advice please--palate expansion ?

[sbgrace]

I've got a nearly 7 year old with a tiny head (well less than 10%) and, presumably, normal sized teeth. His permanent teeth development is slower than typical by about 1.5 years it seems. So normal in progression but slow.

 

His pediatric dentist took one look at his x-rays and sent us to orthodontists saying he would need early intervention. He's got teeth coming in sideways/rotated 90 degrees ("3rd and 4th" front teeth) and crowding already on the permanents in the bottom. Lots of teeth are going to be partially rotated or crowded. His baby teeth are sort of crowded for baby teeth in that there is not much space surrounding them like baby teeth typically have. I'm not surprised by this. I've seen it coming.

 

Both orthodontists we've seen say the bite itself is perfect. One doesn't seem to think that matters and the other acted like it was reason to wait to treat.

 

The first orthodontist said as soon as he gets the 6 year molars we would do palate expansion--this is estimated to be 4-6 months away so around 7.5.

 

We did a second opinion this week mostly because I didn't want to travel quite as far for treatment and now I'm confused.

 

That orthodontist said his x-rays (at 6.5) look like a 5 year old mouth so he's slow to develop orthodontically and things could, presumably, change in time. He said any child's mouth at 5 years old is going to look messy in x-rays as there is still growing going on. Then he did say that you wouldn't typically see this degree of crowding and, yes, he's got small jaws and etc. He indicated that something was going to have to be done but the question in his mind seems to be when.

 

He told us it was pointless to do palate expansion at the 6 year molar point as those rotated teeth will be coming in rotated regardless and his bite is very good. He told us to wait until we get all four front permanent teeth, see what we're dealing with, and then if needed (I can't see how it wouldn't...) do palate expansion and braces on those front teeth together. This would be approximately 1.5 years down the road for all those teeth so he would be about 9 years old the dentist thinks.

 

I'm confused. Thoughts? I don't want to pay out of pocket for yet another opinion!

Edited January 7, 2011 by sbgrace

[Stacie]

Wait. It's not like he's nearing the window of palate fusion so there should be no harm in waiting. Mine had one put in at 9 years, and it was a very quick procedure. I think expansion was complete in 6 weeks and appliance was removed in 6 months. His smile is beautiful now!

[OLG]

My ds had this problem at that age and the dentist suggested the palate extender to avoid braces later. We had it done when he was 7.5 and now at 17 he has beautiful teeth and no problems. It took less than six months of the dreaded appliance. That's just our experience.

 

WIll add that I think many of these folks are 'planning ahead' for some nice business from braces which are much more expensive that this appliance at this age! BUt then, I am skeptical of the big business of the medical field....

[LisaKinVA]

Well, I'd be confused too (can't say that I'm not). But, I'd be inclined to go ahead with the palette expander in 6 mos. I don't really agree that "all 5yo's x-rays" are messy (crowded, etc.), and your dc does sound like he already has a mouthful of issues.

 

What has me worried about the 2nd ortho is the palette expander and braces on the front teeth at that point... starting braces at 9 is usually *not* a recommended age (not saying never, but not sure why... to me, it sounds like a recipe for additional $$$ for extra years of braces, because once your child is "in" braces, he won't be out of them until the work is complete. And at 9yo, that will be something like a minimum of 3-4 years in braces...) Did the first ortho indicate when they would begin braces?

 

I have 5 kids, who all have various mouth issues (missing teeth, extra teeth, small jaws, big teeth, teeth turned sideways...), add to that my own personal experience with dental issues, and I tend to look at things a bit differently (says the person who will have spent close to $45,000 fixing my mouth, because it wasn't done right the first OR second time).

 

My oldest dd (almost 9) was the first to undergo any type of early intervention a year ago. She had severe crowding, and had her 4 eye teeth pulled just to make room for her front 8 front teeth (top & bottom). A palette expander is a non-issue, because it's the depth of her jaw -- not the width. We didn't just "pull" the teeth (even though I was pretty certain when it was rec'd that they would need to be pulled), I took a wait and see approach, but nothing was moving properly. She had teeth under her tongue/sideways, etc. Fast forward one year since the extractions... and her teeth are fairly straight, all more or less in the correct positions. My younger ds (now 7.5) is heading into that same treatment plan.

 

FTR, there was NO COMPARISON between my dd's x-rays at 6, and my older ds's x-rays at 6. My son's mouth was very orderly, you could see a slight bit of crowding, but nothing serious... normal growth is taking care of most of it. My dd's x-rays at 6? What a nightmare. Teeth were just all over the place... mish-mash of angles, on-top of each other...no mistaking the problems present.

 

I guess that's why I'm a bit skeptical of ortho #2. More crowding usually will cost you more to fix through braces later... and is usually cheaper, and less painful to correct early (in our case $400 for the 4 teeth now... and fewer issues with cavities... severe over-crowding also makes it difficult to keep 'em clean... and no braces needed at this point).

 

Maybe you need to ask your dentist for a referral to a 3rd ortho?

[Ferdie]

My son got his expander at age 9. He wore it a little over 6 months - maybe a year, (can't quite remember). I got three different ortho opinions plus his dentist and they all said the same thing.

[littlebug42]

I also have a child with delayed teeth. We have been seeing her ortho since she was 7 because we knew there were serious crowding issues. His plan has been more in line with the 2nd ortho. Her palate expanded was put in when she was not quite 9. She has braces on her front top four teeth only and they are using this to manage the crowding and make more room for the other teeth as they come in. I would be really reluctant to proceed with ortho treatment with that much delay in the teeth coming in. I would go with the second opinion if it were me. My child will need braces again later after this round but not until she is 13 or so when the rest of her baby teeth are gone. She will have a retainer in the interim.