Can orthodontic treatment do for me what it does for
children?
Yes. Healthy teeth can be moved at any age. Many
orthodontic problems can be corrected as easily for
adults as for children. Orthodontic forces move the
teeth in the same way for both adults and children, but
adult treatment may take longer due to the maturity of
the bone. Complicating factors, such as lack of jaw
growth, may create different treatment planning needs
for the adult. This is why a consultation with an
orthodontist, the dental specialist who aligns teeth and
jaws of patients of all ages, is essential.
How does adult treatment
differ from that of children and adolescents?
Adults are not growing and may have experienced some
breakdown or loss of their teeth and the bone that
supports the teeth. Orthodontic treatment may then be
only a part of the patient's overall treatment plan.
Close coordination may be required among the
orthodontist, oral surgeon, periodontist, endodontist
and family dentist to assure that the treatment plan is
managed well. Below are the most common characteristics
that can cause adult treatment to differ from that of
children.
No jaw growth:
Jaw discrepancy problems, including both width and
length, in the adult patient may require jaw
surgery. For example, if an adult’s lower jaw
is too short to match properly with the upper jaw, a
severe bite problem results. The amount that the
teeth can be moved in some cases, with braces alone,
may not correct this problem. Establishing a proper
bite relationship could require jaw surgery, which
would lengthen the lower jaw and bring the lower
teeth forward into the proper bite.
Gum or bone loss
(periodontal breakdown): Adults are more
likely to have experienced damage or loss of the gum
and bone supporting their teeth (periodontal
disease). Periodontal disease is a chronic
bacterial infection that affects the gums and bone
supporting the teeth. The word periodontal
literally means “around the tooth.” Many
people are unaware that they have gum disease
because there is usually little or no pain.
Periodontal disease can affect one tooth or many
teeth. It begins when the bacteria in plaque (the
sticky, colorless film that constantly forms on your
teeth) causes inflammation in the gums.
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Gingivitis
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The mildest form of the disease is called
gingivitis (see photo at right). The gums
redden, swell and bleed easily. Gingivitis is often
linked to inadequate oral hygiene. Gingivitis is
often reversible with professional treatment and
good oral home care.
Untreated gingivitis can advance to periodontitis
(see photo below), a more severe form of gum
disease. With time, plaque can spread and grow below
the gum line. Toxins produced by the bacteria in
plaque irritate the gums. The toxins stimulate a
chronic inflammatory response in which the body, in
essence, turns on itself, and the tissues and bone
that support the teeth are broken down and
destroyed. Gums separate from the teeth, forming
pockets (spaces between the teeth and gums) that
become infected. As the disease progresses, the
pockets deepen and more gum tissue and bone are
destroyed. Eventually, teeth can become loose and
may have to be removed.
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Advanced
periodontitis. Note the loss of gum
tissue, which makes teeth appear longer
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The good news is that teeth that are properly
aligned are less prone to gum disease.
Special treatment by the patient’s dentist or a
periodontist may be necessary before, during and/or
after orthodontic treatment. Bone loss can also
limit the amount and direction of tooth movement
that is advisable. Adults who have a history of or
concerns about periodontal disease might also see a
periodontist (a dental specialist who treats
diseases of the gums and bone) on a regular basis
throughout orthodontic treatment.
Worn, damaged or
missing teeth: Worn, damaged or missing teeth
can make orthodontic treatment more difficult. Teeth
may gradually wear and move into positions where
they can be restored only after precise orthodontic
movement. Damaged or broken teeth may not look good
or function well even after orthodontic treatment
unless they are carefully restored by the patient's
dentist. Extra space resulting from missing teeth
that are not replaced may cause progressive tipping
and drifting of other teeth, which worsens the bite,
increases the potential for periodontal problems and
makes any treatment more difficult.
I have painful jaw muscles
and jaw joints - can an orthodontist help?
One of the problems commonly associated with jaw muscle
and jaw joint discomfort is bruxing, that is, habitual
grinding or clenching of the teeth, particularly at
night. Bruxism is a muscle habit pattern that can
cause severe wearing of the teeth, and overloading and
trauma to the jaw joint structures. Chronically or
acutely sore and painful jaw muscles may accompany the
bruxing habit. An orthodontist can help diagnose this
problem. Your family dentist or orthodontist may place a
bite splint or nightguard appliance that can protect the
teeth and help jaw muscles relax, substantially reducing
the original pain symptoms. Sometimes structural damage
can require joint surgery and/or restoration of damaged
teeth. Referral to a TMJ specialist may be suggested for
some of these problems.
My family dentist said I
need to have some missing teeth replaced, but I need
orthodontic treatment first - why?
Your dentist is probably recommending orthodontics so
that he or she might treat you in the best manner
possible to bring you to optimal dental health. Many
complicated tooth restorations, such as crowns, bridges
and implants, can be best accomplished when the
remaining teeth are properly aligned and the bite is
correct.
When permanent teeth are lost, it is common for the
remaining teeth to drift, tip or shift. This movement
can create a poor bite and uneven spacing that cannot be
restored properly unless the missing teeth are replaced.
Tipped teeth usually need to be straightened so they can
withstand normal biting pressures in the future.
My teeth have been crooked
for many years - why should I have orthodontic treatment
now?
It’s never too late! Orthodontic treatment, when
indicated, is a positive step—especially for adults who
have endured a long-standing problem. Orthodontic
treatment can restore good function. And teeth
that work better usually look better, too. A healthy,
beautiful smile can improve self-esteem, no matter the
age.
Is orthodontic treatment
affordable?
Patients are finding that braces are more affordable
today than ever. The cost of orthodontic treatment
will depend on many factors, including the severity of
the problem, its complexity and the length of treatment.
Your orthodontist will be glad to discuss the cost with
you before treatment begins. Most orthodontists
have a variety of convenient payment plans. Often
there are combined plans available for parents and
children who have treatment at the same time. In
addition, many dental insurance plans now include
orthodontic benefits. Dollar for dollar, when you
consider the lifetime benefits of orthodontics it is
truly a great value.
I am pregnant and want to
begin orthodontic treatment. Is this OK?
Pregnancy brings on bodily changes that can affect the
mouth. Soft tissues such as gums become much more
susceptible to infection. The possible need for x-rays
during the pregnancy is not advised. Discuss
this question with your medical practitioner/physician
and orthodontist before you start orthodontic treatment.
My orthodontist wants to
do something called enamel stripping to make my teeth
smaller. I have never heard of this. Is this
something new? Is it safe?
This procedure goes by many names: enamel
stripping; interproximal reduction; slenderizing;
reproximation and selective reduction. The goal is
to remove some of the outer tooth surface (enamel) to
acquire more space for your teeth. The procedure
has been used in orthodontic treatment since the 1940s
and has been shown to be safe and effective. Some
studies among patients who have had this procedure show
that it neither makes teeth more susceptible to tooth
decay nor does it predispose patients to gum disease.
For detailed information, please read the AAO brochure
“Interproximal Reduction: Reducing Tooth Widths for
Form, Function and Stability.”
I see ads for perfect
teeth in only one or two visits to the dentist.
Will that give me straight teeth?
Crooked teeth should be evaluated by an orthodontist so
that the most appropriate treatment plan can be
suggested.
