Brace yourself for orthodontics

The quest for the perfect 'Hollywood smile' has seen growing numbers of adults opting for orthodontic treatment.

America Ferrera played the ugly duckling Betty in the hit television show Ugly Betty. In the final episode she loses her trademark braces.

It was the question on the lips of every Ugly Betty fan: when will the show's central character, Betty Suarez, finally get her braces taken off? Mercifully, in the final episode which aired in the US last month, their wishes were granted. Gone is the ugly duckling with a mouth full of metal. This Betty, seen striding through the streets of London, looks cool and suave, with a row of perfectly straight, white teeth.

Back in the real world, America Fererra, the actress who plays Betty, needs no such makeover. But increasing numbers of adults are, it seems, now choosing to enter the uncomfortable world of braces. In fact, the whole painful experience, previously a rite of passage for awkward teenagers, has recently found a new market as the desire for perfect teeth, or a "Hollywood smile", spreads from the US. Here in the UAE, the adult orthodontics industry is booming, with clinics all over Dubai and several in Abu Dhabi offering various kinds of orthodontic treatment to an increasingly image-conscious population.

Dr Richard Morris, an orthodontist who practises at the American Dental Clinic in Dubai and its sister clinic, the Advanced American Dental Center in Abu Dhabi, has seen a marked rise in the number of adult patients he sees. "Probably a third of my practice is adult patients now," he says. Though some of them are referred by dentists for problems such as an overbite, which causes heavy wear on the teeth, the same number, he says, are simply in search of cosmetic improvement. "They don't even have a dentist," he says. "They walk in off the street because they see that the sign says 'American' on it, and every American, they say, has a nice big smile. 'We want that kind of smile.'"

Similarly, Dr Joy Antony, an orthodontist who currently has two clinics in Dubai and is about to open a third, has seen the proportion of adult patients at his practices jump from 20 per cent to almost 50 per cent. "Most of the adults are coming in for cosmetic reasons," he says, "to improve their smile. But there are also about 10 to 15 per cent of patients who also have other problems, so this is only part of it."

The quest for the perfect smile may be partly to explain for the rise, says Dr Leslie Joffe, a practising orthodontist and the chief executive of the British Orthodontic Society in London, who recently commissioned a survey on the numbers of adults seeking orthodontic treatment; but there are also other factors at work: "Thanks to appliances such as invisalign (a transparent plastic mould that is worn over the teeth) and ceramics (white braces which are less conspicuous than the metal version), braces have now become much less obtrusive, which makes them more acceptable to adults," he says.

In the UAE and the Arab world in general, there is an increased acceptance of braces, says Dr Mohammed al Muzian, an orthodontist who practises at Al Dehyafa Specialised Orthodontic and Dental Centre in Dubai and whose client list is largely made up of UAE Nationals. "Before, if you put something on your teeth, you would get many jokes," he says, "but now in the UAE and especially in Dubai, the city has become more open to the world so it has become more normal to wear braces."

Most of his patients, he says, used to be under 18. But no longer. "Now, round 10 per cent are over 35; 30 per cent are between 30 and 35; and a further 30 per cent are between 20 and 25." He often sees parents come in with their teenage children and it is they who end up getting braces. "Most of them are mild cases, but they want their Hollywood smile," he says. Such has the trend for orthodontic treatment been embraced here, that it has become, for some, a sort of fashion statement.

"About 15 per cent of my patients come because they have a problem. But they don't want to wear braces as a treatment; they want to wear them as a fashion. So they have the braces without the wire, just for the look. Of course, before we put them on we give them many instructions that this has no advantage, that it accumulates food. We make them sign a paper to say that this is their own responsibility, but they insist."

Combined with the high levels of disposable income in the UAE and the relatively competitive prices for orthodontic treatment (braces here can cost around half the amount they do in the UK), it is not hard to see why adults are clamouring to sign up to treatment. What, though, are the health risks for adults? Anything less than scrupulous oral hygiene may, says Morris, cause lasting damage to the gums, which can be aggravated in adults who wear braces.

"Whereas with kids, the gum tissue seems to recover even when they're terrible brushers, if adults have more damage while they're in braces, then it just doesn't seem to recover," he says. There are also more serious structural issues, such as changing a recessive jaw, which can be achieved via orthodontics in children, but which, in adults, requires surgery because the bone has stopped growing. If it is simply a case of realigning teeth, though, says Joffe, the risk is minimal, since adults' teeth move around in the same way as children's.

"We can have treatment done in 12 -15 months, which is the same as I would expect from a child." All agree, though, that the psychological impact of having one's smile improved, regardless of the reasons for doing it, is considerable. "One of the things that came out of our survey," says Joffe, "was that most people wanted to have orthodontics done for cosmetic reasons; not purely cosmetic, but the feeling that it would enhance their lifestyle or enable them to get a better job ahead of somebody else. It's not just cosmetics for cosmetics sake, it's more about improving your overall wellbeing and sense of worth."

No doubt Betty could vouch for that.