. . . for the following headlines tracking the bustling new world of adult orthodonture.
Midlifers invade orthodontists' offices; kids hide Highlights magazines.
It seems that we don't just want our kids' hard bodies; we want their straight teeth, too. According to the American Association of Orthodontists, of the 5 million people in the United States and Canada wearing braces today, 1 million are all grown up. That's a 14 percent increase over the 875,000 adults wearing braces in 1989. Wealthier areas probably see more adults in braces. Nahid Maleki, an orthodontist in Northwest, says 30 percent of her patients are adults.
Boomers reclaim youth in hand-shaped orthodontist chairs.
I see three reasons why so many boomers are getting braces: residual love of Mary Tyler Moore (she who can turn the world on with her smile), fear of Efferdent, and disposable income.
Some adults have been self-conscious about their teeth for decades. At some point in midlife, they just decide to do something about it. "The braces I had in middle school just didn't make enough room," says Emilija Sakadolskis, a 48-year-old music teacher in Rockville. "My teeth were being pushed forward. They were popping in and out." She got braces last May. "I thought, hmm, menopause, braces and a doctorate all at once. That sounds like a good idea!"
Other adults -- like gastroenterologist Robert Finkel -- get the nudge from their dentists, who predict danger ahead. Crowded teeth that are difficult to clean can invite gum disease. Misaligned jaws -- overbites, underbites and crossbites -- can cause uneven wearing of teeth, jaw problems and gum disease. And gum disease can mean tooth loss and the dreaded dentures.
Prices for adult braces range from $4,000 to $8,000. Some adults get help from their insurance companies; many do not. Sakadolskis and Finkel are paying the full freight themselves -- more than $6,000 in each case.
Adults put highest value on transparency.
Advances in orthodontic technology have given boomers what we crave the most: choices. When we were kids, everyone who got braces got the silvery train-track variety. These days, according to Silver Spring orthodontist Lisa DeMarco, there are basically three kinds of braces: traditional metal ones, ceramic ones that are not nearly as noticeable, and clear plastic shields (Invisalign is one brand name) that resemble removable mouth guards.
Adults with choices don't generally choose traditional metal braces -- it seems the bright-colored wires play better in middle school than middle age. Ceramic braces work exactly the same way as metal braces. They cost a bit more but, DeMarco says, have "more of an adult look." Maleki says nine out of every 10 of her adult patients wear them.
The clear plastic appliances work best for adults who have some crooked teeth but reasonably well-aligned jaws. A fourth type of brace -- lingual orthodontics -- fit behind the teeth, but haven't caught on in a big way. They can mean longer treatment time and tougher cleaning problems. And don't forget conventional, removable retainers, which can sometimes solve the problem without full-blown braces.
Midlifers learn new meaning of "lifetime retainer."
There are other downsides to adult orthodonture besides cost and discomfort:
Cleaning: Maintenance issues for adults with braces can be complicated and time-consuming. "If an adult doesn't floss for a week, they'll get bad breath, their teeth will look horrible and they will have periodontal problems," DeMarco says. And adults with braces must brush after every meal and snack.
Dennis Cullen, an internist who got braces at age 46, says he lost 15 pounds in the 18 months he wore braces. "I wasn't going to eat during the day and be picking at my teeth all the time. I dropped down to a 32-inch waist." (Okay, maybe that's not a downside.)
Time: Adult cases often take longer to treat than adolescent ones, DeMarco says, noting that the typical time for her adult patients is 2 to 21/2 years. Plus, during treatment time, adults must clear their schedules for regular appointments. "There were times when I left my patients in the waiting room, raced down Wisconsin Avenue, double-parked with the flashers on and the hood up, got my adjustment and raced back," Cullen says.
Retainers: To keep that perfect smile, adults must wear retainers several nights a month for the rest of their lives. "Even five years down the road, if you stop wearing that retainer your teeth are going to start shifting," says Michael Malone, president of the American Academy of Cosmetic Dentistry.
That's where Cullen decided to call it quits. "At no point was I going to walk around in the evenings with a mouthful of retainers." Plus, Cullen says, he just couldn't get himself to one more appointment to have his retainers adjusted.
Boomers with braces threaten lawsuits against bullies, own children.
For boomers, taunts like "brace-face," "tin grin" and "metal mouth" have made way for more sophisticated teasing.
"Most people's jaws last a lifetime. You wore yours out in your mid-forties." That's the line Cullen remembers most. "It was particularly hurtful for a talkative guy," he says. "I'm not sure it was a joke."
Cullen says the "leader of the abuse" is his 15-year-old daughter, who also wore braces. "Cost me about $3,600. Her teeth are magnificent, and she wears her retainers. She shows them to me every time she kisses me good night."
Eyes wide shut or miracle of low expectations?
It's particularly important for adults with braces to keep expectations in check, DeMarco says. "If you're 55, your teeth can be sort of brown and worn down." After the braces come off, you may have straight teeth, but "you're not going to look like you're 17."
Someone should tell Tom Cruise. At age 39, he got braces last year.
The columns KidLife and MidLife appear on alternating weeks. Send comments, suggestions and questions to kidmid@washpost.com. For U.S. Mail, see address on Page F2. No calls, please.