Ideally, human teeth would line up as neatly as the keys on a piano. Unfortunately, many people must contend with crooked teeth, crowded smiles, or poorly aligned bites. These problems raise more than cosmetic concerns. Crowded or overlapping teeth can be difficult to clean, making tooth decay and gum disease more likely. Teeth that don’t come together properly when you close your jaws—a problem called malocclusion, or “bad bite”—can cause chewing and swallowing problems. Poor tooth alignment can also make it difficult to pronounce certain sounds and can put excessive stress on the chewing muscles, causing facial pain. Although childhood is the ideal time to make changes in the positioning of the teeth, more adults are opting for orthodontic treatment and coming away with excellent results. The American Association of Orthodontists notes that one in five orthodontic patients is over age 18. If you’re considering orthodontic treatment to correct longstanding cosmetic or bite problems or to remedy the effects of tooth loss, keep a few things in mind: The bones of adults have stopped growing, so some structural changes cannot be accomplished without surgery. The entire process may take longer for you than for a child or adolescent. While the time it takes to straighten teeth varies from person to person, on average, treatment lasts about two years. If you are undergoing orthodontic treatment, you may also need to see a periodontist as well as your general dentist and orthodontist to ensure that the treatment is not complicated by bone loss resulting from gum disease. How braces work The science of orthodontics relies on placing pressure on the teeth to change their position. The orthodontist accomplishes this by attaching mechanical devices, or appliances, to the teeth to gently push them in the desired direction. When a tooth is subjected to pressure from one side, its root presses against the underlying alveolar bone. Eventually, this force causes a portion of the bone next to the root to dissolve, allowing the tooth to move in the direction it is being pushed. As the tooth migrates, new bone builds up in the space vacated on the other side of the root. This prevents the tooth from moving back into its original position. You may need to have one or more teeth removed before you can start orthodontic treatment. Braces are the most commonly used orthodontic appliance. They are extremely versatile, able to move the teeth in a variety of directions at once and treat many teeth at the same time. These devices rely on the use of brackets cemented or bonded to the tooth surfaces. Archwires, which are attached to the molars on either end of the dental arch, are threaded through the brackets to direct the force being applied to the teeth. The arrangement of the wires can be customized to apply different pressures to individual teeth. Sometimes elastic bands or springs are attached to the archwire to boost the directional push. Typically, it takes one to two hours to place braces on the teeth. You’ll probably notice soreness and discomfort for a few days after getting braces and having adjustments made, but an over-the-counter pain medication, like acetaminophen or ibuprofen, can help. Innovations in braces—pros and cons Today’s braces are more comfortable and less obtrusive than those of the past. They’re smaller and use fewer brackets. The wires are less noticeable and more effective than those used previously. Because they are effective and economical, stainless steel brackets are still commonly used. Gold brackets and wires are also available. Some people, particularly teens, opt for colored wires and elastics for a bolder look. Others take a different tack, opting instead for tooth-colored ceramic or clear plastic brackets because they are less noticeable. However, these have some drawbacks. They tend to cost more than their metal cousins. Ceramic brackets can break, and they may not be as comfortable on lower teeth as metal brackets, which tend to be smaller. Also, because ceramic brackets are stronger than tooth enamel, so they can wear away the enamel. For these reasons, some people opt for ceramic brackets on their top teeth and metal brackets for their lower teeth. Plastic brackets aren’t as strong as stainless steel and may stain over time. Both ceramic and plastic devices sometimes create more friction between the wire and the brackets than do metal braces, which means that the teeth don’t shift as quickly and treatment time may be longer. Some orthodontists offer a device called a lingual appliance, which attaches to the back of the teeth so the brackets and wires don’t show when you smile. The downside of these so-called invisible braces is that they can irritate the tongue and cause speech problems. They also tend to be much more expensive and require more care than traditional braces. Costs for braces vary depending on the type of treatment and the severity of the problem, but an average range is $4,000 to $7,500. Some dental insurance plans offer coverage for orthodontic services.