Too Old for Braces?

Prospective clients often use the phrase 'at my age...' or 'I thought I was too old for braces'. So I thought I'd have a look at who my 'typical' adult patient is.

You might be surprised to hear that last year more than half (59%) of my patients were aged 17 or over. The proportion is growing each year, when I started the practice in 2006 adults made up about a third of my clients. I think this reflects both the growing demand for cosmetic dentistry and the availability of more aesthetic types of braces. It's probably not so surprising that women make up 70% of my clients, but the proportion of men seeking treatment is also growing.

The mean age of my adult clients when they started treatment was 38, but this doesn't really tell the full story. My oldest client was 66, with the biggest proportion being the 30-44 year olds, but nearly a third being aged 45 or over. There is no age limit to braces, though the treatment plan may need to be modified depending on missing teeth or dental disease, and sometimes combined with other dental treatment like whitening, crowns or implants.

The types of braces used also reflect the wish of adults to keep treatment as discreet as possible. For teenagers it's quite acceptable to wear metal fixed braces and they often decorate them with bright colours. Whilst a few adults will opt to have this type of treatment I usually use more aesthetic treatments instead. For many years aesthetic fixed braces were considered inferior but modern braces are virtually equivalent so I rarely offer standard metal braces to my adult clients.

The choice of braces is determined both by the problem and the type of tooth movement to be carried out, and the preference expressed by the patient. Standard, or labial fixed braces are attached to the front of the teeth, usually using ceramic brackets which blend fairly well with the teeth. This is the simplest treatment and is often chosen over other, less obviously visible brace types for reasons of time, cost and comfort, which is why it makes up half of the treatments I carry out. Clear aligners are mainly Invisalign, removable clear braces that are virtually invisible. Lingual fixed braces like Incognito are fixed to the back of the teeth so they can't be seen at all, they are perhaps less popular due to cost and worries about comfort, but it's probably the biggest growing area in orthodontics at the moment.

So if you don't notice adults with braces every day, it's probably not because adults don't have them - just that these invisible treatments are often very hard to see!

The truth is, I don't have a 'typical' adult patient. I treat people of all ages, from all walks of life - some of whom travel quite a distance - for all sorts of problems. And I'm happy to say I have a range of skills and treatments available, so I can usually find a treatment to suit each person: it's all part of your assessment, when we sit down together and chat about what you'd like to do. 

It's actually quite common for adults to take action to get the smile they want. So if you'd like to pop in and see us, please do get in touch.

Groupon? Not for me!

A few weeks ago I had a phone call. "Hello its Mark from Groupon, wishing you a very Happy New Year. And by the way, we've got a front page offer you might be interested in." I politely wished him a Happy New Year but declined his offer and asked not to be called again.

"Why?" you might cry, especially if you love Groupon or any of the similar discount voucher sites, in fact you may even have seen offers for for treatment such as tooth whitening or Invisalign.

I did write a really long blog post about the ethics of offering discounts on dental and medical treatment and why the figures don't stack up, and why it might work for businesses like restaurants and beauty salons where they can sell additional items or gain from repeat business.

I've deleted because I think the sort of clients I treat can see that and understand that and don't need it spelling out. There are certain brands you wouldn't expect to see on a discount site, like BMW or Porsche, Armani or Prada, The Ivy or The Manoir Aux Quat'Saisons. If these brands did start offering huge discounts it cheapens the brand, makes it less exclusive, just think what happened to Burberry a few years ago when the products suddenly became just that bit too popular.

So perhaps I'm going a bit far comparing myself to luxury brands, I certainly don't want to make myself and my treatments seem elitist, but much as some people will save up for that certain car, item of clothing or special meal many of my clients are seeing orthodontic treatment as an affordable luxury that will make them feel good about themselves. The true value is not in the cost but in how it makes you feel. Much as a Skoda will transport you, a coat from Primark will keep you warm, or a meal from Pizza Express will fill you up, that cheap braces offer may straighten your teeth, but will you get the same experience, the thing to treasure, to talk about, to make you feel good?

So, please don't ask me for special offers. I don't artificially inflate my prices so I can't offer discounts as this is a business and my livelihood, as well as my passion. I don't even mind if you 'window shop' a bit, by all means visit that practice offering a cheap deal, but come visit me too before you decide.

(If you still don't understand, read about the cupcake disaster, concerns from the ASA and OFT, the problems of time-limited medical offers and the General Dental Council's view of discount offers.)

"Why is your Invisalign more expensive?"

That's a question I often get asked, and it's usually specifically about Invisalign rather than other type of orthodontic treatment I provide.

Do a quick internet search and you will see lots of offers for Invisalign treatment, some significantly cheaper than others. Have a look at your local orthodontic specialist and they will probably charge more than the general dentist down the road. In areas of high competition like London the price differences are even bigger and there may well be aggressive marketing on the internet or in magazines.

So why has this happened and why is a specialist more expensive than a general dentist? Have a read of this article by American orthodontist Ted Rothstein to see a bit of the background.

To summarise, Invisalign is one of a few orthodontic treatments that are easy for any dentist to start using, requiring a one day course to become certified and able to provide treatment (though there are now other similar treatments like ClearStep and Inman Aligner with similar issues to Invisalign). If you were a dentist who could now offer the treatment direct to your patients then why not, rather than referring to a specialist who will take the fees that could otherwise come to you? Why subject your patients to treatment with fixed braces when they can wear invisible removable braces instead? If you are the consumer why should you pay more to see a specialist when the same treatment can be bought for less?

Here's a quote from the article; "Dr. Rothstein reports that he is seeing in recent years a growing number of patients on consultation in treatment with Invisalign by the generalist who simply lacked an understanding of the limitations of the Invisalign appliance. General dentists are not fully trained to recognize the many nuances associated with effective treatment, or even foresee the potential problems lying in wait as they proceed. Training and experience really do make a difference.
There are also cases in mid-course where the general dentist had no idea how to handle the problem that the patient was encountering and cases where the end result of the Invisalign treatment were so lacking that the only recourse was to finish the case with fixed braces."

I'm sure there are some general dentists who get comparable results to a specialist, but only with the right experience and attention to detail, and how do you know who these are? Be sure to ask questions about your potential treatment and also about what is included. Does that cheap fee include hidden extras like refinements and retainers and how often will you be reviewed? What sort of customer service do you get and do you enjoy your visits?

It's a bit like getting your hair cut. Do you prefer to go to the small salon that has out of date magazines and faded decor, see the junior stylist at a medium salon or pay the extra to see the senior stylist at the best known salon in town? The end result is important but so is the experience you receive.

You should know that Invisalign offers significant discounts to providers who commit to providing a large number of treatments per year, they have to get the numbers in or risk paying large penalties. Even with these discounts some offers I've seen are so low it must be costing the practice money instead of making it. As a small practice and a specialist offering many types of treatment my numbers are relatively low so I can't always take advantage of this, or do "extras" like tooth whitening, hygiene or veneers to gain extra revenue.

I'll finish with a final quote from the article which puts it better than I can; "...isn't the consumer better served by the orthodontic specialist even though having to pay a higher fee? Indeed when the consumer pays more to engage the services of the specialist isn't he receiving more in the way of experience and wisdom that far outweighs the additional fees the consumer may have to pay"

Success at the Smile Awards 2011

The 2011 Smile Awards were held on Friday and I travelled down to London with dental nurses Carly-Ann and Lisa. We got glammed up for the ceremony at the posh Royal Garden Hotel (I met Carol Vorderman while checking in!), have a look at the pictures on Facebook to see our frocks.

Although there are several dental industry awards over the course of the year these are the only ones to judge treated cases, they do this anonymously and reward true clinical excellence. Just making the shortlist is an achievement in itself, I was shortlisted for two categories, Orthodontic Smile Fixed Appliances and Orthodontic Smile Removable Appliances, along with some well known orthodontists and dentists.

Although I didn't get an award for the Fixed Braces category I was awarded Highly Commended for my Removable Appliance entry. In a later blog I'll share the pictures of Katherine who I treated using Invisalign. I always do my best to get not just a good-looking result but a technically great orthodontic result as well, so I am delighted to have this recognised in such prestigious awards.

There really was an amazing array of smile transformations on display, from orthodontics to veneers and implants to a full facial reconstruction following severe trauma. There are some talented dentists, surgeons and and technicians out there and I was delighted to see some fellow northern dentists getting awards, congratulations to all my shortlisted and winning colleagues.

After two years of Highly Commended I will be back next year hoping to go one better and get a trophy!

Brides and Braces

If you are getting married you are probably thinking about your appearance on the day, especially as it will be immortalised forever in the photos. Hair and makeup are just as important as the dress, but have you thought about your smile?

A wedding is often the factor that prompts brides into getting dental attention, whitening is probably the most frequently requested treatment but you may also be thinking about the position of your teeth. I have treated several brides-to-be (and mothers of the bride) to give them a better smile before their wedding. The limiting factor is often time, most orthodontic treatments need at least a year and the more time you have the better.

However, if you have less time don't panic, we can get a significant improvement in most people's teeth in about 6 months. We can fit the braces, progress the treatment as far as possible in the time available, then remove the braces in time for your big day. Afterwards we can reassess whether to re-fit braces to complete treatment.

Alternatively, you could pick invisible braces like lingual Incognito braces or removable Invisalign, which means your treatment can be continued without interruption, these are especially good options if time is a bit short or you don't want the additional cost and time of removing/refitting braces.

Recently one patient got married wearing her ceramic fixed braces as she was keen not to interrupt treatment. Ceramic braces are like traditional fixed braces but made of clear porcelain rather than metal so they blend with the teeth. I changed the wire for a tooth-coloured version before the wedding and she smiled with confidence all day. You can see the braces in the pictures (see above) but they are barely noticable. I know Faye herself was delighted that her teeth looked straighter and knows she made the right decision about keeping the braces on. I'd like to congratulate Faye and her husband on their wedding and wish them the best for the future.

If you would like to get your teeth straightened before your wedding please call us to arrange an appointment to discuss the options, it may be easier than you think!

Invisible braces for Chris Evans

Regular visitors to Wetherby Orthodontics will know that we usually have Radio 2 playing in the background and if they're lucky Carly and I will even sing along!

I did miss Chris Evans on this morning's breakfast show talking about his new invisible braces, but it didn't take long for a patient to tell me they'd heard it. Chris is such a smiley person and I've always noticed that his teeth aren't perfectly straight, particularly the lower ones. As more and more people get straighter teeth I guess he has now decided to get something done. I'm sure it will make a big difference to his smile and I wish him well with his treatment.

From the description we think he's wearing Invisalign, clear removable braces that fit tightly against the teeth. They really are almost invisible and are very easy to get used to, they certainly won't give him any problems with his radio and TV work. Of course, if you don't want to tell people about it you don't have to. Other types of invisible braces are available too, like lingual Incognito braces, sported by Myleene Klass (see earlier blog), so there really is something for everyone, they don't have to look like Ugly Betty's braces!

If you'd like to find out more about invisible braces there's more information on our website or on the Invisalign website (linked off the title of this blog). Please get in touch if you'd like an appointment for an assessment for your own teeth.

Smile Awards 2011 Shortlisting

We are delighted to announce that Megan Hatfield has been shortlisted for two categories in the 2011 Smile Awards.

The Smile Awards are the ONLY dental awards in the UK to reward clinical excellence in dental and facial aesthetics. Megan Hatfield has been shortlisted in the Orthodontic Smile-fixed appliances category for her treatment of a teenager with crooked teeth, and the Orthodontic Smile-removable appliances category for her treatment of a young adult using Invisalign clear braces (photo above). Just making the shortlisting is a massive achievement and we are delighted that Megan's hard work is getting recognition.

The awards ceremony is in London on Friday 25th March. Megan will be hoping to improve on the 2010 awards where she was shortlisted for two categories and won Highly Commended in one of them.

Beat the VAT rise!

Here at Wetherby Orthodontics we will help you beat the VAT rise!

How?

There is NO VAT on dental and orthodontic treatment, so our fees remain unaffected by the VAT rise. If you've made one of those "New Year, New You" resolutions why not come along and see us to find out how we can help you achieve a beautiful smile. You can even continue smiling during your treatment with Invisalign or Incognito braces.

However, some things we need to run the practice are affected by VAT and many of our supply companies are putting prices up, so our fees will be changing on 1st February. If you attend for an initial assessment in January you will get our 2010 fees guaranteed for three months (this extends to our young patients too)!

So don't put it off any longer, give us a call and come in for a chat to find out how we can help.

Six Month Smiles?

I've noticed a recent trend in new treatments that promise straight teeth in less time than traditional braces, in six months or even as little as six weeks. These treatments are being promoted to general dentists as a simple way of helping their patients. They are also being promoted as a brand, direct to patients. They are not marketing to specialist orthodontists, who you might think would be the ideal market.

I have a few concerns over whether branded short treatments (such as Inman or Six Month Smile) are the right thing for patients in the long term.

The appearance of the braces is often not very aesthetic, can be quite bulky and difficult to wear, and one make used a type of clear bracket material that is considered outdated and inferior (composite rather than ceramic). In a short space of time a tooth position can be dramatically improved, but for most cases it would still not be ideally positioned in such a short space of time.

There is natural limit on how fast a tooth can move, and I would like to see reasearch as to whether faster movement is detrimental to the tooth, and whether the teeth are more likely to relapse.

My main concern is that dentists who are inexperienced in orthodontics are being told this is an ideal solution for their patients, that it is easy to do and their patients don't need traditional orthodontics. There's a reason that I did three years dedicated orthodontic training and making orthodontics seem easy devalues the many orthodontic specialists. Yes, fitting braces, changing wires, instructing patients is fairly easy to learn, but seeing the whole picture, understanding possible side effects and being able to correct errors is something that takes training and experience. I know from using Invisalign that there is a learning curve with every new appliance and now I understand its limitations I can recommend it with confidence to the right patients.

So if you are considering orthodontic treatment to improve your smile be sure your dentist or orthodontist explains the pros and cons of the treatment, and find out what the alternatives are. I offer a wide range of brace types, varying in speed, cost and aesthetics so for most patients there is an option to suit them.

Can I provide straight teeth in six months? In a few cases, probably.
Can I promise straight teeth in six weeks? No, not to the standard that I would be happy with.
Can I offer the best treatment type for you? Yes!

Volcanic Ash

Even dentistry is being affected by the volcanic ash from the eruption underneath the Eyjafjallajokull glacier in Iceland.

My first thought was that apart from a few patients stuck abroad we would be relatively unaffected, as none of our staff have been overseas. Yesterday we had two things that made me think differently. A supplier has told us that an item we ordered is not available as it has to come from overseas, thankfully it's not urgent and we can use something alternative. Then Invisalign emailed us, they ship their aligners from the USA by air, so anyone waiting for new aligners will have to wait a little longer.

I guess the longer the air disruption goes on (and though there is a re-opening of air-space today the disruption could last a long time, especially if the volcano continues to erupt) the more things will be affected. A lot of dental and orthodontic supplies are manufactured in America. Its too easy to take things for granted without really thinking about how things get here.