SUNDAY, May 20, 2001 (HealthDayNews) -- Alyson Daichendt knew her teeth were in trouble. Her dentist had repeatedly suggested an orthodontist, but she couldn't get past the image of going to work every day with a mouth full of metal.
But when her dentist finally explained that her bite was so far off it was wearing down her teeth, the 32-year-old human resources professional from Atlanta gave in.
In her initial consultation with an orthodontist, Daichendt asked about so-called "lingual" braces, which use a metal bracket and wire attached to the back of each tooth, as opposed to traditional braces, which attach to the front of each tooth. The orthodontist, Dr. Michael Stewart of Sandy Springs, Ga., instead suggested another option -- the new, plastic Invisalign aligners, a series of custom-made, clear molds that progressively shift teeth into place.
"When he told me about them I had some concern," Daichendt recalls. "You don't think by covering your teeth with plastic liners that it can move your teeth."
Stewart says he, too, had initial concerns about the process. But, he adds, "I would say over the last year, we've become more comfortable with it."
Adults in general seem to becoming more comfortable with the idea of wearing braces, once considered strictly kid stuff. The American Association of Orthodontists estimates that of the 5 million orthodontic patients in the United States and Canada, about 1 million are over the age of 18.
Dr. Joseph Zernik, a professor of orthodontics at the University of Southern California's School of Dentistry, says major advances in materials and treatment options have made braces more palatable for adults.
"The development of bonding materials allowed us to bond to each tooth separately," Zernik says, adding, "We now have a very wide range of options."
The creation of clear braces, which are much less noticeable, are also proving popular with many adults, orthodontists say.
And, Zernik notes, cultural influences often pressure adults to fix their teeth.
"In Southern California, it's almost unacceptable in many work places or social environments to appear with crooked teeth," he says. "Orthodontics have become widespread, almost a standard."
The choices are clear
The good news for adults is that orthodontists now offer not just the Invisalign aligners but also lingual braces and labial braces -- the traditional, front-of-the-teeth type -- that have clear brackets and tooth-colored wires.
Each process has its strengths and weaknesses, experts point out.
Labial braces can repair virtually any problem and are usually the least expensive option -- generally in the range of $4,000 to $5,000. But they are more noticeable because they're on the front of the teeth and make it more difficult to keep teeth and gums healthy during treatment.
The Invisalign aligners are easy to wear, but can't be used to repair significant problems, orthodontists say, adding they work best on cases of mild-to-moderate crowding or spacing. Wearers take them out when they eat or brush and floss, which means they can eat what they want and have no problems keeping their teeth clean. The aligners tend to cost about 30 percent more than labial braces.
Lingual braces can correct more serious defects, but aren't as good as labial braces for producing a picture-perfect smile. They also affect the way a person chews because they're on the inside of the teeth. And they make it harder to keep teeth and gums clean. They generally cost about twice as much as labial braces.
He's tried them all
Mark Allen of New York City has used all three types of braces during more than a year of treatment to fix his crooked teeth. Even though he had long envied other people with straight teeth, he says traditional metal braces were out of the question.
"I'm a technology consultant to major banks. I can't really sit down with a manager director at a bank and recommend million-dollar products with a mouth full of metal," he says.
Allen, 30, initially went to a Brooklyn Heights orthodontist, Dr. Ted Rothstein, specifically for lingual braces. When Rothstein recommended lingual braces for the upper teeth and clear labial braces for the bottom teeth, Allen balked. He wanted nothing to do with anything that would be visible to clients.
They chose instead to try Invisalign aligners on the bottom teeth; Rothstein says they fit over the teeth like "vacuum-wrapped cheese." While they were waiting for the aligners to be made -- it took several months for Allen's first mold to arrive -- he had lingual braces put on. He quickly discovered the most common problem associated with them -- the brackets and wires can make the tongue very sore at first.
"You don't realize that you use the entire inside of your mouth to speak," Allen says. "I tore up my tongue for two weeks."
When he finally got his first aligners, Allen also learned about a common complaint. "Wow, it was uncomfortable," he says. "That lasted about two days."
Both Allen and Daichendt say the aligners work well, but take some getting used to.
Daichendt says it took her about two weeks to learn to speak properly again with her aligners. And she avoids drinking coffee because it turns them a milky color. Allen says it's not easy to discreetly remove the aligners to eat a meal.
Within six months, Allen had finished his prescribed treatment with aligners; now he's finishing up with what he said he didn't want in the beginning -- clear braces on the front of his top and bottom teeth.
"It's not bad," he now admits. "People don't notice these."
What To Do
To learn more about braces for adults, here are some Web sites with solid information: The American Association of Orthodontists; the Review of Lingual Orthodontics on the Web; or Yo, It's Time For Braces (this one's designed for children and teens, but has an excellent overview on lingual braces).
For information on Invisalign aligners, visit the company's Web site.
For pictures of adults wearing transparent braces, visit Dr. Ted Rothstein's Web site.
For more general information about teeth problems, check out these HealthScout stories.