Treating Adults

OP: What percentage of your current patients are adults?

Bowman: 17%.

OP: Has this percentage been growing over the past few years?

Bowman: Not significantly.

OP: Do you do any marketing designed to attract more adult patients to your practice?

Bowman: Nothing overt. Adults often refer their friends due to their satisfaction with the results of treatment and the convenience of the offices. (I have two satellites.) The options available—clear aligners, camouflage alternatives to surgical treatments, and, more recently, the advent of miniscrew implants—also attract adult patients.

OP: Do you treat adults differently at their appointments (that is, do they get private rooms, do you have an office that treats only adults, etc)?

Bowman: We do not have private rooms, but we had a quieter area that we used to use. Many adults wondered why they were not out with the rest of the patients where they could hear the rock music or watch MTV or ESPN on the monitors, so we gave that up.

OP: Does the treatment modality you use differ in kids and adults, and if so, how? 

Bowman: Adults require more time and attention to address their concerns. They have a vested interest in treatment, and they are more in tune with what is happening to their treatment. Consequently, they have more questions, and they are more perceptive to the changes during treatment. Orthodontics for adolescents seems to them to be “something done to them,” whereas the hassle factor (things such as making appointments, keeping braces clean for social and business interaction, the discomfort, and disruption of function) are more adult concerns.

OP: In general, have you found that adults’ teeth move faster, more slowly, or at the same pace as kids’?  

Bowman: Adults’ treatment take a bit more time because metabolism or bone-turnover rates are slower. However, they are often much more compliant, and this helps to equalize things.

OP: So you do find that adults have better compliance than kids?

Bowman: Yes.

OP: What’s the oldest patient you have treated?

Bowman: I treated an 85-year-old, but I have photos of a patient who was 80 when she started treatment. She wanted pink “ties” every visit to go with her pink 1965 Mustang. She and her girlfriends were lots of fun in the office. I saw her recently. She is still sporting a lovely smile; however, she now needs the assistance of a walker to get around.

The patient, named Lucy, presented with an anterior crossbite with a chief complaint that she wanted a new upper dental crown. Unfortunately, the crossbite precluded ideal restoration, so orthodontics was suggested. A mandibular osteotomy was not an option for her; therefore, we extracted the mandibular central incisors and closed the space while retracting the other anterior teeth to provide proper overjet. Her treatment was astoundingly 12 months to the day (from October 3, 1995, to October 3, 1996), despite a month-long trip to Hawaii with her girlfriends.

She was so pleased with the final orthodontic correction and alignment of her upper teeth in her new smile that she never sought any additional aesthetic work.

OP: Do you have any plans to expand the “adult-treatment” side of your practice?

Bowman: Not specifically. The mix is pleasant.

S. Jay Bowman, DMD, MSD, is in the private practice of orthodontics in Portage, Mich. He is an adjunct associate professor at St Louis University and the Straightwire instructor at the University of Michigan. He can be reached at [email protected].