An adult’s guide to Getting Braces

Are you contemplating undergoing teeth-straightening treatment? You’ve come to the right place. Consider this your comprehensive guide to in-office and at-home braces, including information on treatment length, pricing and more.

I spent most of my childhood at the dentist's office and, thanks to my cleft palate, wore braces on and off for about 10 years of my life. Although I've never experienced wearing braces as an adult (I finally got mine off in high school), I know that it’s a big step toward achieving a straighter smile. The problem is, most teeth-straightening options, including inoffice braces and at-home treatment plans, are extensive, expensive and might not be covered by health insurance.

As a pre-teen, when my parents and I were deciding which braces to get, orthodontic treatments with braces or clear aligners were only available at the dentist’s, designed and supervised closely by a dentist throughout the treatment.

"In recent years, many direct-to-consumer aligner companies have created aligners available to consumers online without the supervision of a dentist – they're faster, cheaper and more convenient. There’s a rise in direct-to-consumer marketing promising a straight smile from home for less money without seeing a dentist,” says dentist Sharon Huang.

However, she isn't a big fan of athome braces without the supervision of dentists because they go through years of training to master the skills to predictably move teeth to ensure proper resulting biting force, alignment and aesthetics. Plus, she doesn’t love that patients, who have no prior dental training, are required to take moulds and photos of their own teeth (for most at-home treatment plans).

Some other at-home treatment plans will take a scan of patients’ teeth, and most at-home orthodontic treatment programs don’t see patients in person – the full treatment is designed remotely. "It’s very difficult to make a proper diagnosis by looking at pictures of a patient,” says Sharon. “It’s important for patients starting orthodontic treatment to have a proper exam by a dentist to detect cavities, gum disease, signs of resorption, or shortened roots before orthodontic treatment or these may deteriorate throughout orthodontic treatment.”

Another important thing to note is that there are currently no regulations for at-home orthodontic treatments, as stated on the American Dental Association’s (ADA) website. ‘For the health and wellbeing of the public, the ADA believes that supervision by a licensed dentist is necessary for all phases of orthodontic treatment,’ according to a policy passed by the ADA House of Delegates in 2017. ‘The ADA “strongly discourages” the practice of do-it-yourself orthodontics because of the potential for harm to patients.’

Below is a comprehensive guide to getting braces as an adult if you so choose to straighten your smile.

IN-OFFICE TEETH STRAIGHTENING TREATMENTS Traditional braces

Traditional braces have been around for a long time, and they’re probably the most recognisable symbol of orthodontics. Fixed appliances, such as braces, are attached to your teeth and aren’t taken off until you complete your treatment. “These orthodontic workhorses have a long history of successful treatment and are great at correcting many oral issues,” explains Jordan Cogan, an orthodontist. “That’s why metal braces continue to be the top orthodontic treatment for patients of all ages."

An ideal candidate for traditional braces would be someone with more moderately to severely crooked or overlapped teeth or someone with small gaps. If you have a misaligned bite, you might be a good candidate for traditional braces, and you also need to have relatively healthy teeth, as metal braces use a lot of force to move your teeth around.

Bracket technology is always advancing, creating the smallest, lowest profile mix of stainless steel, nickel and other metals to create braces that are durable and significantly less noticeable, according to Jordan. “The wire is a thin piece of metal that runs from one bracket to another, and the orthodontist has advanced training and knowledge to change the shape and curvature of the wire to move your teeth in the right direction,” he says. “Bends in the wire will provide different types of pressure on different teeth." A bend in the wire is how most orthodontists cause specific, precise movements.

Additionally, the time you spend wearing traditional braces will really depend on your teeth’s needs. "The average time spent in metal braces is around 18 to 24 months, but could be shorter or longer, depending on the individual treatment plan,” explains Jordan.

Clear aligners

The history of clear aligners goes back to 1945, when tooth positioners were introduced to refine the final stages of orthodontic treatment after appliance removal, according to a 2014 article in the New York State Dental Journal. In 1997, two Stanford students founded Align Technology – Invisalign (one of the most recognised clear aligner companies) was created in 1999.

“Clear aligners are customised appliances created by the aid of sophisticated 3-D imaging and animation tools that enable virtual simulation of tooth movements,” says Jordan. “Tooth movements resemble a filmstrip, and each frame or stage corresponds to a set of clear plastic aligner trays. As the trays are worn by the patient, every tray pushes the teeth slowly to their proper positions."

Unlike traditional braces that are visible with metal, clear aligners are made with smooth plastic and don’t have metal components that can irritate your mouth — however, you’ll need to change the plastic retainers every two weeks. “Because they’re removed when you eat, you won’t have to watch what you eat like you would when wearing braces.” Before you sign up for these, you must be willing to remove the clear aligners for eating and drinking (other than water) every time — eating with clear aligners could cause damage to the aligner, and drinking with them could cause staining.

Lingual braces

Unlike traditional braces, which are fixed to the front of your teeth, lingual braces are placed on the back of your teeth, toward your tongue. They work in the same way that traditional metal braces work, “applying a gentle, continuous pressure to your teeth to shift them into their new, straighter positions,” explains Jordan. “This treatment can take anywhere from six to 30 months, depending on how severe your bite or overcrowding is.”

Although lingual braces may look less noticeable, you might find them a bit more uncomfortable than traditional braces within the first few weeks. It takes time for your tongue to adjust to the new space in your mouth, causing a slight speech impediment temporarily. Additionally, you might find that your tongue develops canker sores as it rubs against the lingual braces frequently – your tongue should be able to adjust to the new braces, but you should use wax if discomfort continues.

Permanent retainers

Once you’ve completed your teeth straightening treatment plan, your orthodontist might want to insert a permanent retainer on the inside of your teeth to prevent them from moving around. “To help combat unwanted tooth movements, permanent retainers are bonded to the lingual (inside surfaces) of the front teeth,” explains Jordan. “That being said, nothing comes without sacrifice – these metal permanent retainers make flossing and routine oral hygiene more challenging and periodically require maintenance.” If used properly, specifically when paired with a removable retainer that your orthodontist might give you post-treatment, permanent retainers are a great solution to maintaining a perfect smile.