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Teen and Adult Orthodontics
By Judah Garfinkle, DMD, MS
Board Certified Orthodontist
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Since most permanent teeth erupt by age 13, most teenagers are ready for full orthodontic treatment.  If there is a significant jaw problem involved, your orthodontist may want to time orthodontic treatment so that it coincides with the growth spurt to maximize the effects of jaw modification treatment. 

Causes of crooked teeth

Most of the time, having crooked teeth or a malocclusion (bad bite) can be traced to genetics.  This means that many orthodontic problems are usually inherited from your parents.  Some inherited orthodontic problems are crowded teeth, spacing, or having a crossbite, large overbite, underbite, deep bite, or open bite

Other malocclusions stem from environmental factors.  For example, harmful habits such as thumbsucking, fingersucking, or abnormal swallowing patterns may cause protruded upper teeth, narrow jaws, or a large “overbite.”  Early or late loss of baby teeth, mouth breathing, tongue habits, poor oral hygiene, and accidents can also cause bite problems.

Treatment Options

When you are seen for an initial orthodontic exam, the orthodontist will examine your teeth for any crowding, spacing, bite, or jaw problems and discuss with you the possible orthodontic treatment options.


Dental braces are the most common treatment used for teens or adults to straighten teeth.  Sometimes top only braces or bottom only braces will suffice, but most of the time you will need braces on the upper and lower teeth.  If you are concerned about looking like a “metal mouth,” there are esthetic orthodontic options available such as clear braces or lingual braces which are attached to the lingual (tongue) side of the teeth.  If you feel strongly against wearing braces, you can consider Invisalign, which straightens your teeth using a series of clear plastic aligners.  Your orthodontist will be able to determine which option is best for you.


Though jaw modification appliances such as headgears, palatal expanders, and functional appliances are used frequently on children, they are used less frequently for teenagers and even less for adults.  However, sometimes, in addition to braces, other orthodontic appliances may be used to improve bite problems or move teeth.

Although most problems may be treated with dental braces, for some people, braces alone cannot fix the problem.  In cases where the upper and lower jaws are not in balance together, the jaw disharmony may require a surgeon move the jaws into a more harmonious position with a procedure called orthognathic surgery or jaw surgery.  Braces are usually required, with the surgery taking place in the middle of the orthodontic treatment. 

For more information about life with braces, treatment, and general braces information, please see Orthodontics FAQ.


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Dr. Garfinkle is a Board Certified Orthodontist practicing in Portland, Oregon. Read more about Dr. Garfinkle or visit his practice online at



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