Orthodontists: Braces Aren't Just For Teens

Looking for the perfect smile or a better bite? Local orthodontists offer straight talk for adults.

Think braces are just for teenagers? Local orthodontists say their practices claim a healthy number of adult patients—37 percent at Jamie Ahl’s offices in Dover, Milford and Lewes.

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It’s a national trend. A survey by the American Association of Orthodontists shows that the number of adult orthodontic patients increased 14 percent from 2010 to 2012. Who would ever have thought braces would become popular? 

Many adults did not have braces when they were teenagers, says orthodontist Stephanie Steckel of Dover. “Either they declined it when they were kids, or they were from big families that couldn’t afford it,” she says. “I was one of eight kids, and I didn’t get treatment until after dental school.”

Ahl says half her patients had braces at some time, but need more correction because they didn’t wear retainers after their braces were removed. That’s not entirely the patient’s fault. Until about 20 years ago, orthodontists recommended that retainers be worn for only two years. Ahl and O’Connor Orthodontics now advises patients to wear retainers full time for six months, at night for two years, then once a week for the rest of their lives. Ahl practices what she preaches—she wears her retainer to bed every Sunday night.

“It’s a lifelong commitment,” she says. “Teeth are in bone, and that bone can change, allowing teeth to relapse into their original position.” 

Steckel attributes the trend to improvements in technology, and new enhancements that make them more effective and less visible. Crooked teeth may make for a funky smile, but what’s at stake is more than cosmetic. More important than a good smile is a good bite. 

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At her practices in Wilmington and Newark, Connie Greeley of Greeley & Nista is treating patients who are baby boomers and some in their 70s. They need to correct their bite so they can, well, bite. “If you don’t have the correct occlusion, you might choose foods that you don’t have to chew,” Greeley says. “That can negatively affect people’s nutritional intake.” 

Yet there is no question that cosmetics are important to patients—including the way that they look in braces. Invisalign helps. Orthodontists endorse the clear aligners more often than they did when they debuted in 1999 due to the iTero Intraoral scanner—a handheld, high-speed video camera that takes digital images of patients’ teeth used to design the aligners—which improved Invisalign’s efficacy. “It looks like a wand,” says Ali Husain of Delaware Orthodontics in Newark and Middletown. “We take pictures of each tooth in under five minutes, and it’s painless.”

The images are sent to Invisalign, which creates 3-D digital models for orthodontists to review and tweak until the teeth are perfectly arrayed. The company then creates a series of aligners. Each aligner is worn for two weeks, for at least 21 hours every day. (They are removed only to eat, drink, brush and floss.) Adherence to that regimen is not difficult for most adults, Greeley says, but it can be for teenagers, which is why she is careful about which of her young patients use Invisalign Teen. “It comes down to wearing them religiously so that they work, and not losing the aligners when you take them out,” Greeley says. “Parents know their kids best, so it’s their decision to make.”

Patients report some drawbacks to Invisalign, including a temporary lisp, chapped lips and halitosis. There can be discomfort inside the mouth, but it is usually relieved with Tylenol or Advil. “The soreness is less than what can occur with regular braces because we are eliminating the pain of having a bracket in your mouth,” Greeley says. “There are some folks who find that they can’t do it because it bothers their tongues, and other people feel claustrophobic with them on their teeth. Because that can happen, I make patients a test set before they make a full investment.”

Ceramic braces are another nearly invisible option. Also advertised as “aesthetic braces,” they are constructed like traditional braces, but they are made of clear materials. Some brands offer translucent wires and ties. Others leave the metal wire showing. There is a drawback: Ceramic is much more fragile than metal. “Ceramic braces have been known to crack, so I don’t suggest them for people who are very physically active,” Husain says. “They are certainly not for adults or teenagers who play contact sports.”

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Photo by Lance Lanagan

Jamie Ahl of Ahl and O’Connor Orthodontics in
Dover, Milford and Lewes says 37 percent of her
patients are adults who wear braces.

Photo by Lance Lanagan

Stephanie Steckel, an orthodontist in Dover, says
more adults are getting braces because of
improvements in technology, and new enhancements
that make them more effective and less visible.

The price of ceramic braces and Invisalign is virtually the same: $2,5000 to $6,500, depending on the degree of correction required. Both tend to be a bit more expensive than metal braces. Insurance usually covers some of the cost, though that varies by plan. “Just be sure to get all of the pricing up front,” Steckel suggests. “Make a really informed decision about what everything will cost, especially if your teeth take longer than expected to straighten.”

What works fastest depends on how compliant patients are with aligners and what needs fixing. At Ahl and O’Connor Orthodontics, half of the adult patients are in traditional braces, ceramic or metal. “Patients who have severe crowding and require multiple extractions benefit more from traditional braces,” Ahl says. “Invisalign is a terrific modality for patients who need minimal front-to-back corrections in their bite.”

In some cases, patients start with traditional braces, then switch to Invisalign to complete the alignment. Steckel sometimes employs both, applying traditional braces to lower teeth and using Invisalign on upper teeth.  

Other orthodontic options include the In-Ovation brand of metal braces. Instead of using steel threads to secure the braces’ wire, In-Ovation utilizes a built-in clip to activate or deactivate the braces’ wire. “The clip is more reliable, user-friendly and comfortable,” Steckel says. 

Husain offers patients Sure Smile wires in conjunction with traditional braces. He uses a scanner similar to the iTero Intraoral to image the mouth, then sends the information to Texas, where the wires are manufactured robotically. “It’s more accurate than creating the wires by hand,” Husain says. “Patients come into the office less often because their wires don’t need as much adjusting.”

Some adults are not candidates for orthodontics of any kind. Candidates need to have healthy gums, and they can’t be using medications that inhibit tooth movement, like those used to treat osteoporosis, Steckel says. Nor does she approve orthodontics for patients who have bonding or  veneers. “If I can’t move your teeth, we can improve them cosmetically with the help of your dentist,” she says. 

There’s a reason to smile.

See the 2016 Top Dentists results here.