adult orthodontia

[Sam Spade]

What is your opinion of adult orthodontia? What are the important risks and concerns in correcting malocclusion in adults, particularly aged 50+ and of good overall health? How does treatment plan differ in children and adults? A friend inquired of his general dentist his options for aesthetic (not functional) improvement of mandibular front teeth alignment by orthodontic therapy. The GP advised against ortho and explained that the adaptive bone response to mechanical loading becomes compromised with age and would not be able to accommodate tooth movement in the adult mandible. Intuitively, I'm skeptical of this explanation and I wonder what motive the GP would have for discouraging treatment. Thank you for taking the time to share your insights.

Sam

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[oms fan]

I'm only a second year student but it is my understanding that as long as the adult is free of caries and their periodontal health is good...orthodontics can be performed and expected to work, though at a slower rate. How old is this general dentist I wonder?? Ortho back in the day was done by applying a lot of force to the teeth over a short amount of time. This only causes excessive bone resporption, root blunting, etc. More recently, the technique is much better and there is a better understanding of the bone remodeling mechanism. I don't think the general dentist has any malicious intent. They probably think they are looking out for their patient. Maybe they need to just read up a little bit. I would suggest a second opinion. I hope this is of help.

Here is a section from "Contemporary Orthodontics" by Proffitt.

"There are no fundamental differences between treatment for adults and children. The response to orthodontic force may be somewhat slower in an adult than in a child, but tooth movement occurs in a similar way at all ages, and comprehensive treatment for adults can be divided into the same stages discussed in Chapters 16 to 19. Despite this, comprehensive treatment for adults brings with it a set of problems that simply do not exist with younger patients. Special considerations for adults fall into three major categories: (1) different motivations for seeking orthodontic treatment and different psychological reactions to it, (2) heightened susceptibility to periodontal disease, and the possibility that active periodontal disease and the replacement of missing teeth is the reason for seeking treatment in the first place, and (3) a lack of growth, even the small amounts of vertical growth on which orthodontists can rely during treatment in late adolescence. This not only precludes changing jaw relationships without surgery but makes tooth movement more difficult.

 

[DcS]

The post above did a good job. I know for a fact it is doable, as I remember that exam question on Dr. Profitt's Ortho exam last year...it was something like T/F it is possible and realistic to conduct ortho tooth movement on a 68 year old.

If it's mild mandibular crowding, as it seems like you described, that is pretty easily remedied. The mand incisors can be shaved a bit and moved with a removable appliance. Of course, there are cautions w/ adults, because movement is slower and a w/ pt at that age periodontal concerns are much more important. I would advise a 2nd opinion.

 

[no2thdk999]

Is the DDS recommending $18K worth of veneers or crowns that he doesn't want to lose to the ortho?

There are plenty of reasons why someone wouldn't be a good candidate for braces, but to my knowledge having had a certain number of birthdays is not one of them.

JMHO
Rob

 

[rpalmer]

Sam, Others ...

I know that sometimes just plain stubborness can be the culprit.

My father is a GP, 62 years old. When you ask him about procedures like the 6 month braces techniques or Invisalign, etc... he just gets irate. He will start spewing info about damaging teeth, bone and gums. (even though these are low force methods)

He will choose his CE courses based on what he already does and accepts. So, because he does not know all the info on something, he will speak negatively about it. Not only this, but up front cost to GPs to start using these can be heavy, hence more negativity.

It's the old saying ... We tend to be afraid of things we don't understand. I realize there are some smoke and mirror techniques, but adult orthodontia is a much desired and beneficial practice. Look at the life-changing Makeovers being done in such a public venue, encouraging more folks to seek it out.

This has been my experience with some GP's and newer techniques.

Now, I also know MANY older docs who grasp on to new technology and techniques and have a blast. So, this is just one reason.

take care,

Rebecca

 

[Sam Spade]

Thanks everyone for your replies. Interestingly, the dentist in question is not likely to be uninformed, impervious, or simply apathetic to the advances of the dental and scientific communities, as many of us would suspect. In fact, he's a part-time instructor at an acclaimed dental school in the Northeast. Puzzling, indeed.