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Aren’t braces uncomfortable, unattractive and expensive?
So why are more adults getting them?

What Gillian Sinclair lacks in height she makes up for in smile. Yet she’s thought about getting braces for years. Her teeth are crowded and she concedes they’re not the straightest bunch, but when her jaw began aching she knew she had to do something.

Her bite is degenerating her jaw joint and she has opted for braces to fix it. “I don’t want to get them, but I know it’s the best thing for my teeth and I’ll end up with a great smile.”

Teeth make a big contribution to our appearance; next to the eyes a smile is your most communicative feature. To some people it isn’t important, but teeth that are crooked, jumbled, or out of alignment are certainly noticeable. And even if you are concerned there are still lots of reasons to put off having orthodontic treatment, particularly for adults.

There’s a stigma about vanity, as though cosmetic reasons are insufficient cause, especially when the whole world can see what you’re doing. Some perceive braces as undignified, even humiliating on a mature person, endowing adolescent connotations on the wearer. Even if they missed out when younger, they fear it’s too late now. Then there’s fears of the cost, pain, reactions of others and most of all, standing out.

“I think braces could be difficult in adolescence, but at least friends and others would have them. No one else has them at my age!” laments Scott Rogers, a 32 year old, Canberra lawyer. Rogers has braces because a wisdom tooth extraction went wrong; he’s getting it fixed free but that doesn’t make having them easier.

“Occasionally they annoy me when eating and the need to constantly brush,” says Rogers, but he’s trying to look at it positively. Rogers chose clear brackets on his top teeth. “They’re difficult to see unless I really bear my teeth. Surprisingly, most people who don’t know me don’t notice initially. When they notice, they might make a comment but it’s no big deal.”

Rogers is in good company, joining celebrities such as Tom Cruise, who had ceramic braces put on last year. Innovations such as ceramic and clear brackets are making wearing braces less obvious and thereby more attractive to adult patients. “When people like Tom Cruise have braces it changes the public perception,” says Geoffrey Wexler, of the Australian Society of Orthodontics.

“Adult orthodontics is certainly a strongly growing area,” says Wexler. Although still in the minority, adults make up approximately 20 percent of patients. This can be much higher in inner city practices as adults are particularly concerned with proximity to work. Given most people will wear braces for 18 months to two years and see their orthodontist for adjustments every six weeks, convenience and location are significant issues.

COSTS
Most people however, are concerned about the cost of orthodontic treatment; with good reason. On average it will set you back between $3,000 and $5,000 dollars, however it can be as low as a few hundred dollars or as high as $13,000.

No two cases are the same, so before you start saving, or panicking, get a quote. After an initial consultation an orthodontist can advise you on your specific treatment needs. Most orthodontists have payment plans to spread the costs over the period of treatment, and because referrals aren’t necessary, it’s possible to shop around. If you have private health insurance ask whether there are any waiting periods or restrictions to their payments. Check with your accountant too, some people are able to claim tax deductions when their health expenditure is high within a single year.

SELF ESTEEM
Chris Laffey, a 39 year old Newcastle accountant, admits his decision to have braces was both to fix his jaw and his smile. His teeth became crooked in his twenties but more alarming there was an audible clicking when he chewed.

“No one will probably tell you that they’re getting it done for cosmetic reasons, but I’m damn sure that’s a big part of it,” he says. “Why do people get their noses fixed or liposuction? It’s to look and feel better. It gives tremendous satisfaction when it’s done.”

Laffey thinks it’s harder for men than women. His wife also had braces and her friends were overwhelmingly supportive. Whereas his mates had a “right ol’ laugh” when he told them he was getting braces. “But I bet deep down they were thinking they wouldn’t mind getting it done too.”

Before his treatment, he mumbled, subconsciously trying to hide his teeth. Now he says he speaks more clearly, which is significant in his dealings with clients and running seminars. Laffey reflects he’s still no super model but he gets lots of compliments about his smile. “Whatever gives you that extra bit of confidence, that makes you feel good about yourself, it’s going to help.”

ALLEVIATING JAW PAIN
Chris Laffey persuaded his sister Louise to see if braces would overcome the severe jaw pain (temporomandibular disorder or TMD), she developed after an accident dislocated her jaw. “I was playing indoor hockey and I head butted a concrete floor,” says Louise Laffey. As she had spent three years in agony and exhausted several alternate therapies such as mouth splints, she was amazed that the pain mostly disappeared within a few months of having braces.

“When I look at my face I can see that the whole shape has changed - it’s a totally different feeling. I really wish I’d had it done earlier.”

As a 34 year old, commercial manager, Louise Laffey felt she was “a bit old” for the ‘train tracks’ she’d had as a teenager. “It’s hard enough being a professional woman,” she says. She felt braces would affect her credibility with clients and colleagues and wouldn’t match the rest of her image. “They hardly go with Armani suits!” she laughs.

But those fears were allayed when she met Dr McCrostie, one of Australia’s foremost experts in lingual orthodontics, based in Sydney. Lingual braces are attached to the back of the teeth - the tongue side. People can’t tell she has braces and because the teeth are visible she clearly sees the improvement.

At first they ulcerated Louise’s tongue, but now it’s learnt to stay out of the way, something cheeks and gums can’t do with conventional braces. The main drawback has been overcoming the slight lisp they cause, which has required tongue-twister exercises.

The exercises are something she works on with Dr McCrostie. Louise feels, as an adult patient, she’s in partnership with her orthodontist. They talk about her treatment and he’s open to her feedback and ideas.

She’s obviously enthusiastic about her results but still says for the amount of money involved, cosmetic reasons wouldn’t have been enough. Louise’s three years of treatment will cost her over $13,000.

Lingual braces require more clinical time and expertise from the orthodontist, who must ‘turn inside out’ to see what they’re doing. This translates into much higher costs than conventional braces. Even so, Laffey sees it as an investment in her health; she intends to get good use out of her teeth. “I’m only a third of the way through my life,” she says.

LONG TERM INVESTMENT
Seeing the long-term outcomes helps many people take the plunge. Straighter teeth are easier to clean, reducing the risks of gum disease, gingivitis and cavities. Correction of malocclusions (or bad bites) can reduce grinding and clenching that can cause excessive tooth wear, headaches, gum damage and effect the jaw joint.

“Orthodontic treatment has been clearly shown to give people healthier teeth. In part that’s because of the unraveling but it’s also an increased interest in their teeth,” says Geoffrey Wexler. “People who’ve gone to the effort and have at one point felt fantastic about their teeth are more likely to look after them in the long term.”

Maintaining teeth in their new position is part of that long-term outlook. Teeth can relapse, or return to their original position after treatment, which is why patients wear retainers for another year or two after their braces are removed. Retainers can be plastic moulds, plates or wires fixed behind the teeth. Michelle Vella, a Sydney project manager and busy mum had braces five years ago, but still wears retainers one night a week and more if they’re a bit tight. She was especially careful during her first pregnancy when she noticed movement in her teeth. “It’s definitely been well worth it but it’s also made me conscious of looking after my teeth,” she says.

Gillian Sinclair has to have some extractions first, but will soon have full braces with clear brackets on her front top teeth (an extra $300). She agrees adults are still in a minority but even her orthodontist has braces! “I think having braces as an adult has more impact on your life but people are more sensitive when you’re older, they know you’re conscious of it yourself.”

No matter what age you are some challenges of braces remain the same. “It’ll be interesting,” laughs Sinclair. “Kissing someone? Could be quite dangerous!”

For further information about orthodontics or to find an orthodontist in your area visiting the Australian Society of Orthodontists website at www.aso.org.au

BRACES TIPS
• Avoid hard or excessively sweet foods
• Chop foods like carrots or apples into small pieces.
• Always brush after eating and floss regularly
• Continue to have check ups with your dentist

What’s the difference between an orthodontist and a dentist?

An orthodontist is a dental specialist in the diagnosis, prevention and treatment of teeth and jaw alignment problems. They have undertake further studies usually a masters degree on top of their dentistry qualifications and passed state board examinations.

ALTERNATE BRACES OPTIONS

There are a number of alternatives to steel ‘train-track’ braces although they’re still the cheapest and most commonly used. You can have gold, silver, even ‘glow in the dark’ braces. Or if you want to make a statement, the little rubber bands (ligatures) used to secure the wire to the bracket now come in a wide range of colours from pastel blues to fluorescent pink.

CERAMIC OR CLEAR BRACKETS
The ‘clear’ braces have been around since the 1980’s and most orthodontists now commonly use them, particularly with adult patients. Although they are slightly larger than metal brackets they blend with the tooth’s colour making them harder to see. They are a little more expensive than traditional brackets, around $50 per tooth. Many people will only have the clear or ceramic brackets put on the front top teeth, which are the most visible.

LINGUAL BRACES
Lingual braces are attached to the back of the teeth, (lingual meaning tongue). Although virtually invisible, they are time consuming to put on and adjust making them up to two and a half times more expensive than conventional braces. There’s no risk of permanent marking the front tooth enamel and improvements are easily seen. Different methodologies are required to traditional braces so ensure your orthodontist has the necessary specialist training and experience. Only a relative few orthodontists in Australia use lingual braces. Lingual braces can slur a person’s speech, however exercises to open the mouth, such as tongue-twisters help significantly.

AESTHETIC SEQUENTIAL ALIGNERS
A relative new option are aesthetic sequential aligners. These are clear plastic moulds like retainers, that are worn over the teeth, but can be removed to eat or when a person chooses. There are no wires to catch or tear the inner cheek or tongue and although they take some getting used are comfortable to wear. Over the course of treatment a new, slightly different mould will be worn every two weeks slowly moving the teeth into the desired position. Though usually less expensive than lingual braces they are still pricey and you may have to search for an orthodontist who provides this option. There are two brands used in Australia, Invisalign a US based company, and ClearSmile.