Convincing adults to accept orthodontic treatment

We’ve all been through a lot lately: the pandemic, the whole world being shut down, eternal homeschooling, a million Zoom meetings . . . the list goes on. However, there is light at the end of the tunnel, so let’s focus on better times to come. Let’s imagine a not-so-distant future when we’ll get to see one another’s faces again . . . only to notice what’s been hiding underneath those masks!

It’s common knowledge that the first two things we notice about people are their eyes and their smile. Well-aligned teeth are esthetically pleasing and easier to clean, and have been linked to increased tooth longevity. As many as 75% of American patients would benefit from orthodontic treatment, and I would bet many of them have considered their mask both a safety precaution and a security blanket.¹

General dental practitioners and staff are poised to be the first to identify patients who’d benefit from orthodontic treatment, define the advantages and disadvantages, and work collaboratively to develop a treatment plan that yields a functional and esthetic final result.

The orthodontic boom

The perception and impact of a beautiful smile is profound. A 2014 study showed that “persons with ideal smiles are considered more intelligent and have a greater chance of finding a job.”² It has also been found that “in the absence of other information, the judgments an individual makes concerning the personal characteristics of others are influenced by dental appearance.”³ In a society where physical appearance and social attractiveness are favored, adult patients are increasingly seeking cosmetic dentistry and orthodontics; the American Association of Orthodontists (AAO) estimates that “27% of all US and Canadian orthodontic patients are adults.”⁴

The m-word: malocclusion

A “bad bite,” or malocclusion, causes a plethora of issues for our patients. Premature occlusal wear and chipping, abfractions, recession, periodontal disease, temporomandibular disorders (TMD), difficulty speaking or eating, tooth decay, and tooth loss are all related risks. The psychological effects of a less-than-perfect smile should also be taken into consideration; self-esteem or lack thereof due to insecurities about one’s smile can have a significant impact on patients of all ages.

Related reading:

The chief complaint

Listening to our patients and having them involved in decisions about their treatment is paramount to comprehensive and patient-specific care. This discussion can begin at the new-patient exam, but also may arise or continue during treatment as we observe our patients and document the changes we see or that they report. Adults in particular can have significantly higher expectations of dental and orthodontic treatment. Asking probing questions will help you understand what’s important to your patients. This might include, “How do you feel about your smile?” “What do you like about your smile and what, if anything, would you like to improve?”

You may consider including questions like this on your new-patient intake form to better understand what treatment your client may benefit from.

Do you have digital scanning or photography in your office? Consider including these as part of your records, opening the conversation about how smiles change over time. Your patients may find it easier to articulate the changes they desire if they are able to specifically pinpoint them on a screen while sitting upright, rather than fully reclined with your mirror and explorer hovering inches away. If you have a digital scanner, use the images to show the patient what their smile could look like. You can also use the scanner to discuss the importance of tooth alignment, as well as treatment options and expectations.

Functional considerations

Patients may present with increasing wear on their teeth. It may take a long time for them to notice, but as clinicians we are trained to recognize signs of bruxism and attrition. If you are taking photos of their smile at every visit, you can illustrate the detrimental effects of their malocclusion. Buccal abfractions, incisal chipping, and occlusal wear can all be signs and symptoms of malocclusion. If the patient keeps returning for class V and incisal edge restorations that continue to break off, consider shifting the discussion to fixing the underlying issue rather than repeatedly concealing the aftereffects with costly visits and chair time. Patient satisfaction is sure to increase when a recurring issue is addressed rather than patched up, and when they have a better understanding of the root cause. Furthermore, in large restorative cases, managing the occlusion is paramount to a successful and long-lasting result. How well will those beautiful veneers last on the class III patient, or the one with the anterior crossbite? It’s our job to educate our patients on what is necessary for stability and longevity if there are complicating factors at play. We don’t want to be scratching our heads when Mr. Jones returns frustrated with the same veneer that has cracked or popped off three times already. Well-aligned teeth, favorable gingival margins, adequate space, and optimal occlusion pave the way for successful and stable restorations requiring less tooth structure to be removed or compromised.

In addition, teeth that are crowded are more difficult to keep clean. For patients coming in at every recare visit with the same amount of deposit at the crowded mandibular anterior, this could be an opportunity to discuss the benefits of aligning the teeth to improve gingival and periodontal health and prevent tooth decay and tooth loss. This may come as no surprise, but a study on dental esthetics, orthodontic treatment, and oral health attitudes in young adults showed that “less plaque accumulation was found in subjects with higher dental esthetic scores and in those with previous orthodontic treatment.”⁵ Rather than repeating the flossing dialogue, ask the patient if they have ever considered aligning their teeth and review the associated benefits to their oral health.

Psychological considerations

According to the Canadian Association of Orthodontists, the psychological benefit of increased confidence and self-esteem is often listed as a patient’s number one treatment goal. A 2019 study showed “a significant improvement in self-esteem and social interaction” of the individuals who underwent orthodontic treatment.⁶ Our smile is one of the very first things people notice about us. If we’re unhappy with our teeth, this reflects poorly in others’ perceptions of us as well as our perception of ourselves. For the patient who presents with the telltale signs of low self-esteem caused by their smile, orthodontics can be life-changing.

Addressing patient concerns

Inevitably, your adult patients will bring up some concerns that are completely fair and valid. Here are some suggestions on how to address the most common barriers to treatment:

“I’m worried about how the braces or aligners will look. I’m an adult and I face clients on a daily basis.”

Suggested response: “There are various options to make your treatment more inconspicuous. If you proceed with braces, there may be the option of placing clear/ceramic brackets for improved esthetics. Clear aligners are very discreet and can be removed for a brief presentation when necessary. You may have slight difficulty speaking at the beginning of your treatment, but this should resolve within the first two weeks.”

Tip: If your office provides orthodontics, mention the percentage of adult patients who are undergoing orthodontic treatment, as well as the age of your oldest patient, to illustrate that it’s never too late for a beautiful and healthy smile.

“I’m worried about getting cavities and keeping my teeth clean with braces.”

Suggested response: “We will do a full examination of your teeth and surrounding structures and restore any teeth with decay before you start any orthodontic treatment. You will be shown in detail how to keep your braces/aligners clean. The long-term benefit to keep in mind is that teeth that are aligned are easier to keep clean. It will require more of your time and attention while undergoing treatment, but the ease of cleaning and decreased chance of tooth decay in the long run is a worthwhile trade-off. We may recommend more frequent recare visits to monitor your oral health.”

Tip: If you refer out, temporarily removing the archwires to facilitate easier access for cleaning can be coordinated with the orthodontic office.

“I’m worried about the cost of orthodontic treatment.”

Suggested response: “Our office offers financial plans requiring a low down payment and affordable, interest-free monthly payments. We can assess your insurance benefits to obtain the maximum amount, and figure out a payment plan that works for you. In the long run, a healthy and functional smile may reduce costly dental expenses associated with repairing or managing issues such as chips, fractures, decay, gum disease, and tooth loss.”

Tip: According to studies, 51% of patients who didn’t start orthodontic treatment mention financing as the main reason!⁷ It’s crucial to be accommodating to your patients by offering financing options.

Be flexible

If your office doesn’t offer orthodontics, or a particularly challenging case could benefit from orthodontic intervention, consider referring them to an orthodontist. Most importantly, listen to your patients and take their preferences and perspectives into account when formulating a cohesive treatment plan.

Let’s get it straight

A beautiful smile is a lifetime investment, and healthy teeth can be moved at any age. The benefits of orthodontic treatment can be esthetic, functional, psychological, and social. Adults can be very compliant and motivated patients, and 92% say they would recommend orthodontic treatment to other adults.⁴ Through collaborative treatment planning and management of expectations, we can achieve orthodontic results that will leave our patients wondering, “Why didn’t I do this sooner?”

References

Brunelle JA, Bhat M, Lipton JA. Prevalence and distribution of selected occlusal characteristics in the US population, 1988-1991. J Dent Res. 1996;75 Spec No:706-713.
Pithon MM, Nascimento CC, Barbosa GCG, da Silva Coqueiro R. Do dental esthetics have any influence on finding a job? Am J Orthod Dentofacial Orthop. 2014;146(4):423-429. doi:10.1016/j.ajodo.2014.07.001
Newton JT, Robinson PG, Prabhu NT. The impact of dental appearance on the appraisal of personal characteristics. Int J Prosthodont. 2003;16(4):429-434. https://www.ncbi.nlm.nih.gov/pubmed/12956500
Adults are seeking orthodontic treatment in record numbers. Dental Tribune. April 29, 2016. https://us.dental-tribune.com/news/adults-are-seeking-orthodontic-treatment-in-record-numbers/
Klages U, Bruckner A, Guld Y, Zentner A. Dental esthetics, orthodontic treatment, and oral-health attitudes in young adults. Am J Orthod Dentofacial Orthop. 2005;128(4):442-449. doi:10.1016/j.ajodo.2004.05.023
Grewal H, Sapawat P, Modi P, Aggarwal S. Psychological impact of orthodontic treatment on quality of life—a longitudinal study. Int Orthod. 2019;17(2):269-276. doi:10.1016/j.ortho.2019.03.009
Strategies to convert modern customers. Invisalign learning module. Unpublished; found via website gated for doctor access.