Straight Talk About Perfect Teeth
It's never too late to perfect your smile -- just ask the increasing number of adults who are getting braces.
By Cherie Berkley, MS
Reviewed By Brunilda Nazario
Thinking about getting braces? Experts say it's never too late. These days, adults make up nearly half of orthodontic patients hoping to finally get the perfect smile they've always dreamed about.
Braces have evolved considerably in the last 15 years. Breathe easy, the days of being a true "metal mouth" are over and more lightweight and cosmetically friendly options are out there.
"The [brackets] are smaller and we don't use all the bands or appliances that wrap all the way around [the tooth] like we used to. Now, we use bonded brackets that are a lot smaller or the clear braces that are a lot more cosmetic as far as their appearance," Michael Sebastian, DDS, an orthodontist in Atlanta, tells WebMD. Sebastian says this and less pain and time associated with wearing braces have more adults making the plunge. Sebastian says adults can expect to wear braces an average of 12 to 20 months.
Bracing for Braces
But why now? Maybe the reason is as an adult you can afford braces when your parents couldn't or you are simply more conscious of the cosmetic and health benefits of having straight teeth.
Most people want a great smile, and adults know that it can make a great difference not only in their personal but also their professional lives. Many say the payoff is worth the temporary inconvenience and expense of braces.
"Patients that I see now, I think there's an initial concern, but if they really and truly want the braces, they're not that concerned once they make the decision. Once they've made up their mind to get them, they fall right in because they either know someone that had them before or they've seen their kids go through it and they want the same thing for themselves," says Duane Anglin, DDS, a dentist outside of Baltimore who decided to get braces during dental school. He says he has no regrets.
"From a professional standpoint, I think I'm a lot more comfortable walking in the room and saying hello, good morning, and meeting a new patient for the first time, because in the back of my mind it was always, 'How am I going to be a dentist and have teeth that are not straight?'" he says.
Sebastian says age shouldn't be a worry. He says as people live longer, he sees more adults of all ages interested in preserving their teeth. Senior citizens are even becoming more common in his practice.
The Healthy Smile
Dental professionals say there are also health reasons for having a correct bite.
"With teeth that are in cross bite, teeth that are misaligned, there is an increased chance of plaque buildup, food buildup in between your teeth, which is a trickle-down effect because the more food buildup, the more plaque; therefore, the more concern for periodontal disease and gum disease," Anglin tells WebMD. Improper bite also means you can't chew food properly, which can lead to gastrointestinal problems, he says.
So how do you get that Hollywood smile? There are more options than ever. With traditional braces, you can select metal or clear/ceramic braces, but there are pros and cons.
"Traditional metal braces -- if the patient has a significant bite problem or severely crooked teeth -- are slightly more effective at moving teeth than clear braces. If you came to me and said, 'I want my teeth as straight as fast as possible,' and you had really crooked teeth, then I'd say put metal braces on," Sebastian says.
He says clear braces work fine in most cases but there are some downfalls. The adhesive that holds the bracket in place can stain from dark drinks and smoking, and they cost more than metal braces.
Often, adults hoping to avoid "metal mouth" go the clear route.
"I'm not embarrassed about having [braces] at my age because you see a lot of people now, young adults, even older adults wearing braces," says Ivy Horn, a lawyer in Atlanta who is considering clear/ceramic braces after already wearing metal braces as a teen. "In my field I do a lot of speaking when I am in court a lot. I just think it would look better if I had the clear braces rather than the metal braces so people aren't focusing so much on what's in my mouth but the words that are coming out of my mouth."
Statistics from the October Journal of Clinical Orthodontics show that the average cost of an adult set of braces in the U.S. is $4,800.
Invisalign vs. Braces
Another option for the vain at heart is Invisalign. Patients wear a series of clear, removable orthodontic aligners that are adjusted as the teeth shift into place without metal or wires. A series of custom-made aligners are worn each for a period of two weeks. Each aligner moves the teeth progressively into place. Average total treatment time: a few months to 1 1/2 years. While orthodontists say Invisalign can be a good alternative to traditional braces, there are limitations.
"Invisalign does not do a great job on vertical problems, where the teeth are at different heights, teeth are lower or higher than others. It doesn't not do a good job on teeth that are severely rotated, and it does not do a good job at correcting bite issues," says Sebastian, who also says Invisalign would also not be the best option for fixing severely overcrowded teeth.
Sebastian says Invisalign can cost an average of $500 more than a one-year treatment with traditional braces.
A critical component of braces are the end game -- wearing the retainer. "It used to be, your teeth are straight, you wear retainers for a year, it will never change. Well, we know that's just not fact. Now we have to tell patients to plan on retention for years; lifetime retention is the word that they use now," says Sebastian, who has a number of patients who are repeat orthodontic clients.
Veneers: The Quick Fix
If you don't have time to wait for orthodontic treatment and want instant results, porcelain veneers might be for you. Porcelain veneers are wafer-thin shells that are bonded to the front side of teeth to improve their cosmetic appearance.
"A lot of times if a patient comes in and their teeth just are not pretty, I just go straight to veneers because with veneers I can typically fix the position, the shape, the color, and the appearance of the tooth all in one fell swoop. If a patient comes to me and they have beautiful, virgin, healthy teeth and they're just crooked, then I would talk about braces, then I would talk about Invisalign," says aesthetic dentist William Dorfman, DDS, who has received two lifetime achievement awards in cosmetic dentistry and has been featured on the hit TV show Extreme Makeover.
"Porcelain veneers also give you a quick fix. If I have a patient who is an actor or actress, or business person, and he or she really needs to have their teeth perfect and really needs to have it done quickly, obviously porcelain veneers will give you a much faster result because we don't have to wait for the teeth to move," he tells WebMD.
Dorfman says veneers are also sometimes used in conjunction with braces in cases of broken, chipped, or severely stained teeth. But the instant beauty of veneers doesn't come cheap. They can cost between $700 and $2,000 each and typically need replacing every 10 years -- depending on upkeep.
"Now if you just have some minor problems, some minor spacing, and it's because the teeth are small, then veneers work great. But if you have rotated, crowded teeth ... they do a good job but they make the teeth much thicker, so it puts the tooth in an unhealthy situation and you can't correct bites with veneers. I think they have their limitations," Sebastian says.
Whatever your motivation to straighten your teeth, Dorfman -- who has had a complete smile makeover himself -- says it can change your life.
"I would say that if you're not happy with your smile, 90% of the time, changing it is a lot easier than you ever thought and you should find a good cosmetic dentist in your area and go and have a consultation and talk about it. Life is too short not to be able to walk into a room and just have a beautiful, healthy, happy smile that makes you feel good about yourself."
Published Nov. 10, 2003.
SOURCES: Duane Anglin, DDS, general dentist, Baltimore. Michael Sebastian, DDS, orthodontist, Atlanta. William Dorfman, DDS, aesthetic dentist, Los Angeles. Ivy Horn, lawyer, Atlanta. Journal of Clinical Orthodontics, October 2003; vol 37: pp 547.
©1996-2005 WebMD Inc. All rights reserved.
Last Editorial Review: 1/31/2005 7:06:26 AM