Satisfaction with our appearance is an important aspect of overall self-esteem, and having a bright, warm smile can provide a big confidence boost. Orthodontic treatment straightens crooked teeth, corrects malocclusion ñ misaligned upper and lower teeth - and can give you a movie-star smile.

But there are other benefits, too. Correctly aligned teeth make oral hygiene easier and more effective, both at home and in the dentistàs chair, and can dramatically reduce the risk of periodontal disease - the most common cause of tooth loss in adults.

Orthodontic treatment involves using braces to exert precise forces on teeth over time to straighten them and allow the upper and lower teeth to align correctly. After the braces are removed, retainers are usually worn for at least a few months to prevent teeth from moving out of place.

Nearly all orthodontists provide a free initial consultation, and most can be contacted directly, without the need for a referral from a dentist.

"The American Association of Orthodontists says the first evaluation should be at age 7," says Dr. Kyle Childers, who sees patients in Benton, Harrisburg and Du Quoin. "For beginning treatment, it all depends on what is going on in the mouth. If the jaws aren't growing correctly, it could start earlier."

Many adults undergo orthodontic treatment, too. Dr. John Phelps, an orthodontist practicing in Carbondale and Marion, says adults make up about 25 percent of patients. "I put braces on a 73-year-old," Phelps says. "She's very happy. She's about 80 now and still wears her lower retainer."

Phelps partner, Dr. Joseph Hudgins, says the percentage of adults seeking treatment has stayed about the same over the years. "A person is never too old for orthodontics," Hudgins says. With adults, it's harder to correct a bite, however, and it may be necessary to wear retainers indefinitely. It's also more common for adults to have teeth extracted to make room for other teeth to move.

There is some difference of opinion among orthodontists as to how early treatment should begin, but many agree the best time is at junior high school age.

Most patients require about two years in braces. During the initial consultation, the orthodontist will conduct an exam, determine whether a patient can benefit from orthodontic treatment and make an estimate of the treatment's cost and duration. The orthodontist should also let you know if the teeth can be properly aligned with braces alone, or if surgery is indicated. Because orthodontic treatment is specifically tailored to individual patient needs, costs can vary widely - anywhere from $1,000 to $25,000.

Some health insurance plans provide a maximum lifetime orthodontic benefit, which will usually cover around a third of the total treatment cost. Check your insurance plan ñ surgery is usually considered elective and may not be covered. Orthodontists offer a variety of payment options, and many take credit cards.

After the initial consultation, the orthodontist will set an appointment to take impressions of the teeth. Recent technological advancements have vastly improved this part of the process, enabling orthodontists to make more precise diagnoses and develop more effective treatment plans.

Phelps, Hudgins and Childers use a service called OrthoCAD. The impressions are used to create three-dimensional digital models showing the patientàs teeth before and after treatment. The orthodontists review the model and determine the treatment approach, then send this information over the Internet to the OrthoCAD Center.

Technicians there create a customized tray which enables the orthodontist to fit brackets to precise locations on the patientàs teeth. "More accurate bracket placement means a shorter treatment time, fewer appointments and less time in the chair," Hudgins said.

OrthoCAD reduces the amount of on-site lab work for orthodontists, and eliminates the storage problems that come with keeping plaster casts of thousands of patients' teeth.

"My basement is full of plaster casts," Phelps said, laughing. "Now we can store the information on our computer drives." OrthoCAD is developing a system of digital imaging that would eliminate the need to take impressions or create plaster casts. Instead, the orthodontist would place a specially designed scanner in the patientàs mouth, and the scanned information could be sent directly to the OrthoCAD Center.

"It gets the brackets on more accurately," Childers said. "If you don't have to move the brackets around, you save the patient a couple of appointments. We can straighten teeth so easily now that the work has become more detailed. There's more of a focus. We're trying to get the teeth placed just right within the smile.

Advances in metallurgy have also improved the effectiveness of orthodontic treatment. "The single biggest advance during my career has been the development of nickel-titanium arch wire," Phelps said. This wire, made from an alloy developed by NASA, has a "memory" - a patient's body heat causes it to try to retain its original shape, which keeps light and steady pressure on the teeth. This also reduces the number of appointments necessary, speeding up treatment.

The use of brackets, which are bonded to the tooth enamel, rather than bands, which are strips of metal wrapped around the tooth, was also a significant advancement during the last few decades. Now, orthodontists commonly use a bonding adhesive that releases a steady stream of fluoride while the brackets are attached to the teeth, ensuring that tooth enamel remains strong throughout the treatment.

Braces make many patients, young and old, feel self-conscious. During the past two decades, a lot of effort has gone into making braces less conspicuous. Brackets made of a clear polymer make braces a lot less noticeable, and have become very popular.

Dr. Chris Farrell, a dental clinician with private practices in England and Australia, says problems with jaw and facial development in children can be caused by habitual behavior such as mouth breathing, thumb sucking, incorrect tongue positioning, incorrect swallowing patterns and overactive lip muscles.

His company, Myofunctional Research, has developed a training appliance which can be used before beginning orthodontic treatment and can dramatically increase the treatment's effectiveness. Your orthodontist can tell you if a trainer will benefit your child.

Orthodontists can make the treatment fun for kids. The rubber bands used during treatment come in a variety of colors - kids change them every visit, or wear their school colors. Brackets can be gold or silver in color and are manufactured in different shapes, including hearts, footballs and soccer balls.

In Illinois, orthodontists must be licensed by the Department of Professional Regulation, and must pass board exams in dentistry as well as orthodontics. However, orthodontists licensed by the state of Illinois are not allowed to practice general dentistry.

Orthodontic treatment can be a long haul, and orthodontists do what they can to make it pleasant. Getting braces removed at the end of treatment is always cause for celebration, and the staff will usually try to make it a festive and memorable occasion.

"We love what we do. We don't use needles in this place," Phelps says. "It's fun. It's the best possible thing to be doing. We're helping people with their smiles."