Adult Braces, Self-Esteem and Confidence: What Research Says

Self-esteem is not the same as dental confidence

Studies use several different outcomes: global self-esteem, dental self-confidence, oral-health-related quality of life, aesthetic concern and social impact. These are related but not interchangeable. A person can dislike the temporary look of braces while having healthy overall self-esteem.

Early treatment can temporarily feel worse

Studies measuring the first hours or weeks after fixed braces are placed have documented short-term problems such as pain, eating difficulty, cleaning difficulty, embarrassment and avoiding smiling. Recent systematic reviews in adults similarly describe an initial decline in oral-health-related quality of life before improvement.

This pattern makes sense: the beginning combines discomfort, novelty and new routines. It should not automatically be interpreted as evidence that treatment is psychologically harmful long term.

Wearers may judge themselves differently from outside observers

A study in adults found that participants rated their own beauty lower when shown with fixed orthodontic appliances, particularly metal appliances. Independent raters did not find significant differences across several broader personal attributes. That is an important distinction between self-perception and social judgment.

What happens later?

Some prospective studies and reviews report improvement in dental self-confidence and oral-health-related quality of life during or after treatment. A 2025 systematic review found a significant improvement in dental self-confidence following fixed labial appliance treatment in the included evidence.

However, systematic reviews of self-esteem specifically have emphasized uncertainty and methodological limitations. Straight teeth are not a treatment for low self-worth, and orthodontics should not be sold as a guaranteed psychological transformation.

Important limits in the evidence

• Studies use different appliances, age ranges and questionnaires.
• Some samples are small or observational.
• People who choose orthodontic treatment may differ from people who do not.
• Confidence is influenced by relationships, work, mental health, culture and many factors unrelated to teeth.
• Recent reviews have rated parts of the evidence as low or very low certainty.

How should an adult patient use this information?

Expect an adjustment period without assuming it will be miserable. Treat claims of guaranteed confidence with skepticism. If your reason for treatment is mainly appearance, be clear with yourself and your orthodontist about what orthodontics can change — tooth position and bite — and what it cannot promise: a new personality, relationship or career.