Straight Talk

Not just for kids, more and more adults are opting for braces.

Say braces and the image of a teenage metal mouth immediately comes to mind. But it’s time to adjust that picture. According to the American Association of Orthodontists, one in four patients seeking orthodontic treatment, aka braces, is over the age of 18. The AAO estimates that more than 1 million adults in this country have braces at any given time.

There are many reasons for an adult to seek orthodontic treatment, including aesthetics and functionality. Malocclusion, poor tooth alignment commonly known as bad bite, can cause swallowing and chewing problems. In the latter, excessive stress on the chewing muscles can lead to facial pain. Crooked, crowded or overlapping teeth can be more difficult to properly clean, increasing the risk of tooth decay and gum disease. And, of course, everyone wants a self-esteem enhancing beautiful smile.

“In my practice, with offices in Ocala and The Villages, adults make up 40 percent of my patients who get braces,” says Dr. Luisa Betancur of Betancur Orthodontics. “We have adults from 21 to even [in their] 70s and 80s choosing braces.”

When considering braces, adults have different issues to cope with than children do.

“Adult patients are more prone to having pre-existing dental conditions than teenagers, which can affect their orthodontic treatment,” says Betancur. “Some degree of bone loss can be very prevalent in adults, and this can lead to compromised orthodontic results.”

In addition to bone loss, mild gingivitis infections and biomechanical limitations can all affect how adult teeth respond to braces. If an adult has had one or more teeth extracted, sections of prosthetic bone may have to be added; extraction sites are generally not suitable for teeth to move into during orthodontic treatment.

The risk of tooth root absorption is higher in adults than children. It is possible for the orthodontic treatment to cause friction, weakening a tooth’s root to the point that it is reabsorbed by the body, and the tooth simply falls out. Adults are also susceptible to temporomandibular disorder (TMD), which can cause jaw pain, difficulty chewing and clicking/locking of the jaw joint.

In the latter, Betancur notes that “TMD often needs to be treated with an occlusal splint, which is similar to a mouth guard, prior to starting orthodontic treatment.”

When taking into consideration specific adult issues, Betacur adds, “In many adults, a multidisciplinary treatment approach is necessary to achieve the best dental results. Our treatment would be completed in conjunction with a patient’s general dentist along with possibly a periodontist, prosthodontist or oral surgeon. The final treatment might also include restorative measures, such as new crowns or implants to have a better final result.”

According to Betancur, adults also have different expectations than children when it comes to orthodontic treatment. They are typically more informed and want to be apprised of all aspects of the treatment.  They expect little inconvenience, the lowest level of discomfort and the best results in the shortest amount of time possible.

“Of course, every patient is different,” says Betancur. “But on average, the time frame for an adult wearing braces is 12 to 18 months. Depending on the pre-existing dental issues and the type of braces used, the average cost is $5,000.”

How It Works

Braces are the most commonly used orthodontic appliance, placing pressure on teeth by brackets cemented or bonded to the tooth surfaces to change their position. Archwires, attached to the molars on either end of the dental arch, are threaded through the brackets to direct the force being applied. The arrangement of the wires can even be customized to apply different pressure to individual teeth. Springs or elastic bands can also be attached to the archwire to further boost the directional force. Under pressure from one side, a tooth’s root presses against the underlying alveolar bone. This continued pressure causes a portion of the bone next to the root to dissolve, and the tooth moves in the direction it is being pushed. New bone builds up in the vacated space, preventing the tooth from moving back to its original position.

The good news is that braces today are less obtrusive and more comfortable than past models. They are more effective, smaller and use fewer brackets with wires that are less noticeable. Getting braces typically takes one to two hours. Discomfort and soreness are common for a few days following the procedure. Generally, over-the-counter pain relievers will alleviate that issue.

Othodontic Treatment Options

“Today, there are so many more braces options available, and this has drawn a lot of adults,” says Betancur. “In my practice, the two most popular braces choices are the traditional, both metal and ceramics, and Invisalign, the clear plastic aligners. It’s a 50-50 ratio between those two choices.”

Traditional metal braces: Effective and economical, stainless steel brackets remain the most commonly used. Just a single bracket cemented on the front of the tooth and metal-alloy wires are threaded through slots to the brackets. Some patients may also have metal bands encircling the teeth. The wires, held in place by tiny rubber bands called ligatures or o-rings, exert a constant, gentle pressure to move teeth.

Traditional ceramic braces: Tooth-colored ceramic or porcelain brackets are affixed to teeth and metal-alloy wires are threaded through slot in the brackets. The same principal of pressure to move teeth applies. Ceramic brackets are less noticeable than stainless steel, but they may not be as comfortable on smaller lower teeth. Ceramic brackets can break, wear away tooth enamel and tend to cost more than metal brackets. Ceramic devices can cause more friction between the wire and the brackets than metal brackets. This can lead to the teeth not shifting as quickly as with metal brackets, extending the treatment time. Ceramic brackets also cost more than stainless steel. Some people opt for ceramic brackets on their top teeth and metal brackets on their lower teeth.

Lingual braces: Similar to conventional braces, except that the brackets in lingual braces are cemented to the back side of the tooth. Virtually invisible, they work just as quickly as conventional braces. But they can irritate the tongue and cause speech problems. And because they are custom-made, they typically cost more than conventional braces.

Self-ligating metal & ceramic braces: The wire in self-ligating braces passes through small built-in metal clips on the bracket. This eliminates the need for elastic bands to help move the teeth.

Aligners: These clear trays remain in your mouth for 20 to 22 hours a day, being removed only for meals and cleaning your teeth. They are switched out every two weeks as the teeth shift. Although less conspicuous than conventional braces, they are not completely invisible. The most common brand of aligners is Invisalign.

Elastics: Tiny rubber bands are attached to small hooks on selected upper and lower brackets; configuration can be vertical or diagonal. The rubber bands apply force to a tooth or teeth to move them into the ideal position in ways that braces alone cannot. The patient is responsible for placing and removing the elastics.

Speeding Up The Process & Ensuring Success

“Thanks again to technology, we can even speed up the straightening process,” says Betancur. “We use both AcceleDent, which is a vibrational device that patients buy and use at home every day, and Propel, an in-office procedure that is usually done once. Both cause an inflammatory response that accelerates the healing process that makes the teeth shift.”

Once the braces have been removed, it’s time for a retainer.

“It is absolutely essential to wear a retainer after braces are removed. Over time, teeth can still shift. There are permanent retainers, as well as removalable ones,” says Betancur. “I recommend using them to protect your investment in your teeth.”

Made of a plastic-like material, retainers are clear, thin and slightly flexible to fit the exact shape and placement of teeth after orthodontic treatment. After braces are removed, retainers are generally worn full time for six months and then on a nightly basis to ensure the success of the treatment.

“Any adult considering braces should consult with an orthodontist to be aware of all their options,” says Betancur. “You want to make an informed and best choice for you.”

Tips For Living With Braces

Wearing braces will definitely affect your life. Here are a few tips to get you started:

Don’t consume acidic or sugary drinks more than once a day, including coffee, soda, sweetened tea and sports drinks. These drinks can erode and stain your tooth enamel.

If you have ceramic braces, avoid tomatoes, tomato paste, mustard, coffee, wine and colas that will stain them.

Don’t smoke, as it will also stain your teeth and ceramic braces.

Avoid whitening products. Your teeth will be whitened when the braces are removed.

Clean your braces after every meal and snack. Food particles become easily trapped in the braces, leading to a greater risk of developing dental problems. Wait at least one hour after eating to brush your teeth. Floss every night; using a floss threader will make it easier and more efficient.

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