Your Guide to Better Oral Health

Braces for Adults: An Expert Perspective

It is normal for adults to get braces, in some cases mandatory even, to improve the success rate of other dental treatments. But is there a catch?

We are very well exposed to braces, in fact, one of the first few images that one would conjure up when we talk about braces is the grin of a teenager fitted with shiny brackets and metallic wire. Though awkward looking at first, braces have always been an essential treatment transforming crooked teeth into a beautiful smile. And as technology and innovation are continuously put into the field of orthodontics, these days braces treatment is no longer just for adolescents. 

Adults getting braces had been on an upward rising trend. From 1970 to 1990, an 800% increase in adult patients was observed. The general public is becoming more aware of dental health and the benefit of getting braces. Some underwent the treatment in order to rectify the dental condition that they neglected in younger days, while others who initially put off braces treatment due to financial reasons return to get their teeth treated as they are now able to afford it as an adult. 

Before getting into the meat of the topic discussed, we need to lay out some basic understanding first, like understanding alphabets before words. 

Firstly, we need to understand how a tooth is kept inside the jaw bone (alveolar bone). Unlike a bolt and a screw, a tooth is held within a tooth socket in the jawbone by the means of a connective tissue, namely the periodontal ligament (PDL). This spring-like fiber attached itself onto the root surface of the tooth on one end and then the bony foundation (alveolar bone) on the other end. This also enables the ligament to act as a shock absorber, distributing chewing forces onto the surrounding bone.

Secondly, there are considerations to be made in adults getting braces compared to a younger patient. We will further elaborate as we go.

Is it normal for adults to get braces?

There are different reasons for an adult to get braces. Ultimately, the end goal is the perfect Hollywood smile but sometimes braces are only one small part of a greater arching treatment plan. In this case, braces will be known as an adjunctive treatment, meant to improve the success rate of other treatments such as: 

  1. Prosthodontic: For instance, braces can help upright teeth and create spaces in your mouth for implant placement, denture and dental bridges.
  2. Temporomandibular Joint Disorder (TMD): In some cases, braces can be used to improve or correct bites, as well as coordination with the chewing muscle and the temporomandibular joint (TMJ: the hinge joints at both sides of the head in front of the ears, allowing opening and closing of the mouth). However, a thorough TMJ diagnosis is required first as braces may also exacerbate the condition too if ill-performed. 
  3. Gum health: By realigning the teeth, we can reduce food lodgment around tilted or slanted teeth and calculus build up in certain areas while also making it easier to clean and brush teeth. Ultimately, it will also improve gum health. 

A complex treatment plan involving more than just braces are commonly seen in patients with a mutilated occlusion (disfigured/bad bites). We advise you to consult your orthodontist or general practitioner first to draft up the most suitable treatment plan for you.

Do braces take longer for adults? 

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The working mechanism behind orthodontics is essentially external mechanical force application on the crown of the tooth resulting in the shift in the tooth position. However, it is not as if the surrounding bone bent out of their way to follow the change in position. 

An analogy if you will:

Imagine a tree branch (the tooth) inserted upright into the dirt (the alveolar bone). To shift the branch to the left side, the dirt on the left side is dug out (bone resorption) to create space so that the branch can move into place. While the branch is moved into the newly developed space on the left, the created void on the right is filled in (bone deposition). The end result here is the tree branch is shifted slightly to the left from its original position while remaining upright.  

The overall process takes time to complete, the reason why orthodontics can take up to years to complete. This process of breaking down bones and reforming them are significantly different in terms of speed between an adolescent and an adult. 

Adult bone is less reactive to mechanical force. There is also reduced blood vessels and regenerating cells in the adult bone, in analogy terms, fewer hands to dig out and fill in the dirt. Thus, the orthodontic treatment will tend to be longer.

Which age is best for braces? Is it worth getting braces at 30? Are there special kinds of braces for adults over 50?

It goes without saying, orthodontic tooth movement is most effectively carried out in younger patients.  

When comparing between an adult and an adolescent, there are a few marked differences that need to be clarified. To ease discussion, we will split them into a few subheadings:

  1. Role of growth: 

Growth potential in adolescents is an important factor when it comes to orthodontics. Orthodontists can harness the natural growth to move teeth and effectively treat malocclusion caused by the issues in skeletal structure (malrelation of the upper and lower jaw) without resorting to surgery.

  1. Reduced blood vessels and regenerating cells in adult bone: 

As previously mentioned, adult bones tend to respond slower than an adolescent. This will somewhat affect the treatment period.

  1. Density of bone: 

Adults exhibit greater bone density, greater effort is needed to reshape the surrounding bones, thus orthodontic tooth movement will be slightly delayed. 

  1. Pre-existing oral health conditions: 

We also have to look into the gum as well as the TMJ status. Between an adolescent and adult patient, gum problems such as periodontitis and TMJ problems tend to show up more in an adult than adolescent. For the adult to get braces, we advise that the periodontal and TMJ issue are stabilised first before proceeding to braces treatment.

  1. General health: 

Studies have shown a two-way relationship between diabetes and periodontitis. An uncontrolled diabetic status usually comes with unstable mobility of teeth. Braces are also ill-advised in patients with osteoporosis, where bones are more porous and slower to reform.

As long as the conditions are met, age, whether 30 or 50, is not an absolute contraindication to braces treatment. But, it is imperative to bear in mind that more considerations and compromises are to be expected in older age groups. 

How much do braces cost for adults? 

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We arrived at the second most important question of the topic, the cost of braces.

This is solely dependent on the complexity of the malocclusion and the treatment plan given to right the issues. The more complex the problem, the more expensive the treatment is.

There are also esthetic considerations that can be made, more esthetic appliances will cost more. Our advice is to consult your orthodontist first, and tailor a treatment plan suitable for your teeth and your wallet.

Conclusion

Be it an adult or a teenager, we should be well aware that braces require high discipline and strong motivation in taking care of our oral health. Conventional braces provide surfaces for food to get stuck on and if not taken care of, we run the risk of tooth decay and gum disease.  

A quick search online regarding braces will yield an almost endless amount of products and appliances for braces treatment. But before deciding on any one of them, we reiterate again that it’s best to consult your dentist/orthodontist first. Also be very aware of fake braces that are usually marketed at far cheaper price but done by unqualified personnel. 

It is normal for adults to get braces, in some cases mandatory even, to improve the success rate of other dental treatments. But it is important to understand that there are slightly different considerations when compared to a teenager. 

Invisible braces or clear aligners are a popular choice of treatment among adults compared to metal braces for various reasons: They are non-obtrusive, removable, convenient, and easy to take care of. They used to be the most expensive type of teeth straightening method, but now teledentistry has allowed become to make it more accessible and 75% more affordable than before. They can even be cheaper than metal braces.

To summarize:

  1. Adult braces are a common sight. 
  2. The treatment period for adult is longer than that of adolescent
  3. Age is not an absolute contraindication for braces treatment. However, it is advised to get braces at a younger age.
  4. Consult your dentist/orthodontist regarding your interest in braces. 

We hope that this article will help you in your judgement for getting braces treatment.

References:

  1. Bhalajhi, S.I. Age factor in Orthodontics. In: Bhalajhi, S.I (ed.) Orthodontics The Art and Science . New Delhi: Arya Medi Publishing House PVT LTD; 2013. p. 277-280.
  2. Dinesh kumar bagga. Adult Orthodontics Versus Adolescent Orthodontics: An Overview. J Oral Health Comm Dent. May 2010;4(2): 42-47.
  3. Mohammed almuzian. Adult Orthodontics Part 1: Special Considerations in Treatment. Orthodontic Update. October 2014;7(3):
  4. Preshaw, P.M, Alba, A.L, Herrera, D, Jespen, S, Konstantinidis, A. Periodontitis and diabetes: a two-way relationship. Diabetologia. [Online] 2012;55(1): 21-31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228943/ [Accessed 9 July 2021]

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