Brace Yourself: Options for Fixing Crooked Teeth as an Adult

Straight talk on invisible, removable, and visible braces.

In Washington, image matters. So when Hill staffers, lawyers, and TV personalities want a straighter smile, they usually want to achieve it as discreetly and as quickly as possible. Luckily, adults in the market for dental braces will find more than just clunky metal.

We asked general dentists and orthodontists to tell us the pros, cons, and prices of the most popular options these days for straightening teeth. Note that every case is different and not everyone is a candidate for each method.

Invisible Braces

The choices: Lingual braces are placed completely behind the teeth. Incognito is one brand, as is Harmony, which uses digital technology to create a customized bracket-and-wire system.

The pros: No one can see you’re wearing braces. Because the brackets and wires are custom-made for each tooth, treatment is faster—on average, six months to a year—and requires fewer appointments, says Dr. Shadi Saba of Saba Orthodontics in Sterling and downtown DC, whose office has expertise with Harmony braces. “It’s a great option for people in the public because they have a lot of concern about aesthetics,” she says, noting that Harmony braces can also correct faulty bites with the addition of bite blocks.

The cons: Adjusting to this system can be a struggle. Much as with traditional metal braces, a patient has to avoid eating crunchy foods like carrots. Lingual braces also can cause a patient to speak with a lisp, at least for the first few weeks. “What you don’t see you often hear,” says Dr. John Shefferman of Shefferman Orthodontics in DC. Constant contact between the brackets and the tongue can sometimes lead to irritation. Saba says that tongue irritation can be eased by coating the brackets in wax. Applying the braces is extremely technique-sensitive, so orthodontists have to be well trained.

The price: $6,000 to $13,000.

Nearly Invisible Braces

The choice: Invisalign, introduced in 1999, uses clear, removable plastic trays to straighten teeth. Every two weeks, the patient receives new trays that are closer to the teeth’s ideal position. Among the dentists interviewed, Invisalign is a clear favorite—Shefferman says 60 percent of his patients choose it. “Anything I can do with lingual braces I can do with Invisalign,” says Dr. Andrew Schwartz of Capitol Orthodontics in the District and Rockville.

The pros: Invisalign is nearly invisible to the naked eye, and trays can be removed for cleaning the teeth and for meals—eliminating worries about what you eat or about food stuck in the braces. Dental appointments are relatively short because the system is easy to apply and requires little maintenance. There’s also less discomfort compared with other options. “Clear braces are going to become the standard for adults,” says Dr. Danine Fresch Gray of Clarendon Dental Arts, adding that the ability to remove the trays occasionally is good for gum health.

The cons: The big one is compliance. Patients have to wear the aligners for up to 22 hours a day. Anything less will result in a longer treatment time—treatment averages one year—because the aligners aren’t applying constant pressure. Patients need tooth-colored attachments, or “bumps,” bonded to the front of selected teeth, to keep the trays from slipping off. If you have severe alignment problems—such as large gaps or twisted teeth—Invisalign won’t do the trick.

The price: $4,000 to $8,000, depending on length of treatment.

Visible Braces

The choices: Anything fixed on the front of the tooth. This could mean traditional metal wires with stainless-steel brackets, metal wires with clear plastic brackets, or metal wires with tooth-colored ceramic brackets. Damon is one brand of ceramic braces.

The pros: Traditional braces are often suggested to fix more severe alignment problems, such as a turned tooth, because they have a better grip on it. Schwartz, whose office uses Damon braces, among other options, says that the Damon system minimizes friction between the bracket and wire, allowing teeth to move more easily.

The cons: These braces are completely visible. The brackets can cause discomfort and irritate the inside of the mouth for the first week or so until a patient adjusts. There are also issues with eating certain foods and keeping the teeth and braces clean. Clear brackets can stain. Treatment time for metal braces is typically longer, an average of 20 months, because cases tend to be more severe.

The price: $4,000 to $7,000.

This article appears in the August 2014 issue of Washingtonian.