Cognitive Daily

When our dentist told us Jim and Nora needed braces, we just took them straight to the orthodontist and signed them up for treatments — we didn’t even think twice about it. On the other hand, their treatments haven’t been especially dire — neither child needed “headgear,” for example. I know people who’ve had elaborate, painful gear, requiring horrific hand-cranking and years of dreaded visits to the orthodontist, beginning as early as the second grade. It does make you wonder: is it all worth it?

A new study suggests that it may not be. Researchers followed a group of children for 20 years following dentists’ recommendation of orthodontia. Some of the kids had gotten braces, but others had not. Here are their results:

Orthodontic treatment, in the form of braces placed on children’s teeth in childhood, had little positive impact on their psychological health and quality of life in adulthood.

Further, a lack of orthodontic treatment in childhood did not lead to psychological difficulties in later life for those children where a need was identified but no treatment received.

It can be concluded that, although in general participants’ self-esteem increased over the 20-year period, it was not as a result of receiving braces and didn’t relate to whether an orthodontic treatment need existed in 1981. This runs contrary to the widespread belief among dentists that orthodontic treatment improves psychological well-being, for which there is very little evidence.

There was some evidence that those who had their teeth straightened felt better about their teeth, but that was it — for the most part the braces made no difference. I do wonder, however, whether changing attitudes about braces may mean that if we began a new, similar study today, we’d find a different result. When I was in school in the 70s and 80s, lots of kids had braces, but lots did not. Today, it seems, nearly every child ends up getting braces. Twenty years from now, will crooked teeth be a greater stigma than they are today?


  1. #1 Mattias
    January 31, 2007

    Well… I personally have never understood the whole US thing with braces. Why the headgear? Why the gigantic and horrible ordinary braces? Here in Europe (Estonia in my case), we lack anything of the sort. They are really modest compared to those You have there. And they must only be worn for a maximum of two years, which is also not so much.

  2. #2 Skrud
    January 31, 2007

    I wonder if being ridiculed by peers for having braces and/or headgear has a negative impact on a child’s psychological well-being.

  3. #3 Dave Munger
    January 31, 2007

    Another point to ponder: this study was done in Britain. Perhaps we’d have different results in the U.S.

  4. #4 redSAID!
    January 31, 2007

    I had awful teeth for as long as I can remember. True, I developed a maturing confidence into my adult years; but I never outgrew the shame over my teeth. I did not smile in pictures. I covered my mouth when I laughed. I went to an orthodontist when I was 29 and had braces on for 2 1/2 years. I am 32 now, and for the first time ever, people tell me how beautiful my teeth are and how great of a smile I have. I finally feel comfortable in my own skin, and I am not embarrassed to smile anymore. Maybe I was the anomaly??

  5. #5 Dave Munger
    January 31, 2007

    “Maybe I was the anomaly??”

    One thing we don’t know from the press release version of this study is how badly crooked the participants’ teeth were. Perhaps most or nearly all the kids with very bad teeth got them straightened, while kids with only marginally crooked teeth didn’t. If this was the case, we still wouldn’t know if extremely crooked teeth might contribute to unhappiness.

    I, for example, would probably be recommended for braces today — I have a gap between my front teeth. It’s not a big deal, though, and I’ve never felt it was a problem. So would I count as a part of the “not getting braces doesn’t harm you” result?

  6. #6 Mike Peter Reed
    January 31, 2007

    I had dental treatment from the age of about 11, which finished 10 years later. It was on the NHS, and free! I had the headgear ‘whisker’ brace, the bits of metal glued on and the elastic bands and wire-tightening sessions, then finally the more classic plates (upper and lower).

    Was it worth it?

    Absolutely. No more “what’s up doc?” (although sharing a name with an old Radio One DJ and an actor out of Eastenders still endlessly amuses some – I think how much worse it could’ve been!)

  7. #7 Dave
    January 31, 2007

    My wife has had a life-time of dental problems because her parents DIDN’T get her teeth fixed. So to say orthodontia procedures are purely for aesthetic reasons is false.

  8. #8 Al
    January 31, 2007

    I will be interested to see a study done on poeple who had their teeth done cosmetically. I say that I feel very confident now with my new veneers than i was 10 years ago as I had awful teeth.

  9. #9 Amy
    February 1, 2007

    I agree with Dave. My parents didn’t get me braces (I don’t blame them; they just didn’t have the insurance or money to pay for it). Since then I’ve had continuous dental problems in several teeth due to their mis-alignment — constant cavities because I can’t brush the whole surface. I’ll probably have to have a root canal in a few years, because there isn’t much tooth left anymore.

    So I found this whole study to be kind of beside the point. But then, maybe a certain percentage of people who get braces do it only for the aesthetic improvement?

  10. #10 Filip Salomonsson
    February 4, 2007

    Like others have noted, to imply that orthodontists’ only objective be to make people less ugly seems rather.. well, wrong. (And kind of stupid.)

  11. #11 len
    February 5, 2007

    i read this story elsewhere and i thought it said the study was done in England–Europeans are known for having horrible teeth as it is. everyone i’ve known that endured braces (including me) felt better about their appearance after the ordeal. at least we were more confident when smiling. As fars as “psychological dificulties” and self esteem goes, we can all agree that many factors contribute to how we feel about ourselves and our self worth namely–the whole nature/nurture comes to mind. Who can doubt that fixing one’s teeth is not a benefit?
    studies have shown that the more attractive you are the higher your income or the more likey you are to be hired.

    on an aside(kinda)– whether or not one has psychological issues would largely depend on what type of home a child grew up in. Were they accepted and loved or neglected/abused? Whether or not one wore braces as a child is insignificant.
    As an adult, one could decide to fix their teeth if it’s a major psychological bother to them.

  12. #12 Dave Munger
    February 5, 2007

    As I’ve mentioned before, we don’t know from this report whether the study made a distinction between truly medically necessary orthodontic treatment and cosmetic treatment.

    I’d submit from these results that either kids with medically necessary treatment were excluded from the results, or that very few kids whose treatment was medically necessary did not receive treatment.

    I suppose it’s possible that even people who did not receive “medically necessary” treatment are still just as happy as those who did. But this then brings to question the definition of “medically necessary.”

  13. #13 Lisa
    February 28, 2009

    I am 42 at 40 I underwent cosmetic reconstructive surgery , it cost me 30,000 dollars . I am not a rich person by any means . I grew up poor and neglected in many areas my teeth being one area . I also got veneers .. It is the best thing I have ever done for myself I even had a wolf tooth . Now I smile all the time and have very pretty teeth. I am so very happy.. If you are giving veneers a thought go for it . I read a lot of negative things about them online before getting them. They don’t come off they don’t stain the are easy to take care of..Now I smile all the time before I kept my mouth closed or covered. Teeth have a lot to do with the way one feels about their self .. No matter how pretty or ugly you are nice teeth make you look and feel great..

  14. #14 Dentist Thornhill
    July 19, 2009

    Having straight teeth can definitely make you happier. There are many people who are embarrassed by their smile and suffer from low self esteem. Improving their smile can give a person self confidence which leads to improved quality of life.

  15. #15 Invisalign
    January 15, 2010

    Many adults are using Invisalign invisible braces to straighten their teeth. This shows that many people desire to look good and feel better about themselves.

  16. #16 Emergency Dental
    January 15, 2010

    Dental braces are so common now that teenagers actually want them because their friends also have them. This is in stark contrast to 10 yrs ago when you had braces, everyone made fun of you.

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