Americans Brace Themselves For Beauty

FARMINGTON –– Tom Cruise, America's heartthrob, has braces. Beautiful as he is, he has nonetheless joined the growing number of adults –– about 880,000 of them, which is an increase of about 23 percent over 1994 –– who want a more perfect smile.

Braces, for the most part, are applied for cosmetic reasons; to straighten teeth or eliminate crowding or spaces, and generally improve appearance. "In a very few cases, there may be some health reasons for getting braces. Mostly, though, braces make a real difference in how people feel about themselves," said Andrew Kuhlberg, DMD, professor of orthodontics at the UConn School of Dental Medicine, and director of its orthodontic practice, which treats hundreds of adults and children every year.

"Crooked teeth and ugly smiles almost certainly have a negative impact on a person's self image, and that's hardly a trivial problem" said Dr Kuhlberg. "Next time you watch a movie, notice that the monsters and villains almost always have horrible teeth and the heroic characters always have beautiful smiles. I don't think the artists create them that way by accident. The message is clear. Monsters and bad guys have bad teeth. Good guys have nice teeth," he said.

So if you have decided you or your child needs a better smile, there are a few things you should know about braces, according to Dr Kuhlberg.

New technology. Bands are no longer wrapped around the tooth. Instead, brackets are glued to the outside of the teeth. And instead of stainless steel, today's wire is a space-age alloy of nickel and titanium. Developed by NASA for use on satellites, the modern wire applies a more constant force, moving the teeth gradually. "That means patients can go longer between appointments for adjustments and the force applied to the teeth is more gradual and less painful," said Dr Kuhlberg.

Time and length of treatment. An early evaluation, around age 7, is fine, and for a few specific problems, early treatment may be best. A cross bite, for example, can sometimes be treated in young children with a jaw expander. Then, as the child grows, the teeth come into the proper position and there is no need for braces. Generally, though, the optimum time for braces is roughly ages 10 to 12 when the child has mixed dentition (some baby teeth and some adult teeth). "That's when you have the most options and can take advantage of space and growth," said Dr Kuhlberg. Most orthodontic treatment lasts from12 to 36 months, with 24 months being average.

Expanding the jaw. This idea has been around for a long time, "but it's not really consistent with our current knowledge about normal jaw growth and tooth development," said Dr Kuhlberg. The idea behind expansion is to widen the upper jaw, which consists of two bones and has a separate left and right half. But the jaw does not grow in the front; it grows in back, behind the molars. "Expansion works, but it's not clear if it provides any advantage over regular treatment at a later stage," says Dr Kuhlberg. "And young children can be hard to treat. They're small and squirmy and dentistry on a moving target isn't easy."

Metal, clear or invisible. There are two main types of braces, metal and clear, and metal is still the most common, according to Dr Kuhlberg. Clear braces, which are either ceramic or plastic, are probably more popular with adults; but the clear braces are harder to remove from the teeth and they are more expensive. The new invisible braces are really a series of clear, plastic mouth guards that are worn in sequence to move the teeth. "It's an exciting technology, but it's probably suitable only for fairly uncomplicated cases," said Dr Kuhlberg. And, the invisible braces are more expensive than the metal ones.

Cost. The fee for comprehensive treatment ranges from $3,500 to $5,000 with quite a bit of regional variation. These days, some insurance plans cover part of the cost of braces, but generally, people should expect to pay at least half the cost out of pocket.

Value. Braces may not be essential for physical health, but they do a lot to enhance appearance and self-esteem. "I like to think orthodontic treatment doesn't make you well," said Dr Kuhlberg. "It makes you better."