Braces are often associated with teen growing pains, acne and bad haircuts.

But the market for adult braces is booming. Currently, about 32% of the patients getting orthodontic treatment in the U.S. and Canada are adults, according to data provided to Marketplace by the American Association of Orthodontists. That population of patients has increased more than 40% in the last decade.

In some cases, adult patients are retreating the issues they had in their youth.

“After not wearing retainers for about 30 years … I couldn’t close my mouth,” said Philadelphia mom Sophie Yang.

She had braces in her early teens to correct a protruding front tooth, but over time it started poking out again. Yang started to think about getting braces again in her 30s but waited until her kids needed braces themselves before taking the plunge again.

Even after round two, she admitted she could be more serious about wearing her retainer. “Hopefully, my children will have better discipline,” Yang said, chuckling.

Whether returning to the orthodontist’s chair or getting braces for the first time, adult patients have different needs from adolescents, according to Dr. Peter Greco. Around 60% of the patients at Greco Orthodontics in the Center City district of Philadelphia are adults.

“These patients require very sophisticated communication skills — not only by us, but by our staff,” he said.

Braces can tap into self-esteem issues, for example, and adults also ask more questions about why they might need a particular treatment. To cater to this clientele, Greco’s offices feature private treatment areas, dad rock on the speakers and understated decor. 

The father-daughter clinic has seen increasing interest in younger-looking smiles, driving some of the newer demand.

“I think part of that has to do with the fact that baby boomers are aging, and they don’t like to age,” Greco said.

Younger adults are also seeking treatment to make themselves look better online. “With the pandemic, Zoom was a huge sort of boom for us,” said Dr. Alexandra Greco, Peter Greco’s daughter.

Aesthetics are the top reason adults get braces, according to a couple of recent international surveys. But adult patients also report a variety of dental or physical health reasons for getting braces later in life.

For example, “a bad bite that is causing them to wear their teeth incorrectly, wear their teeth down in certain places — that’s causing them to beat up on the gum and bone around their teeth,” said Dr. Dale Anne Featheringham, trustee at the American Association of Orthodontists and a practicing orthodontist in Ohio.

Other common problems include pain or issues with the jaw joint, as well as tooth crowding that makes certain areas of the mouth hard to clean.

Regardless of the underlying reason, one technology has made it easier to sell adults on the treatment: clear aligners. Those are the clear, plastic trays that straighten your teeth.

Invisalign, a brand of aligners sold through dentist and orthodontic offices, was approved by the Food and Drug Administration in 1998. But 10 or 12 years ago, “it started to hit the tipping point that adults started to see other adults doing Invisalign treatment or doing treatment with some kind of clear aligners,” Featheringham said.

In that time, newer companies emerged and began selling aligners directly to consumers. The practice has drawn some controversy and lawsuits brought by and against such companies.

But Featheringham credits marketing campaigns by companies like SmileDirectClub and Byte with bringing more interest to adult braces in general.

“That did drive business into our offices because we were oftentimes the trusted source in the community for that,” she said.

For people like Sarah Bishop-Stone, a 41-year-old Philadelphian who works in the arts, aligners were the obvious choice.

“I just, at this point in my adult life, couldn’t psychically go back to having braces on my top teeth,” she said.

A couple of years ago, a lower canine tooth started receding, and her dentist warned her that if she didn’t treat it, it might change the shape of her face over time. 

She decided to get Invisalign on her top teeth and ceramic, tooth-colored brackets on her lower ones. She now thinks of the few thousand dollars she paid in installments as an investment in her future health and appearance.

“The idea of the toothless crone with her, like, face caved in really put the fear in me,” she said.