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Nothing but the Tooth column: Braces for older adults require a commitment

Dr. Richard Greenberg
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Q: I am 70-years-old and I have some crooked teeth on my lower jaw. This was caused many years ago by a baby tooth that had to be removed due to a cavity when I was a child and impacted molars that were removed in my late teens. Would it be too late for me to get braces to straighten out my teeth?
- V.M., Warwick, Rhode Island

A: No matter what the cause, it is always possible to move teeth without regard to age. There are, however, some important things to consider.

As we age, the bone in our jaws does also, therefore making it more difficult to create the tooth movement. What that means is that more force may be needed as well as more time. Be that as it may, the treatment can still be considered.

I assume it is the looks that bother you as it appears that you have been able to function well in spite of the position of these teeth. Assuming that the current position is not affecting the lifespan of the teeth involved and as long as money is not a concern, I have a few suggestions for you to think of in making your decision.

The first is that I would make sure that you get the opinion of a board eligible or board certified orthodontist. This is a four-year dental school graduate who has two extra years of specialty training. My reason for saying this is because I believe there are members of my profession who offer orthodontic treatment to their patients with a minimal amount of training. Certainly not even close to that of a specialist. Why they do this, I am not sure, but very possibly for financial gain which has become a driving force in my area of the health professions. Certainly, there is nothing wrong with being paid for services rendered but they must be for services we can deliver in a most ethical manner. Providing orthodontic treatment with minimal training does not qualify. If your general dentist has suggested this treatment, I would hear him/her out carefully and then get the second opinion of the specialist.

Something else to consider is that your overall gum health has to be excellent if you consider adult orthodontia. If your gums bleed or are tender and/or sore in any areas where you consider braces, the treatment can accelerate the gum problem to a level of disease that can cause significant bone loss and consequent loss of a tooth or teeth. Any dentist that considers moving your teeth should discuss that issue with you prior to treatment.

Another important issue is that when teeth are moved in adult years, they have a much greater tendency to move back to their original or similar position when the braces or aligners are removed. When braces are done for young people, they are prescribed retainers to wear for a number of additional years so that the tooth position will solidify. If they do not, their teeth will have a tendency to drift somewhat and often much more than desired. As an adult, retention of the desired tooth position has to be retained indefinitely. This means that some type of wire needs to be bonded to the inside of the teeth moved or some retainer has to be worn at night forever. And I do mean forever. If not, the teeth will most assuredly move back to or toward their original position. Bonding the inside of teeth together can be very annoying in that the bonding will not remain in place forever. Usually it will need rebonding at undetermined intervals. This also is annoying and of course adds more expense.

I hope I have clarified some of the considerations and if you are comfortable accepting responsibility for those and the looks are that important, then I would definitely consider the treatment.
Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at dr.richard@nothingbutthetooth.org.