Although childhood is the ideal time to make changes to teeth positioning, more adults are nowadays opting for orthodontic treatment and coming away with excellent results.

Dr Pascal A. Demajo, dental surgeon with a special interest in orthodontics, says there is no such thing as being “too old for braces”. Today, nearly half of his patients are adults.

“My oldest patient undergoing orthodontic treatment is over 60. She opted to have the treatment instead of having an implant placed in the space of a missing tooth. This allowed the alignment of her otherwise crooked teeth.”

Braces are used to align and straighten teeth. One can opt for different types, with the most common one being the traditional metal brace. But there are also ceramic or plastic braces that are tooth coloured.

Lingual braces are the same as traditional braces, placed on the inside of the teeth. There are also clear plastic aligners that are custom-made and replaced every two weeks.

“Today’s fixed braces are more comfortable and less obtrusive than those of the past. They’re smaller and the wires are less noticeable,” says Demajo.

Contrary to popular belief, the initial process of getting the braces fixed is normally not painful.

“First the brackets are cemented or bonded to the tooth surfaces. Arch-wires are then threaded through the brackets to direct the force being applied to the teeth. The arrangement of the wires can be customised to apply different pressures to individual teeth. Sometimes elastic bands or springs are attached to the arch-wire to boost the directional push,” explains Demajo.

This takes around one or two hours without any anaesthetic used.

The time it takes for the teeth to straighten may vary but, on average, adults can expect to be wearing braces for 12 to 24 months.

“Simple straightening of the six front teeth may take as little as six months.

“In more complicated cases, the entire process may take slightly longer than it would in a child or adolescent.”

Demajo says that today’s braces are extremely versatile and can move the teeth in various directions.

Once fitted with brackets, one may experience some discomfort. While this can vary from one individual to the other, it normally wears off in a few days. Routine adjustments may also cause such discomforts which also depend on the changes made.

Initial complaints from adults with recently fitted braces include mouth sores − which can be easily solved with application of dental wax − difficulty in speech and limitations in eating certain foods.

Wearing braces has now almost reached the stage of a status symbol of personal self-improvement

He also highlights the importance of meticulous oral hygiene.

While many attribute wanting a bright smile with straight teeth as the main reason for getting braces, Demajo refers to health benefits.

“Misaligned or crooked teeth and mal-occlusion − incorrect bite− lead to an accumulation of food build-up. As a result, unless there is a strict tooth-cleaning regimen, there will be an increase in plaque which is the main contributor to periodontal problems, gum disease and caries.

“People with an irregular bite pattern often experience stress and impact on certain teeth; this eventually leads to premature dental problems.

“Over time, difficulty in biting, eating or chewing food may result in digestion issues as well as elicit pain in the temporo-mandibular joint.”

Adults seeking such treatments need to also keep in mind that their bones have stopped growing. For some structural changes, especially skeletal ones, surgical intervention may be required.

Demajo advices potential patients that they need to commit to maintain good oral hygiene when wearing braces.

“It is very important to brush teeth after every meal and to use mouthwash and floss daily. This may seem tedious but is needed to maintain good oral health. The extra responsibility of caring for braces and teeth properly is something that patients need to be prepared for.”

As for care needed post-treatment, Demajo talks of the importance of using a retainer.

“It takes about nine months for periodontal ligaments − which hold the teeth in bone − to ‘remember’ their new positions.”

One can get either fixed or removable retainers and these are often invisible on the teeth.

Certain medical conditions may prevent patients from being able to get braces fixed. These conditions include severe heart-valve disease, bleeding disorders, leukaemia, severe uncontrolled diabetes and low bone density count.

Periodontal diseases must also be brought under control prior to any orthodontic treatment as this may aggravate the disease.

Prices of treatment depend on whereabouts in the world one gets it and the cost range of braces can vary greatly for each type. In Malta, prices tend to be lower than those in the UK, Italy and the rest of mainland Europe.

A basic treatment in one arch costs around €1,000 to €1,500, whereas a two-arch treatment costs about €2,300 to €3,000, inclusive of post-treatment retainers.

While admitting that stigma towards those with braces has decreased drastically, Demajo says people’s reactions may cause patients to feel uncomfortable and self-conscious.

“Close friends, partners or other important people in your life would know about the braces; business associates or fellow office mates may not.

“Sooner or later, you’ll open your mouth and they’ll react. One must be prepared to deal with different reactions.

“Some men feel funny with braces, whereas women tend to feel unattractive. In other words, both tend to feel self-conscious.

“The best way to get through this is to plan ahead. A little forethought helps with getting through the initial awkward moments.”

He adds most people are sympathetic and realise it is something positive and improves both well-being and appearance.

“When it comes to straightening teeth, there is no age cut-off. Wearing braces has now almost reached the stage of a status symbol of personal self-improvement, especially in young adults,” points out Demajo.