Adults are wearing braces more and more often. Unlike children and young people, the health insurance company does not cover the costs for them. Some private providers use this and turn orthodontic treatment into a business model. Experts criticize that.
Smiling teenagers, some of them have something metallic shining on their teeth: the brackets. Then they wear fixed braces. However, crooked teeth are not only an issue for children and young people, adults also often wear braces or invisalign to straighten their teeth .
Exact figures on how many adults that is are not yet available. However, the 20 to 40 year olds in particular use braces more often, says Alexander Spassov, a specialist in orthodontics. Many of them had orthodontic treatment as children or teenagers and as adults wear braces or splints again because their previously straight teeth have shifted over the years. "I hadn't worn my loose braces well enough, which is why my misaligned teeth have shifted back," says Natalie, who wears braces again as an adult.
That was the case with Natalie, for example. As a teenager, she wore loose braces and now, as an adult, she has a plastic dental splint, a so-called aligner model. Compared to fixed braces with brackets, aligners are hardly visible and can be easily removed, for example when eating.
Natalie did not need a referral or support from an orthodontist for the splint. Such aligner treatments are now offered by private companies that work together with dentists.
Making a business out of medical treatments
However, the costs for braces or splints in adulthood are usually borne by the patients themselves. Health insurance companies only cover the costs of orthodontic treatment for insured persons under the age of 18 if it is medically necessary, i.e. there is a deviation of at least three millimeters between two teeth there. This is what it says in the fifth book of the Social Security Code, paragraph 29. For everyone over the age of 18: You pay yourself.
Take out a loan for health
Johanna knows how expensive such treatment can be. She has had braces since she was 34. Because she suffered from migraines for a long time and other treatments such as medication did not help her, a doctor referred her to orthodontics.
Thanks to the braces and an operation on the jaw with a controlled jaw fracture, Johanna no longer has migraines. She paid a total of 8,000 euros for the treatment. Unlike the medication, the visits to the sleep laboratory and the like, the health insurance company did not reimburse her for the braces. Instead, Johanna took out a loan that she was able to pay off in monthly installments.
Criticism of private assumption of costs
Orthodontist Alexander Spassov considers the regulation of the lack of cost coverage in adulthood to be questionable. On the one hand, not everyone can afford the often necessary treatment with ceramic braces or splints. On the other hand, medical treatment is becoming a business, he explains.
According to the Federal Audit Office, statutory health insurance companies spend around 1.1 billion euros on orthodontic treatment for under-18s every year. However, the Federal Court of Auditors criticizes the fact that it is unclear how great the benefits of the treatments are. An expert opinion prepared by the Federal Ministry of Health in response to criticism from the Federal Audit Office in November 2018 also leaves the question unanswered as to whether straight teeth are fundamentally healthier.
Straight teeth: health or aesthetics?
Private providers in particular who sell braces and splints for adults advertise that straight teeth are aesthetic. With regard to the report by the Federal Ministry of Health, the question also arises to what extent we are brought up to say that teeth should be straight. The Health Committee of the Bundestag is now also dealing with this issue. There is also a discussion as to whether providers of dental splints should be more heavily regulated.
