Straight talk about braces and aligners from a Pittsburgh-area expert

Photo above by Loren Joseph via Unsplash.

Your child’s dentist has officially broken the news: It’s time for braces — the dental appliances that have provided generations of kids with impeccable smiles. But the exact path isn’t necessarily clear. Today, parents and their children have options, usually choosing between the traditional wire and metal bracketed braces and the newer clear aligners.

“It’s patient specific,” says Mark DeMaria, DMD, of DeMaria Family Orthodontics in Murrysville and Greensburg.

The American Association of Orthodontists (AAO) recommends that by age 7 children be seen by an orthodontist who can spot problems – as excessive crowding or impacted teeth – and recommend next steps.

“Very rarely do we need to do anything (that early),” Dr. DeMaria says. But it’s important to begin learning about what’s happening with your child’s teeth, so you can make choices about what’s needed as they grow.

Braces of any kind are a big investment and not every choice is right for everyone — especially kids and teens. How do parents choose?

Learning What’s Available

Removeable aligners, or “tooth positioners,” aren’t actually a new concept. They’ve been around since the 1940’s, and by the ‘60’s, plastic splints were used to correct minor teeth issues. As research advanced, aligners became more common in the 1990s. Invisalign, invented in 1997 by Stanford University students, was originally targeted at adults for discreetly correcting their teeth.

The custom-made, removable Invisalign clear aligners are becoming increasingly popular with children and teens these days. Made from FDA-approved medical grade plastic, aligners are designed to move teeth bit by bit. The user puts in a new set of aligners (usually weekly) that move their teeth just a bit further in the right direction over a period of months.

“One of the nice things is that we can straighten your teeth without interrupting your life too much,” Dr. DeMaria says.

Then there are traditional braces, which are now more comfortable and smaller than in decades past. They remain a popular option, especially now that they don’t create gum-bleeding, Marcia Brady-like embarrassment.

“A lot of kids, in my experience within the last year or two, are choosing the braces over the Invisalign,” Dr. DeMaria says. This may be because they like the statement-making fun of choosing colored rubber bands or they consider braces a status symbol. Some teens, he says, have even requested extra time with their tinsel smiles.

Facts to Consider 
• The success rate is similar with both braces and aligners, but may be slightly higher – as in 1 percent – with braces, says Dr. DeMaria, because there is no temptation to remove them and “take a break” as with aligners.

Tweens and teens may assume that they won’t take their aligners out at school except for lunch, but it’s tempting to simply leave them in the case. A student might think “I’ll just take it out today…” and then not wearing the aligners soon becomes a habit. Though braces aren’t fun, the fact that they can’t be removed means they’re doing their job every day and teeth get straightened on schedule.

• Aligners require responsibility. Kids need to wear them at least 22 hours a day or they aren’t going to work. Though they are clear, aligners aren’t invisible. And while you’re wearing them, they do create a very slight change in the way a person may sound when speaking — not quite a lisp, but a bit of a faint sound. If there is any doubt that your child won’t wear them, then braces are the way to go.

Also, aligners can get lost. “The biggest concern is that they’ll throw it away,” Dr. DeMaria says. If aligners end up napkin-wrapped in the cafeteria garbage, the child may be able to use the last week’s set or get a jump start on the next set. But if not, replacements will need to be ordered, delaying treatment and adding another trip to the dentist’s office.

• There are no food restrictions with aligners, because they can be removed for meals. With braces, kids need to avoid hard, sticky and crunchy food that can cause a bracket to break or a wire to pop out of the bracket.

• For athletes, mouth guards can be worn on top of aligners. But if your child feels as though that scenario is keeping them from playing their best, Dr. DeMaria says they can take out the aligner for the game. (“I don’t recommend it,” he says. “Just make sure you put it in right away whenever you’re done.”)

For those with traditional braces, your orthodontist will recommend or provide a mouth guard that is not the typical “boil and bite” guard.

• School musicians need not worry about cut lips. Aligners can be removed for band practice, as long as they’re put back in as soon as practice ends.

• Sugary or acidic drinks can seep into aligners, causing stains or decay. According to the AAO, “it is critical to avoid drinking soft drinks, flavored waters or sports drinks of any kind with aligners in.”

• Aligners can be used if there are still baby teeth and, in certain circumstances, can actually be helpful. For instance, if an adult tooth isn’t directly underneath the baby tooth, aligners can help to loosen the baby tooth, helping it to fall out on its own – ultimately avoiding having it extracted.

Also, aligners over baby teeth can help with certain bites – something that is challenging to fix with braces, Dr. DeMaria says.

• If a tooth is really out of place, braces will be able to put it into alignment a bit faster first, before correcting any issues with bite. But with aligners, both issues can be accomplished simultaneously.

“From a comprehensive standpoint — fixing your bite, fixing that tooth — Invisalign might be a little bit faster,” Dr. DeMaria says.

• Soreness can occur with both braces and aligners, but it may go away more quickly with braces because, unlike with aligners, your child cannot take a break from wearing them by simply taking them out. Kids are “forced” to get used to them.

• Insurance is starting to cover both aligners and braces. Price is office-specific, with braces usually costing a bit less than aligners. In some offices, the initial down payment for aligners may be higher.

• Retainers are for life – for both traditional braces and aligners. So neither option will help kids skip that step.

• Don’t be afraid to ask questions!

“I would be honored if somebody came in just to get the information,” Dr. DeMaria says. “They can go elsewhere. It’s always nice to talk to people about it.”