When she was a teenager growing up in Fort Wayne, Indiana, Eddie Meisner’s dentist advised her parents that she should have orthodontic braces on her teeth. Her jawline was too small to allow all her adult teeth to grow in correctly, he said, and that would give her problems in the future.
“But I didn’t want to do it, because I was informed I would have to have two teeth extracted first,” Meisner said in a recent conversation. The idea made her squeamish. “Plus, we weren’t well-to-do and I didn’t want to put my family through that strain.” She and her parents decided to bypass the braces option and let nature take its course.
Fast-forward a few decades, and Meisner, now 66 and living in Bangor, is finally ready.
“I’ve lived my whole life with this,” she said. “But this past spring, my dentist said that because of the crowding in my mouth, my teeth would keep chipping as I get older and recommended orthodonture.”
In May, she said, she had two “perfectly good” teeth extracted and in June she was provided with a graduated series of clear, plastic trays, custom-made for her particular orthodontic configuration and goals. Over the next two years or so, these trays — they snap over her teeth like a retainer or a night guard — will gently move her teeth into a healthy alignment. The goal is to avoid additional chipping and cracking damage, make it easier to floss and generally maintain the good health of her teeth.
And, yes — her smile will be enhanced as well.
“I will enjoy the cosmetic benefit,” she admitted. “I can already see that they are a little straighter.”
“My turn now”
Adult patients like Eddie Meisner make up about 30 percent of the patient population at Hardy Orthodontics in Bangor. Dr. Jamie Hardy, who is just 30 years old and works with his father, Dr. Louis Hardy, and the elder Hardy’s longtime clinical partner, Dr. Kent Tableman, says that’s a significant increase from just a decade ago, when only about 5 percent of the patients in the practice were adults.
Largely, he said, that’s due to the advent of “clear aligners” — such as the clear-tray technology Meisner is using, top and bottom — that minimize the visibility of the process. Even more than teenagers, he said, adults don’t want their orthodontic appliances to be the first thing people notice about them.
Other options include clear ceramic brackets affixed directly to the teeth with a white or plain metal wire for traction, and, for the more flamboyant, shiny metal brackets with multicolored elastic ties.
“A lot of our adult patients had orthodontics as a child and have relapsed,” Hardy said. “Others didn’t need it when they were younger but now want to align teeth that have moved around.”
Hardy said many older adult patients have provided orthodontic treatment for their children and now have the opportunity to seek treatment themselves.
“They tell me, ‘It’s my turn now,’” he said. Others are attracted by improvements in technology that make orthodonture more precise, less uncomfortable and, sometimes, less time-consuming. And some seek realignment in preparation for dental implants and other restorative work.
All of this is made possible by generally improved dental care enjoyed by many Mainers compared to that of their parents or grandparents, Hardy said. “A lot more patients are keeping their natural teeth longer,” he said, and actively seek to maintain a healthy and attractive smile rather than surrendering to a mouthful of sliding teeth, gaps or full dentures.
A typical “full-bite restoration” costs between $4,500 and $6,000, he said, and takes about a year and a half to complete. Adult orthodonture, with some exceptions for medical necessity, is rarely covered by any kind of insurance.
According to orthodontist Michal Kleinlerer, who practices in Waterville and Augusta, the number of patients nationwide who are 18 and over has increased by nearly 70 percent since 1989. As of 2014, she said, 27 percent of all U.S. patients undergoing orthodontic treatment were adults. In her own practice, about 20 percent of patients are over 18, and about a third of those are over 40.
Her oldest patient was 78 when she entered treatment. Like many older patients, her teeth had become crowded and misaligned over the years and she wanted a more beautiful smile going forward.
Kleinlerer is the incoming vice president of the Northeastern Society of Orthodontists and is active in the American Association of Orthodontists.
“People are living longer and healthier in their later years,” she said. “They may be 50, but they’re 50 years young and expect to live another 30 or 40 years. Why not invest in a healthy mouth and an attractive smile and the benefit of their natural teeth?”
Older patients interested in orthodontic work should have essentially sound teeth with healthy roots and gums, Kleinlerer said.
“If roots are shortened” — often the result of poor oral hygiene over time — “orthodontic treatment can make it worse,” she said. They should also have realistic expectations about how long their treatment will take and be wary of claims that their teeth can be realigned over just a few months.
“There is no quick fix in orthodonture,” she said, regardless of which appliances are used.
And, she noted, though regular dentists can generally perform basic procedures to improve tooth alignment, specialized training in orthodonture is needed for more complicated situations.
“When a patient is looking for orthodontic treatment, it’s important to do due diligence about whoever is doing their care,” Kleinlerer said.
Following the rules
In Bangor, Eddie Meisner has gotten used to her new routine, but it hasn’t been easy. She appreciates that the clear alignment trays fit tightly and are nearly invisible, so most people don’t even realize they’re there.
“The hardest part is that it’s such a nuisance to take them out and put them in,” she said.
Fortunately, that doesn’t happen often — she’s supposed to wear the trays 22 hours a day, seven days a week. That leaves just two hours for eating and drinking, brushing and flossing, cleaning the trays and putting them back in.
“For someone my age who is used to lingering over my morning coffee and then enjoying a second cup of coffee, that’s tough,” she said. “And I like to have a glass of wine before dinner and then enjoy a leisurely dinner.”
But she’s a rule-follower, she said, and has learned to accommodate the changes — and has lost five pounds as a result of her curtailed snacking and mealtimes.
“In the beginning, I thought, ‘Oh my God, what have I got myself into,’” she said. “I thought, ‘I will never get these out. I’ll never eat again.’ But like other things, with practice, you get the hang of it.”
Her family is long-lived, Meisner said, and she expects to live well into her 90s.
“I’m going to need these teeth for a long time,” she said, and that makes her commitment stronger to getting the most out her long-delayed orthodontic treatment.