Most adult orthodontic patients get fixed braces in some form or other but at some point in your treatment you may be required to comply with instructions from your orthodontist to use a removable appliance or elastics.  If you think this won’t apply to you, just remember that every orthodontic patient will eventually get a retainer and unless this is fixed in place, you will be required to meet strict wear schedules to ensure your teeth do not relapse after treatment.

So do adults religiously wear their removable appliances and elastics?  Accordingly to a paper reviewed by Prof. Kevin O’Brien in his well respected orthodontic blog, young people do not generally meet the required wear time for removable appliances even when there is a timer mechanism embedded in the appliance so are adults any different?  I would suspect they may not be so this post explores my experiences with complying with instructions from my orthodontist.

Part way through my treatment, I was required to wear class 2 elastics which were used to reduce my overjet. Getting used to them took all of five minutes and they did not affect my speech at all.  They were quite comfortable and discreet so wearing them became second nature quite quickly. I wore them pretty much all of the time, often when eating as well, and only took them out to clean my teeth. I always had some spares with me and if one broke, as it frequently did, or seemed to have stretched to the point of being ineffective, I changed it for a fresh one. Thinking about this time, I think I can honestly say I wore these elastics pretty much 23.5/7.

Later in my treatment I was required to different elastics which were a little more awkward and visible. Did I wear these 24/7?  No, of course not.  It would be fair to say these were worn almost full time, including at work, on most occasions, but there were certain times when I removed them when I felt they were likely to be in the way. It was difficult to eat with them in so they were removed prior to meals and important meetings and sometimes not replaced for a while after.  Overall, I would say I achieved at least 75% compliance with these elastics. I could have easily worn them a lot less but my motivation to achieve a great result at this point overcame my concerns about what other people might think and looking back, it doesn’t seem as big an issue as it may have appeared at the time.

So what would have happened if I had been asked to wear an awkward removable appliance during my treatment? I suspect that like many others, I would have strived to meet the required wear schedule but depending on the impact this was having, may have considered how practical it would have been to wear it for the prescribed number of hours. Wearing a removable appliance whilst at home and when not working would be quite easy but at work, other factors need to be considered and maybe compliance would have been harder to achieve. Given that I am probably no different from many other adult patients, should this be taken into account by orthodontists and more realistic wear time prescribed or would this not achieve the desired results? Maybe the solution is in making the appliance fixed rather than removable? Would it be easier to justify wearing something that cannot be removed rather than a similar appliance that can be? I often wonder when an orthodontist states that a removable appliance should be worn 24/7 why this isn’t designed as a fixed appliance. I’m sure there a good number of reasons but recognising that patients don’t always make the right choices, would they find it easier to accept treatment if the option was taken from them?

I’m also curious to know whether the inclusion of a timer mechanism in removable appliances would have more impact on an adult patient particularly as adults have a stronger financial interest in their treatment outcomes?  I have previously written about timer mechanisms in removable appliances and feel this may lead to some interesting insights into patient motivations.

Now that I have finished my active treatment, I have to wear removable retainers whilst my teeth settle into their new position. In another post I will explore how I have adapted to retainer wear and how closely I met the required full time wear prescribed by my orthodontist.

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