Laura Nolan from Dancing with the Stars. Photo: Moya Nolan

Laura Nolan of Dancing with the Stars says her smile is “much fuller, bigger and brighter” since having Invisalign treatment to fix a problem that began with getting her wisdom teeth.

“There wasn’t space for my wisdom teeth to come up, and when they did my teeth got pushed together. One or two started to turn. There was one in particular, on the top right, that I noticed a lot when I was on camera,” says the 27-year-old professional dancer.

A star of RTÉ’s Ultimate Hell Week , Nolan began treatment at Dublin-based D4Dentist in March 2021 and knew from the start she wanted clear plastic aligners. “I’m a dancer on TV. I also model. I didn’t want people to see me with train tracks. I wanted it to be discreet.”

Dr Rozelle Owens, principal dentist at D4Dentist, says demand for adult braces has been rising for over a decade but it has soared more recently, fuelled partly by an increase in people working from home and on Zoom.

“Adult braces are definitely in hot demand. We’re seeing more people saying ‘I’ve been looking at myself and this is driving me mad — I want it fixed’.”

Explaining that ideal alignment is rare in nature, Owens says the eye is drawn to any discrepancy and — with more of us video-conferencing — there’s more opportunity to spot the flaw.

“It’s about confidence. With many adults, I find it isn’t that they want to look beautiful. They’re just very self-conscious about their teeth. It stops them from smiling and interacting with people they don’t know well. Work interactions come into this —going into a meeting or interview, they’re holding back, not meeting people in an open way, and this impacts on their success.”

Originally from Cork, Dr Paul Murphy is principal orthodontist at South Beach Clinic in Greystones. He says a convergence of factors made the pandemic and post-pandemic phase the perfect time for many adults to go for braces. Aside from more opportunity to see yourself “up close and personal”, he points to more disposable income in people’s pockets. “Some decided to use it to fix crooked teeth. And wearing masks meant they could be more discreet about it — no one would know.”

In addition, complex cases — for example, somebody with a bite issue would need correction pre-treatment — now had the time needed for multiple appointments. “Being home-based it was easier to just pop out and get it done. So a few things aligned at the same time and it was the perfect situation for a lot of people to pursue this,” says Murphy.

Braces or aligners can be used to remedy problems like spacing, crowding, crooked teeth, prominent teeth, buried, or missing teeth. Patients can opt for: fixed braces — metal or ceramic — which are glued onto outside of the teeth; invisible braces that are glued onto the inside of teeth (lingual); or clear, plastic aligners that can be taken in and out.

The decision around which technology to opt for comes down to patient preference — for example, some people struggle with the stricture to only take out aligners for two hours daily — as well as the orthodontic problem to be remedied. “Some appliances are better at certain types of teeth movement,” explains orthodontist and president of the Orthodontic Society of Ireland Dr Ciara Scott.

Dr Ronan Perry of Dentalhouse.ie, says clear plastic aligners are very popular with adults. “Patients want the benefits of treatment, not the process. Maybe they’ve a family wedding coming up or there’s one tooth they’ve always disliked — they’ll have a name for it, like ‘snaggle tooth’. They come with a specific problem and they’re looking for a process to fix that without it taking over their lives.”

The procedure of getting aligners begins with the taking of a digital scan, which gives an exact replica of the person’s teeth. Full clinical photos and a panoramic X-ray are also done. “Once we’ve all the information, we use a computer programme to plan the orthodontic movement needed to straighten the teeth. We take the patient’s goals into consideration in the plan,” says Dr Owens.

With Invisalign, attachments are used — little white buttons stuck onto teeth to correspond with the aligners. “Attachments stay on the teeth for duration of treatment and allow teeth to be moved in more complex ways.”

Aligner treatment is broken into increments of movement, with each aligner having a maximum amount of movement built in. Aligners are changed on a weekly basis. “Each aligner has a job to do, so with the first aligner you might feel some pressure on the left side, with the second you might feel it on your top teeth.”

Dr Owens likes patients to have a “gentle entry” to the aligner procedure. “We give the first two aligners without attachments — making it easier for them to get used to wearing aligners. The third appointment is the most involved — we put all the attachments on and we give the patient a few sets of aligners to take home and change themselves. We typically like to see people every six to eight weeks.”

When patients initially put in a new aligner, they may feel pressure on their teeth for a day or two. “After that, teeth feel more passive but the aligners are still working. Compliance is essential — you have to wear them 22 hours a day. I tell patients ‘you have four 30-minute breaks to eat’” says Dr Owens, who estimates most cases take six months to a year to complete, although more complex cases can take up to two years.

The main risk post-treatment is that teeth may move, so wearing retainers after orthodontic treatment is essential. Dr Owens recommends wearing one full-time for six months, and a removable one at night-time — forever. “Teeth are dynamic. It’s why we can move them. But if we don’t hold them in the position we’ve put them in, they’ll relapse.”

Prior to any orthodontic or cosmetic work, the patient should first have a full clinical examination, X-ray and oral health assessment. “Any problem needs to be stabilised first. If you don’t start from a healthy base you incur risks to oral health and to your teeth,” says Dr Owens.

At the Orthodontic Society of Ireland, Dr Scott says best practice guidelines advise taking an OPG (orthopantomagram) — a panoramic scanning dental X-ray of the upper and lower jaw. This, says Dr Scott, assesses for the three Ps:

“Otherwise, there’s a risk the underlying issue will be made worse. If there’s untreated gum disease and you start moving teeth, the teeth can become loose or gums may bleed and the appliance [braces, aligners] may be uncomfortable,” says Dr Scott.

Dentists and professional orthodontists all over Europe are concerned about a rise in start-up companies promoting and selling orthodontic treatment using aligners by post (direct-to-consumer). Last October, the European Federation of Orthodontic Specialists Associations (EFOSA) said this type of remote treatment is “provided without proper initial diagnosis or any form of regular clinical monitoring”.

They said the companies often present their services as affordable, fast, and safe, “although they clearly don’t meet required professional dental standards”.

The growing concern has seen 31 professional dental and orthodontic societies, associations, and institutions from 25 countries come together to endorse a Joint Declaration regarding this “unacceptable and potentially unsafe remote treatment”. The Declaration states basic requirements that must be met for any orthodontic treatment.

“Orthodontic treatment without thorough clinical face-to-face examination of the patient, X-ray imaging and regular clinical monitoring, is potentially hazardous to the patient’s health,” EFOSA warns.

Here, the Dental Council warned five years ago about a number of manufacturers “providing orthodontic appliances directly to members of the public outside of the dental surgery setting”.

Scott has met patients “seeking repair” after choosing to go for DIY braces. She says the “smile-experts” and “treatment coordinators” at these companies are often simply salespeople. “They don’t have any specialty in orthodontics.”

What are the benefits of orthodontic treatment, professionally done? And is it worth the investment? The cost of braces and aligners can be in the region of €3,500-€5,000, with the price tag on very complex cases rising to €6,000 or more.

Dr Ronan Perry says orthodontics isn’t simply about the improvement of the alignment of teeth — it’s also about function. “Healthier teeth look better, work better and last longer,” he says, citing a study that found having 20 or more teeth at age 70 was associated with a considerably better chance of living longer than people with less than 20 teeth.

“Anything in healthcare is an investment for a longer life. Adults are having this treatment now, partly because of the Zoom-effect, but they also want to live longer, healthier lives. Looking after the health of their teeth and gums is a big part of that,” he says.

Studies have shown links between gum disease and heart disease, says Dr Perry. It has also been implicated in respiratory disease, rheumatoid arthritis and problems controlling blood sugar in diabetes.

Perry says very practical factors underlie why people with stronger teeth that fit well together fare better in general health. “People having treatment with braces or aligners will have been checked before starting to ensure their gums and teeth are healthy. Their nutrition will be better and it’s definitely easier to clean your teeth if they’re straighter.”

And, of course, if your teeth look better you’ll be more motivated to look after them. “It becomes a positive reinforcing cycle,” says Perry.

‘I’m back to wearing bright lipsticks’

The plan was to have great teeth by her 50th birthday. Meath-based Karen Armstrong, pictured below, was aged 49 when she began to fix her teeth. “I’d developed a significant gap between my front teeth and my top teeth had started to kick out at the ends... I’d see it in side-profile photos. I didn’t look like myself anymore. I wanted to get them straightened, pulled back in and maybe close the gap.”

Unfortunately for Karen, now 55, things did not work out. “I was left without any kind of a bite. My teeth looked gorgeous, they were very straight and the gap was closed in, but my top teeth didn’t overlap my bottom ones. The dentist told me they’d settle in time.”

Karen had to contort her mouth to chew her food. “It was functionally really tricky to chew anything at all. I was so self-conscious, I didn’t want to go out to dinner or eat in public.”

Karen eventually sought treatment from the orthodontist treating her daughter, Dr Ronan Perry. When conservative treatment proved unsuccessful, she began Invisalign. “It needed to be a slow, gentle process because my teeth were too loose. I didn’t have any pain. The bite function took a while to restore.”

Karen finished treatment at Christmas. She now has small wires on some of her top and bottom teeth. “You can’t see or feel them. They’re to prevent any kind of movement of my teeth. I also wear a retainer at night.”

Delighted with her teeth, she says she is “back to wearing brightly-coloured lipsticks.” 

“It gives you more than straight teeth. It gives you confidence... that translates into your work and relationships.”

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