December 3, 2022

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Today older adults are getting their teeth fixed in record numbers. According to Humana, more than 4 million Americans wear braces, and 25 percent of them are adults. The numbers for those age 50 and over are difficult to determine, but experts agree that they are growing.

Leila Jahangiri, clinical professor and chair of the department of prosthodontics at the New York University School of Dentistry, says that many older adults who are having their teeth aligned either didn’t have them fixed as children or have teeth that have moved and shifted over time. Many may now have grown children and fewer expenses, so they’re better able to afford the cost.
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Fewer people are wearing dentures — baby boomers are the first generation to keep their natural teeth over a lifetime — and advances in the technology for tooth alignment are less intrusive and more aesthetically pleasing. “With increased demand,” Jahangiri says, “more dentists are being trained to treat older adults.”
“As our lifespans lengthen and we try to remain healthy and active well into older age, our social lives and activities continue, we have more relationships, and we’re more focused on how we look and feel. That includes what our teeth and mouths look like,” says Joana Forsea, clinical director of orthodontics at the New York University School of Medicine.
By the time you’re in your 50s, says Dale Anne Featheringham, an orthodontist in Columbus, Ohio, your teeth may have shifted. This can happen after you’ve lost teeth and your remaining teeth drift into those empty spaces. Or it can be the result of bone loss around the teeth, the way you position your tongue, or ongoing pressure from your tongue and cheek muscles. “Because the bones of the jaw and around your teeth and gums change as you age, problems can arise that prompt older people to seek orthodontic treatment,” she says.
Poor alignment of the teeth can cause other problems. If they’re crowded, they can be difficult to clean. That can cause inflammation, which in turn can lead to bone loss. “Every day we’re learning more about the connection between the health of the mouth and overall health, and we’re discovering that inflammation is linked to more serious problems like heart and lung diseases,” Featheringham says.
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In addition, a bad bite can cause wearing of the tooth enamel, which can lead to more expensive dental work and problems including tooth decay, gum disease and difficulty chewing. Jawbones, soft tissue and teeth tend to move as you age. For some older people, it’s about looking better, and getting orthodontal care help with that.
The American Association of Orthodontists (AAO) suggests that if your teeth are crowded, protruding, spaced too far apart, meet abnormally or don’t meet at all, correction may be recommended. Braces and aligners are the “appliances” orthodontists most commonly use today for moving teeth into their proper positions.
Adults often have more tooth problems than children, says Featheringham. When an adult is looking to have teeth moved and aligned, they should seek out an orthodontist, because orthodontists are the best prepared and educated to treat the complicated problems adults can have. “It used to be,” she adds, “that the only adults who came in for treatment were those who had serious functional problems like the inability to eat or speak well. But now we’re seeing significant numbers of adults seeking treatment for cosmetic improvement and overall wellness.”
When considering whether to have your teeth fixed, says Forsea, beware of false claims, especially on the internet, about over-the-counter “do-it-yourself” kits. “Never do it yourself — it can be very dangerous,” she warns, “and can cause tooth erosion, misalignment of your bite leading to TMJ or joint problems, gum infections and, in some cases, even tooth loss.”
During the COVID pandemic, 57-year-old Jill Gainer, director of marketing for the AAO, spent a lot of time in Zoom meetings. Seeing herself on the computer screen, she became increasingly aware of how her teeth looked, and she wasn’t happy. “My top teeth were pushing on my bottom teeth, making all my teeth crooked. And when I could no longer stand it, I went to see an orthodontist about having them fixed.”
Gainer, like many older adults, thought fixing her teeth might involve heavy, tight-fitting metal braces. She was surprised to learn there are many options that didn’t exist in her younger years, ranging from those traditional metal braces to ceramic brackets and clear aligners designed to minimize the appearance of the appliance. “Braces are no longer as ugly as they once were,” says Jahangiri.
Orthodontics is the dental specialty that focuses on the diagnosis, prevention, interception, guidance and correction of bad bites. Its purpose is to create a healthy bite — straight teeth that properly meet opposing teeth in the opposite jaw. An orthodontist has two or three years of specialized training beyond dental training.
While traditional braces are still made of metal, most adult patients opt for newer technologies like 3D computer-generated aligners, which look like thin pieces of clear plastic and are placed over the top and bottom teeth. Featheringham estimates that about 80 percent of her adult patients decide to use aligners to straighten their teeth. Occasionally, depending on the bite problem, metal braces or pieces may be needed to achieve the intended result.
To start with, says Featheringham, an orthodontist will see you for an examination and will make X-rays and take photos of your bite. Then, using a scan, they’ll create a digital representation of your teeth and mouth. Computer software is then used to virtually move your teeth to a better position and a good bite. This produces a computer simulation that the orthodontist uses to show you what your future smile and bite will look like. The software is then used to create a series of clear aligners that you’ll change every week or two.
How long it will take to fix your teeth depends on the complexity of your problem. “Most patients have treatment that lasts between 10 and 24 months, and come for appointments to check progress and make needed adjustments every 6 to 12 weeks,” says Featheringham. Adult braces can be more complicated than kid braces because the loss of baby teeth can make planning easier.
Clear aligners are worn all the time, except when patients are brushing their teeth or eating. Featheringham says it’s probably this feature — being able to remove them to eat and clean their teeth — that patients appreciate the most. Aligners are typically changed on a weekly schedule.
“When I weighed the pros and cons,” says Gainer, “my primary issue was the cost. But most orthodontists will see you and advise you without charge before embarking on a plan.” Gainer also considered her appearance and her health, and she’s found that it’s easier to floss and brush with her teeth more properly aligned.
Because their teeth are healthier and it’s easier for them to chew, older adults who have had orthodontic treatment are also now better able to eat healthier foods, Forsea says.
The costs of dental appliances are comparable to the cost of metal braces. A 2020 American Dental Association Survey estimated that the average cost of braces and aligners for adults was $5,500, with variations based on geographical location. Gainer says that most orthodontists will negotiate payment plans that can make the costs easier to handle.
“It’s really never too late,” says Gainer, “and in addition to having a more beautiful smile, I’m taking better care of myself and am healthier.
Based in New York, Barbara Sadick is a freelance health journalist. Her work has appeared in The Wall Street Journal, U.S. News & World Report and The Washington Post, among other publications.
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