Adults are not growing and may have experienced some breakdown or loss of their teeth and the bone that supports the teeth. Orthodontic treatment may then be only a part of the patient’s overall treatment plan. Close coordination may be required among the orthodontist, oral surgeon, periodontist, endodontist and family dentist to assure that the treatment plan is managed well. Below are the most common characteristics that can cause adult treatment to differ from that of children.
No jaw growth: Jaw discrepancy problems, including both width and length, in the adult patient may require jaw surgery. For example, if an adult’s lower jaw is too short to match properly with the upper jaw, a severe bite problem results. The amount that the teeth can be moved in some cases, with braces alone, may not correct this problem. Establishing a proper bite relationship could require jaw surgery, which would lengthen the lower jaw and bring the lower teeth forward into the proper bite.
Gum or bone loss (periodontal breakdown): Adults are more likely to have experienced damage or loss of the gum and bone supporting their teeth (periodontal disease). Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. The word periodontal literally means “around the tooth.” Many people are unaware that they have gum disease because there is usually little or no pain.
Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes inflammation in the gums.
The mildest form of the disease is called gingivitis. The gums redden, swell and bleed easily. Gingivitis is often linked to inadequate oral hygiene. Gingivitis is often reversible with professional treatment and good oral home care.
Untreated gingivitis can advance to periodontitis, a more severe form of gum disease. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body, in essence, turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Eventually, teeth can become loose and may have to be removed.
The good news is that teeth that are properly aligned are less prone to gum disease.
Special treatment by the patient’s dentist or a periodontist may be necessary before, during and/or after orthodontic treatment. Bone loss can also limit the amount and direction of tooth movement that is advisable. Adults who have a history of or concerns about periodontal disease might also see a periodontist (a dental specialist who treats diseases of the gums and bone) on a regular basis throughout orthodontic treatment.
Worn, damaged or missing teeth: Worn, damaged or missing teeth can make orthodontic treatment more difficult. Teeth may gradually wear and move into positions where they can be restored only after precise orthodontic movement. Damaged or broken teeth may not look good or function well even after orthodontic treatment unless they are carefully restored by the patient’s dentist. Extra space resulting from missing teeth that are not replaced may cause progressive tipping and drifting of other teeth, which worsens the bite, increases the potential for periodontal problems and makes any treatment more difficult.