Magazine

Tinsel Teeth, Take Two


You'd think that after suffering through braces as an adolescent, you'd have paid your dues. That the tradeoff for being mocked as a metal mouth during your formative years was knowing that when the wires came off, you'd have a perfect smile for life?

Well, guess what? Your teeth naturally shift as you age, and over time, speech, breathing, and chewing patterns can throw them out of alignment. Plus, teeth that have been corrected have a tendency to go back to where they were before. "It's only within the past few years that we've realized you should wear retainers every night for the rest of your life if you want your teeth to stay put," says Don Joondeph, associate professor of orthodontics at the University of Washington in Seattle.

Fortunately, if your adult vanity can't abide crooked teeth, fixing them -- for the first or even the second time -- is easier than you might think. Recent advances have made the apparatus used to straighten teeth less painful to wear and less noticeable to others -- not to mention more efficient, which means significantly shorter treatment times than in years past.

You can get a retainer made for about $60 to nudge teeth that are just slightly out of place. But if your teeth are more significantly misaligned, you're probably going to need braces. An option that's been available for about three years is removable appliances, such as the ones marketed under the names Invisalign, OrthoClear, and Orthotain. They look like the clear plastic mouth guards football players wear and are custom-made by the manufacturers based on impressions your orthodontist makes of your teeth. You get a series of aligners and wear each at least 22 hours per day for two to three weeks before graduating to the next one.

"PERFECT LITTLE SOLDIERS"

Removable braces are almost invisible and you can take them out to eat and brush your teeth. The downside is they can only move teeth horizontally. They won't work if your teeth turn in or out or are uneven vertically. Jennifer Davy, for example, was not a candidate for a removable appliance when she got braces last April at the age of 42. Many of her teeth were rotated and she had "this bucktooth thing going on," said the substitute teacher from Frederick, Md. Removable braces generally cost about $5,000 to $7,000, or about 25% more than regular metal braces.

Another orthodontic approach is lingual braces, which are affixed to the back rather than the front of your teeth, and cost about $10,000. This involves molding a gold alloy to the inside of your teeth. Jim Singh, a 28-year-old software product manager in Austin, Tex., says he has had lingual braces for nine months and contrary to his fears, "they don't affect my speech at all." He decided to get lingual braces because as a young, single male, he didn't want his orthodontia to show. A clear, removable appliance wasn't an option because he needed to correct an underbite that was affecting his ability to chew.

While regular metal braces are not as cosmetically appealing as removable and lingual braces, they often straighten teeth faster and with more precision, thanks to recent advances in design and materials. Jeryl English, chairman of the orthodontics department at the University of Texas Dental Branch at Houston, says brackets now have openings that shut and latch over wires like closing and locking a window. "There's much less friction than with the rubber bands we used to use to hold the wires in place," he says. Called self-ligating braces, they've been available for only about three years so not all orthodontists use them. But "they are so much better that soon everyone will offer them," Dr. English says.

Another improvement: nickel titanium wires. Dr. English says unlike older, more rigid stainless steel wires, nickel titanium wires have "shape memory." That means they gradually go back to their original form, bringing the teeth along with them. As a result, patients see results faster and only have to go to the orthodontist for an adjustment every two months rather than every month for steel wires. Indeed, after just five months of a projected 18 months of wearing braces, Davy -- who has nickel titanium wires -- says "my teeth are now lined up like perfect little soldiers." It will take more time to correct her overbite, however.

The entire course of treatment will cost Davy $5,000. She doesn't have dental insurance, and even if she did, most plans don't cover orthodontia for adults. But if asked whether it's worth it, Davy's smile will tell all.

By Kate Murphy


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