Braces are for grown-ups too

Roger Grunwald’s acting career has taken him to off-Broadway stages and the set of the soap opera “One Life to Live.” He certainly has reason to smile. But in all seven of his professional headshots, his lips are sealed shut.

“Being in the performing arts, a crooked smile doesn’t do you any good,” says the middle-aged New York City actor. Most distressing was a particular tooth that protruded from his lower jaw. So about three years ago, he went to an orthodontist and got outfitted with braces. Now, he says, “I don’t feel self-conscious about the snaggletooth.”

Not long ago, braces were considered just for kids. But patients like Grunwald are now straightening their teeth without taking on a mouthful of metal.

Gone are the giant metal braces, big steel wires and unsightly headgear they remember from childhood. Instead, they can opt for braces with clear ceramic brackets or brackets attached to the backsides of the teeth. In some cases, they can forget about brackets altogether and go for Invisalign, which utilizes a series of clear plastic trays to coerce the teeth into place.

These higher-tech options are making orthodontics more appealing to older patients. The number of U.S. adults wearing braces topped 1 million in 2008, up about 25% since 1989, according to the American Assn. of Orthodontics.

“The stigma of being ‘too old’ for braces has diminished for the most part,” says Dr. Stephen Tracey, an orthodontist in Upland whose oldest patient was 80.

Orthodontists cite a host of reasons for the growing acceptance of braces among adults. They’re more affordable because insurance coverage for orthodontic work is on the rise. They’re more comfortable and more discreet. Treatment times are shorter and fewer office visits are needed.

And there’s ever-increasing pressure to look one’s best.

“Whether we like it or not, we are often judged by our appearance,” Tracey said. “Many adults are concerned about how their smile might affect their chances for employment or advancement in a competitive job market. Many are reentering the dating scene after a divorce and are looking for a more attractive, youthful appearance.”

Just as bone density decreases with age throughout our bodies, the bones in our mouths lose density and shift with age. Teeth also shift due to wear and changing pressures in the mouth, Tracey says. Even adults who had braces as children sometimes need to return for orthodontic treatment in midlife or later, especially if they aren’t diligent about wearing their retainers and their teeth shift out of alignment.

Orthodontic technology has improved significantly since patients like Grunwald were in junior high school. Unlike the days when braces were tightened down with stiff wires, many of today’s braces use a lighter, more flexible arch wire made of nickel titanium. These wires can be custom-designed to fit the mouth of each patient, and they have shape memory so they don’t require frequent adjustments.

“That allows for longer times between appointments, so it doesn’t interfere as much with your work schedule,” says Dr. Michael Rogers, president of the American Assn. of Orthodontists. “It moves teeth faster because it works all the time.”

Some braces have no wires at all.

Braces typically cost between $4,000 and $8,000, depending upon the treatment. Insurance may cover part of this cost, and the number of new patients with orthodontic benefits has jumped from 54% in 1996 to 73% in 2008, according to the orthodontics organization.

Orthodontists say that the benefits of braces can affect the health of teeth for a lifetime. Teeth are easier to clean if they’re not crowded, teeth wear evenly if they are properly aligned and patients learn how to take better care of their teeth.

Demand for braces can seem almost contagious.

Sometimes parents are inspired to get braces after seeing how effective they are for their kids, says Dr. Lee W. Graber, an orthodontist in Vernon Hills, Ill.

“People will bring children in, and the children will be successfully treated, and then the mom will see other adult patients in the office and recognize that she can have something done,” Graber says. “Then they’ll pull Dad in. That is not an uncommon sequence.”

The contagion can spread through the workplace too, says Rogers, who practices in Augusta, Ga.

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“I’ve got one company — I must be treating almost everybody in that company because one gets it and another gets it and they just feel like it’s an acceptable thing to do,” he says.

Ellen Adams, a marketing consultant in Somerville, Mass., was nervous about getting braces at age 30 to correct her bite and straighten her teeth. Though she opted for braces with clear brackets, she feared people would stare at her mouth or ask her awkward questions. Instead, she says, she discovered that adults with braces were a lot more common than she had realized.

“Once I had them, I’d notice other people and feel like, ‘Oh, it’s not so bad,’” she says.

Adams’ braces, which came off two years ago, cost about $4,200, she estimates. Her dental insurance covered “a token amount” in the beginning, but most of the expense was paid from her own pocket, she says.

Rachel Robins spent about $7,000 — none of it covered by insurance — for her braces. But the 26-year-old says it’s a bargain.

“For the results I have now, it would have cost some $20,000 in surgery,” says Robins, whose problems included excessive gum tissue and a distended upper jaw. Over the last two years, bone screws placed in the top of her upper jaw have gradually pulled her face upward, making her face an inch shorter. She hopes to have the braces removed by the end of the summer.

“My entire face and mouth has just transformed,” she says. Now the kids she works with as a Girl Scouts program aide in Avondale, Ariz., find her more approachable, she adds. “I’m much more likely to flash a smile now than I would’ve before. It’s really had a profound impact on how I interact with others.”

Indeed, studies suggest that orthodontic work helps people advance in their careers and personal lives. People have a tendency to assume that “attractive” individuals are more intelligent, are more qualified in job interviews and have happier marriages. A 1974 study in the Journal of Research Personality and a 2001 report in the Journal of Social Psychology found that physical appearance even influences the verdicts and sentencing of defendants on trial.

Some research has focused specifically on dental issues, finding that people make negative judgments about individuals with rotten teeth. A soon-to-be-published study extends those findings to teeth that are merely crooked.

Researchers recruited teenage volunteers ages 10 to 16 and took their photos. Then the researchers digitally inserted straight or crooked teeth into the images.

Those pictures were shown to other study participants, so that one group saw a face with crooked teeth while the other group saw the same face with straight teeth. The reviewers were asked to rate the popularity, sports ability, leadership and intelligence of the people portrayed in the pictures.

In an upcoming report in the American Journal of Orthodontics & Dentofacial Orthopedics, the researchers say that those with straight teeth were rated 10% higher than the faces with crooked teeth in all of the categories except for smarts. In the intelligence category, the difference was not quite statistically significant, but it was close, says Dr. Steven Lindauer, chairman of orthodontics at Virginia Commonwealth University in Richmond, who led the study.

The results indicate a “modest social benefit” to having straight teeth, he says.

Graber, the orthodontist in Illinois, can vouch for the allure of perfect teeth. One of his patients is a physician he describes as “pretty” and “smart,” yet she feels self-conscious because of the way her teeth make her lips sink in, he says.

“We live in a society where not looking abnormal, but looking good, is a valued commodity,” he says. “You can say you’re not supposed to judge a book by its cover, but we do it every day.”

healthkey@tribune.com