Braces have become more affordable, with insurance often covering part… (Getty Images / Rubberball )
Gone are the days when braces regularly provoked taunts of "tin grin" and "metal mouth." Nowadays, braces are not only more accepted than ever — for children and adults alike — they're often downright desirable.
"I think it's become a rite of passage in some way in this society," says Dr. Indru Punwani, professor and department head of pediatric dentistry at the University of Illinois at Chicago.
Between 1982 and 2008, the number of people getting braces in the U.S. leaped a whopping 99%, according to the American Assn. of Orthodontics. And adults are on the bandwagon. From 1989 to 2008, the number of adult patients getting braces rose by 24%.
"The stigma of being 'too old' for braces has diminished for the most part," says Dr. Stephen Tracey, an orthodontist in Upland, Calif. "It wasn't that long ago that adults considered orthodontic treatment 'just for kids.'"
Orthodontists cite a host of reasons for the acceptance of braces. They've become more affordable, with insurance often covering part of the cost. The devices are more comfortable and less noticeable than in the past. Treatment is shorter, requiring fewer visits to the orthodontist. Society overall is recognizing the importance of oral health. And, of course, there's an ever-increasing social pressure to look one's best.
Braces are "faster, they're sleeker, they're smaller, they're smoother, they're just far more comfortable," says Dr. Michael Rogers, president of the AAO. "I think from that standpoint, the public is just more willing to have the braces and more willing to go through the treatment."
Dr. Lee Graber, an orthodontist in Vernon Hills, Ill., and past president of the AAO, would agree. He's had orthodontic patients ranging from 3 to 88 years of age.
Not only are patients willing to start treatment well past adolescence, they're also willing to assess their children's need for treatment much earlier.
"We're seeing more youngsters because more and more people are recognizing that orthodontics is a component of an oral healthcare program," says Graber.
Braces, it seems, have no age limits.
Orthodontic treatment for children sometimes occurs in two stages. Phase one, or early intervention orthodontics, begins around age 7 or 8 when children have gotten their first permanent teeth. Phase two begins when the permanent teeth are in, typically age 11-14; this is when the majority of kids get braces.
"Phase one is not so much to make the smile beautiful, it's more to get the problems intercepted so that the jaws grow better and things function better," says Rogers.
Reasons for early intervention include severe crowding of the teeth, pronounced overbite or underbite, jaw-growth discrepancies, and cross-bites, in which the upper teeth fail to overlap the lower teeth.
"Many times if you wait until the adult age to correct a cross-bite, it can involve a surgical procedure by an oral surgeon to free up the segments of bone, whereas if we correct them early, the bones are pliable, and it's corrected easily and non-surgically," says Rogers.
If children are not biting straight from an early age, orthodontia can alter their jaw development — another reason to begin in the 7 to 9 age range.
"Orthodontics can straighten the teeth up, but it can't realign that lower jaw," says Dr. Rhea Haugseth, a pediatric dentist in Marietta, Ga., and president of the American Academy of Pediatric Dentistry. "So you've got a skeletal discrepancy then. So if we see something skeletally wrong, we want to go ahead and fix it and try to get them into a more normal growth pattern."
Orthodontists say that the benefits of braces for both children and adults can affect the health of teeth for a lifetime. Teeth are easier to clean when not crowded, and they wear evenly when properly aligned. Further, the treatment helps teach patients how to take care of their teeth.
"There's an educational process that takes place at the same time that they're going through corrective therapy," says Graber.
In some cases, orthodontists must make close calls about putting braces on children, Graber says.
Occasionally he encounters moms who say that their daughter is embarrassed of her teeth and doesn't want to smile at school. "She'll say, 'You know, four of her friends are getting braces right now. She thinks her teeth look funny and her friends are getting it taken care of; isn't there anything you can do?'" says Graber. "You sometimes end up really having to talk to parents about what really is appropriate and normal."
But he acknowledges that in rare cases, if a child's self-image is hindering their development or causing them difficulties at school, it may be worth it to put braces on even if the treatment isn't essential. "Sometimes it may be a very short period of treatment, and the psychological benefit certainly is worth it," says Graber. "The mental is sometimes more important than the dental."