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Easing the Concerns of Adult Patients by Pamela Waterman

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For more than 50 years, a famous East Coast offprice clothing store has declared “an educated consumer is our best customer.” That statement should also be the mantra at orthodontic offices seeking winwin partnerships with today’s prospective adult patients. This growing market segment wants to know how orthodontics will impact their entire lifestyle, not just their budget, from treatment options to hygiene commitments to eating challenges.

With the reality of similar costs among practices, addressing these broader concerns can be the tiebreaker for a patient choosing between you and the practice down the street. Adults who are “shopping around” generally investigate three to five possibilities, seeking what differentiates each. Be proactive. Offer information and don’t assume adults have all the answers – they may be misinformed, embarrassed to ask obvious questions or not even know what to ask.

Appearances Can Be Everything
Adult patients, whether age 18 or 48, might worry even more than teens about adjusting to life in braces. Just because prospective patients have searched the Internet for “types of braces” or talked to a friend who had Invisalign back in 2008 doesn’t mean they’re aware of the techniques available right now. Today’s wide array of treatment approaches can be overwhelming, and improvements in material science need to be translated into easily understandable impacts. Of course, not all options are viable for a given case, but patients need to have a clear picture of their possibilities to be happy with the final decision.

Where is a good place to start? “Assure adults that excellent results can be obtained at any age,” says Dr. Michael Rogers, a practicing orthodontist of 38 years and member of the American Association of Orthodontists (AAO). “Then have your treatment coordinator (TC) follow up by emphasizing possible limitations of treatment, (e.g., a protrusion that could only be corrected by orthognathic surgery). I believe it is important to help people understand what orthodontic treatment can and cannot do for them on an individual basis.”

Dr. Rogers, who is also the 2011-12 AAO President, adds that his TC makes sure to discuss options for dealing with issues such as missing teeth, as well as the importance of long-term retention with retainers or perhaps lingually bonded wires.

Adults are accustomed to kicking the tires of a potential purchase, as well as dealing peer to peer; they want to see what you have to offer and be given the chance to ask, “So what does that do?” Invest in multiple 3D dental models that demonstrate the appearance and placement of the latest bracket, arch wire, hook, ligature, aligner, etc. used in your practice. At the same time, check out using case presentation software to help explain the pluses and minuses of each possibility.

Lynn Schneider, owner of the online supply company www.dentakit.com, knows firsthand the frustrations that some adults feel. She went through the process of braces 10 years ago. She says she couldn’t find answers to many basic questions and often felt uncomfortable asking her orthodontist. Moreover, Schneider wanted to hear the experiences of others going through the process from her side of the chair. She solved the problem by founding the Web site www.archwired.com. This online community now features dozens of forums covering topics from braces 101 and lingual braces to dental products and orthognathic surgery.

“Adults don’t want to be surprised,” says Schneider. “If you’re going to be adding new hardware at some point, such as springs, don’t just put them in without discussing it; this will only make a previously happy patient resentful and non-compliant.” Another example concerning expectations is if a patient has any teeth with gold crowns, you should explain that those teeth will require banded brackets rather than the cube type, due to bonding issues.

Managing Pain and Maintaining Good Dental Health
Although the orthodontic community has made the conscious effort to use the word “discomfort” when discussing orthodontic treatment, adults are just as savvy as teens in figuring out that sometimes things are going to hurt. Key to getting past this objection is not merely to say, “You’ll feel much better after two or three days.” Even though that statement is true, you’re better off acknowledging the concern, then giving patients information and tools that will help them to feel in control.

A great forum for sharing experiences on this topic is the online professional organization Women in Orthodontics (WIO) (see sidebar). For example, Anne Pearson, WIO member and professional relations coordinator for McDonald Orthodontics in Salem, Oregon, says that for pain management, “along with over-the-counter pain relievers, many adults love the Invisalign ‘chewies’ (the soft rubber rolls patients bite on to seat their aligners).” To ensure a successful start, the practice also requires a current cleaning and requests perio charting even before the new patient exam. Another pointer comes from Dr. Natalie Parisi of Reading Orthodontic Group, in Wyomissing, Pennsylvania, a WIO member who strongly recommends that adult patients use a Sonicare toothbrush and a water-flosser system.

Fortunately, today’s adults have grown up with a vastly improved and accepted regimen of regular dental care. For a little perspective, consider the results of a recent survey by the National Institute of Dental Health: the rate of toothlessness among people ages 55 to 64 has plummeted 60 percent in the past 50 years. Knowing that one’s teeth could (and should) last for 60, 70 or 80-plus years gives new relevance to making them their best.

People are also getting the message that having a proper bite is directly related to overall dental health. Explain that teeth are easier to clean if they are not as crowded, periodontal health is improved and a wellaligned bite helps prevent teeth from wearing down.
Managing Pain and Maintaining Good Dental Health
Top Ten TC Tips for Adult Patients

From members of the professional organization Women in Orthodontics (www.womeninortho.org) come these great tips to share with adult patients.

  1. Apply moist heat around face to ease muscle soreness, and chew gum or eat a steak. (Stephanie T., Jeremy Smith Orthodontics, Rogers, Arkansas)
  2. Use an oxygenating oral rinse and a rubber-tip stimulator to help decrease the hyper-plastic response to the appliances. (Paula H.)
  3. Tell them that discomfort is a sign that things are progressing. (Ellen E.)
  4. Assure patients that it’s better to have attention drawn to your smile because it is “under construction” rather than because it is unsightly and unhealthy. (Melissa T.)
  5. Change your Invisalign tray at night before going to bed, because your teeth adjust more while you are sleeping. (Kristi L.)
  6. Brush more than once a day. (Cyndie P.)
  7. Dry brush! Anywhere! It’s the motion of the bristles that makes your gums healthy. (Rosemary Bray, Consultant, Carlsbad, California)
  8. Follow instructions exactly as they are given; many adults want to rush the process thinking they will speed up finishing. (Carolyn Friedman, OrthoAssist, Tallahassee, Florida)
  9. Fruit smoothies, milk shakes, ice cream, pudding and cold applesauce can be very soothing for aching teeth. (Lisa Anderson, Orthodontic Specialty Services, Fort Wayne, Indiana)
  10. Let them know that patients in their 80s have had braces and said it was worth it! (Anne Pearson, McDonald Orthodontics, Salem, Oregon)


So, What Can You Eat?
The new-patient packet for any age patient usually includes a classic “foods to avoid” magnet for prominent placement on the refrigerator. It’s true: hard/crunchy/sticky/chewy items are likely to cause problems. However, while the content and purpose is absolutely in the patient’s best interest, this list also operates from a sense of denial: don’t do this and don’t eat that. You can reassure prospective adult patients that just because they might feel like a kid again, they don’t have to eat like one.

Adults don’t want to feel restricted, whether they are eating at home, a party or a business function. Pass along tips such as, 1) seal freshly baked items in a lidded container with a slice of fresh bread (to add moisture), 2) use cauliflower instead of broccoli for a party dip, and 3) try microwaving an item instead of popping it in the toaster.

For the adult who has never had orthodontic treatment, how food affects braces will be a new topic. Other adults, especially if they had traditional full-band braces in the 60s and 70s, might have eaten pretty much what they wanted, never had a problem and wonder what the big deal is. The fact is that today’s small, aesthetically improved cube brackets are not as ruggedly attached as the older full-band type. Biting into apples, hard cookies or jerky might indeed have been fine for the latter, but today’s patient must be advised about the best food types, ingredients and preparation techniques to ensure continued bonding.

Arming patients with information that will help them avoid bracket/wire breakage will also directly help your business. Fewer repairs mean fewer unscheduled appointments to interfere with your daily timeline.
“Give it to Me Straight, Doc”
Children and teens are passive patients; they come to an orthodontist primarily because their parents make them. However, adult patients are proactive – older, wiser, professional and seeking information. As Lynn Schneider, adult braces wearer and owner of Dentakit.com says, “Adults want to know exactly what you’re doing every step of the way. They’re not trying to second-guess you or annoy you; they merely want to understand the science behind the fascinating process of orthodontics.” Successfully meeting this need not only gains you a patient, but also helps ensure compliance throughout the treatment.


Resources for Adult Patients
Lastly, go the extra mile to find printed and online resources you can share with prospective patients. Send home a packet that will help prospective patients make an informed, pressurefree decision in the quiet of their home. Beyond the written cost and timeframe estimates, consider these additions:

  • Print out color photos of the patient’s teeth (not just generic images) showing the problem areas with diagrams of how they can be corrected.
  • Describe the hardware and process each treatment approach would entail (again, with pictures).
  • Suggest watching the Webisode on “Adults and Orthodontics,” featuring AAO member Dr. Larry Wang (scroll through the AAO’s YouTube channel at www.youtube.com/user/AmerAssocOrtho#p/u).
  • Update your own Web site with clear visuals to help adults understand typical problems that might compare to their own situation, that they can take their time viewing. Three good examples are at:
    www.berkmanshapirosmiles.com/?p=ortho
    www.identalhub.com/article_choosing-righttype-of-braces-159.aspx
    www.badgerspiller.com/appliances.
    A downloadable AAO brochure on adult treatment is at www.braces.org/learn/Brochures.cfm.

Use the take-home packet to reinforce how much you care about the patient as a whole person by including a list of the additional items they will receive once they start their treatment. These items should further differentiate your practice and could include a braces-friendly cookbook targeted to adults, an orthodontic version of an electric toothbrush, flossing product-samples and, later, compliance awards appropriate to adults, such as gift cards for Starbucks, Jamba Juice or frozen yogurt. This is your chance to show prospective adult patients they are “more than just a mouth” – take advantage of all the resources that will help you convert those consults to starts.
Author’s Bio
Pamela Waterman is the president of Metal Mouth Media, a publishing company dedicated to “taking the bite out of braces” through specialty cookbooks, articles, Web resources and workshops. She has been a spokesperson for the American Association of Orthodontists and is the creator of the new “Braces- Friendly” Seal of Approval. Based in Mesa, Arizona, Waterman has more than 25 years of experience in engineering and writing and is the author of four books including the award-winning Braces Cookbook series. She can be contacted at pwaterman@metalmouthmedia.net.
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October 2025
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