Invialign and braces can be an excellent component of a dental treatment plan for the adult patient. Tooth movement can have amazing cosmetic benefits as well as improvements in the potential health of the gums and underlying bone. From my perspective as a periodontist, the concern that I have for any adult patient facing orthodontic treatment is the health of their gums. Many adults as well as children can have either too much gum tissue or not enough. A receding gum line on one or more teeth can worsen with tooth movement so the first step may need to be a gingival improvement procedure. A much more difficult condition for the patient to “self-diagnose” is that of bacterial periodontal disease since in some cases it may be present without symptoms as a “silent disease”. Periodontal disease is the most common reason we see for people losing their teeth. A periodontal examination including probe measurements of at least six different areas around each tooth to evaluate for gum and bone attachment loss is the most common way to rule this out. The normal range would be that of 1 to 3mm crevices without bleeding. Any measurements greater than 3mm especially with inflammation may require periodontal treatment and/or monitoring. The movement of diseased teeth with braces or Invisalign is a big problem and can be disastrous in some cases even accelerating tooth loss. Luckily many cases can be treated quickly with the minimally invasive PerioLase laser using the LANAP protocol before starting orthodontic movement of any kind. This can save your smile!