STYLE PLUS - Brace Yourself Adults' Return to the Orthodont Washington Post (c) 1996 Washington Post. All rts. reserv. 2032345 STYLE PLUS - Brace Yourself Adults' Return to the Orthodontist Chair. The Washington Post, September 06, 1991, FINAL Edition By: Norie Quintos, Special to The Washington Post Section: STYLE, p. f05 Story Type: Features Line Count: 108 Word Count: 1189 "Don't worry. They're nothing like they used to be," said my dentist when he told me I needed braces ... again. Well, yes and no. True, orthodontics has come a long way since I was a kid, when braces were big clunky bands encasing each tooth, giving their wearers a fortified smile visible for miles. Modern technology has provided several innovations in the intervening years: smaller brackets that stick to, rather than wrap around, teeth; flexible wires that hold a preformed shape, requiring fewer visits to the orthodontist; and, perhaps most significant, clear or tooth-colored brackets that are a less noticeable option to the metal braces of old. For those who can afford them, and whose type of treatment will allow it, there are even so-called "invisible braces," or lingual braces, that attach to the back of the teeth for total obscurity. Still, braces are braces. They hurt. They're impossible to keep clean. And, for most of us, they remain embarrassingly visible. People over 18 now make up a quarter of all orthodontic patients, double the number of only a decade ago. Industry experts attribute this growing trend to a greater public awareness of health and concern about appearance, a stronger emphasis by the dental community on keeping teeth longer and a demographic shift resulting in fewer children and more adults. Though many adults decide to get braces for cosmetic reasons, orthodontists see straight teeth only as a byproduct of a nobler medical purpose-correcting a malocclusion ("bad bite"), which, when left untreated, often results in periodontic disease and jaw disorders. Because of adults' fully developed facial structures, orthodontic treatment for them is more complex than for children. In addition, adults may already have begun to develop medical complications. In about 10 percent of adult cases, orthodontic treatment must be combined with surgery. But on the whole, orthodontists agree, adults are a vain bunch, neurotically concerned with their diminished looks. Many opt for clear braces, despite the higher cost (between 50 percent and 100 percent more). Almost all of Jacob Harris's adult patients in the District, for instance, choose some type of cosmetic braces. In fact, Harris and his partner maintain a practice that specializes in the treatment of adults, and are two of only a few orthodontists in the area who apply lingual braces on a regular basis. Harris chuckles at the polarity of his patients: the older ones who want to hide their braces behind their teeth; and the younger ones who "beg for the latest prepubescent status symbol-fluorescent brackets, with a different color for each tooth." No doubt, adults can be extremely self-conscious of their changed appearance. They hate to look foolish. In work situations, they want to appear professional. In social situations, they want to appear attractive, appealing, even sexy. (Braces are not sexy.) Family, friends, and co-workers usually are supportive. Margaret Dominguez, a 53-year-old real estate saleswoman in Northern Virginia who wore braces for four years, says, "Other than the occasional 'My mom, the kid' comment from my children, everyone was great." It's the social situations with passing acquaintances and strangers that give adults the most trouble. According to Ginni Booher, a 24-year-old meeting planner from Alexandria who wears metal brackets: "In work situations, it's never been a problem. Most times I'm not even aware of my braces. But I'm a lot more conscious about them at a bar, for example. People always seem to be staring at me, or the bartender will pick me out among my friends to ask for an ID." Dating takes on a whole new level of trauma. Steve Rogue, a 24-year-old law student at American University now in his third year of treatment, recalls: "It was hell. For a year I wore a bite plate that impaired my speech and gave me bad breath. I hardly went out to eat-I lost 25 pounds." Still, he says, "People were very nice about it. I found I made a bigger deal of it than anyone else." Booher agrees. She met her boyfriend soon after getting her braces two years ago. "He's never seen me without my braces," she says. Across the board, fellow adults tend to be more forgiving than kids. Carole Richardson knows. She wore braces as a child and wears them today as a 49-year-old dentist in the District. "I was teased to no end when I was a kid. Oh, it's much easier now." Then there are the very real logistical difficulties one would expect from having a mouth full of foreign matter 24 hours a day. "You just never get the feeling that your teeth are totally clean," complains Booher. "Plus, you always wonder whether or not you've got broccoli stuck in your hardware." The new clear brackets do not stain easily, but the elastic bands around them usually do; giving up gum and nuts is easy compared with cutting down on coffee, tea and cola. Braces also can impair speech, and many braces wearers have to deal with mouth and tongue sores from appliance abrasions. Kissing, thankfully, is not a problem for most people. Despite these negatives, few adults regret the decision to undergo orthodontic treatment. In fact, braces wearers are braces' biggest fans. "I see people now with crooked teeth and wonder why they don't do something about it," notes Dominguez. Still, there's one sentiment brace faces of all ages agree on: They can't wait to get them off! Norie Quintos is an assistant editor for Caribbean Travel and Life magazine. She hopes to have her braces off in time for her wedding in June. CAPTIONS: Do You Need Them? If you think you might need braces: First, consult your regular dentist for his or her opinion and recommendations of orthodontists in your area. Make appointments with several orthodontists. Initial consultations often are free. At the initial consultation, ask many questions: What are the costs involved? What is the orthodontist's experience with your particular problem? Will you be able to schedule appointments at convenient times? If possible, get references from current or former patients. Although membership in orthodontic associations is not required, it may provide greater security if your chosen orthodontist is a member of the American Association of Orthodontists (460 Lindbergh Blvd., St. Louis, Mo. 63141; 1-314-993-1700) or certified by the American Board of Orthodontics (Suite 310, 225 South Meramec St., St. Louis, Mo. 63105; 1-314-727-5039). Orthodontic fees vary, depending on the procedure and treatment time, starting at about $1,500 for the simplest procedures. Clear brackets and lingual braces will cost extra. Remember that treatment also may necessitate some extra costs not included in the treatment price, like tooth extractions and more frequent teeth cleaning by your dentist. Some dental insurance policies may cover a portion of orthodontic treatment, but few offer full coverage. The length of treatment generally ranges from one to three years, but can take longer for complicated procedures. It's best to discover potential problems and start treatment right away-7 years old is not too early. However, you're never too old to begin orthodontic treatment. According to Bethesda orthodontist James P. Kerrigan, "The only criterion to treatment is that one has to have healthy bone around the teeth, and many older people have that. My oldest patient was 76." -Norie Quintos DESCRIPTORS: Adults (Age 21 65); Dental problems; Dentists