Out of the Mouths of Adults
Whenever I see an adult wearing orthodontic appliances, I strike up a conversation. These people are clerks in stores, managers, bank tellers, secretaries, lawyers, automobile sales people--adults in all kinds of jobs who have decided to have orthodontic treatment. So far, every one of them has been enthusiastic and upbeat about orthodontics for adults.
When I ask them why they decided on treatment, they speak about improving their appearance and their self-image.
When I ask them whether it bothers them to have visible appliances, they tell me they inquired about lingual braces or tooth-colored brackets, but when their orthodontists explained the pros and cons of each alternative, they went along with the orthodontists' recommendations of visible appliances. They have gotten used to them, don't think about them any longer, and find them to be an item of conversation at work and at social gatherings.
When I ask them whether they are concerned about privacy during their appointments, they tell me either that their orthodontist has a private treatment room for adult patients or that they have grown accustomed to a lack of privacy, but would prefer privacy if it were available.
When I ask them whether it bothers them that treatment takes so long, they tell me that they understand the reasons and knew the ground rules going in. Time, they say, passes pretty quickly.
When I ask them about discomfort, they say that there is some, especially when a new archwire is placed or an adjustment is made, but that the discomfort lessens before long and is not a problem.
When I ask them if they have had occasion to recommend orthodontic treatment to others, they appear divided between two answers: "Yes, I have" and "That has to be an individual decision; I'm satisfied that I am doing this, but we all have to decide for ourselves".
The profile I get from these conversations is that of a serious, determined adult who has weighed the pros and cons, the hurdles and the benefits, and opted to undertake orthodontic treatment. It may be significant that these people made their own decisions and were highly motivated to reach a successful conclusion.
The other lesson we might derive from these man-in-the-street and woman-in-the-street interviews is that there must be a lot more of these types around who are not having orthodontic treatment. The fact that many adults were enthusiastic about their own treatment but lukewarm about recommending it to others may be an indication of why the percentage of adult patients in the average orthodontic practice is declining, according to the 1991 JCO Orthodontic Practice Study (JCO, November 1991-January 1992). That and a preference on the part of orthodontists to treat children.
The idea that commitment comes from decisions one makes for oneself can be applied to children as well. Too often, the commitment to undertake treatment is made between the orthodontist and the parents. But if the child is not involved in the decision-making process, poor cooperation often follows.
Judging by the recent JCO Orthodontic Practice Study, the average practice is currently able to do well despite a declining percentage of adults. This may be related to the children of the so-called baby boomers reaching orthodontic age. The demand side of child orthodontics has increased, and is likely to do so for several additional years. Nevertheless, there is already talk of a decline in the birth rate that may be expected to affect orthodontic practices eight or 10 years down the road.
Now would be the time to encourage a greater representation of adult patients and to gear the practice environment and administration to adult care, without neglecting child treatment. A better mix of the two will serve any practice well now--and certainly by the turn of the century.