Braces are placed on teeth to straighten them. There are several reasons to seek orthodontic treatment. Aesthetics, speech, breathing or chewing problems are the on the commonest.
The American Association of Orthodontics (AAO) recommends that initial orthodontic evaluation shall occur at age 7. In the majority of cases, orthodontic treatment isn’t required at this young age. Early evaluation provides both early diagnoses of the problems and greater opportunities for timely treatment.
There is no specific age to get the braces. You can get them at any age but there are pros and cons of getting braces at any age. We will look into them separately.
Braces at a young age
The best approach is to get the treatment at an early age. Parents should monitor their children for any crowding or spacing or growth problems with the jawbones. Early treatment corrects the teeth while the face and jaws are still growing and produce more desirable and stable results.
Since 90% of the face is developed by age 12. In young patients, any problems with the growth of jawbone that is either too forward or backward placed can be corrected with a growth modification appliance while the jawbone is still growing.
It has been estimated that approximately 75% of children have some form of misaligned teeth by age 12; therefore treatment must be initiated early to avoid any complexity and costly treatment later on.
It is advised to try and intervene the orthopaedic (bone-related) problems in the mixed dentition (both milk and permanent teeth are present) before the eruption of all the permanent or adult teeth.
The disadvantage of starting treatment at a young age is the length of treatment. First, the treatment may prolongs while waiting for the eruption of all the permanent teeth to bring them to the correct position. Second, patients with problem with jaw growth may require a two stage treatment, an intial phase of growth modification followed by straightening of the teeth.
Braces in adults
you can get the orthodontic treatment at any age, however, children respond well to the required corrections because of the growing jawbones.
It is important to note that it’s never too late to correct your teeth. So if you are an adult and you are not happy with the way your teeth and smile look, you have bite or speech issues due to malaligned teeth, book an appointment with your orthodontist right away.
To start an orthodontic treatment, your orthodontist will evaluate your teeth and jaws on the following grounds to see if you are fit to get the braces.
In general, the medical conditions that affect orthodontic treatment are relatively few although their incidence is likely to increase with age. Among them are pregnancy, diabetes, rheumatoid arthritis, osteoporosis and renal problems.
Certain medicines have a bearing on orthodontic treatment, for instance, steroids, bisphosphonates and NSAIDs. Their long-term intake and the way they work interfere with bone resorption and the eventual tooth movement.
Previous orthodontic treatment
An orthodontic retention appliance is given to every patient at the end of the treatment to prevent relapse. The treatment relapse occurs in patients who don’t wear the retention appliance regularly and may require re-treatment.
Before considering the retreatment your orthodontist accesses your case to see if there are any root resorptions or decalcifications from the previous orthodontic treatment.
Root resorption is the dissolution of root and is an undesirable side effect of long orthodontic treatment.
The rate of resorption is reported to double in retreated cases. These teeth need to be closely monitored with a minimum possible force application.
The presence of decalcifications doesn’t preclude you from re-treatment, however, strict oral hygiene measures and periodic evaluation are important to see any changes.
Treatment motivation and co-operation
Patient co-operation and compliance during the treatment are also age-related. Due to long duration of treatment in young patients and the resulting patients/parents burnout, they show less compliance and prematurely discontinue the treatment.
Adult patients seek treatment because they are driven by self-motivation to improve their aesthetics and show up more regularly on their appointments.
Lack of growth
As discussed earlier, face development completes by age 12. Adults seeking treatment due problems in jaw growth that are either too forward or backward positioned cannot be treated because of completion or cessation of growth. These patients may have compromised treatment results.
Mild to moderate problems with jaw growth can treated with braces alone. Yet, severe cases may require corrective jaw surgery (orthognathic surgery) with pre (aligns teeth to prepare jaws for surgery) and post (final finishing changes after surgery) surgical orthodontics (braces).
During orthognathic surgery, an oral surgeon either cuts away the excess bone in enlarged jaws or add bone grafts in small jaws that need augmentation.
Age related affects on bone
Ageing is associated with decrease in blood supply and turnover or remodelling of bone, with a consequent decrease in the pace of tooth movement and an increase in treatment duration.
Children are less prone to root resorption due to growing, vascular and more elastic bone. Moreover, teeth with an open apex or end in young patients are less susceptible to root resorption.
Newly erupted teeth have roots with open apex. The open root apex closes within 2-3 years of tooth eruption and terminate into a small hole through which blood vessels and nerves enter the tooth.
More than half of the adults suffer from some form of temporomandibular dysfunction (TMD) at any point in life. Signs and symptoms of TMD increase with age, particularly during aduldhood, until menopause.
Temporomandibular joint (TMJ) is the joint between the lower jawbone and skull and it allows your lower jaw to move forward, side to side, up and down. The upper is jaw fixed and it’s the lower jaw that allows all the movements.
TMD are disorders of the jaw muscles, temporomandibular joints, and the nerves; associated with compromised movement of the jaw, muscle pain and difficulty in chewing. Orthodontic should therefore be deferred until TMD is stabilised.
Chronic periodontitis occurs in all age groups with an increase in percentage with age. It affects 56% of teenagers, 74% of adults and 86% of old age people.
Patients with active periodontal disease (infection and of tooth attachment fibres and bone) are not fit for orthodontic treatment because force application during the treatment, leads to further loss of periodontal support.
Misaligned teeth or overlaping teeth harbour more plaque and tartar, and can initiate the periodontal disease. Periodontitis also alters the stability of teeth, leading to drifting, tilting or rotation of teeth. An orthodontic treatment provides teeth that are easy to clean. It can be initiated in patients with controlled periodontal disease to improve the stability and appearance of the teeth.
Previous dental treatments
The presence of metal fillings or porcelain crowns may present difficulty in placement of orthodontic appliance. It is though possible to bond brackets to gold, porcelain and ceramic but requires complex techniques and armamentarium.
Additionally, adults with multiple fillings, root canals and crowns indicate patient’s motivation towards oral hygiene. Orthodontic appliance makes the cleaning difficult so patients with compromised oral hygiene before the treatment aren’t good candidates for the treatment. Furthermore, multiple and heavy restorations can complicate the tooth movement.
Fixed orthodontic treatment can be given at any age. However, treatment in young patients produce more desirable and stable results.
As you age, periodontal problems, certain health issues and use of some medications, history of previous orthodontic treatment and other restorations may need evaluation to start the treatment.