Search for Dentists, educators, educational materials and stories

Medical or Cosmetic: Are Braces Really Necessary?

Anywhere between 50% and 80% of kids in the US are flashing metal-filled, rite-of-passage-to-teenagerdom smiles. But how many of those kids absolutely needed braces for medical reasons? It’s hard to say.  A thought-provoking article by Marc Ackerman, the Director of Orthodontics at the Boston Children’s Hospital, explained, “In simple terms, we orthodontists are able to…

Anywhere between 50% and 80% of kids in the US are flashing metal-filled, rite-of-passage-to-teenagerdom smiles. But how many of those kids absolutely needed braces for medical reasons?

It’s hard to say.  A thought-provoking article by Marc Ackerman, the Director of Orthodontics at the Boston Children’s Hospital, explained, “In simple terms, we orthodontists are able to straighten your teeth, but we really have little idea how or why they went crooked in the first place.  In fact, many of the dental traits that have been labeled orthodontic problems are merely examples of normal human variation.”

Human variation? Like how some people have bright red hair and some have blonde? Or how some people hit the gym for two hours a day to no avail and others just seem to shed pounds in their sleep?

Turns out, some people’s teeth are overcrowded simply because it’s written in their genetics. What’s more? Orthodontists haven’t been able to determine exactly what makes a “healthy bite” and who has, unfortunately, been handed down genes that require a little stainless steel intervention.

Ackerman goes on to explain that an imperfect bite cannot actually determine whether a person needs braces.  Instead, it’s the symptoms, or what results from that imperfect bite, that ultimately plays the deciding factor.

Are your child’s teeth so crowded that they can’t brush them thoroughly, and end up dealing with cavity after cavity?  Did their teeth erupt in such a way that they’re causing a speech impediment?  That’s when it’s time to step in with braces.


But what about the other kids who are walking around with a mouth full of metal?  The ones who could eat, breathe, and talk normally without braces?

Our society has become more image-centric than ever before.  Many times, parents opt for braces for their kids solely for cosmetic improvements – although this might be as good a reason as any.  A good smile goes much further than we think.  Children who grow up with crooked or buck teeth often face ridicule that leads to insecurities.

Unfortunately, the bias doesn’t seem to disappear with adolescence.  A top social scientist claims that our standing in society “is becoming increasingly dependent not on our education or our upbringing – but on the state of our gnashers.”  Malcolm Gladwell, famed author, agrees that “teeth are becoming the new benchmark of inequality.”

According to these two, people with bad teeth have less of a chance at success because they are denied certain entry-level jobs. Interestingly, a survey showed that people with whiter teeth were thought to earn over $16,000 more than they actually do. Hence, nicer smiles imply greater success.

Nice smiles imply greater success.

Bottom line – it’s more difficult than you think to classify who needs braces and who doesn’t. Instead, parents have to consider a multitude of factors: their preference, their child’s preference, their child’s medical history, the long-term effects of NOT fixing their smile, timing, and cost.  Either way – whether braces are medically necessary or cosmetically necessary – both are good reasons to give your child braces.

Ackerman offers his decision-making guidelines: “When a parent thinks their kid needs braces then they probably do, and when a parent doesn’t think their kid needs braces then they probably don’t, it’s as simple as that.”

So where do you stand? Are you willing to shell out a few thousand dollars for your child’s perfect smile? Or are braces an unnecessary expense that’s become a quick and easy way for orthodontist’s to keep their practice up and running?

Comments (4)

John Sutcliffe,08/22/2015

I had braces over 50 years ago, they certainly did the job for me (it's still free for under 18 year olds in the UK). I quite like Marc Ackerman's sentiments, if you think your child needs braces then they probably do.  


I am in a situation where the dentist is recommending braces for my stepson because of overcrowding.  Now otherwise his teeth are healthy, but (pardon the pun) it is like pulling teeth to get him to take the time and perform proper oral hygiene.  He has severe ADHD and impulse control issues.  I fear that while having braces, could he do worse damage to his teeth in the long run by lack of proper care and impulsively eating things that should be avoided, even do damage?  What are the risks?  What are the potential additional costs for unplanned trips to fix/clean his braces due to this?  I've seen limited information on the consequences of improper care with braces.  I’ve read some opinions that suggest waiting if he’s not experiencing pain, having difficulty with eating or speech.  It seems to me that many people who didn’t have the resources as a kid are electing to have braces as adults without much issue.  How do people survive in 3rd world countries where dentistry is few and far between?  I guess the bottom line is I’m looking for reasons to back up my gut feelings that this is something that can wait until my stepson’s maturity and oral hygiene catch up with his age.  I feel pressured and feel it is not necessarily for the right reasons.  Much of the information published seems to be put out by the orthodontics industry.  As said in the article orthodontic industry is collectively run as businesses and as such is in business to make money.  Seems to me there is little money to be made by dentists/orthodontists in recommending against braces.  


There is a gross overuse of health care and medicine in the US, including orthodontics.  Children who have fully functional and cosmetically appealing teeth are still being fleeced by dentists who send them to orthodontists.  They work together with referrals and they both make money when they send their patients to each other.  Health care is a business.  And this is a capitalist society.  People also seem to be forgetting to include in the argument that after thousands of dollars and years of treatment, children's teeth will naturally move out of their "perfect" alignment.  I understand correcting a bad "bite" or straightening grossly crooked teeth for better care (cleaning, etc) but to put braces on a child who has beautiful teeth that function perfectly is the equivalent of fraud.  It's no different from any other unnecessary service.  The "professional" recommends the work and explains its necessity and the customer, who is most often not familiar with business, feels they are being guided expertly.  That is not always the case.  I don't know much about cars so if my mechanic tells me I need new brakes, I have no reason to doubt him.  If the orthodontist tells me my son's teeth will be "healthier" with orthodontic treatment and I am not familiar with dentistry or medicine, I might not know any better.  We need to be more skeptical when it comes to health care and any kind of treatment.  Not everything is as necessary as the professionals claim.


From someone who has not had braces, I would urge children that need it to get it. Unfortunately, when I was young I had a fall which effect my jaw etc. In the end it was too late for me to get braces due to age and type of education. I wish I could of done more to ensure I have healthier teeth. There seems to be a various amount of options except for braces but it seems like I have lost a lot of time! 


Only registered community users can give award!

Sign In / Sign Up
Shopping Cart