Deciding on Orthodonic Treatment

The pediatric dentist suggested that both my older granchildren needed braces. He showed us x-rays and explained what we were seeing. Until I saw the x-rays I didn'T understand. After my daughter said she was open to the idea of braces the dentist referred the 12yo to an orthodontist. My grandson was 9. This year he's 11 and the dentist says it's now time to see the orthodontist. I suggest the dentist was telling you what he thought needed fixing or that this is what you understood him to say and not what the orthodontist would say. I would talk with the dentist, tell him what the orthodontist described and ask him about the discrepancy.

My BIL is a dentist. An excellent dentist. He loves his craft and often travels for continuing education seminars. Our entire family sees him exclusively for dentistry. He can spot some orthodontic issues, but he freely admits that his knowledge in orthodontics is very limited. So when I ask about my son's treatment plan from the orthodontist, it takes a few days for him to get back to me, because he has to research it. So, although the orthodontist's reaction seems a bit unprofessional, it may be true, your dentist, may be incorrect about your son's orthodontic needs.

But I believe in getting multiple opinions when possible. You can make an appointment elsewhere and then decide if the $300 work up is warranted. Sometimes it all comes down to going with your gut. I would call the dentist and ask for a referral since you trust him.

I would think that the ortho's opinion is the more valid one. When you go for the x-rays, you pay for them so you own them. Ask for copies and let them know that due to the differing opinions, you'll be consulting with another doctor to confirm the suggested treatment plan. Having the x-rays should cut down on the cost of the second opinion.

FWIW, my two younger sons both have crossbites. My 10 year old finished round one of his treatment plan a year ago and although he didn't get a traditional expander, his treatment did push his top teeth forward and pull his bottom jaw back, correcting his underbite. He'll have another round of treatment at 12 or 13 and possibly another round at 18 to avoid the surgery I had when I was in high school.

For my youngest son (8), I was surprised that his underbite will be treated differently. In his case, it's more that his top jaw needs to be pushed out and widened, so he will need headgear that will pull his upper jaw out.Their dentist always defers to the ortho in terms of what he thinks they need...sounds like your dentist recognized the crowding issue (as did you) and took a guess at the treatment. There was no reason for the ortho to say that he doesn't know what he's talking about, as clearly some kind of expansion and alignment is needed, but I think it's probably pretty common for a dentist to think of a treatment plan at the most basic level while the ortho's expertise would allow him or her to refine the diagnosis and treatment plan.

Our ortho does a complimentary exam and consult to discuss what treatment is (or is not) needed Including xrays. No cost. You can walk away. (can't take the xrays though).

I'd get a 2nd opinion.
(and perhaps a third)

Please listen to the orthodontist. Some dentists "do" orthodontics but unless your dentist has a specialist degree in orthodontics as well as dentistry, why would you go with a generalist for what is a specialist service? An ortho. deals with appliances and braces and moving teeth all day every day. A dentist who does ortho. is not doing it as often as an orthodontist and just won't have the same level of experience.

Do get a second opinion from another orthodontist. In our area tons of kids start the procedure for spacers, expanders, braces etc. as young as seven or eight and it's very common here for parents to see at least two orthodontists for initial treatment opinions. It's just good due diligence on your part because some orthodontists are more aggressive than others, some love to pull permanent teeth while others want to wait a bit, some are good at specialized appliances and others don't have a clue, some may think things are worse than others do....So get two opinions. It is free to get an initial consultation so why not?

We had two orthodontists tell us two different things to start and the main difference was that one wanted to start yanking out teeth right away. The other was more conservative and tries not to pull teeth especially right at the start. We went with the second one, who also had a plan for dealing with our child's fairly rare issue of "reversed" teeth that came in but were in the wrong positions. The first orthodontist didn't even mention our kid's reversed teeth but seemed more interested in getting us to sign a contract right away.

Remember, you don't have opinions from two orthodontists right now -- you have an orthodontist's opinion and a dentist's opinion and that's not the same thing.

I would get a second (third) opinion, definitely. I wouldn't tell the next orthodontist you go to what the dentist or first orthodontist said. Just have him/her look at your son and give an opinion.

Fortunately when we went through this, the doctor and orthodontist said the exact same thing to us, and I do trust them both.

Many kids start growing massive amounts of adult bones and teeth at this age. I know many kids who start their adventure with braces at 7.

One thing I've seen done is permanent teeth pulled just to make room. If the face isn't deformed by the small jaw, like sunken in with no chin...anyway, if the face looks okay it might just be that he needs a tooth pulled out on both sides of the bottom repeat on the top. Then he has room for new teeth.

I don't know how your sons bones will grow as he gets older. The dentist will have a MUCH better idea of how this needs to be handled.

I would say you need to go with what YOU see and think. If you think his lower jaw is too long then go that way and if you think it's too short then go with that guy.

i haven't had that huge disparity between orthos, and like you would be pretty shocked. i DID get a 2nd opinion when i heard the rather horrifying potential for dental diabolic-ness that was my second son's mouth, and it all turned out to be true. :P
i DID have a schmuck dentist claim the same kid had 6 cavities, and busily set up a slew of appointments to deal with 'em. the guy smelled wrong to me and sure enough, when i got a 2nd opinion on HIM (from the wonderful dentist we all still go to today) there was not one single cavity. my kid was 11 then- he just got his first cavity this year at 23.
definitely get a 2nd opinion, and even a 3rd. for a treatment this invasive and expensive, you want to be absolutely sure.
good luck!
khairete
S.

Your gut instinct to have a second orthodontist look at your son seems like a really good idea. It is always a good idea to get a couple views from experts about what might need to be done, why, and how much it should cost. The dentist's rough guess should not figure into your decision at all, not because he is a bad dentist or anything, just that he doesn't have the expertise to know the appropriate treatment.

See if you can get recommendations for another orthodontist from friends, so you can comparison shop.

Good luck!

I agree to see 2 orthos and get a pretreatment plan from each. Many insurances need a pretreatment plan anyway, for their own review. Bear in mind, too, that not all orthos are the same. We had a shyster for an ortho (the one we were stuck with due to the insurance we had then) for SS and after DH had a shouting match with him in the office, we paid out of pocket for the rest of SS's treatment and all of SD's. SD started around 8 or 9 with small appliances and was done by the time she was 11, but her mouth is 2 years ahead of her chronological age. Now, I don't know if you can get all that written out for you without paying for both, but if you are concerned that the ortho isn't giving you a straight answer, you'll need that second opinion. Does the dentist have a referral for someone else who might not cost $300?

I'm all for fixing bad teeth when they are young - my sister was not able to get braces and as an adult they said they'd have to break her jaw to MAYBE fix it. But we were also not in a rush because sometimes you can do more harm than good or at least waste money.

A second opinion is always an option, and any doctor or dentist or orthodontist should be open to it. You can get another referral from your dentist or ask friends if they like their ortho. Bear in mind that X-rays already taken belong to you can be taken by your to the next orthodontist, so you don't need to pay twice.

Most orthodontists will institute a payment plan too, as they understand that these costs need to be spread out over time for many families. Don't be embarrassed to ask for this.

My husband has suffered his whole life from improper dental treatment from a family friend who just wasn't very good at his job. I had moderate orthodontia but I still remember not being treated well. I left one pediatric dentist because he couldn't wait to get us in for a consult on braces when my son was really little. I thought he was money-grubbing. So I got another referral and while my son definitely needed braces and palate expanders, that recommendation was only made after a full set of 360 degree x-rays. They also brought up a payment plan before we did. I liked that.

I guess I'd be a little suspicious of someone who gave me the "plan" without those diagnostic tools. If you don't like this person, go elsewhere, but you can always do the X-rays and then take them to a 2nd opinion.