What are the main differences and considerations for someone undergoing braces in her 40s versus 20s?

Thank you for your question. There is a saying that goes 40s are the new 20s, people are embracing their age and living life without apologies.

However, these are some of the differences I see in my practice that may differ between the 2 age groups.

1. Gum support. Generally speaking, the older one gets, the higher the risk of gum disease and reduced periodontal support. The cause of gum disease is multifactorial with plaque bacteria being one of the main culprits, hence an older individual may be more at risk as the bacteria has had a longer time to fester. However, gum disease also has a genetic component and hence not everyone is affected to the same degree. A good screening radiograph and a clinical examination will help determine your risk.
2. Dental history and compromised teeth. Someone in their 40s may present with more extensive dental treatment and this may result in a different treatment plan compared to someone in their 20s. Sometimes the motivation for braces treatment is different between age groups and for an older individual, braces treatment is to facilitate other dental treatment. e.g (uprighting a tipped molar for proper dental implant placement)
3. Appliance consideration. In my experience, someone in their 40s would often prefer braces appliance that is less conspicuous and may prefer tooth coloured braces, lingual braces or clear aligner treatment. Lingual braces are braces on the tongue side of the teeth and can be a constant irritation to the tongue and can be challenging to get used to. The cost of those types of appliances mentioned does tend to be higher as compared to traditional metal braces. Your dentist/orthodontist will be able to advise on the pros/cons of the various appliances.
4. Bone metabolism and rate of tooth movement. As one gets older, the supporting bone around the teeth get less cellular, and the biological reactions needed for tooth movement to occur tends to occur more slowly. This means that the overall rate of tooth movement does tend to occur at a slower rate and hence overall braces treatment time may be slower in an older individual.
5. Black triangular spaces. Black triangular spaces at the gums are caused by the lack of dental papilla (gums at the necks of the teeth), these tend to be more obvious in an older individual due to pre-existing gum recession which happens with time.
6. Adaptability. Braces/orthodontic treatment requires forces to be placed on teeth and this results in some pain and discomfort at the start of treatment and at each review visit. Generally speaking, a younger individual tends to adapt better to these changes in the mouth and may be more accepting of the appliance. However, this is very patient dependent and I do have patients over 40 who adapt very well to the braces appliance.
7. Retention. At the end of braces treatment, retainers are fabricated to maintain the teeth in its new position, this is needed as teeth can still shift out of place after braces treatment. It is important for all patients regardless of age, however, I do find that it is important to communicate this at the start as it may influence an older individuals' decision making as they may not be committed to wearing retainers every night.

Hope this helps in your decision making.

All the very best,

Dr Priscilla Lu