With three sons in the midst of orthodontic treatment, Alison Karrh decided to take a closer look at her own teeth.
Karrh, 43, had braces in high school, and has always been proud of her smile. But over the last few years, she'd noticed her bottom teeth shifting slightly, so she asked Dr. Andy Vondran , the orthodontist treating her sons, for advice. He recommended Invisalign, a brand of clear plastic aligners that straighten teeth without metal brackets.
"I thought, well, I'm up there anyway," says Karrh, of Little Rock. "I'm just trying to get my smile back where it was, where everything lines up well and my lower teeth are more straight again."
Vondran, who is also tweaking his smile with Invisalign, says that Karrh is not alone. Vondran estimates that adults make up as much as 45 percent of his patient base. He says that's at least 10 percent more than when he opened his practice 15 years ago.
The American Association of Orthodontists reports that the number of adults in braces increased by 14 percent between 2010 and 2012, for a record of more than 1.2 million patients 18 and older being treated. Nationwide, 21 percent of people in active orthodontic treatment in 2012 were over the age of 18, and that was up 40 percent from the number in 1989.
Vondran says the reasons behind those statistics include improved aesthetic products -- like Invisalign and clear ceramic brackets -- that make it less obvious that a patient is undergoing treatment, and a population that is increasingly appearance- and health-conscious.
"People are seeking face lifts, dermabrasion, laser peels, and I think adults are just taking better care of themselves," says Vondran. "I just think as a society we're more in-tuned to our health and aesthetics, so I think that's a part of it, too."
But there are plenty of reasons that aren't cosmetic that warrant a visit to the orthodontist.
Ashley Burks, 34, also of Little Rock, suffered from jaw, facial and neck pain and headaches that her dentist attributed to a problem with the way her teeth fit together.
"I've had TMJ [temporomandibular joint dysfunction] problems for about 10 years. Progressively it's gotten worse," she says.
Burks' orthodontist first had her try sleeping with a soft splint that allowed her teeth to meet more comfortably, before deciding she would benefit from braces.
"I felt so much better with it in," she says. "I think it corrected my bite at night enough so that everything was aligned. It just felt so much better in the mornings when I would wake up."
Her orthodontist told her clear aligners would not be a good choice, so Burks chose clear ceramic brackets for her top teeth and, because they were a little less expensive, traditional silver brackets for her bottom teeth.
"I'm really glad they have the ceramic ones that I've got. That's so much better for your self-esteem," Burks says. "People really don't even notice I have them at first."
Amanda Dorsett, 45, of Little Rock was alarmed when her dentist told her in December that her bottom teeth were loose, probably because she was grinding her teeth.
Her dentist recommended a slight correction to her bite to help her stop the damage, so she started treatment with a clear aligner system called Clear Correct. Eight months later, she is almost done with her treatment, four months ahead of schedule.
"There have been a few times, like the last few times I've put them on, oh, they get tight. And they hurt. I'm lucky I can take them out," she says.
Because she doesn't eat with them in her mouth, she doesn't have the usual food restrictions -- no popcorn, no sticky candy, no corn on the cob -- that come with traditional braces. And that's not the only kind of flexibility that modern orthodontia allows.
Dorsett's son, 14-year-old Logan, who lives in Vancouver, Wash., with his father, recently got braces to correct an overbite. She took him to her orthodontist, Dr. Michael Ashcraft in Little Rock, over the summer and Logan got his braces before school started, went back to Washington and will not have his braces adjusted again until he's back in Arkansas for the Christmas holidays.
"For the first few days he was hurting because they did a lot more to him than they would do to someone else because he wasn't going to be back for four or five months," says Dorsett. "But as soon as he got to his dad's, which was about five days later, he was doing great. ... They don't bother him at all."
The American Association of Orthodontists reports that the average appointment interval for patients in 2012 was six weeks. About 20 years ago, visits were often required as often as every three weeks.
"In years past, if you were not seen by the orthodontist and had an active adjustment performed on your braces, your teeth were not going to move," Ashcraft says. "Well, the new style of braces, the wires that we use have a memory in them so they reactivate themselves every three weeks whether we see the patient or not."
Ashcraft treats some college students who don't want to find an orthodontist in the town where they're going to school, so they get their visits in while home for holidays.
"As long as they take care of their braces and don't break them they can go through extended periods of time without having them adjusted," he says. "Obviously those are not ideal circumstances, but there is a lot of flexibility in orthodontics today that was not there 20 years ago even."
Ashcraft's oldest patient was an 82-year-old who needed a couple of teeth moved so she could clean them more easily and maintain oral health.
"If you're a person with healthy teeth and are wanting a better smile, there aren't age limitations," he says.
When brackets come off -- or aligners come out -- retainers are often used to keep teeth in place, says Ashcraft.
The American Association of Orthodontists backs up that stance.
"A past AAO president told me that when he started practicing 40-some years ago, orthodontists typically told patients to wear retainers for a couple of years," says Pam Paladin, association spokesman. "He [and his colleagues] came to understand that wearing retainers needed to continue indefinitely. Retainer wear is the best way to minimize shifting."
Patients shouldn't have to wear their retainers every day for the rest of their lives, though, Ashcraft says.
"That's not the goal. The goal is to get you to a point where you can occasionally wear your retainer to maintain your treatment goals."
Dr. Darrin Storms of Fayetteville has his patients wear a clear plastic retainer during the day and a traditional retainer made with metal at night for the first four months after treatment ends. He likes it when parents and children go through treatment together because that typically makes them both more likely to abide by their orthodontist's rules, keep their appliances cleaner and wear their retainers, too, because they keep each other accountable.
He says parents often start treatment after their children do.
"I give some moms a hard time because their kids are the test subjects -- they let them come in first to see how nice I am," he says. "We do our best to make it affordable so more than one family member can have treatment at a time. There are also older adults doing treatment who have wanted this their entire lives but just never had the money to do it. They put their kids through school, they put their kids through college, they've paid for the weddings and now it's their turn. It really can boost their self-esteem and self-confidence and it really makes them more outgoing and more willing to react as opposed to trying to hide their teeth and not talk because they're embarrassed of their smiles."
Karrh hopes her sons will be proud of her for doing this now, rather than waiting.
"They see me doing all kinds of things for them and they know that my life and my husband's life typically revolve around them, and I think they will see that as a positive, that I'm doing something for myself," she says.
Her 10-year-old, Wilson, certainly is.
"I think it's pretty cool," he says. "You won't be able to see them really, but I just hope my mom is comfortable with it. I hope it's comfortable for her mouth. Yeah, I think it's cool."
Family on 10/07/2015