When it comes to self-care, Lisa Bohmart is not one to drop the ball. The Manhattan social worker keeps up her running routine, salon highlights, and even Botox appointments faithfully. It wasn't until the pandemic hit, that she decided to do something about her teeth. "I felt like this was the last frontier," says the 46-year-old. In the decades since having braces as a teenager, her teeth had started to slide back toward their original state — her bottom row especially. "It was totally tolerable but it always bothered me," she says. So she booked an appointment with her dentist and got fit for Invisalign, the clear aligner trays that have all but replaced the old-fashioned wire and bracket braces that many remember from childhood. "It's a good time to do it," explains Bohmart. "In person, you can notice I have aligners, but it doesn't come through on Zoom."
Bohmart is one of myriad women and men who've opted to enhance their smiles since the outbreak of COVID-19. While dental visits have seen a precipitous decrease during the pandemic, the orthodontics industry — whose global value is expected to reach nearly $10 billion by 2026, according to Fortune Business Insights — has not seen the same impact. Blame hours and hours of Zoom calls during which people are forced to stare at their faces, seeing themselves in a new, unflattering light — perhaps inventing "flaws" that aren't even there. But are virtual meetings the only catalyst for this adult braces boom? Turns out, there's more to the story.
The Zoom Effect
One of the more troubling terms to enter the lexicon over this past year is "Zoom dysmorphia," the phenomenon whereby people over-focus on their pixelated, often poorly lit images and, frankly, don't like what they see. While the filtered feeds of social media have been plaguing mental health and body image for years, hours (if not days) spent seemingly indefinitely on video conferencing has incited a surge of self-criticism and even depreciation, according to a November 2020 paper published in the journal Facial Plastic Surgery & Aesthetic Medicine. "Unlike the still and filtered selfies of social media, Zoom displays an unedited version of oneself in motion, a self-depiction very few people are used to seeing on a daily basis. This may have drastic effects on body dissatisfaction and desire to seek cosmetic procedure," writes the paper authors.
"Becoming more conscious about your double chin or smile can affect self-confidence and incite more intense doubts about physical appearance and make you feel as if you need facial reconstruction in order to look better," says Martina Paglia, Ph.D., director of the International Psychology Clinic in London. And the stress brought on by this self-examination can have a deleterious effect on your sense of self, explains Paglia. "Looking at your face constantly for hours can be stressful, and the ability to see oneself can act as a catalyst in increasing your insecurities." With that, it can have especially triggering ramifications for people who already have low self-esteem.
Need not forget the fact that there's an ongoing global pandemic, which has been taking a toll on mental health since its start in the U.S. in March 2020. And the heightened pressures and anxieties that accompany living through such a traumatic, turbulent time can also impact your physical health in some very real ways. For example, the American Dental Association conducted a poll of its members and found that the pandemic has given rise to a 59 percent increase in teeth grinding and clenching, a 53 percent increase in chipped and cracked teeth, and a 53 percent increase in jaw pain and compromised movement known as temporomandibular disorder — all of which can be brought on by stress. No wonder so many people have been opting for orthodontics.
"Most [dental] practices were closed down in April and May, and once they reopened there was a big uptick of people going in for appointments," says Christopher A. Roberts, D.D.S., M.S., president of the American Association of Orthodontists. "The colleagues I've spoken to have been busier between July and October than they were [during these months] last year." Meanwhile, the WFH times have also caused a massive bump in teledentistry, according to Harvard Medical School's Harvard Health Publications.
Case in point? The orthodontics start-up Byte, whose sales of direct-to-consumer aligners grew more than 1,000 percent in the first half of 2020 versus 2019, according to the company's president, Neeraj Gunsagar. "People are increasingly relying on the at-home economy, trading gym memberships for a Peloton, conference rooms for Zoom, restaurants for Blue Apron kits," says Gunsagar. "Byte fits into this 'new normal,' since you can achieve your dream smile without ever leaving your home."
Aligners — the modern type of orthodontic treatment that use clear plastic-like trays to gently nudge and reposition your teeth, according to the AAO — are an investment in money (treatments range from $2,000 for at-home treatment plans to $6,000 for professionally administered Invisalign), time (expect to wear trays 22 hours a day), and attention (users can't so much as nibble on an almond or take a sip of tea without removing their trays). But the promise of a glow-up at the end of the rainbow is appealing. John Sheldon, chief marketing officer of SmileDirectClub, a teledental company offering direct-to-consumer aligners, likens the adult braces trend to the rise in sourdough baking. "We call it the quarantine project," says Sheldon. "Everyone's looking for a project to get them through this time." The SmileDirectClub's latest service is an at-home whitening treatment that involves plugging a light into your phone and aiming it at your teeth for five minutes twice a day for a week. "A lot of customers are doing both [aligning and whitening] at the same time so that when things return back to normal they have their big reveal," says Sheldon. (Related: Why You Should Remineralize Your Teeth—and Exactly How to Do It, According to Dentists)
Even though aligners are transparent, many people say they prefer to wear them in the privacy of their homes. There's a lot of tooth brushing and removing and reinserting trays throughout the day. In some cases, there's also the unattractive chomping on "chewies" — small foam bits that help aligners settle into place. Brianne Wills, a photographer and the creator of the Instagram account Girls and Their Cats, says she's happy she waited until a time when she barely sets foot inside a restaurant to get aligners. "At a restaurant, you'd have to put your hand in your mouth and take the trays out," she shares. "There's drool all over the place, and you can't be graceful about that."
It's Not Just About Aesthetics
It's misguided to believe that the benefits of teeth straightening start and end with vanity. Compared to crooked teeth, which tend to have more places for plaque to build up and get missed while brushing, straight teeth are easier to clean and, in turn, help reduce your risk of cavities, gum inflammation, and gum disease, according to the AAO. What's more, an improper bite can also cause added wear and chipping of teeth, teeth grinding, and up your risk for developing jawbone and joint problems (think: TMJ pain, headaches, and migraines). That's all to say, for some, misaligned teeth can be benign, but for others, they can truly mess with your wellbeing.
Research suggests that dental disorders such as malocclusion (misaligned teeth) can cause a "profound impact" on self-esteem, thereby negatively affecting the overall quality of life. While studies show this to be more common in adolescents (especially given their age and "increased aesthetic desire" and "unique social and physiological needs"), a 2019 poll of 2,000 people emphasizes that adults are also subject to insecurities around their teeth. The study, conducted by OnePull and funded by teeth-whitening company Snow, found that seven in 10 Americans are self-conscious about their teeth, and 50 percent try to smile with their mouths closed (perhaps as a result).
"In quarantine, a lot of people are doing things for themselves. It's really about them feeling the level of quiet confidence of having a smile they love."
——John Sheldon, chief marketing officer of teledental company and SmileDirectClub
After years of suffering with self-confidence issues about her teeth, Laura Graber Masliah finally got around to getting fitted for aligners at a local dentist's office. "It was the silver lining of COVID-19," says Masliah, who reasons that because she wasn't spending as much money on clothes and jewelry the expense of her treatment was justifiable. "You need something to feel good about," says the San Diego resident, nodding to the fact that the pandemic has been tough, to put it mildly. (Related: This Floss Turned Dental Hygiene Into My Favorite Form of Self-Care)
Steps for a Straighter Smile
Should you decide to straighten your teeth, there are some important things to know. If you have some major bite, tooth-crowding, or misalignment issues, plastic aligners may not get the job done. A review of studies study published in 2019 that looked at the efficacy of Invisalign versus traditional braces found that it's possible to treat complex tooth misalignment with aligners, but the results are "less accurate than those achieved with fixed appliances," aka traditional braces. Other research found that both types of orthodontic treatments are effective at improving misalignment, but the mouthful of brackets still wins when it comes to more nuanced tooth-placement measures (such as producing adequate occlusal contact, the points where your teeth meet). Regardless, getting a professional opinion before making any decision is always your best bet.
As mentioned, the logistical and financial commitments inherent in aligners are considerable. In addition to committing to a contraption inside your mouth for 22 hours a day, the financial burden starts at around $2,000 and can run up to $6,000. Invisalign, the Cadillac of the services in the market, involves steadfast oversight of a dental professional. "You're moving a body part," says Sharon Huang, D.D.S., the founder of Manhattan dental practice Les Belles NYC. "I don't recommend moving any body part without the supervision of a doctor." Her colleague, Bridget Glazarov, D.D.S., agrees that at-home services can backfire. "Even taking the impressions is a skill that takes close to a month of training," says Glazarov. "If you do it yourself and you mess that up, you're not starting in the correct position, and then there's no dentist who is quarterbacking. There's a lot of different steps that need to go right."
At-home aligner treatments, on the other hand, tend to involve the regular submission of photographs of a client's progress, which are reviewed by representatives. For example, Byte's customers are instructed to take photographs of their teeth and send them to the company via email. The images are regularly reviewed by members of the "patient care team" (whose members' level of training is unclear) rather than doctors, who are only called in to analyze the submissions in the case of an extraordinary turn of events. That said, satisfaction can't be universally guaranteed. A 2019 study published in The Journal of the American Dental Association surveyed 470 customers who used direct-to-consumer (DTC) orthodontics and found that while most people (87.5 percent) were satisfied with their treatment, 6.6 percent had to visit their dentist due to adverse effects.
It was a dentist's recommendation a few years ago that inspired Kaari Pitkin, a 48-year-old radio producer who lives in New Haven, CT to finally undergo tooth straightening. "My dentist is in her sixties and she had just got Invisalign," says Pitkin. "She said I should do it, too since it will help me when I clean my teeth. She doesn't fit patients at her practice, so she doesn't profit off them, so I took her advice seriously."
Now more than halfway through her process, Pitkin is happy with the results thus far and says now is the perfect time to finally take the plunge. "When I leave home to go to the dog park twice a day I have a mask on so nobody knows anything is different."