Too Long in the Tooth for Braces?

Now adults have teeth-straightening options too.

Looking back on our youth, we fondly recall the fun, the freedom and the friends. But we gratefully close the door on the awkward aspects of the prepubescent and teenage years, with their socially awkward moments and ugly duckling stages. So what are we thinking when, as adults, we sign up for orthodontic treatment? Did we not get enough "metal mouth" comments as a kid? Do we long to fumble with those little elastic bands that become part of many middle school lunches? Maybe we're looking for attention and secretly hope for a return to the dreaded headgear.

OK, probably not. In fact, many adults seek teeth straightening for the long-term cosmetic enhancement that braces will bring, some want to improve functionality in a faulty bite and all might understand the benefits of the easier maintenance that can result from bringing crooked teeth into line.

With age might come wisdom, but when it comes to straightening teeth, extra years can also bring complications. Age does not preclude eligibility for braces, however. "Age isn't really a factor in terms of whether someone's going to be a candidate for orthodontics," says E. Diane Shieh, DMD, MMSc, a board-certified orthodontist at Amherst Orthodontics, but it does make us more likely to have gum or bone problems that can be aggravated by moving the teeth. Chances are we might come with a medical history attached and be on medications that require special consideration when creating an orthodontic plan, Shieh says.

Grown-ups also don't have metabolism on their side anymore, so are likely to face longer treatment times than their younger counterparts. And don't forget that adult orthodontic patients have had "more life on their teeth," she says. In the face of fillings or missing teeth, sometimes straightening-related compromises must be made, resulting in wonderful oral improvements, but falling short of orthodontic perfection, Shieh says. And yet, age does not appear to dampen the desire for straight teeth. "My oldest patient was 77," Shieh says.

Fortunately, in the last 25 to 30 years, research has given orthodontists a better understanding of what happens to our teeth as we age, leading to new approaches and better results. Research confirms, for example, that front bottom teeth tend to shift as years pass, due to factors such as pressure from jaw muscles, tongue, cheeks and lips, years of chewing, and possibly grinding and clenching. Even former orthodontic patients find with dismay that their once perfectly aligned teeth are gradually replaced with ones that have partially returned to their crooked and haphazard beginnings. To enable patients to avoid such a fate, today's orthodontists stress the post-treatment, life-long use of retainers, which are simple appliances that persuade teeth to stay put after braces have come off.

Those of us who have over the years experienced the creeping, crowding and overlapping find that teeth maintenance becomes more of a struggle at home and even at dental visits, where dental hygienists can find it difficult to negotiate scraping tools through partially obscured cracks and crevices, Shieh says. But since research has shown that there is a link between cardiovascular disease and an unhealthy mouth, we now know that it's in everyone's best interest to keep teeth and gums in the pink. "There is a systemic benefit to straighter teeth" not only to your overall health and well-being, but also in terms of improved self-esteem and function, Shieh says.

In addition, straightening teeth prior to undergoing an expensive dental plan, such as one that involves crowns or bridges, for example, can simplify the work that the dentist needs to do, resulting in a more conservative and less costly treatment plan. Dental treatment outcomes often will look better and last longer, Shieh says, if orthodontics have established a good foundation for the dental work.

The options

Many adult patients prefer to take a discreet approach to their teeth strengthening, and luckily, they have options. One of the most popular straightening solutions among adults is Invisalign, Shieh says, which features clear, custom-made "aligners" that slowly guide teeth into proper position. The patient switches aligners every couple of weeks as teeth gradually move closer to their ideal spots. Second-timers who wore braces in their youth are prime candidates for Invisalign, Shieh says. "They've had the bulk of their bite corrected, and really at this point need braces for minor shifting."

Ceramic braces, which have nearly translucent brackets, are another popular choice among adult patients who want to avoid the metal mouth moniker. They allow "the natural tooth color to come through," says Timothy Finelli, DDS, an orthodontist at Seacoast Orthodontics in North Hampton. The wire that is threaded from tooth to tooth is not clear, but the overall look of the braces is subtle.

Lingual braces, a third choice appreciated by adults, are glued onto the back of teeth. Their placement makes them less visible but they tend to be significantly more expensive, often costing double the amount of other straightening methods, Finelli says. Besides being pricey, they take some getting used to, given that they are located immediately next to the patient's tongue. Patients tend to become less sensitive to the feeling of lingual braces over time, Finelli says.

Of course, plenty of adult patients just want the optimal result and don't care what their teeth look like in the meantime. "They say, 'If [traditional] braces are the best way to do it, do it that way,'" Shieh says. And, depending on the patient's specific circumstances, treatment options might be limited. Invisalign, for instance, is often well-suited to purely cosmetic goals, but might not be effective in more complex cases.

But, as legions of moms have told their kids, you won't have to wear braces forever, so adults who yearn for straighter teeth might just want to bite the bullet and go for the heavy metal, if necessary. "The biggest thing for adults is the look" of braces, Finelli says. Many adults fear that they will appear unattractive during treatment or that they will become some sort of social outcast, but in reality, Finelli says, the old-fashioned stainless steel route is not as bad as adults think it is. Braces can be a conversation starter. Some patients even find that other grown-ups commend them for their bravery. For sure, wearing braces as an adult "has become more socially acceptable," he says. NH