Orthodontia: Braces for Adults
New technologies have made it quicker and easier to straighten teeth. When a 47-year-old mother finally decides to get braces, she finds the experience both fascinating and frustrating.
Despite the bright light in my eyes and the cotton stuffed in my mouth, I try to relax on the recliner. I focus on the piped-in music. “Don’t go changing to try and please me,” Billy Joel croons. “Don’t change the color of your hair.” Okay, but how about the appearance of my teeth?
I had decided, at age 47, to get braces. Nini, the orthodontic assistant, has applied the roughening agent and begun to dab blue adhesive on the center of each tooth. I have already spent a morning with my dentist getting some old veneers chipped off. The last thing I need is to be second-guessed by a pop song.
My braces will place me among a million other grownups in the United States who, according to the American Association of Orthodontists, represent 20 percent of all braces-wearers. The number of adult patients increased 37 percent in the past decade.
New techniques and materials have made orthodontics less onerous. Baby boomers—who, unlike many of today’s kids, rarely got braces as a matter of course—have fallen hard for the promise of perfect teeth. Advertising, television makeovers, and celebrities with gleaming smiles have helped teeth become the newest frontier in the quest for youth and beauty.
I must admit that my teeth didn’t look that good. Still, without my mom to drag me to the orthodontist, making up my mind to get braces was agonizing. In my early thirties, when I probably should have done it, I had opted for thick porcelain veneers that hid my recessed and crowded front teeth. Fifteen years later, the veneers were looking stained and old. The crowding on my bottom teeth was worsening, too, as happens with age.
Also, I had what’s called an overjet: My top front teeth protruded beyond my bottom front teeth, rather than sliding snugly when my jaw closed. My molars took all the pressure every time I chewed. An overjet is often mistakenly called an “overbite”; with an overbite, the top front teeth come down low over the bottom front teeth.
My Northwest DC dentist, Andrew Cobb, had been gently broaching the idea of having my bite corrected since I started going to him in 1999. Every six months, after the hygienist finished cleaning my teeth, Dr. Cobb would come in and ask how my jaw was feeling. (It hurt near my left ear when I yawned or chewed.) He’d point out that the veneers were ill-fitted to my gum line. He’d examine my molars, which I was grinding down even though I wore a mouth guard at night. He’d explain that I would eventually lose my molars unless I took steps. That was the point at which I hightailed it out of his office, because I knew he was talking about braces.
The idea alarmed me. I imagined strangers staring at the middle-aged woman with wrinkles and braces; friends looking away politely from spinach that would hang like green tinsel on a silver Christmas tree. I worried about pain, both financial and physical. The undertaking would cost close to $10,000, and I had heard that whatever pain kids go through, adults feel it more acutely. As Nancy, the ever-cheerful practice manager at Dr. Cobb’s put it, “Kids’ teeth move like they’re going through Jell-O; with adults it’s like through cement.”
Although I had put my son, Nathaniel, into braces without a second thought, I proceeded with caution on my own behalf. But little by little, my son’s visits to Northwest orthodontist Jeremy Orchin became all about me. While Nathaniel lay in the chair with his mouth open, I peppered Dr. Orchin with questions that would send most men running: “Do you think I would look better if I got my teeth fixed? How much better? Are you saying it looks bad now when I smile?”
Dr. Orchin took photos of my teeth, smile, and profile as well as digital x-rays. He sat with me and answered all my questions. No, modern orthodontics do not weaken teeth or bone. In fact, moving teeth into the right position prevents deterioration. Yes, everyone feels nervous. No, I was not a candidate for Invisalign, removable plastic trays that work like braces but are effective only in certain cases. Yes, my bite would be improved.
“You ready, nini?” asks Dr. Orchin. He is roaming among patients in the five chairs in the treatment area, supervising all activity and performing key procedures. Getting braces is a social event; the standard treatment room contains no partitions. We’re all in this together, and everyone’s teeth are everyone else’s business, which, strange as it sounds, creates a jolly atmosphere.
The doctor rolls up a chair and begins to set the little metal brackets of my Speed-brand braces onto each adhesive-beglobbed tooth. I watch the progress by holding up a hand mirror, occasionally hitting Dr. Orchin in the head with it when my arm gets tired. “Hnngg,” I say in apology.
After all the brackets are arranged, Nini introduces me to an arch wire. Made of nickel-titanium, this “NiTi” wire was adapted for orthodontic use from the aeronautics industry and is an example of the kind of advance that makes braces easier for both doctor and patient. Strong yet flexible, the wire exerts light but steady pressure on teeth and, in contrast to traditional braces, reduces the frequency of orthodontist visits.
Nini fits the wire into the brackets and snaps them closed, one by one. Each bracket is a teeny spring-release trap that holds the wire. This “self-ligating” feature is another advance: No additional elastic or wire is required to hold the arch wire onto the brackets. The brackets allow the wire to slide through them as the teeth move. This feature reduces the friction between the brackets and the wire, enabling me to avoid frequent adjustments.
Nini snips the end of the arch wire just beyond the last bracket on each side, creating a raspy metal endpoint that I can feel with my tongue.
With the admonition to not eat gummy worms ringing in my ears, I walk out into the April sunshine. I clutch my little supply kit that contains miniature brushes, wax, floss threaders, and a rubber bracelet that says braces are cool. It does not contain what I really need, which is a vodka tonic. Although everyone has been as gentle as possible, I am shell-shocked. I almost have several accidents on Wisconsin Avenue as I drive home because I am looking in the mirror instead of at the road. I am fascinated and horrified by the new me. There is no turning back.
The first few days in braces are like having a new baby—everything takes ten times longer than it used to. Flossing requires 45 minutes each night and the dexterity of a lacemaker to maneuver the plastic floss-threader around the brackets.
Food must be soft. I am starving, but pain prevents me from chewing. I pop Tylenol and vow to take advantage of this opportunity to lose ten pounds. By the fifth day the ache has started to subside, and I am up to blueberries.
I am obsessed with how I look. The brackets push my lips out a bit—maybe I have a sexy bee-stung pout like Angelina Jolie? My husband’s first reaction provides a more realistic assessment; he averts his eyes but says, presumably referring to our marriage, “Don’t worry, I’m in this for the long haul.”
My husband says I sound different. I practice speaking in front of the mirror: “I should have been a pair of ragged clawsh schuttling acrosh the floorsh of schilent sheas.” I have to move my jaw to the right to get a true “s.”
The good news is that I can already feel my bite hitting in a new place—more forward—and the pressure is off my back teeth. They aren’t called Speed braces for nothing.
Braces work by applying force to move teeth and holding them in the new position long enough for bone to rebuild. Thirty years ago, the appliances consisted of metal bands that wrapped around each tooth. To make room, the orthodontist often had to file or even extract teeth. Wire ligatures tied the arch wire to the brackets.
The advantages of my modern metal braces are the small size of the brackets—less visible, more hygienic—and the swiftness with which they work. They are so speedy that they wear me out, especially after each orthodontic visit. I see Dr. Orchin every seven weeks and can feel my teeth move within the first 24 hours of a tightening or adjustment. Each time, the ache persists for days.
While that pain eventually subsides, the irritation on the inside of my mouth, from the brackets and wires rubbing on skin, is chronic. Jamming a blob of soft wax on the offending metal part helps alleviate the problem, but I inevitably spit out the wax.
With anyone outside my family, I feel self-conscious. I deal with it preemptively in every conversation by pointing out my braces. Most people are polite—except that like being pregnant, wearing braces serves as an invitation for everyone to tell you the intimate details of their own experiences. Women, especially, share stories about their lateral wisdom teeth and class-three malocclusions.
Within my family, braces are all I talk about for the first few weeks. I cannot imagine, looking back, how dull that was for them. Nathaniel, having been through the experience, provides some sympathy, though it is sympathy with undertones of revenge.
“Does it hurt?” he asks at dinner.
“Inside of your mouth getting all chewed up?”
“Mom, watch,” he says, and bites hard into a carrot stick with his front teeth.
Meanwhile, on the financial front, I was working to extract some help from my parents. My three younger sisters all received orthodontic treatment—most memorably the youngest, who tortured our parents with creative ways of losing her Frankel appliance. I have no recollection of having been evaluated for braces and admit that I still resent this oversight on my parents’ part. So when I found out the cost of my treatment, I realized that there was a way they could make it up to me.
I got them on the phone and explained the gory details of what I faced, which could have been avoided had I been properly cared for as a child. A week later a generous check arrived in the mail. My sisters each got one on the same day for the same amount, so technically they’re still ahead, not that I’m counting.
In June, I notice brown stains on my teeth, especially around the adhesive. Staining is a problem typically associated with ceramic clear braces, which use elastic ligatures that can turn a mustard color. I consult Contemporary Orthodontics, the textbook I have borrowed from Dr. Orchin. As it says nothing about discoloration, I call Dr. Cobb’s office in a panic. Pam, the hygienist, sees me on an emergency basis.
“Have you been drinking coffee or red wine?” she asks. Of course, I tell her, and tea and Diet Coke, too; I’m a functioning adult. She advises me to use an electric toothbrush and linger on each tooth for at least three seconds; drink lemon water following any staining beverage; and stop reading Contemporary Orthodontics. Then she gets out the Prophy-Jet—a device that sprays mint-infused baking soda on my teeth. My surfaces are clean again.
Within a few months, lethargy sets in regarding hygiene. I floss only half of my mouth each night—either the uppers or the lowers. Doing more is just too hard.
New problems pop up. When I kiss my little girl, strands of her long red hair get caught in my braces and she has to stand perfectly still in the grocery-store aisle while I unthread them. One morning, I pull a T-shirt over my head and the fabric snags on the left front bracket. The tug is so strong that I am sure I must have done some damage. But Speed braces are tough.
When it comes to breaking off a bracket, it turns out to be the angle, not the amount, of force that matters. That is why a Jordan almond—one of my favorite indulgences and the only item on the forbidden-foods list I cannot resist—flips off a side bracket with seemingly no effort. With the bracket dangling from the arch wire, I return sheepishly to Dr. Orchin’s office, where all is set right, no questions asked.
Six months into treatment, elastic bands enter the picture. Whereas braces move individual teeth, “elastics” bring the bite into alignment. They hook onto brackets on the upper and lower jaws in a variety of combinations, like a game of cat’s cradle, depending on what needs to be moved where. They are supposed to be worn at all times and need changing a couple of times a day. As an adult, I am given a little plastic bag of elastics. I know from my daughter’s sixth-grade friends that they come in lots of colors. Thinking myself quite the fun person, I choose green to attend a business meeting. When I catch a glimpse of myself in a bathroom mirror, it looks like I’m chewing a wad of Trident spearmint.
On Valentine’s Day, everyone is in a jolly mood in Dr. Cobb’s office. Two vases of tulips brighten the waiting room, and Nancy wears socks with hearts on them.
My bite, which feels like it has moved forward to the very front of my mouth, with my teeth sliding together the way they’re supposed to, doesn’t perform so well in Dr. Cobb’s grip. He gently pushes my lower jaw back, aligning the joint, and now my overjet has reappeared. He says I am unconsciously sliding my jaw forward with each bite.
Upper and lower teeth interlock like jigsaw-puzzle pieces. They’ll override the jaw’s desire to be in its correct position, demanding that muscles pull it wherever it needs to be for the teeth to mesh. Eventually the muscles get tired and strained, resulting in jaw or head pain.
What you want is for the teeth to mesh when the jaw is in the right position. The solution for me is either “bite adjustment,” a process in which the dentist grinds down some of the ridges or builds up some of the valleys of enamel so uppers and lowers fit together, or continuing to refine the braces until the teeth lock perfectly in the correct position. These are two bad choices, as far as I am concerned: shaving off yet more enamel or continuing in braces six months longer. I choose bite adjustment.
In March, Dr. Orchin pimps my teeth with a gold chain. It’s not jewelry but a “permanent” retainer glued across the inside of my bottom six front teeth. I barely notice it with my tongue, which is great, because it will be in place for several years. It’s an indication that the end is approaching, but Dr. Cobb is still not satisfied with the position of my top front teeth, especially the one on the right. Dr. Orchin makes an offset—a butte-shaped detour—in the top arch wire to rotate that tooth into place.
The new wire does its job quickly. I can feel the tooth advancing into position, hour by hour. At night, I listen to all my teeth as they move about gently, making deep, primordial sounds, like whales singing, in my head. As I think about the braces coming off, I feel unaccountably sad. I am reminded of childbirth: What a relief it was to get the baby out, but how I missed that abdominal bump, so full of promise.
Despite all the inconvenience, expense, and pain, one thing about my year in braces was a pleasant surprise: Friends didn’t laugh, and strangers didn’t stare. The humiliation I anticipated boiled down to the occasional double-take—and frequently from someone who had just finished wearing braces and wanted to swap stories.
Looking less than my best for so long reminded me that appearances really don’t matter much; I simply wore less jewelry—my daughter said it clashed with my teeth—and went about my business.
On a Friday in April, Dr. Orchin reviews my x-rays one last time to make sure the roots of my front teeth have moved into parallel position. This is important, he says, because of the cosmetic work Dr. Cobb will do when he installs my new veneers. He uses special pliers to pop off the brackets one by one with a little twist. It hurts only a little on a couple of teeth. When he grinds off the residual adhesive, however, the pain is intense. Evidently, my teeth have thin skins. “Hny’h huau eng Rr. Onngg hoo ih?” I ask. “You just read my mind,” he says. “We’ll let Dr. Cobb finish this when he has you anesthetized.”
And that’s it: My braces are off after 50 weeks, two months sooner than predicted.
The pain near my ear is gone. My front teeth slide together when my jaw closes. The new thin veneers I will get this fall, after my teeth settle into position, should fit my gum line. I have a beautiful sparkly silver retainer that looks like a high-tech sea creature, although it makes me lisp slightly. I will wear it around the clock for the first six months or so, then nights only. It is visible, with a metal wire across my front teeth, but nothing like the braces. And I can take it off.
My year in braces was a success; my only regret is that I didn’t do it sooner. But who knows what opportunities might lie ahead? Another shot at junior high school?