Cosmetic dentistry gains popularity - More adults are seeking orthodontic treatment, including those who had braces as teenagers

As a teenager, Marty Huie wore traditional metal braces for two years. It was a painful and annoying process-she had all of her wisdom teeth pulled and had to wear a headgear at night.

For nearly a decade after she had the brackets and wires removed, she faithfully wore a retainer to keep her teeth neat and straight.

But then, soon after graduating from college, she started to break that habit. "I just kind of got out of the practice of putting it in at nighttime," Huie said.

And that's why, a year ago at the age of 37, the Gloucester resident made a visit to an orthodontist's office. She had noticed that her bottom teeth looked crowded. And sometimes when she bit down, she felt a little bit of pain.

Huie, who recently completed a year-long treatment of Invisalign, is one of a growing number of adults seeing orthodontic treatment - for the second time. Many of them say they should have listened to their orthodontists or parents who nagged them to wear retainers. Some say that they weren't told they would have to wear retainers forever.

Loretta R. Rubenstein, Huie's orthodontist, guessed that about 25 percent of her adult patients were receiving orthodontic treatment for a second time. Rubenstein, who has been practicing since 1986, said there "absolutely has been an increase" in adult orthodontics.

In 1989, the first year that the American Association of Orthodontists began tracking patients by age and gender, 3.5 million people in the United States and Canada were treated by members of the professional organization. Of those, 875,000 were adult patients, those 18 years of age or older.

The number of adults in both countries seeking treatment jumped to 1,092,500 in 2004, the most recent year for which the 15,000-member group has data available. That's an increase of 24.8 percent between 1989 and 2004. The total number of all patients climbed to 5.75 million, an increase of 64.28 percent.

Scott Golden, a spokesperson for Anthem Blue Cross Blue Shield of Virginia, said his company has noticed an increase in adults seeking orthodontic treatment. Over the last few years, the health insurance provider has provided orthodontic coverage either as a standard benefit or as an add-on option, depending on the plan an employer chooses.

"There are more adults than 20 years ago going for orthodontics," said Steven J. Lindauer, chair of the Department of Orthodontics at the Virginia Commonwealth University School of Dentistry. "There are more appliances that are more aesthetically pleasing," he said, citing Invisalign and tooth-colored porcelain braces as examples.

Invisalign is manufactured by Align Technology Inc. According to the company's Web site, more than 250,000 people have used its product since 1997. Made of clear plastic and resembling tooth-whitening trays, Invisalign is custom-made for patents.

Jennifer Farris Howard, who is planning to open her own private dental practice in Smithfield in January, said that the increase in adult orthodontics is part of a bigger trend in medicine.

"We're not dealing with a lot of necessary treatments but with more optional treatments," said Howard, who sees patients at a dental practice in Norfolk. "It's just like medicine - look at cosmetic surgery. Cosmetic dentistry is getting more popular."

She also added that until recently, not all dentists and orthodontists told their patients that retainers must be worn part-time forever in order to prevent teeth from shifting.

Howard said that her orthodontist didn't tell her that-and she's planning to undergo Invisalign treatment herself.

At his private practice in Hampton, Jon Scott has been treating adult patients for a "good little while."

"It's nothing new," he said of adult orthodontics. "But in the last few years, it has increased."

He added: "Invisalign has a lot to do with it."

Dentists and orthodontists say that Invisalign works best for people who need minor re-alignments, which is often the case for adults whose teeth have shifted after their braces were removed.

"There has been a lot demand from people who had braces as teens and didn't wear their retainers," said Marko Venne, a dentist with a private practice in Newport News. "These are adults who need fine-tuning but figured they were too old for the metal braces."

That isn't to say that adults are not being fitted for metal or porcelain braces - they are. Dentists and orthodontists say they recommend traditional braces if a patient's teeth have shifted significantly.

But they say that their patients often ask for Invisalign first.

"It virtually doesn't show," Lanny C. Hinson, a dentist in Newport News, said explaining Invisalign's popularity. "And they can maintain the health of their teeth and gums because they can take it out to brush or floss."

He added: "If they have a special occasion and they don't want to wear it, they can take it out - but if they skip a lot, then it's going to take longer to reach the desired result."

Huie, now 38 years old, learned her lesson the first time. During the course of her Invisalign treatment, she only took her aligners out to eat or to brush her teeth. And nowadays she doesn't forget to wear her retainer at night.

The first time she underwent orthodontic treatment, as a freshman in high school, her parents shuffled her to her appointments, reminded her to wear her headgear and footed the bill. This time she's the one in charge - and the one who paid for it. Lindauer said many adult patients are like Huie. They're more committed and responsible.

"They are doing it because they want to and not because their parents are forcing them to," he said. "And they are laying out the money."