Adult Orthodontics: A Narrative Review of Global Evidence on Biological, Clinical, and Sociocultural Dimensions With a Malaysian Perspective

Objective: The global population’s demographic shift toward aging has broadened the demand for orthodontic treatment among adults, including individuals aged 40 years and above. This review aimed to evaluate the biological feasibility, clinical outcomes, and sociocultural barriers associated with orthodontic treatment in adults aged ≥40 years. Current research demonstrates that, if periodontal stability is preserved, orthodontic tooth movement is biologically viable throughout life. Treatment uptake among adult patients is still disproportionately low despite clinical success rates ranging from 88% to 90%. Methods: A structured literature search was conducted across PubMed, Scopus, and Web of Science up to January 2026 using predefined Boolean search terms. Studies were selected based on defined inclusion and exclusion criteria. A total of 512 records were identified, of which 30 studies met the eligibility criteria following screening and full-text assessment. Evidence was synthesized into seven thematic domains. Results: Evidence indicates that orthodontic treatment in adults aged 40 years and above is biologically feasible despite age-related changes. Favorable clinical outcomes can be achieved with careful case selection, light force mechanics, and interdisciplinary management, resulting in functional, aesthetic, and psychosocial benefits. Sociocultural barriers including financial constraints, limited awareness, perceived age stigma, and access disparities remain significant factors limiting treatment uptake, particularly in middle-income settings such as Malaysia. Conclusion: In adult patients, conservative biomechanics and interdisciplinary cooperation can guide orthodontic treatment, which is both clinically and biologically successful and beneficial to periodontal health. The greatest obstacles are not biological limitations but perceived societal myths, professional skepticism, and systemic health policy gaps, particularly in Malaysia. To ensure that adult populations receive fair orthodontic care, it will be crucial to address these obstacles through education, referral reform, and increased access to healthcare.