Adult Orthodontics: Straightening Teeth Later in Life

In general, suitability depends on the gums, supporting bone and the problem itself; existing crowns and fillings add fixed-brace risks.

Orthodontic tooth movement relies on bone turnover and tissue remodelling, a 2024 British Dental Journal review explains.

At Deepcar Dental Care, our dentists treat mild to moderate crowding and spacing, and offer bite correction. Complex and extraction cases are assessed case by case; some need braces or a combined approach. As general guidance, where braces or aligners at the practice are not the right tool, for example a problem that comes from jaw position and may need surgery, the patient is referred to an orthodontic practice or a hospital orthodontic department; your consultation confirms what applies to you.

Gum health comes first because, as a 2024 British Dental Journal review puts it, periodontal health is generally a prerequisite for starting orthodontic treatment. It says it is typically suggested that treatment waits until any active gum disease (periodontitis) is under control, with ongoing maintenance for people prone to it, because untreated inflammation may keep the condition going or make it worse. It adds that orthodontics could be called almost “periodontally neutral”, but that this rests mostly on healthy gums treated over short periods, and people prone to gum disease still need careful management.

A 2022 review, based on a small number of low-quality studies, found tooth movement had no significant impact on gum measures in adults without gum disease or with stable, treated gum disease.

If you have had gum problems, tell the dentist planning your treatment; the condition itself is explained on our page about how gum disease develops.

What does guidance say if you have had severe gum disease?

For severe (stage IV) gum disease where teeth have drifted, fanned out or lengthened, European Federation of Periodontology guidance recommends orthodontic treatment once gum treatment meets its targets: no 5 mm pockets that bleed, none 6 mm or deeper. It recommends gum checks, ideally at each orthodontic appointment, and suggests fixed over removable appliances. If gum disease returns, it recommends pausing tooth movement, holding affected teeth until gums are stable, then restarting, with lifelong, tailored gum care and retention afterwards.

Risks to weigh include shortening of the tooth roots and gum recession.

In a 1995 study of 343 adults from four orthodontic practices, the six upper front teeth lost an average of 0.94 mm of root length, and 40% had at least one tooth shortened by 2.5 mm or more; in paired comparisons, root-filled teeth shortened less. BOS says the risks should always be explained, so ask about yours before starting.

Gum recession is the gum shrinking back from the tooth. Another 2024 British Dental Journal review links thin gum tissue (a thin periodontal phenotype) with a higher risk of recession during treatment, while calling carefully planned treatment generally compatible with gum health, even in susceptible people. A 2020 review of three controlled studies found recession did not increase significantly straight after treatment, versus untreated people with normal bites, though the risk on the front teeth seemed to rise in some comparisons, especially during retention; it said the findings should be viewed cautiously. If you notice your gums shrinking back, show a dentist.

The general risks of orthodontic treatment are covered on our page about orthodontic treatment.

Our page about what it costs covers orthodontic costs. The practice’s current fee list, which gives “from” prices, shows this price:

• Clear aligners: from £1,495 per arch

The fee list does not say whether the £1,495 per arch line covers fixed metal, ceramic or lingual braces. Retainers and orthodontic consultations have no line on the fee list.