Oral health practitioners aim to deliver quality care that satisfies clinical objectives and their patients’ expectations – this part can be trickier. Patients’ expectations are high, they differ and can sometimes be unrealistic. They are also a “key determinant in their satisfaction with treatment (encompassing) not only notions of the outcome (…) but also the process”. So, not only the result, but the entire experience.
Patients desire beautiful smiles, and there are a range of solutions available to improve appearances that also benefit function and health. Over the past decade, more adults are opting for orthodontic treatment, often self-referring, particularly since the introduction of near-invisible options for efficiently and ethically straightening teeth. People are doing their own research and finding out that, unlike treatment they may have had as a child, no one needs to know that they are wearing an appliance. They’re discovering that the cost of quality orthodontics is manageable and the risk of complications is small. Although it tends to be easier to move the teeth while the mouth and jaws are still growing, treatment for adults can be incredibly successful, and give lasting results – it’s not too late!
Broadly, the objectives of orthodontic treatment will be the same whatever your patient’s age. For cases involving adults, the difference is likely to be with their expectations. Someone in their 40s, who has spent years feeling unhappy, self-conscious and disliking their appearance in photographs, will be aware of how much their confidence and self-esteem has been affected. Their expectations might be primarily for a beautiful smile, plus for significant psychological, emotional and social benefits. You will also be able to tell them that, even if their concerns are nearly entirely aesthetic, aligned teeth are also easier to keep clean, and will optimise mechanical function and the distribution of force and stress. Long-term oral health and comfort can therefore be improved.
But delivering adult orthodontics can be challenging. If they expect perfection, this might not be achievable. Body dysmorphic disorder (BDD) is a “psychiatric disorder in which an individual has a preoccupation with a ‘slight’ or ‘perceived’ defect in appearance”. Such individuals “sometimes seek inappropriate or unnecessary treatment from multiple health care providers including orthodontists (…) and are frequently dissatisfied with the results of treatment.”
In all cases, although modern methods are undeniably efficient and retention protocols vastly better, an adult starting orthodontics must understand the level of commitment required during the planning stage, as well as for long-term maintenance. The internet and social media will show photos of smiles transformed by beautifully straightened teeth, but often not the journey that the dental team and the patient had to take to reach their final destination.
For successful orthodontics and to establish a patient’s confidence, expectations will need to be identified and managed. Workflows are becoming increasingly digitised, with cutting-edge software available to enable virtual monitoring between practice visits, but there will also need to be plenty of good conversations too, and they must be willing to commit the time to having these discussions. The potential for age-related changes in the mouth must be understood, for example. If they have been neglecting their oral health, they will need to improve it. An adult patient is likely to have more restored teeth and exhibit signs of tooth wear. The dental team – including the dental hygienist and/or dental therapist as well as the dentist/orthodontist – will need to emphasise how to minimise the risk factors for caries, periodontal disease and gingivitis. Poor oral hygiene can compromise the success of orthodontics, so encourage them to get into good habits during the planning stage; also, they need to understand that even when their teeth are beautifully aligned, periodontal problems can still follow if they are not cleaning properly. They may require regular visits to the dental hygienist, as well as practise elevated daily hygiene. This means they must be shown how to brush and clean interdentally to remove debris lurking in small spaces and around their appliance. One range you could recommend is Tandex, with different-sized brushes and interdental tools that can be used, safely and comfortably, to keep teeth and gums healthy before and during treatment and beyond.
Successful adult orthodontics comes with more challenges for the clinical team. Expectations must be managed and, in some cases, the patient will need to understand that the ideal plan might need to be deviated from. Modern treatments may be simpler, more ‘user-friendly’ and conservative than they were in the past, but this is also high-quality dentistry, being delivered by skilled, knowledgeable and talented professionals. To achieve the most satisfactory outcome for everyone involved, there needs to be cooperation, commitment, education and understanding.
References available on request.