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. 

Gingivitis

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.

Advanced periodontitis.
Note the loss of gum tissue, which makes teeth appear longer

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.

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