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Adult Orthodontics: What Has Changed? Part 2

A couple of posts ago, I started talking about the evolution of adult orthodontics, the subject of my master’s thesis. Since then, I had a couple requests for blog topics from family and friends (hence my last few posts). Today, I will continue where I left off. I finished my first blog on adult orthodontics by establishing the adults are most concerned about the appearance of the orthodontic appliance and that they tend to rate clear aligners (like Invisalign) and ceramic brackets as the most attractive treatment modalities. Then I posed the following question: “But does this also extend to how the individual wearing the appliances is perceived?” This will be where I will start today.


The Impact of a Straight and Healthy Smile


Many studies throughout the years have attempted to correlate dental appearance and social and physical attractiveness. Overall, people with healthy, straight smiles are seen as more socially, intellectually, and psychologically competent that their counterparts. (1 ,4)  These judgements extend to the workplace as well. One study in the American Journal of Orthodontics and Dentofacial Orthopedics found that individuals with ideal esthetic smiles were more likely to be hired and were seen as more intelligent that those with a malocclusion (bad bite). (5)


The research clearly shows the advantages of the outcomes of orthodontic treatment, but what about during the treatment?


This is one of the most common concern I hear from my adult patients. They are concerned about how they will be perceived during their treatment. Though there is some conflicting research, most of the research indicates that interpersonal social and physical judgments are not influenced by the presence or absence of orthodontic appliances. (2,3) One study even found that we tend to judge ourselves more harshly than others perceive us.


My Research


My research focused more on the job-related impacts of orthodontic appliances. I looked at the influence of orthodontic appliances (metal, ceramic, and Invisalign) on an employee’s performance, intelligence, and attractiveness. My study found that overall, the presence of absence of an orthodontic appliance had no effect on an employee’s performance rating, intelligence, or attractiveness.  I did find some interesting gender biases for the different types of orthodontic appliances.




As the number of adult patients in orthodontic offices continues to grow, orthodontist continue to evolve their treatment modalities to address the needs of these patients. The benefits of orthodontic treatment for adults are clearly established. Treatment can improve esthetics, but it can also improve self-esteem, body image, and other psychosocial aspects of someone’s life.  The temporary appearance and use of any orthodontic appliance serves only as a necessary means to an end treatment goal.


  1. 1. Beall AE. Can a new smile make you look more intelligent and successful? Dent Clin North Am. 2007;51(2):289-97, vii.
  2. 2. Berto PM, Lima CS, Lenza MA, Faber J. Esthetic effect of orthodontic appliances on a smiling face with and without a missing maxillary first premolar. Am J Orthod Dentofacial Orthop. 2009;135(4 Suppl):S55-60.
  3. Fonseca LM, Araujo TM, Santos AR, Faber J. Impact of metal and ceramic fixed orthodontic appliances on judgments of beauty and other face-related attributes. Am J OrthodDentofacial Orthop. 2014;145(2):203-206.
  4. Newton JT, Prabhu N, Robinson PG. The impact of dental appearance on the appraisal of personal characteristics. Int J Prosthodont. 2003;16(4):429-434.
  5. Pithon MM, Nascimento CC, Barbosa GC, Coqueiro Rda S. Do dental esthetics have any influence on finding a job? Am J Orthod Dentofacial Orthop. 2014;146(4):423-429.
  6. My thesis (the very long version)

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