In the United States, braces are a rite of passage for many of us during our pre-teen and teenage years. But orthodontics isn’t just for children. Adults can also benefit from orthodontic treatment and new technologies, new focuses on “whole mouth health,” and society’s increased willingness to embrace cosmetic procedures mean that you’ll be seeing braces in more grown-up mouths.

Nationally, about 35 percent of orthodontic patients are adults, according to Dr Jennifer Ashmore, of Mayfield and Ashmore DDS LLC, an orthodontic practice with offices in Bremerton and Port Orchard. For her practice, that percentage is closer to 15 to 20 percent. She agrees with the notion that more adults are getting braces these days.

“As smile awareness becomes more prevalent, people are putting a higher priority on braces,” said Dr Ashmore. “That’s usually what brings people in the door.”

Dr Ashmore notes that many of her adult patients are the parents of younger patients. Seeing the advances in braces and the benefits their child is gaining is often an incentive for adults to treat their own teeth.

But it’s more than just the aesthetic aspects of having the perfect smile that encourages adults to see an orthodontist.

“There is often an element of ‘I hate my teeth, I want to look nice,’” said orthodontist Dr Mark Heinemann of adult patients who come to his practice, “but usually something is wrong with the teeth that needs to be addressed.”

Dr Heinemann, who has offices in Silverdale and on Bainbridge Island, estimates that around 25 percent of the patients he treats are adults. The majority of these patients come to him at the urging of their dentist to address a problem that should be treated orthodontically, or as part of a combination of treatments to address functional issues.

When it comes to adults, according to both Dr Ashmore and Dr Heinemann, orthodontists are frequently part of inter-disciplinary teams, working with dentists, maxillofacial surgeons, orthognathic surgeons, and periodontists to address adult patients’ “whole mouth health” and resolving problems, such as tooth loss, tooth restoration, periodontal disease, underbites and overbites, and so on.

“The dental community is putting more value on treating whole patient issues,” said Dr Heinemann.

For example, in preparation for a crown or bridge implant, adult patients may require braces to straighten and adjust the surrounding teeth so that the implant will fit properly in the mouth. More dramatically, orthodontics may be used prior to and after orthognathic surgery – realigning the jaw to address severe bite problems – to move the teeth into the position they will need to be once the jaw has been re-positioned.

There are a number of new technologies that make wearing braces a much less painful and awkward experience than it was in the past, helping self-conscious adults get over their fears of being a “brace face.” One of the main advances in braces has been in the materials used to for the archwires, the wires that are threaded through the brackets and actually do the work of moving the teeth.

These wires, formerly only available in stainless steel, are now available in several alloys, such as nickel titanium, which are more flexible, and provide a smaller, but more sustainable force on the teeth. This means that wire adjustments can be made less frequently, and adjustment discomfort is less.

The metal brackets that are bonded to the teeth have also come a long way, with new designs blending comfort and function in a bracket that has a lower profile and is more rounded, reducing abrasion on the inside of the mouth. There is even a self-ligating bracket, with a snap bracket to hold the archwire. This eliminates the need to tie the archwires to the bracket with yet more wire, reducing the changes of a stray piece of tie wire coming loose and causing discomfort.

Self-ligating brackets have also been shown in studies to reduce the amount of time braces need to be worn, said Dr Heinemann, as they can reduce friction on the archwire, increasing the wire’s range of movement and allowing the wire to work more efficiently. He does not find them as versatile as the standard brackets, however, and so he does not rely on them too heavily.

Clear, ceramic brackets are also available. These brackets provide reduced visibility so that braces aren’t as noticeable. But there are drawbacks. Ceramic brackets are significantly more expensive than metal brackets, and they are usually larger. Ceramic brackets are also more brittle than metal brackets and break more frequently. They can also wear down tooth enamel if teeth rub up against them.

Invisalign® uses digital images of patients’ teeth molds to create an accurate three-dimensional model of the teeth. A computer program then simulates the movement of the teeth in half-millimeter increments, and plastic “aligners” are created based on this simulation for the patient. Each aligner is worn for two weeks at a time to move the teeth based on the computer modeling and on input from the orthodontist. Patients go in for check-ups every six weeks so that the orthodontist can review the tooth movement and make adjustments as necessary.

The idea of Invisalign appeals to many adults, since it uses clear, removable aligners that can be taken out while you eat, drink, or brush your teeth, but Invisalign is not the answer for everyone.

“If teeth are turned, it won’t work,” said Dr Heinemann. “If teeth need to be pulled forward it won’t work.”

But he notes that his Invisalign patients are happy patients. Invisalign, in cases where it is appropriate, can more comfortable than traditional braces, are nearly invisible, and because they are worn on the tooth, don’t cut into cheeks or gums.

In Dr Ashmore’s opinion, Invisalign is ideally suited for patients who have had previous orthodontic work and need a “touch up.”

“I don’t recommend [Invisalign] to my patients that have serious corrections,” said Dr Ashmore. “It’s coming along, but it still has a way to go.”.