Increasingly, orthodontists are turning their attention to image-conscious adults


November 02, 1993|By Patricia Orsini | Patricia Orsini,Contributing Writer Health Magazine

The saleswoman at Banana Republic was closing the dressing room door when she looked at me and smiled. "Hey, I just got my braces off," she said.

I admired her teeth. "They look perfect," I said. She admired mine. "They look pretty straight to me," she said. We talked ceramic vs. metal brackets, fixed retainers vs. removable ones. We talked the big T: How much time.

"A few more months," I reported.

"Then the worst is over," she said.

"I know," I told her. "This is my second time."

Admittedly, I'm an unusual case. Well, maybe not so unusual. Last year a quarter of all orthodontic patients were adults, a nearly fourfold increase over 20 years ago. An estimated 15 percent to 20 percent of those were in my boat. Call it Jaws II; somehow the keyboard-straight ivories we won the hard way in our teens didn't stay on track into adulthood. Chalk it up to a combination of bad genes and lost retainers. Now we're going through the whole wrenching rigmarole again.

Lucky for us and for nearly a million other adults wearing braces, it's a whole lot less wrenching than it used to be. For starters, most orthodontists today are going out of their way to cater to image-conscious boomers. Some are going as far as opening second offices, close to busy downtown workers. You don't need a business degree to figure out why: Self-improvement is a growth industry. And what good is an otherwise perfect body if your teeth are crooked?

What a difference a decade makes.

As recently as 10 or 15 years ago, braces hurt like the devil and looked like the grille of my father's Oldsmobile. The introduction of lighter, elastic wires and stronger adhesives has changed all that. The new wires, made of a nickel and titanium alloy, move teeth continuously, gently. New bonding agents have had an equally profound effect on the cosmetic side; they've made it possible to glue wire-gripping brackets directly to the front teeth. The steel bands that used to encircle each tooth are now virtually obsolete. Voila! No more tin grin.

Today's brackets come in a choice of three basic materials: stainless steel, plastic and ceramic. Metal remains the most popular choice, largely because it's both cheaper and more durable than its cosmetically appealing cousins. But clear plastic brackets, after a lackluster start in the mid-'70s, are beginning to catch on. They're still not perfect; they add about $400 to the standard cost of treatment, which can range from $2,800 to $4,000 or more. Even so, problems associated with the early versions -- they broke easily and tended to turn an unsavory shade of pea green a few months into treatment -- have been fixed.

Lingual braces, introduced in 1983 in an attempt to hide all the metal on the tongue side of the teeth, are yet another option. They're great in theory, not so great in your mouth.

"It takes about three to five days to get used to regular braces," says Dr. Robert Boyd, chairman of the orthodontics department at the University of California in San Francisco. "It takes up to six weeks to get used to lingual braces." According to Dr. Boyd, the braces irritate the tongue, making it hard to talk, and the orthodontist has to all but stand on his head to adjust them. At $7,000 to $9,000, they're also pricey. Not surprisingly, only about 2 percent of orthodontists now offer them at all.

More change is on the horizon. At least one company is experimenting with tooth-colored wires; researchers say they could show up in orthodontists' offices as early as next year. So-called white wires have been tried in the past, says Dr. Charles Burstone, a professor of orthodontics at the University of Connecticut School of Dental Medicine in Farmington. "But the Teflon coating was on the surface of the wire," he says. "It tend ed to flake off pretty quickly." The color is embedded in the new wires, Dr. Burstone adds.

Take it from someone who knows -- change is good. Dr. Boyd likens the experience I had as a teen-ager, almost 16 years ago, to a series of bone-crunching adjustments. Moving a tooth causes the bone at its base to dissolve in the area under pressure, he explains. "Fifteen years ago, we applied the necessary force in short, painful bursts. We literally winched teeth into position, and patients spent the next three weeks recovering."

Now orthodontists achieve the same result by applying a much lighter continuous pressure over a four- to six-week period. How much force? Just four ounces -- about what a 2-year-old applies to her teeth when she sucks her thumb.

As a result, the interval between visits has been stretched from three weeks to an average of four. Some lucky souls can go up to six weeks between visits. The visits themselves are shorter, too, generally lasting no more than 15 or 20 minutes.

Age is no longer an issue. A 70-year-old or a 7-year-old in an orthodontist's office today is now a common sight.

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