It started out harmlessly enough. Like one wrinkle, or that first gray hair, Brittany Donkin noticed that her once-perfect teeth seemed...

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It started out harmlessly enough. Like one wrinkle, or that first gray hair, Brittany Donkin noticed that her once-perfect teeth seemed to be getting just a little less perfect.

She started peering at herself in pictures, comparing the smile she’d earned through three years of adolescent braces with the slowly migrating teeth she saw in the mirror.

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“You don’t necessarily notice it at first,” the 30-year-old Seattle paralegal assistant said. “But my retainers didn’t fit, and one tooth started moving drastically.”

So she did what more and more adults are opting to do. She got braces.

Again.

Donkin is one of a growing number of adults who have already perfected that telltale, rubber-lipped smile and who know exactly what they’re in for when the orthodontist tells them to open wide.

There are no statistics on how many adults are getting braces again after suffering through them as kids, according to the American Association of Orthodontists. But Puget Sound-area practitioners say they are seeing more patients return to the office they knew well as a tween. Dr. Don Joondeph, a Bellevue orthodontist, estimates that of the 20 percent of his patients who are adults, about 20 percent of them are back for a second go-round.


FYI: adult braces




Healthy teeth
can be moved at almost any age.


One in five
orthodontic patients is an adult.


Adult teeth
can move more slowly and may require more than just braces to correct a problem, whereas children have the benefit of a still-growing jaw. Factors such as gum or bone loss, jaw problems or missing teeth sometimes require surgery and coordination with other dental professionals.


Most adults
wear their second-time braces for 18 to 20 months.


The cost of care
varies for the individual but will generally run around $5,000 to $6,000 for that time period.

Source: American Association of Orthodontists and Dr. Don Joondeph, Bellevue orthodontist

Lisa Heyamoto, Seattle Times staff reporter


“People are coming back in because they had their teeth straight at one time and probably really liked the feel and the bite and the look,” he said. “It’s more or less of a fine-tuning or a spiffing up of what used to be there before.”

Jeanie Holm, who works the front desk at Joondeph’s office, decided to go through it a second time after stewing on the idea for years. After she finally finished paying for her two kids’ orthodontic care and got them off to college, she decided to go for it.

“I thought since they’re done, it’s my turn now,” the 45-year-old said. “Being in the business, you’re just that much more aware of perfect teeth as opposed to ones that have shifted.”

So she’s been wearing the braces for two years now, thanks to a misaligned bite. It’s not particularly painful, she said, nor does it bother her to be sporting the traditionally adolescent accessory.

“So many of our patients are adults, I think nowadays it’s pretty common,” she said. “I mean, Tom Cruise had them, didn’t he?”

It’s not that Donkin and Holm have overly mobile teeth, or were bad retainer-wearers, or that their orthodontist had been on cruise control when they sat in that chair the first time. Instead, they learned the hard way what has in the last decade or so become common orthodontic knowledge: Your teeth never stop moving.

Like that one wrinkle, or that first gray hair, your teeth change as you age, says Dr. Robert Little, professor of orthodontics at the University of Washington School of Dentistry. People who thought their Crest smile would never change find that their teeth start to crowd and overlap as their jaw compacts. It can happen at any age, but most of the movement occurs during your 20s and 30s.

Think about getting those first braces the way you’d think about a first facelift, Little says. It may do a great job of perking things up for a while, but no one expects it to look the same forever, or even 20 years later.

“It’s just normal physiology,” Little said. “We are temporarily interrupting normal physiology with our orthodontic treatment and the retainers that follow, and once we release those changes, it kicks in again.”

It may sound like a no-brainer, but it’s a departure from orthodontic thought of the ’60s and ’70s, which held that wearing a retainer for a couple years after braces would be enough to keep teeth in place for life.

Another disproved idea is that removing wisdom teeth eliminates the likelihood of crowding.

“Any field in medicine or dentistry is in evolution,” Little said. “As new evidence comes along, you adapt.”

Many of the new lines of thought come straight from Little himself, who conducts studies from one of the biggest collections of long-term orthodontic records in the world. Started by the late Dr. Richard Riedel, former chairman of the UW Department of Orthodontics, it includes data from as far back as the 1950s and follows patients for decades.

The findings, however, aren’t very encouraging for those trying to predict their odds for roving teeth. Little has found that about two-thirds of people have jaws that will decrease in width and length with age. And here’s the kicker: It happens even if you wore braces for years.

It doesn’t matter if you have vast spaces between your chompers or if they seemed huddled together for warmth. There is no regard for whether you’ve got an overbite, an underbite, are missing teeth, have extra teeth, had braces for the better part of your childhood or were born with a perfect smile.

“You can’t predict [the outcome] based on how they looked when you first began,” he said. “You don’t know which pattern is going to be a winner and which is going to be the loser. You just have to play it cautiously.”

The only way to keep things in place, he said, is lifelong use of retainers.

Which is exactly what Donkin discovered. Yes, she wishes she’d known that her hard-won smile wasn’t long for this world, but was she really going to faithfully wear that retainer once she got to college?

“You’d never date,” she said.

But sporting braces in her late 20s created a similar problem. At first, she resisted the idea. She was in a new relationship and didn’t really feel like throwing braces into the mix. But at $800, they were only $300 more than a series of corrective retainers, it would only be her front six teeth and she could get the braces in a clear color. Anyway, it was only for a couple of months.

“I wanted to save what I had,” she said. “I’m going to pay a little bit extra, and I’m going to get what I want.”

Three months, however, turned into six, thanks to a particularly stubborn tooth. And though she was a willing wearer, she nonetheless was living the life of braces. She had to re-experience the familiar lip-and-cheek chafe. She got ID’ed everywhere. She’d preemptively point out her braces to new people she met, only to discover that they hadn’t noticed them in the first place.

“I think I was more self-conscious than I needed to be,” she said. “Those last three months were like, ‘Am I done yet, am I done yet, am I done yet?’ ”

Now, Donkin is delighted with her newly perfect teeth and has even inspired some of her friends to consider re-bracing themselves. But there’s one lesson she’s learned for certain.

“Oh, I’m being very good about wearing my retainer,” she said.

Because three times is not the charm.

Lisa Heyamoto: 206-464-2149 or lheyamoto@seattletimes.com