Managing the Rising Trend of Adult Orthodontic Patients

Gerald S. Samson, DDS


How many times have you heard adult patients bemoan about how they didn’t wear their retainer when they were younger? According to the American Association of Orthodontists, more than 1.4 million adults in the United States sought orthodontic treatment in 2014 alone. With advances in treatment options in recent years, that number has certainly risen. 

Whether or not those adult patients actually wore their retainers, it’s a fact of life that everyone’s teeth will shift with time. I tell people that their dogs’ bottom teeth used to be straight when they were puppies but are now misaligned as they have aged.

Another way to think of shifting teeth is a similar aging phenomenon that happens to your skin. With age, your skin will wrinkle. That’s a natural aging process. Applied to dentistry, think of it as, “wrinkling skin, wrinkling teeth.” Yet, like aging and wrinkling skin, nobody wants crooked teeth. It’s an “old look.”

Over the course of my career, I’ve had the pleasure of treating patients from all walks of life—old, young, male, and female. And regardless of the demographic, the desire for a beautiful, healthy, and well-balanced smile is always strong.

In the past couple of decades, I’ve witnessed increasing numbers of adults inquiring about orthodontic treatment. Why? First and foremost are the incredible advances in technology and techniques. This has led to effective marketing. Comparatively speaking, it’s easier, more comfortable, and quicker than ever to get the smile you want. 

With the influx of adult patients over the past decade, there’s likewise been an explosion in the number of treatment options. Most frequently, adults will prefer clear bracket options, like Damon Clear or Symetri Clear, or an array of clear aligners. At a recent dinner function, I was surprised to see a woman in her late seventies remove her aligners before dining. This goes to show that when it comes to a nice smile, there really isn’t an age limit.

But while many patients may like the freedom associated with aligner options, it’s critical that they understand that treatment requires consistent compliance and may take longer, and results may be less in line with their expectations.

What does this all mean from your perspective? As a general dentist, it’s worth considering having some sort of in-house orthodontic treatment capability or consultation option. With the number of older and “boomerang” patients steadily rising, it would be wise to update your orthodontic knowledge base and have a handful of local orthodontic referrals on hand. Or, you may prefer to investigate the convenience and business sense of having an orthodontic specialist working with you in house.

When thinking a patient may be a good candidate for orthodontics, you don’t want to jump to conclusions. It’s polite to ask how aware the person is of modern orthodontic advances for smile alignment. People generally like to talk about themselves, and this is a nice, low pressure way to get the conversation in motion. Listen to their goals, expectations, and reservations. Then, if appropriate, accurately inform them of their options. 

If I had to guess, I would say that about 90% of adult orthodontic patients have specific aesthetic goals in mind. That being said, it is critical to determine exactly which type of orthodontic regimen they’d like to pursue and then provide clinically sound treatment options.

Based on the person’s expectations, you may not be comfortable providing treatment. In such situations, referral to an orthodontic specialist is in everyone’s best interest. This would be a scenario where having an in-office orthodontic specialist may be beneficial.

From the practitioner’s perspective, it’s crucial to realize that just as in general dental care, all orthodontic cases are unique. Be mindful that dealing with adults is different than treating adolescent patients. Regardless, it’s most important to provide accurate information about timelines, costs, and processes associated with achieving their goals. Put yourself in your patients’ situations and understand their expectations. You will then be better prepared to meet their orthodontic objectives.

Dr. Samson completed his pediatric dental residency at Emory University in 1979 and his orthodontics residency at Northwestern University in 1981 under the direction of Dr. Hal Perry. Since that time, he has been in private orthodontic practice. He is a Diplomat of the American Board of Orthodontics and a Fellow of the American College of Dentists. In addition to orthodontic private practice, he holds formal faculty appointments at seven postgraduate programs, lectures extensively, and reviews orthodontic mechanics articles submitted for publication to The Angle Orthodontist. He can be reached at

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