were younger but their teeth since shifted because they didn’t continue to wear a retainer. Most orthodontists recommend putting in a retainer at night indefinitely. An alternative is to get a bonded retainer, which involves permanently gluing small wires to the back of the teeth to hold them in place.
For adults self-conscious about wearing metal braces, other options are more discrete, but often cost more and may not suit every patient. Plastic clear aligners sit firmly over the teeth and are changed every few weeks as the teeth shift. Orthodontists say clear aligners can be a good option for less complex cases. Also less visible are porcelain braces and lingual orthodontics, or braces glued to the back of the teeth.
Ken Dillehay, an orthodontist in Wichita, Kan., and a member of the American Association of Orthodontists’ board of trustees, said adult treatment can sometimes take a few months longer than for children, in part because of possible additional challenges with adults getting braces. The average treatment time for adults is 24 to 30 months, compared with 18 to 22 months for adolescents, Dr. Dillehay estimates.
Dr. Aamodt, of UCSF, said he often uses a more gradual treatment for his adult patients, including lighter wires and less pressure, because they tend to feel more pain from forces placed on the teeth. Adults also should have lower expectations for orthodontic treatment because a history of dental work and disease makes the procedure more difficult than with teens.
“Our goal for treatment of children is to achieve perfection,” Dr. Aamodt said. That often isn’t possible in grown-ups, he said, “so our goal for treatment of adults is to achieve the best compromise.”