Braces as an Adult: Is It Too Late, and What Does Treatment Involve?

Teeth that stick out, and a bite that does not close

Adults ask about orthodontic treatment for crowded or gapped teeth, and often for two bite problems:

• Upper front teeth that sit well ahead of the lower ones. The distance is called the overjet. When it is large, the lips may not close comfortably over the teeth.
• Front teeth that do not meet when the back teeth are together. This is called an open bite.

A large overjet is more than a matter of looks. In studies of children, an overjet of more than 5 mm went with roughly 1.8 to 2.4 times higher odds of injuring the front teeth¹, depending on age. These are odds from observational studies, and the studies did not look at adults.

Bite problems rarely have a single cause. They may be inherited, or follow an injury, the early or late loss of teeth, or thumb-sucking². Long-term thumb or finger sucking is linked to bite problems³, but it is not the only cause.

Is treatment different for adults?

Adults are not an afterthought in orthodontic research. In one review of studies comparing clear aligners with fixed braces, the 887 patients had an average age of 28⁴. Most people are in treatment for one to three years, followed by a period of wearing a retainer².

In children and teenagers, some appliances work while the jaws are still growing. In teenagers, fixed or removable "functional" appliances reduced the overjet by 4.62 to 5.46 mm on average compared with no treatment⁵, in small trials of low quality. Those trials were in teenagers, and none of the sources we rely on shows the same effect in adults.

For an adult, the orthodontist therefore first works out whether the problem lies mainly in the position of the teeth or in the jaws. Where it is the teeth, braces or aligners alone may be enough. Where the jaws themselves are the main cause, the options are different, and for some adults they include jaw surgery combined with orthodontic treatment. Which applies to you can only be judged at an examination.

Adults also bring a dental history: fillings, crowns, missing teeth or gum problems. Decay and gum disease are treated before teeth are moved, so the first visits may be with your dentist rather than the orthodontist.

Braces or aligners?

Both are used in adults, and the choice depends on the case. In brief: in a review of studies in adults, the finished bite was less precise with clear aligners than with fixed braces⁴ (moderate-quality evidence). A newer review found that where teeth are taken out to make space, fixed braces gave better treatment quality, while in cases without extractions there was no significant difference⁶. And aligners have not been shown to finish faster⁷ in mild to moderate crowding.

For the full comparison, including comfort, cleaning and what each asks of you day to day, see our guide to Invisalign and braces.

What treatment involves, step by step

1. Examination and records. Your teeth, gums, bite and jaws are examined, and X-rays and impressions or scans are taken as needed. The UK dental regulator accepts that some parts of dental care can be provided safely at a distance, while others need a face-to-face visit or a physical examination⁸. For orthodontics, it says there is at present no effective substitute for a physical, clinical examination⁸.
2. Treating what comes first. Decay and gum problems are dealt with before any appliance is fitted.
3. The plan. You are told what will move, which appliance is proposed and why, roughly how long it will take, and what happens afterwards. Ask about the risks, the alternatives, and what would happen if you chose not to have treatment.
4. Fitting and adjustments. Braces are fitted and adjusted at regular visits; with aligners, you wear the trays for the hours you are told and change to a new set as planned.
5. Retention. When the teeth are in place, a retainer holds them there.

The first weeks, and living with braces

Teeth are often tender for a few days after braces are fitted or adjusted. In studies that tracked pain through the first week, pain was usually highest in the first 24 to 48 hours and eased within about a week⁹. Over-the-counter painkillers reduced orthodontic pain compared with taking nothing¹⁰, and anti-inflammatory painkillers (NSAIDs) and paracetamol were not shown to differ¹⁰ (low-quality evidence); follow the leaflet and ask a pharmacist if unsure. Chewing aids and vibration devices have not been shown to help¹¹. If it is still painful more than a few days after a fitting or adjustment, contact your orthodontist¹².

With fixed braces, do not chew gum, which can get stuck, and try to avoid hard, crunchy or sticky foods¹².

Cleaning matters more than usual. White marks on the teeth, an early stage of decay, are common with fixed braces: in pooled studies whose patients averaged about 16 years old, they were present in about 55 in 100 orthodontic patients, against about 29 in 100 people without treatment¹³, and more often the longer treatment lasted. These figures count all the marks found, not only new ones. Brush at least twice a day with fluoride toothpaste¹⁴, taking care around the brackets, and cut down how much and how often you have sugary food and drinks¹⁴.

After braces: retainers

After treatment, teeth tend to drift back towards where they started¹⁵. A retainer helps stop your teeth moving back to their original position¹². It may be a thin wire bonded behind the front teeth, or a removable one. Neither type has been shown to be clearly better at keeping teeth straight¹⁵; each has trade-offs in breakage, comfort and the gums, and the evidence is of low or very low certainty.

Your orthodontist will tell you how long to wear it¹². Research has not settled on an exact length of time, and no retainer can promise that teeth will never move again. Bonded wires can come loose: bond-failure rates of 12% to 50% were reported for multistranded wire retainers¹⁶, varying between studies, on low-quality evidence. If yours feels loose, contact your orthodontist.

When to see a dentist or orthodontist

If you are thinking about treatment, a check-up is the place to start: your dentist can look at your teeth and gums and tell you whether an orthodontic assessment makes sense.

During or after treatment, contact your orthodontist if:

• pain lasts more than a few days after a fitting or adjustment
• a bracket comes off, or a wire breaks or digs into your cheek
• a bonded retainer feels loose, or a removable one no longer fits
• you notice white or chalky marks around the brackets
• you knock a front tooth

Emergencies. Facial swelling, a fever or throbbing pain is not an expected part of orthodontic treatment; see a dentist without waiting. Difficulty breathing or swallowing, or swelling spreading fast in the mouth or neck: go to an emergency department or call 112.

Frequently asked questions