Advancements in dental care like clear aligners and aesthetic brackets have made adult patients more comfortable getting treatment
Patients over the age of 18 now account for almost a third of those seeking orthodontic care, according to the American Association of Orthodontists. Photo: Shutterstock
I’d thought I’d said goodbye to braces back in middle school. But several decades later, after an unfortunate encounter with a piece of jagged pavement sent me tumbling and knocked an incisor askew, I found myself headed back to the orthodontist to once again straighten my smile.
Arriving at the clinic at Tufts University School of Dental Medicine, I expected to be surrounded by kids and their parents. I was wrong. Adult patients over the age of 18 now account for almost a third of those seeking orthodontic care, according to the American Association of Orthodontists.
That trend holds at Tufts. “The numbers have grown significantly in our clinic,” says Shankar Venugopalan, chair of the Department of Orthodontics at Tufts. “Orthodontics has been thought of as a modality only for children. Now that’s changed significantly; more adults are seeking care, and there are a number of reasons for that.” Chief among these, he says, is that with advancements in medical and dental care, people are living longer and holding onto their natural teeth longer, too.
Some patients, like me, need orthodontic treatment to repair damage from an accident. Others are catching up on long-delayed treatment that wasn’t accessible to them when they were younger. Or, patients return to correct misalignment that has developed in the years since their first orthodontic experience. Lillian Norton-Hunt, a retiree now living in Plymouth, Massachusetts, who has been a patient at TUSDM since 2021, falls into the latter category,
“I did have them as a kid. The memory’s not great,” says Norton-Hunt. “They were the old style, with the wax and everything, and oh, they were so uncomfortable.” As the years went on, she felt that one of her front teeth was just never quite right. “It was always one of those things; I always wanted it to be better.”
Her general dentist, Janis Moriarty, D94, referred her to Tufts University Dental Care Center. That was in 2021, and Norton-Hunt remains enthusiastic about her decision. “I think it’s been a wonderful thing for me. It’s been a positive experience all around,” she says.
A Dental Journey
At Norton-Hunt’s initial evaluation, the dentists recommended that several other dental issues be addressed before embarking on braces—a situation Venugopalan says is not uncommon, since it’s important to have healthy bone and gum tissue before attempting to move teeth. That’s also among the reasons people should avoid direct-to-consumer aligners that don’t involve a comprehensive exam and constant monitoring by a dental professional, or DIY hacks lifted from the internet.
Lillian Norton-Hunt, a patient at Tufts University School of Dental Medicine, opted to use clear aligners, or medical-grade thermoplastic full-mouth trays that sit over the top and/or bottom teeth and easily snap in and out. Photo: Alonso Nichols
It wasn’t until the fall of 2024 that Norton-Hunt was ready to begin her orthodontic treatment. To her delight, she learned the “metal mouth” of thick silver bands encircling wide swaths of the mouth are no longer standard practice. For most adults, that helps seal the deal, Venugopalan says.
“Back in day it was just traditional fixed appliances, and many adults were not comfortable walking around with braces in their mouths. There was a bit of a social stigma attached to it,” says Venugopalan. “That has changed with the advent of clear aligners and aesthetic brackets. You can now have tooth-colored brackets and wires that have made adults feel more comfortable.”
The clear aligners—most often known by the brand name Invisalign—are medical-grade thermoplastic full-mouth trays that sit over the top and/or bottom teeth, anchored by tooth-colored attachments—little plastic bumps on the teeth—that easily snap in and out. They are meant to be worn full-time, but can be removed for eating, brushing, and flossing. Both Norton-Hunt and I opted for the aligners.
It was not the braces experience Norton-Hunt remembered from being a kid. “It was a complete difference. I thought I wasn't going to be able to sleep. I thought I’d feel like a hockey player with all this stuff in my mouth, and I would sound like I had a mouthful of nickels, as my grandmother used to say,” she says. “That was not the case. These have worked out really well. It took me a little bit in the beginning to get used to it, but now, I’m fine. And the teeth have moved substantially, more than I thought they would.”
How it Works
The aligners slowly move the teeth toward their preferred position; after a short period of time, say, two or three weeks, patients swap out their current set for a new one, which then move the teeth even further.
Both aligners and fixed braces apply gentle pressure to move teeth. Teeth are connected to the jawbone by a band of connective tissue fibers called the periodontal ligament, which transmit the gentle pressure to the bone to be remodeled, allowing the teeth to move, says Venugopalan.
How long do most adults have to wear their braces or aligners? The timeframe varies considerably, but Venugopalan advises that treatment will move slower for a mature mouth than for a youngster.
“In children, as they are growing, the bone is not fully mature,” he says. “The rate of tooth movement in a 15-year-old, versus a 50-year-old, is not the same. If I were to treat a mom and her daughter, chances are highly likely that with the same type of dental problem, being treated the same way, the daughter’s treatment would be finished earlier. Her teeth could be moving twice as fast. We ask adults to be mindful of that.”
Norton-Hunt is nearing the end of her treatment with the aligners. Like younger patients, adults are very often prescribed retainers at that point, usually for daily use during the first three to six months and then for continued use overnight. They’re vital for maintaining the new positions of the teeth, “Retainers are for life,” Venugopalan emphasizes.
I’ll confess I was not consistent with my retainer as a teen, and I’d completely abandoned it by the time I was an adult. I wasn’t alone. “[The retainer] was always a problem when I was a kid,” confides Norton-Hunt. “This time it will be a little different. I’ll do what I need to do.”
Are you ever too old for orthodontics? “There’s no age limit as long as you want to have straight teeth, and don’t have other health conditions that prevent it,” says Venugopalan.
“In my practice the oldest patient we had was someone in her late 70s,” he recalls. “She was my most wonderful patient.”
