A Badge of Childhood, Now Worn by More Adults By JULIE BICK Published: January 14, 2007 Danielle Psachos, an orthodontic dental assistant for Dr. Diane M. Doppel in Seattle, wears clear ceramic braces and holds two of the more-visible types. WHEN Brenna Moore’s two teenage children got braces, she also took the plunge and bought her own set, to correct an underbite that had become worse over the years. Ms. Moore, 43, of Basking Ridge, N.J., had already had braces as a teenager, but “apparently your teeth can continue to move your whole life,” she said, “so if you haven’t been wearing a retainer for the last 20 years, your teeth might not be where they’re supposed to be.” The most recent survey by the American Association of Orthodontists showed a 37 percent increase in the number of adult patients from 1994 to 2004, and the growth appears to be continuing. More than one million adults in the United States are currently in braces, according to the association, and adults now account for one of every five orthodontic patients. Most often, adults end up in the orthodontist’s chair because they want to straighten crooked teeth — to achieve a picture-perfect smile. In a time when even Tom Cruise gets braces, “Dental aesthetics are now part of the overall beauty package,” said Dr. Don Joondeph, president of the American Association of Orthodontists, adding, “The same person who goes to the gym, is also motivated to get their teeth straightened.” Dr. Joondeph estimates that 75 percent to 80 percent of adult patients are getting braces for the first time. There are plenty of medical reasons for adult orthodontics. Crowded, excessively spaced or misaligned teeth can wear unevenly over time and, for some people may be more likely to weaken and fall out. Other problems associated with misaligned teeth include headaches, jaw pain and difficulty in cleaning and maintaining the teeth, possibly resulting in more decay and gum disease. “Today, people want to keep their teeth until they are 100 years old, so they invest to head off potential problems,” said Dr. Diane M. Doppel, who taught postdoctoral orthodontic students at the University of Washington and now practices in Seattle. Sixty percent of Dr. Doppel’s patients are over 21. The patient usually bears most of the treatment cost, with fees typically running from $2,000 to $7,000, depending on the region and the complexity of the case, according to Dr. Doppel. The orthodontists association found that 59 percent of patients have dental insurance that includes orthodontic benefits. That insurance generally offers a maximum payout that translates to about 25 percent of the charges, said Dr. Doppel, who noted that most courses of treatment take one to three years. Like members of any group who share an experience, adults in braces often seek one another out. Iain Silverthorne, 39, a banker in San Francisco who got braces last year, says strangers have approached him to compare notes about their own orthodontic work or to ask for advice about starting the process. Web sites like ArchWired.com, offer orthodontic information, photographs, news and a place to share stories. Not everyone is sympathetic to adults in braces. Mr. Silverthorne’s friends teased him that he was returning to childhood. “The braces made me more self-conscious than I expected,” Mr. Silverthorne said. They also hurt, he said. Pain from wires tightening to move teeth, and gums rubbed raw by metal brackets are still common, but adults coming back for Round 2 of braces may be pleasantly surprised that a metal band is no longer fitted around each tooth. For the most part, a small bracket is glued to the front of each tooth, and a wire threaded between them. The wire exerts lighter continuous pressure over a longer period to move the teeth, as opposed to the stiffer and more painful wires of previous generations. The classic silver-colored braces are the still the most common and least expensive option. For those who want to stand out, the brackets can be outfitted with a variety of tiny colored rubber bands — red, white and blue for patriots, for example, or pink and green neon for clubgoers. Many teenagers are fine with metal brackets and enjoy the colored bands, but most adults want less visible braces. That may be especially true for second-timers: adults who had a mouthful of metal in their teenage years usually don’t want to revisit that look, Dr. Joondeph said. ArchWired.com offers encouragement to adults who worry that their braces will ruin their love lives. In general, the less noticeable the braces, the more expensive. Clear or tooth-colored brackets can replace metal ones. And brackets can be put on the backs of the teeth instead of the front, but this is technically more difficult and can cause more mouth and tongue irritation. There is also the Invisalign system, a series of clear thin plastic mouth trays that slowly move the teeth. One advantage of Invisalign is that it can be removed for meals or left at home when the wearer goes to a special event. It is not available, however, for patients who need the greatest degree of tooth movement. Tooth-colored brackets, hardware glued to the back of the teeth or Invisalign usually increase the overall treatment cost by 5 percent to 25 percent. Braces can be tougher physically on grown-ups than on children, Dr. Joondeph said. Adult jaws are no longer growing, so jaw surgery may be required to correct a severe overbite or underbite, while a child may need to wear a headgear attached to the braces and held to the head by a strap, to modify the growth rates between the jaws. Similarly, children may use a palate expander, which exerts pressure across the roof of the mouth to widen it and provide more room for teeth to fit in. This is often impossible for adults, because they are no longer growing and their palates are less malleable. Oral surgeons, periodontists or endodontists may need to weigh in on adult cases if bone loss, gum disease or other problems have started to take a toll. AS more adults become their patients, many orthodontists are changing the design of their offices, Dr. Joondeph said. Some are adding more soothing colors and music, or providing greater privacy to discuss treatment options and progress. “Some offices in downtown urban areas cater almost exclusively to business people, and are taking the spa route,” he said. Offices may offer a more restful, less clinical atmosphere and include more cosmetic treatments like teeth-whitening. “Some offices in the suburbs have a teen area and a grown-up area.” Many just try to strike a happy medium between the two age groups. Ms. Moore, who is going through the treatment with her children, said it was easier the second time around. “I was thinking of doing this for a couple of years,” she said. “Quite a few friends are doing it.” This time, though, she’ll wear her retainer.

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