Adults: Brace Yourselves by Elvira Maricic As more grown-ups opt for orthodontia, there are special considerations to be aware of print article      send to a friend

Grandmothers have come a long way, and Sandy Osborne is a prime example. At a time when her grandkids should be starting orthodontic treatment, Osborne, a 54-year-old business owner and grandmother of four, recently completed her own. "I had some crooked teeth and my bite was somewhat off. I thought that if I got the braces it would straighten out my bite and make it more comfortable and it did," she says.

While she's a far cry from grannies of old who kept their teeth in a glass on the nightstand, Osborne's experience is really not that unusual, as more and more adults are opting for orthodontic treatment. In fact, the American Association of Orthodontists estimates that nearly 1 million adults in the US and Canada are receiving treatment from an orthodontist. Thomas G. DiMassa, DDS, MS, a Cleveland, Ohio, orthodontist, sees this first-hand in his own practice. "More than half of our patients are adults," he notes.

Adult patients have a variety of reasons for starting treatment, and appearance is often at the top of the list--but it's not the only reason. "Appearance is a major concern," says DiMassa. "However, some patients come in because they're starting to have problems. Their teeth don't fit together very well; they're starting to develop some wear on the teeth; they're starting to strain their jaw joints," he says. Fortunately, orthodontic treatment can restore good function, and many orthodontic problems can be corrected just as easily for adults as for children. But there are some differences.

Advantages of youth

"The number one difference between treating children and adults is that [in adults] we don't have growth to deal with. With kids, very often we can do things to change the way their jaws are growing and we can't do that with adults. Another thing is that adults very often have lost teeth or have wear on their teeth so sometimes the treatment is a little bit of a compromise; it's not ideal," says DiMassa. "We do a lot more orthodontic surgery on adults," he adds.

Osborne was already missing two bottom teeth when she started her orthodontic treatment, and her orthodontist removed even more. As a result, she feels that the shape of her face has changed.

"You have to be very careful not to do that more often in adults than in children," DiMassa says when told about Osborne's case. He, like many orthodontists, does computer imaging with all his patients to determine what they're going to look like with removal of teeth and without removal of teeth, a technique that Osborne could have benefited from. "I think it's important to do the diagnostic planning, especially with adults, so that you don't end up with a face that's flatter than the patient would like," DiMassa notes.

Some things never change

Aside from the points mentioned above, orthodontic procedures are essentially the same for adults as for children and teens, right down to the frequent visits and food in the teeth.

"When you first get the braces on, you really know that they're there," says Osborne. "Every time you go in to tighten them, usually every six to eight weeks, for about a week afterward you get almost an itching feeling. It's not a pain, it's almost like your teeth are itching and the bones are moving around. After a week, it doesn't bother you, " she says.

The braces used for adults are the same ones used for children, says DiMassa. "Typically, we use the outside metal ones. However, for adults, we also have a number of other types of braces. They work on children as well, but they're considerably more expensive and so we usually use them mainly on adults," says DiMassa. "We have inside metal braces that are glued to the inside of the teeth which, obviously, you can't see. The treatment takes a little bit longer, and the technique is much more demanding," he adds. "The other way would be with the ceramic brackets or the clear brackets, and those are on the outside."

With orthodontic treatment, your teeth will definitely work better, but will they look better? "Every case is individual," says DiMassa. "It depends on the wear that you have and it depends on how your jaws have grown." Orthodontists are limited by the latter factor, since adults are not growing anymore.

Grandma's words of wisdom

In retrospect, Osborne says she would have done some things differently. "I think that if I had gone for other opinions to orthodontists who treated adults, I would have been more knowledgeable about the procedure. I had recommendations from two people whose children had used my orthodontist, but none from adult patients. But he was convenient, he was nearby, I knew I would be seeing him frequently, and that's the main reason I selected him," she says.