No more Heavy Metal

By staff October 1, 2001

Remember puberty? That awkward period when your face breaks out, your voice changes and you have to learn how to shake hands with the opposite sex without sweating? As if all that weren't hard enough, many adolescents also have to cope with getting braces.

If you were one of the legions who had them years ago, you remember the drill: First came names like "Railroad Tracks" and "Tinsel Teeth." Then there were the rubber bands that shot out of your mouth at the person you were speaking to. (Not funny then, but hilarious now.) And God help you if you failed to do a "teeth check" before opening your mouth and missed a strand of spinach looped around a wire. No wonder some people who could have benefited from braces opted out of the experience.

What a difference a few years makes. With their flashy colors, clear brackets and invisible appliances, today's braces have become downright chic. In addition to the kid skateboarding down your block, you're just as likely to see accountants and lawyers sporting metal hardware in pursuit of straighter teeth and a sexier smile. Adults now make up about one third of all orthodontic practices. The hit HBO television series "Sex and the City" even built a recent episode around braces.

Not everybody needs braces, of course. "Plenty of people have a nice smile with a bite that doesn't need correcting," says Sarasota orthodontist Lynn Dettenmayer. "I try to present braces as an opportunity, not a necessity. Very few people die of severe malocclusions (bad bites)."

Dettenmayer credits much of the rising popularity of braces to the sheer variety of styles and treatments. Gone are the days when you had a railroad running through your mouth. Taking the place of metal bands that surrounded each tooth are smaller modern brackets that are affixed directly to the front of the tooth and held in place by a single archwire. From there, your options are wide open.

Dettenmayer especially likes mini-braces, or "mini-diamonds." Four times smaller than traditional metal braces, they minimize lip and cheek irritation and are easier to keep clean. If you prefer a more natural look, there are clear (sapphire) and white ceramic brackets that blend with the color of your teeth. People with olive or dark complexions may want to explore gold-plated braces to better match their skin tones.

Also disappearing are those rigid wires so thick you could hang clothes on them. They're giving way to space-age wires made of nickel and copper-nickel titanium. Thinner and more flexible than traditional stainless steel, they're less conspicuous and easier to adjust. Soon, they may become even less apparent. According to the American Association of Orthodontists, a clear orthodontic wire is in the experimental stages.

To go truly invisible, you could follow the example of many actors and singers by getting lingual braces, which go behind the teeth. You'll look great on camera-but lingual braces do make it harder to speak and eat. Dettenmayer finds lingual braces difficult to control and rarely uses them. He says they can cost twice as much as regular braces and take twice as long to correct problems. He also says they can turn your tongue into hamburger meat until you get used to them.

Quite a few patients are going to the opposite extreme, choosing extra-conspicuous colored braces. Available in everything from soft pastel to glow-in-the-dark hues, they can be accented with interchangeable rubber bands that can mix and match to any outfit. "Every St. Patrick's Day, we have a run on green," says Dettenmayer. "One girl came in to match a set to her pajamas for an upcoming slumber party." Retainers are even starting to incorporate sports team logos into their designs.

Fifty percent of Dettenmayer's adult patients choose metal brackets, which he believes are still the easiest to work with and the most efficient. People in the public eye, however, usually opt for clear or ceramic material.

For adults who remain skittish about braces there is Invisalign®, a system of clear plastic molds that straighten teeth without the use of wires or brackets. Over the course of the treatment (which ranges from six months to two years), patients wear a series of removable aligners that gradually straighten the teeth.

Anyone whose jaw and teeth have stopped growing may be a candidate for Invisalign if the problems are limited to minor crowding or misalignment of the front teeth, says Bradenton orthodontist Steven Tinsworth. But, he cautions, "the more complicated cases still require traditional braces." The Invisalign approach is also more expensive because of substantial laboratory costs associated with the procedure.

Other removable appliances look like retainers, but tiny springs embedded in plastic behind the teeth provide enough pressure to move them. Dettenmayer says these are also effective, but only as long as people use them with diligence.

Some things about braces haven't changed. Treatment times still average from three to six months for minor problems and two years or more for major realignment; all this technology hasn't shortened the time it takes for teeth to move around in your mouth. Plus, many patients still dread the discomfort of realigning their teeth.

Dettenmayer believes this is more of a problem for adults than children. "Adults have a much lower threshold for pain. Kids come in and hurt for a couple of days," he says. "Adults will come in here weeks later wanting to know what I've done to them."

Leaving as many teeth intact as possible can eliminate some of that discomfort. Years ago, if a patient's mouth seemed too small to accommodate all future teeth, dentists extracted teeth before proceeding with braces. Dettenmayer says dentists now realize that missing teeth can eventually detract from a person's overall appearance. By using a device called a rapid-palatal expander, Dettenmayer gently expands the palate so that it can accommodate all the teeth in a patient's mouth.

Also new are self-ligating brackets, which Tinsworth predicts "will have a significant impact on the way we do braces in the future." They work in tandem with the new lightweight wires; and because they don't require tie wires or elastic bands, they may eventually decrease treatment time. Tinsworth says they're gaining popularity for their unique design (their contoured fit bonds more easily to a tooth's surface) and ability to move teeth faster and more efficiently.

Just imagine a future where braces are less visible, less painful and stay in your mouth less time. Given the AAO's assertion that as many as 75 percent of people could benefit from some type of orthodontic care, that's news you can really sink your teeth into.

Braces Now!

-Mini-braces or mini-diamonds

-Clear and white ceramic brackets to blend with the color of teeth

-Space-age wires made of nickel and copper-nickel titanium

-Lingual braces that go behind the teeth

-Color-coordinated braces and rubber bands in soft pastel to glow-in-the-dark hues

-Retainers designed with sports team logos

-Invisalign®, a system of clear plastic molds without the use of wires or brackets

-Self-ligating brackets

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