Long In The Tooth

I never had braces, or needed them, and lucky me because my mother definitely would not have been able to afford them. All my life I’ve had the good fortune of a big, easy smile, the kind that inspire compliments. When my own kids had braces (they did need them), my memory is of slogging multiple children to the dentist, carrying knapsacks and scarves and snacks and doing homework in waiting rooms. I remember being on my phone, being mid-divorce, being sad. I have no recollection of feeling sorry for their painful tongues, or for their shock at having mouthfuls of metal.

Now, at 51, I’m getting my comeuppance. It started slowly. Maybe a year ago I noticed on Zoom calls that my smile had become slightly pointy and lopsided. Was it my teeth, or was it my face? It turns out it’s both: for men and women alike, as we get older our lower jaw tends to grow forward and become more narrow. In women the additional factor is declining estrogen, which decreases skin collagen, resulting in reduced skin elasticity, and sagging faces. The jaw changes often cause our lower teeth to crowd together and overlap, and can also change our bites, i.e. the way our top teeth and bottom teeth come together. All this adjusted pressure adds up over time, culminating in teeth that suddenly protrude in weird ways. Oh, and let’s not forget that our lips also tend to get smaller and thinner as we age! Another source of pressure on the teeth, and thus the movement.

Like all the other bodily changes that creep up on us (back fat, chin hair, muffin tops), I tried to just ignore my new weird smile for awhile, and then, at a masked cleaning, my first in six months thanks to COVID, my dentist of 30 years (a man I consider resolutely non-interventionist) broached the subject. “I think we need to do something about those teeth” he said. “It’s only going to get worse.”

Ugh, Why? Braces are high on the list of things I never thought I’d experience, and my mouth doesn’t look terrible (yet). Why do I have to address this at all? Well, it turns out there are lots of reasons:

Things to tell yourself over and over again, when you’re going through middle-age orthodontia:

1. You Don’t Want Gum Disease
   When we have crooked teeth, they are harder to clean, so we become more prone to gum disease.
2. Dental Hygiene Is Crucial
   Flossing is hard enough, but with crooked teeth, it’s even more challenging to get it between those tight spaces. The same thing applies to your toothbrush, which means you could have a tough time trying to keep your oral hygiene in check.
3. Crooked Teeth Wear Out Faster
   When teeth rub together, the protective enamel wears away, resulting in problems like cavities and abscesses.
4. Bad Breath Is Embarrassing
   Crooked teeth tend to harbor bacteria, so bad breath is more likely to become an issue.
5. Self-Esteem Should Be a Priority!
   Your smile plays a big role in both how you look and how you feel. Smiling openly and easily lowers stress and anxiety levels. If your teeth make you feel self-conscious to the point where you are smiling less and stressing more, that is not good.
6. We Want To Avoid Heart Problems If At All Possible
   When harmful bacteria are in your mouth, they can get into your bloodstream and cause problems with your heart valves.
7. Crumbling Teeth Are The Stuff of Nightmares
   When your teeth are crooked, it puts excess strain on the jaw, your jaw muscles, and the teeth themselves. If your jaw is constantly strained, there’s no doubt that you’ll feel it in time. Strained jaw muscles can cause pain and put excess pressure on the teeth, resulting in a higher risk of breakage.
8. Chewing Is Essential
   A misaligned jaw and crooked teeth can lead to difficulty chewing!
9. Frequent Headaches Suck
   Any part of the face that feels pressure or excess strain can cause your head to hurt.
10. So Does TMJ
    If you have an unaligned smile, you could end up suffering from TMJ disorder. TMJ is caused by too much wear on your jaw and the hinge joint, and crooked teeth and TMJ often go hand-in-hand.
    

After reading this list my mind went to my beloved grandmother, with whom I spent weeks and weeks at a time during my childhood. I remember the Polident in her medicine cabinet and the one or two moments when I caught her without her dentures, covering her mouth with an embarrassed hand. I suppose that one of my jobs as I age is to try my best to take care of myself – diet, exercise, medical care – and so within weeks of the dentist’s warning, I decided that maybe I should just bite the bullet and deal.
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What Are The Options?

• Old fashioned metal braces on the front of your teeth
• Lingual braces which are metal and go on the inside, or backside, of your teeth (upside practically invisible, downside more painful)
• Ceramic braces (clear, but more likely to break)
• Invisalign (or Smile Direct, Byte, ClearCorrect or any of the other “invisible” aligners out there).
  

Even though everyone told me to go with some form of Invisalign, I personally felt that a) it’s kind of gross to take them in and out of your mouth all the time and b) I know myself — not always the best rule follower — and the likelihood that I wouldn’t wear them all the time, or even much at all,  seemed high. My thinking was that If I’m going to suffer, and spend the time and money, I should do it in a way that will really work.  

I wound up going with a kind of lingual braces called Breezy Braces from Tend in Manhattan. $5,000 for 6-8 months of treatment, all inclusive including the retainer at the end of the process. They suck; they really do. It’s hugely uncomfortable; my tongue stings and my mouth feels like it’s full of metal cotton balls. I can’t eat half the foods I normally do (you’d think that I’d lose weight, but no; I’ve just re-discovered ice cream). My Water Pik has become my new best friend (not joking), and I have a lisp. It’s all super un-sexy, and my boyfriend will confirm that if asked. Tend annoyingly charges the full price up front, but honestly I now understand why. If I hadn’t already paid, I definitely would have had the braces removed in the first month.

The upside: I feel very upright and responsible; I have a new-found sympathy for all dental problems (those grandchildren will love me!); my smile is going to look gorgeous, and my orthodontist promises they’ll be off before my 52nd birthday!

Tips for Preserving What You Already Have

• For the love of God, use an electric toothbrush. They clean better.
• Brush for two minutes after every meal and floss and rinse twice a day. Seriously.
• Consider upping your number of professional dental cleanings to three or four times a year. As gums recede, there's a larger area where food particles can get stuck, thus more plaque formations, this increased rate of decay!
• If you wear braces, wear your retainer after the braces are removed. Teeth will always want to move back to their original position based on your musculature
• If you have restorations like fillings, veneers or crowns, have them checked periodically. They do not last forever — the average life span is seven years
• Get fitted for a nightguard. Anyone who has stress in their lives (and who doesn't?!) will tend to clench or grind their teeth in their sleep.

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