Nothing but the Tooth column: It’s never too late to get your teeth straightened
Q: I am 70 years old and I have some crooked teeth on my lower jaw. This was caused many years ago by a baby tooth that had to be removed due to a cavity when I was a child and impacted molars that were removed in my late teens. Would it be too late for me to get braces to straighten out my teeth?
- V.M., Warwick, Rhode Island
A: First, I want to apologize to my readers who might have noticed my column missing over the last month or so. I suffered an eye injury being a bit too athletic, the consequences of which were to keep me inactive for a long period of time. But I am coming back to normal and happy to answer this great question.
It is never too late to get your teeth straightened.
Now that I have said that, let us look at some particular facts that may affect your decision.
Braces are best done as soon as the alignment problem is noticed. Usually in adolescent to teen years for good reason. In order to move teeth, force has to be placed on them without causing any damage. The best way to do this is with light, steady force applied in the right direction by a well-trained dentist called an orthodontist. That training takes two years after receiving a dental degree and earning a Master’s Degree. (As a General Dentist, I would only diagnose the need for braces but never do them myself; I will talk about that in a moment.)
The reason that light force is important is because if teeth are moved with too much force and too fast, they can be irreversibly damaged and possibly lost in subsequent years. When patients are younger, their bone structures are softer and it is therefore easier to move those teeth with the benefit of not exerting too much force.
Often, a patient may be part of a family that cannot afford braces or the patient at a young age refuses to have braces put on because of aesthetics. Or maybe, the need is not noticed by the dentist, the family or the patient until years move on. And in your case, you have lived with the problem for years and only now have entertained the thought.
As I said above, the treatment can still be done but may be a bit more difficult. As we age, the bone of our upper and lower jaw tends to get denser and harder. When that happens, it takes more force to move the teeth. That may cause damage and treatment might take longer. As a result, it may be more expensive and you have to be ready to take on that financial responsibility. At times, because of the difficulty in moving teeth at an older age, the case will not give the exact result that you might have been looking for, so you have to be prepared for that.
Most important is what I said in an earlier paragraph. I prefer to have patients treated by an orthodontic specialist. Why? Simply because they know more. They did not get that extra training and spend that extra time and money for no reason. They learn much more about the science of moving teeth than there is time to learn in four years of dental school. There is just not enough time to learn everything in that period. This is why some graduates choose to extend their studies.
What I want my readers to be very aware of is that today, there are techniques available where placing brackets and wires on the patient’s teeth in order to apply force to move them, is being replaced by using full mouth plastic aligners similar to mouthguards that athletes wear to protect teeth from injury. These are hard and firm and are placed over your teeth. The orthodontist directs force in a particular way achieved by the way the aligners are designed. These aligners have become very popular because of excellent marketing (the American way), and also because they are clear and often patients like that better than conventional braces.
I caution you and all my readers to understand that many dentists for whatever reasons do not have the two years of training but only take a short course given by the creative developers of this technique. How much they learn in that course is for you to ask. The dentist takes a simple impression of your teeth, sends it to those developers, and they design the aligners for the particular case and then they direct the treatment.
As a former associate professor of dentistry and facilitator of ethics at a major teaching institution, I think that only if the dentist can ethically feel that he/she is comfortable taking on the responsibility for that treatment and all the obligations for results and failure (yes, it can fail) should they attempt it in the first place.
What that means is that I personally am only comfortable having a specialist in orthodontics perform any kind of tooth movement other than very simple procedures.
V.M., one last consideration. After teeth are moved, they have to be held in place for a period of time after treatment needs are achieved. If not, they tend to move back to where they started. For young patients, those retainers might be worn for a few months to a few years. For the older patient, those retainers may have to be worn forever. That, plus the finances are considerations that you must discuss and become comfortable with before starting your treatment.
I hope that clearly answers your question and now that I have returned after my injury, I look forward to answering many more as the weeks move on.
Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at email@example.com.