In recent years, the number of adults choosing to undergo orthodontic treatment, usually for cosmetic reasons, has been on the rise. While having an incorrect bite can also have a negative impact on wider health, and may even be associated with jaw issues and headaches (TMD), there is much misunderstanding and inappropriate treatment performed.
In Canada orthodontic treatment is assumed to be necessary only for children and then not available from governmental plans which are virtually non-existent for any kind other of dentistry too.
Whilst braces are available in the UK on the NHS for those under the age of 18, for those assessed to require them, adults wanting to correct the position of their teeth usually have to pay an orthodontist or dentist to perform the work. Occasionally, adults may receive braces as part of NHS treatment, if required for serious health problems.
Certainly in British Columbia, Canada the government appears to attach no value to dentistry – coverage for clinical medicine is also on the decline as administration takes the lion’s share of funding, as in Britain’s NHS.
Fixed braces have always been the mainstay of children’s orthodontics as they are easier and with forced compliance, more profitable than other means. As many children’s parents have insurance which covers treatment once, it is considered important to straighten the teeth once, alas there are consequently some problems which affect children and adults too.
Insurance plans are less likely to reimburse adult orthodontics.
In America, Canada and slowly Britain too, treatment by braces has become a ‘right of passage in life’ while orthodontic offices have often become factories turning out the same smile on everyone regardless of stability.
This is an over generalisation as there are many good orthodontists who provide appropriate care but would be the first to be critical of short cuts and a lack of understanding shown by some of their peers.
Fixed metal fixed braces
Fixed metal fixed braces are usually the most commonly used, but are also generally the most visible of the different types of adult braces. These braces must be regularly adjusted every few weeks as the teeth gradually move.
Ceramic fixed braces
Ceramic fixed braces are also available, as an alternative to the metal finish. These essentially work in the same way, but are tooth-coloured, making them a little more discreet. Ceramic fixed braces are generally a little more expensive than metal ones.
With the advent of Invisalign and similar products, adult orthodontic services have sky rocketed in provision given their lack of visibility and promotion by almost all dental offices these days.
Both fixed and clear (Invisalign type) braces generally need changes every 4-5 weeks or so. Orthodontic adjustment of fixed braces must be done at the dental office while clear braces are supplied.
As with most things, the condition which requires treatment (the patients primary complaint) should dictate treatment, not the perceived need by the dentist (or team), the ability to provide the service nor the availability of funding.
Treatment should be all about diagnosis
Treatment is all about diagnosis and without a complete and full exam, diagnosis and treatment plan, good communication and patient consent, no treatment should ever be provided.
It came as somewhat of a disappointment to find that Invisalign require only impressions, scan or models to provide treatment, claiming that it’s not necessary for their type of treatment.
Tooth (position) retention is always an issue
Retention is always an issue. Retention is keeping the teeth where treatment placed them. This is true for children as well as adults. Retention is necessary because the position the teeth have been moved into an unstable one, due to muscle balance (otherwise they would stay in position despite a slight memory of where they were.)
Again this is part of diagnosis as orthodontics means straight teeth. What most people need is aligned jaws and then straight teeth.
Aligned jaws is orthopaedics ( unlike many other parts of the body surgery is rarely required to align jaws). If the jaws are aligned, as well as the teeth, the likelihood that everything remains in balance and incidentally retention is great.
Lingual braces are fixed behind the teeth, so are not visible from the outside. They work in a similar way to fixed braces, by applying continual pressure to the teeth to gradually move them into the desired position. When lingual braces are first fitted, it can take the tongue and palate a few weeks to adjust, so may give a temporary lisp. They may cause soreness, even abrasion and cuts.
These braces are usually more expensive than fixed metal or ceramic braces, and have a similar length of treatment time, which can range from months to years, depending on the nature of the teeth alignment required.
Clear braces or aligners are removable and custom-made. The custom aligners are made from dental scans or impressions of the patient’s teeth and treatment time is usually claimed shorter than fixed.
The aligners can be removed for short periods e.g. to eat or when brushing teeth, which makes them less problematic to care for than many other types of brace. However, to avoid bacteria getting trapped in the aligners teeth will still need to be brushed and flossed.
Invisible braces like this usually may come at a higher cost than the other types of braces, and aren’t suitable for every type of orthodontic issue. They may be promoted due to their high profitability due to reduced chair time.
Dr Stephen Bray 2020