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Orthodontic treatment. Does this sound right to you?


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I want to bang my head against the wall over this orthodontics stuff for dd. She is 8 and only has 4 adult teeth in front on top and 3 on the bottom front. She has obvious crowding and bite issues. Her baby teeth crossed over each other in front like an X. So we've known since she was a year old we would most likely be doing orthodontics at some point.

 

Last month we were told 1 bottom adult tooth extraction, palate expander for up to 6 months, then braces top and bottom for 6 months to a year. Well, I had a few questions about the extraction, which I think is reasonable when they are talking about removing a healthy adult tooth for aesthetics. So he back pedaled on that and decided to skip it for now. Let's see how the uppers respond to palate expander + braces simultaneously. We were supposed to have her get the impressions then but our consult took so long, they had us reschedule. At that point, I was aggravated. We drove 30 miles, let's get the ball rolling, ya know? Whatever.

 

Fast forward a few weeks to today. We go in to get impressions of the uppers for the palate expander. They put in spacers in between her molars to make room for the brackets. Then she did the impression. Crying, hyperventilating, gagging, coughing caused air bubbles. Take 2 was no good as well. So Dr looks in her mouth and says let's just do bands on the molars (no impressions needed for that) and braces. Uppers only still.

 

I'm asking what about the palate expander? Does she need it or not? If not, why did you recommend it in the first place? He says it would have been better but we don't want to traumitize her with repeated impression fiasco so let's see where we get with braces. So we leave having done 2 unusable impressions and have to go back again to start a whole new treatment plan that didn't even require today's 2nd impressions appointment! See? Head banging.

 

Am I just a dummy or does this sound ridiculous? Right now, I'm questioning the whole thing. (1) I wrote them this huge check and feel like we are just spinning our wheels. (2) I think dd is too emotional/ high strung/ immature/ whatever label you want to give, for this intervention. I still supervise her teeth brushing and flossing because she doesn't do a thorough job on her own. And we have prepped her for this impression thing for a while. She knew what to expect. (3) Why not wait til all her adult teeth are in and see what needs to be done at that point? He did throw around the easier mobility aspect since she's young but that was in reference to the palate expander which apparently, she suddenly doesn't need since she couldn't take a usable impression.

 

Btw, I am trying to get a 2nd opinion. I am having a hard time getting a recommendation. I don't want to just pick one from the phone book. But everyone I know has used this one. Everyone loves him.

 

So, if you've read all that, does it sound fishy to you? Like he's just trying to make money? Or is it common to change treatment plans on the fly if kids can't tolerate a particular aspect of the process?

 

Eta: sorry! I meant to post this in chat!! I may XP later.

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I don't think it is that she doesn't need the palate expander.  I think he's trying to treat the child he has in front of him - one with serious dental anxiety, from the sound of it.  I can sympathize.  I used to have to give valium to my dd before dental appointments and even then we had some appointments that we had to stop before they actually did anything. 

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Gently, it sounds like he's trying to treat her, and you keep second-guessing him. so he's offering up alternatives.  It really sounds like neither you nor your dd are ready for this process.

 

By the way, the impression process does cause gagging.  It does.  They try hard to help with that, but it's gloopy stuff that tends to go to the back of your mouth.  I can see where crying and hyperventilating would make it a no-go.

 

And, honestly, much of orthodontics is about aesthetics.  So your complaint about that and your note that her baby teethed are crossed seems ironic.  That's an aesthetics issue, too.  And yes, sometimes adult teeth do get removed in the braces process.

 

Best of luck in whatever you decide.

 

 

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I have taken my son (almost 11) in every for year for the past three years for free pre-treatment consultations to see how his teeth are progressing.  I live in a fairly small community, but both orthodontists offer free yearly or twice-yearly consultations until treatment starts.  My son has a very crowded mouth, but neither ortho would put braces on until he has enough adult teeth, around age 12.  And the last one I saw said they try at all costs to avoid extractions....and they certainly try and let things progress and not do it prematurely.  I know many kids who have gotten braces and it's all been around 11-13 years old...I've never heard of an 8-year old getting braces, but maybe your daughter has a very unique situation.

 

I believe I would feel the same way as you. I would try to get a second and possibly third consultation, and they should be complimentary until treatment starts.  My dentist told me of some parents who will visit two or three orthodontists, not only to get their pre-treatment opinions, but also to find the doctor that feels best to the family.  So I recently did that, and am so glad I did, as the second ortho was ions more helpful and thorough, not to mention friendly, than the first.

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She could really use the palate expander.  It is super super important.  However, if he has in front of him a kid with dental anxiety, gagging, crying, and a total fiasco, he figured he would try the other method and see how it goes for a while. To me, he sounds reasonable and calm.  My orthodontist has explained numerous times that orthodontia is not an exact science and there's no ONE way to do it.  It's not unreasonable to try different methods...that said, I really really think she needs that palate expander.  

 

HOWEVER I will say, that my dd had an inexperienced and "rough" tech do one of her impressions and it was horrific.  We moved and got a new orthodontist and the tech had worked with "gaggers" before and knew exactly what to do.  She had all these tricks about how to breathe, she giggled with my dd, she told her it was ok if she vomited, no one would be upset, they had happy music going, etc. etc. and guess what....my dd gagged a little but the breathing tricks worked and she didn't vomit!  She even put less goopy stuff in, so it wouldn't get into the back of her throat as much.

 

If you do decide to go with another orthodontist, by WORD OF MOUTH, also check yelp.  WHen you go for another consultation, when it's time to get impressions, be sure to tell them your dd has a really strong gag reflex and really needs an experienced tech, and that you are willing to come in at odd hours, etc. etc to get the right tech.  

 

PS an orthodontics office should be a VERY fun, cheerful, brightly colored place with happy people!!! The orthodontist where my dd had her crying, gagging vomtiing experience was going for the "modern" look with all muted greys, and his office staff were very stiff, serious Asian people (including him) and his music was all calm, classical music- the whole office very businesslike, and quiet!  Horrible!  The other 3 orthos that we have worked with all had a wall of toys, games for the kids to play, prize drawings, bright bold colors like torqouise, fun 50s rock and roll or Oldies playing, fish tanks, Mascots, and talkative, friendly girls working...FYI just in case that helps you choose the next ortho.

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FWIW, most of the parents I know who had kids get braces this early ended up having braces put on a second time when they were older, but YMMV.  I seriously hesitate to put braces on a child that young unless there are medical issues, not cosmetic ones, but maybe with the palate expander suggestion there are more concerns than just cosmetic?  

 

Braces make it MUCH harder to keep teeth clean, they HURT, etc.  If your child already has extreme stress over dental work then maybe waiting until she is more mature could be the better option, unless, again, there is some sort of medical reason for doing this now.

 

I agree that the change to not getting an expander is probably the dentist trying to deal with the child in front of him.  With that much anxiety it would probably not be beneficial to the child to force getting impressions, even if the expander might be the better way to go (no idea if it is).

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We did a few different consultations with our boys before beginning treatment.  Each orthodontist saw the same problems.  One was slightly more aggressive in how to handle the issue. In the end, we went with the orthodontist who "everybody" goes to and who has uniformly high praise from all of his patients. 

 

Palate expanders can save you a ton of time and money in braces later on.  

 

I have a kid with sensory issues who is prone to dental trauma.  It's certainly part of the discussion as we don't want to set him up for lifelong anxiety.

 

Sometimes ideal dental treatment is not ideal with the whole kid in front of you.

 

Are you anxious about this as well? It seems like the money and time commitment is a strain for you.

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My son requires a palate expander. Getting it in was not a fun experience! He didn't enjoy the impression and then they said his back molars were uniquely shaped which made it a real struggle to get the expander in. But his mouth looks sooooo much better now. His teeth are lining up properly and some have shifted straighter than ever. If she needs it then it might be worth pushing through the initial insertion process. I had to talk to my son a lot about roughing things out to get passed them to comfort. It was a good growing experience for him.

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I agree that probably the most important thing for her right now is the palate expander.  They are doing these earlier now so that the body views this as normal growth patterns.  This makes the expanded mouth stay expanded without the need for retainers.  Also, it helps the future adult teeth have room to grow, making for less orthodontic work later.

 

I don't agree with the current trend of 2 rounds of braces though.  Usually they do the first round around 6-9 years old, and then a second round once they have all their adult teeth.  For my DD, we went with an expander for 9 months when she was 6 going on 7.  She just got her actual braces on a few months ago at age 12.  It's worked out really well.

 

I would definitely ask around for a second opinion.  Our regular pediatric dentist was able to do the expander for us if that is an option at this time.  But I do think that your current orthodontist is just trying to figure out a way to get started with your DD given the amount of anxiety she is showing.  And, yes, impressions are not pleasant, but they are a necessary part of the braces process.  They will be repeated when it comes time for retainers as well.

 

 

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Get someone to sit down and talk with you. Maybe go without your dd. Palate expanders are great IF you need them, but there are ways to also expand the palate somewhat with braces. Are you getting braces now, just to have to do it again later? or is this the final treatment? Yes, there are good reasons to put braces on younger kids - but not just for the asthetics at a young age and repeating when older. I think you need to take a step back and talk again about treatment options before actually starting so that everyone is on the same page.

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I know many kids who have gotten braces and it's all been around 11-13 years old...I've never heard of an 8-year old getting braces, but maybe your daughter has a very unique situation.

 

My son got braces at 8--he might even still have been 7, I can't remember exactly.  His two front teeth were so widely spaced that they weren't allowing the next teeth over to come down.  He also had a pretty extreme overbite that they started treating at the same time.  

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Ds20 had a palate expander at 8yo and then did not need any teeth removed when he got his braces later (except for one baby tooth that was not going to come out because his adult tooth grew out of the roof of his mouth. He had his braces at 11 or 12yo. He had a very small mouth with crowded baby teeth. This orthodontist was our 2nd opinion. The first wanted to remove six teeth when ds was 8yo but I knew about palate expanders and went to someone else who would do one. 

 

Dd13 is getting her braces this month but she only has two teeth slightly out of place and a slight overbite. Her orthodontist has been watching her for two years waiting for her to lose all her baby teeth before braces. She is being treated with Invisa-line and does not need to have impressions…orthodontist does everything with computer and photographs/x-rays.

 

I agree that your dd's issue with the impressions probably made the orthodontist try a different route.

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Thanks for all the replies. :)

 

To answer a few of the questions:

 

I had braces myself at 10 and I remember the awful impressions like it was yesterday. I really did try to prepare her and give her tips to take her mind off it by closing her eyes and counting to 100 slowly with her breathing pattern or sing a comforting song in her head. She forgets it all in the moment and hyperfocuses on the discomfort.

 

I wasn't 2nd guessing the extraction, just asked for clarification. I guess I did ask what an alternative would look like but when he explained I was very agreeable to the extraction and said we'll get that done at the regular dentist office, right?but he went ahead and said why don't we wait on that and see how responsive her mouth is up top.

 

Regarding aesthetics: I LOVED her twisted little baby smile. It was like a physical representation of her unique personality. Her adult teeth have come in differently and i miss her baby smile so much. I'm all for aesthetics when all her adult teeth are in. I don't see much point in a perfect smile full of teeth that are going to fall out anyway. I was proceeding now because of the palate expander. Dh had one and he was 7. He had more issues though. Narrow airway, raspy voice. He was even doing speech therapy in conjunction with the palate expander. He is, of course, glad his parents had him do all that intervention because who knows what would have happened if he hadn't. So I was for it, thinking her issues were similar, just milder. But now we aren't even doing the expander???

 

As far as money and time commitment, the money is fine. We've paid it, no stress over having the money (thank you Dave Ramsey) but I don't want to pay for these braces only to have a 2nd round of braces when her adult teeth come in. I do want this money to be put to good use. The time commitment is only an issue because I have to get a sitter for the boys for these bigger appointments. The checkups, I'm hoping I can just hang in the waiting room with the boys. The baby is very attached to me and when I leave him with anyone else they have to be right in his face constantly entertaining him or he melts down. I feel bad for the sitter, really. Again, though, I was willing to go for it because we were told she needed a palate expander.

 

The regular dentist doesn't do any appliance work. We have to go to the orthodontist. They are both 30 min away so it doesn't really matter in saving time.

 

Julie of KY- I think I will make an appointment for a consultation alone. That's a good idea. It was too hard to ask all the questions I had and process everything with dd sobbing and squeezing my hand, lol!

 

Sixpence- I forgot she'll have to do them again after braces anyway! She told ds as they were getting ready for bed "I hope you never have to have impressions. They were terrible!" So I told her she's getting them again at some point. We chatted for a few minutes about the whole thing. I tried reassure her that I had faith in her that she could "make a good impression." She cracked up and I think maybe I could get her where she needs to be emotionally for it to be successful.

 

UCF612- how old was your son when he got his palate expander? How long was it in for? Did they follow with braces immediately?

 

EKS- how were they treating the overbite? Dd is supposed to have rubber bands with the braces to correct an underbite.

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My twins' mouths were a mess. At 10 years old, I took them to three different orthodontists for treatment plans before we decided to do anything.

 

I absolutely do recommend getting second, or even third, opinions.

 

(Eta: They ended up with braces, palate spreaders, and head gear.)

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Both my boys had braces at a young age. They weren't the only ones in their peer group. They are putting them on younger kids these days because parents have more supervision of young kids' brushing etc and making sure they eat brace appropriate food. And, braces on baby teeth can help create space as adult teeth come in.  And it takes advantage of their jaw growth in puberty

 

I've never heard of people needing a second round of braces on adult teeth, That might be a regional thing.  I have heard of teens not wearing their retainer and getting braces as young adults because their teeth moved so much.  Keeping those teeth in place after braces is really all about the retainer. Our orthodontist wears his every night, and he has got to be almost 70 years old. My sister still wears hers and her smile is fabulous.

 

It doesn't sound like the dentist is making up a plan on the fly, it sounds like he had an idea plan, but is adjusting to what your daughter can deal with.  We were given a plan for my younger son, but I was also told it would cause some interference with his speech.  Well, he was already in speech therapy, so I asked if one part could be put off until he was done with that. It could and it was. It wasn't what the ortho wanted, but he worked with us.

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My son is 8. He's had it for a number of months now but not a full year (I think he got it July 2015). He also has a face mask he wears at night (was wearing it more initially) to bring his top jaw forward, his teeth were hitting directly on top of each other before. I was very nervous when we started but I have seen such significant change I'm thrilled. I'm hoping we can avoid braces completely but we'll see since he's still a mix of baby and adult teeth.

 

He's not one to deal with discomfort well at all. I really witnessed a maturing in him during the initial process!

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I'm no dentist or ortho, but it sounds to me like there is more than one way to skin the orthodontic cat and the  ortho is doing what needs to be done in a way that balances DD's meltdown.

I want to bang my head against the wall over this orthodontics stuff for dd. She is 8 and only has 4 adult teeth in front on top and 3 on the bottom front. She has obvious crowding and bite issues. Her baby teeth crossed over each other in front like an X. So we've known since she was a year old we would most likely be doing orthodontics at some point.

Last month we were told 1 bottom adult tooth extraction, palate expander for up to 6 months, then braces top and bottom for 6 months to a year. Well, I had a few questions about the extraction, which I think is reasonable when they are talking about removing a healthy adult tooth for aesthetics. So he back pedaled on that and decided to skip it for now. Let's see how the uppers respond to palate expander + braces simultaneously. We were supposed to have her get the impressions then but our consult took so long, they had us reschedule. At that point, I was aggravated. We drove 30 miles, let's get the ball rolling, ya know? Whatever.

Fast forward a few weeks to today. We go in to get impressions of the uppers for the palate expander. They put in spacers in between her molars to make room for the brackets. Then she did the impression. Crying, hyperventilating, gagging, coughing caused air bubbles. Take 2 was no good as well. So Dr looks in her mouth and says let's just do bands on the molars (no impressions needed for that) and braces. Uppers only still.

I'm asking what about the palate expander? Does she need it or not? If not, why did you recommend it in the first place? He says it would have been better but we don't want to traumitize her with repeated impression fiasco so let's see where we get with braces. So we leave having done 2 unusable impressions and have to go back again to start a whole new treatment plan that didn't even require today's 2nd impressions appointment! See? Head banging.

Am I just a dummy or does this sound ridiculous? Right now, I'm questioning the whole thing. (1) I wrote them this huge check and feel like we are just spinning our wheels. (2) I think dd is too emotional/ high strung/ immature/ whatever label you want to give, for this intervention. I still supervise her teeth brushing and flossing because she doesn't do a thorough job on her own. And we have prepped her for this impression thing for a while. She knew what to expect. (3) Why not wait til all her adult teeth are in and see what needs to be done at that point? He did throw around the easier mobility aspect since she's young but that was in reference to the palate expander which apparently, she suddenly doesn't need since she couldn't take a usable impression.

Btw, I am trying to get a 2nd opinion. I am having a hard time getting a recommendation. I don't want to just pick one from the phone book. But everyone I know has used this one. Everyone loves him.

So, if you've read all that, does it sound fishy to you? Like he's just trying to make money? Or is it common to change treatment plans on the fly if kids can't tolerate a particular aspect of the process?

Eta: sorry! I meant to post this in chat!! I may XP later.

 

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I want to bang my head against the wall over this orthodontics stuff for dd. She is 8 and only has 4 adult teeth in front on top and 3 on the bottom front. She has obvious crowding and bite issues. Her baby teeth crossed over each other in front like an X. So we've known since she was a year old we would most likely be doing orthodontics at some point.

 

Last month we were told 1 bottom adult tooth extraction, palate expander for up to 6 months, then braces top and bottom for 6 months to a year. Well, I had a few questions about the extraction, which I think is reasonable when they are talking about removing a healthy adult tooth for aesthetics. So he back pedaled on that and decided to skip it for now. Let's see how the uppers respond to palate expander + braces simultaneously. We were supposed to have her get the impressions then but our consult took so long, they had us reschedule. At that point, I was aggravated. We drove 30 miles, let's get the ball rolling, ya know? Whatever.

 

Fast forward a few weeks to today. We go in to get impressions of the uppers for the palate expander. They put in spacers in between her molars to make room for the brackets. Then she did the impression. Crying, hyperventilating, gagging, coughing caused air bubbles. Take 2 was no good as well. So Dr looks in her mouth and says let's just do bands on the molars (no impressions needed for that) and braces. Uppers only still.

 

I'm asking what about the palate expander? Does she need it or not? If not, why did you recommend it in the first place? He says it would have been better but we don't want to traumitize her with repeated impression fiasco so let's see where we get with braces. So we leave having done 2 unusable impressions and have to go back again to start a whole new treatment plan that didn't even require today's 2nd impressions appointment! See? Head banging.

 

Am I just a dummy or does this sound ridiculous? Right now, I'm questioning the whole thing. (1) I wrote them this huge check and feel like we are just spinning our wheels. (2) I think dd is too emotional/ high strung/ immature/ whatever label you want to give, for this intervention. I still supervise her teeth brushing and flossing because she doesn't do a thorough job on her own. And we have prepped her for this impression thing for a while. She knew what to expect. (3) Why not wait til all her adult teeth are in and see what needs to be done at that point? He did throw around the easier mobility aspect since she's young but that was in reference to the palate expander which apparently, she suddenly doesn't need since she couldn't take a usable impression.

 

Btw, I am trying to get a 2nd opinion. I am having a hard time getting a recommendation. I don't want to just pick one from the phone book. But everyone I know has used this one. Everyone loves him.

 

So, if you've read all that, does it sound fishy to you? Like he's just trying to make money? Or is it common to change treatment plans on the fly if kids can't tolerate a particular aspect of the process?

 

Eta: sorry! I meant to post this in chat!! I may XP later.

r

 

I don't think it sounds necessarily fishy, there are different approaches used by orthodontists. We got a couple consultations before starting and ended up choosing the orthodontist with the most conservative treatment plan. Ds had a palate expander for a year when he was 8. Then he was just watched about every 6 months until all his permanent teeth were in. Dentist was trying to push extractions, but orthodontist said no. Ds then got braces last July when he was 12 1/2. He'll have them for 22 months. His teeth are looking great already. Ds has sensory issues, and impressions were hard for him, too. Orthodontics in general have been hard, but he's much better in braces now than he would have been at 8. He can't wait to be done, so he's being very compliant.

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Bite issues can need fixing at a young age. DD's bite problem eventually started causing the enamel to wear off of a tooth. She had a totally different treatment that what ds has had for the same problem. I think she had the palate expander. 

 

Ds has only had triad on bottom teeth to try and treat his bite issue. He gets braces on top next month, and they told us they are putting in some kind of bar on the bottom to continue working on the bite problem before putting braces on the bottom teeth. 

 

Our dentist seems to be keeping up with improvements in treatment options because dd's bite phase work was $2800, and ds' was $300. I don't know if a second opinion is doable for your dd, but if she can endure it, I don't think it would be a bad idea. 

 

 

 

 

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My three youngest have each had braces, starting around age 8. All had palate expanders and brackets across the front (top only). The orthodontist said that each one would need braces again, but we will see.

 

DS12 was told that he could stop wearing his retainer. He wouldn't listen when we advised him to keep wearing it (sigh), and within a week his teeth had already moved enough that he could not get his retainer on again. Frustrating, though his teeth still look good. He had a slight underbite, which was fixed.

 

DS11 was told that he could stop wearing his retainer. We insisted that he keep wearing it, despite his arguing. So far he has kept it in at night. I think he understood better that if he keeps wearing it now, he might be able to avoid getting braces again in a few years.

 

DD10 had more issues. She had a larger over jet and was a finger sucker. She had a palate expander, a Herbst appliance, and a special piece installed in the roof of her mouth that kept her from being able to fit her finger in there. I felt very bad for her when she had all of that installed. Now, though, it has been removed, and she has a beautiful smile. It made a huge difference for her. She is wearing a special rubbery retainer called a bite trainer to keep her top and bottom teeth aligned at night while she is sleeping, so that her jaw doesn't return to its previous position. The ortho told us he would not be able to correct everything for her during the first round of braces, so we expect she will need them again.

 

DD14 has not had braces yet. She has trouble with her enamel, so we are waiting until all of her adult teeth are in and will have braces on her teeth for as little time as possible, to preserve her enamel. We will consider Invisiline for her.

 

Having braces around age 8 is extremely common around here, now.

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I agree with pps that the ortho is working with the kid in front of him, which is why he changed the treatment plan.  It is not uncommon for kids to need 2 rounds of braces, one to fix some structural issues that can cause damage to permanent teeth or that can take advantage of growth and then later to make adjustments when permanent teeth come in.  It may not necessarily need to be more expensive than one round, especially if some bigger problems are prevented. 

 

My oldest had a cross bite (one upper tooth came in through the hard palate and was behind the lower teeth when he closed his jaw.)  If we had waited until the permanent teeth came in, he would likely have lost several of his front teeth due to damage from that bite.  So, he got round 1 of braces on when he was about 10.  He got round 2 around 14 or 15 when enough permanent teeth finally came in.  My other two did not need early braces. 

 

I'm surprised that you paid for the treatment up front.  Even though we had the cash to do it up front, None of the orthodontists do it that way.  They all required a deposit to start treatment and a monthly payment plan.  I think they get better compliance if the parent is paying the bill every month. 

 

My 2nd child has an unusual issue.  They are missing a front upper permanent tooth.  It never existed.  So, the plan has always been to leave enough room so that they could get an implant when they were old enough.  They put a fake tooth on a wire that was cemented to the back of the other teeth, similar to many lower retainers.  This was to keep the space as well as prevent the hockey player look.  When that broke after about 4 years, we finally investigated the implant situation.  We found that the roots of the nearby teeth were too close for an implant.  The only solution (other than a bridge which would have required damaging perfectly healthy teeth) was to put braces back on to manipulate the teeth to move those roots.  Our ortho is doing this for free (having had all 3 kids in braces with this ortho probably factored into his decision.) 

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I'm surprised that you paid for the treatment up front. Even though we had the cash to do it up front, None of the orthodontists do it that way. They all required a deposit to start treatment and a monthly payment plan. I think they get better compliance if the parent is paying the bill every month.

At this office, we could have done it that way but they offered a % off for paying in full up front. (After evaluations) We've been saving for it for over a year so we figured we might as well pay it and get the discount.

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I think most offices assume parents prefer a payment plan and offer one immediately but we got discounts from two different orthos for paying 100% up front for mine.

 

My youngest had a palate expander and a first partial round of braces starting around age 9. (He's 11 now) He got the expander out after just under a year and then the braces were expanded slightly (more brackets) as more teeth came in. He got them all off a few months ago. He is just wearing a retainer at night for now but there will probably be a phase two of braces after his adult teeth are in.

 

Manipulating the mouth with the baby teeth and as the baby teeth are coming in is now the preferred method -- it actually makes the second round shorter and easier than a single round on adult teeth; by helping the main adult teeth to come in straight and in a better aligned space.

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You've gotten some great advice and the guy sounds relatively nice.  I think you might feel better if you get a second opinion and if you talk to the first guy again, when you can ask more questions without an upset child present.

 

I do think it's reasonable to anticipate a round of braces when the adult teeth come in at 12-ish.  That can be a whole 'nother level of wonky.

 

My ds13 had a palate expander at 9 y.o. and it was awesome - he was literally happier (weird).  He has all sorts of major sensory issues and other issues and I was concerned that the ortho process would be dreadful, but it's been fine.  The palate expander worked wonders for his mouth.  Still, I was worried we would have to extract a few with the way his adult teeth came in - his mouth has always been seriously mixed up LOL.  He then got braces at 12.  The only major meltdown he had in the office was the first time he tried to insert the rubber bands with his braces.  Just this morning, he had his second set of braces put on (they switched them out for fresh ones) and he's fine - a little ibuprofen goes a long way.  Everything is on schedule at this point, his "eye teeth" have finally come almost all the way down, and from the looks of things, it doesn't look like we'll need to extract any teeth.

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Nationwide dentists and dental schools are moving to interceptive orthodontia. It is pretty standard to need phase two several years after interceptive treatment.

 

Is multiple phases the same as putting braces on the bottom teeth b/c that is the most pressing and then putting braces on the top teeth a period of time later, but keeping the bottom braces on?

 

Both my boys have had that. My younger boy had the bottom braces on for almost a year before he got his top braces on.  My older boy had a similar situation, but it wasn't as long between getting top and bottom braces on.

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We had a very nice dentist who we trusted and another who was a jerk both tell us DD would need braces.  They said she had an overbite and because of her eye teeth coming in horizontally.  I knew better and waited them out.  Kid does still have a very slight overbite that no dentist would think needs fixing and all her teeth are straight.  

 

Where as my DH definitely benefited from having braces young but did have to have a second set in late teens.

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Thanks for all the insight. A friend of mine that has sent 2 of her kids to this orthodontist, reached out to her fb friend that lives an hour away to get a recommendation for someone we could get a 2nd opinion from. Apparently, she's also had 2 in braces. I'm anxious to hear back from that. I also called today and set up an appointment for a consult with the current dr without dd present and I'm working on writing out my list of questions and things I need clarified. I feel a little better now. :)

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A question I always find useful is: what happens if we don't do x now?

 

For what it's worth, both my sons had treatment after their adult molars came in.  One orthodontist had told me that at least one needed an earlier stage of treatment, but we took a second opinion and waited.  It worked fine.

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Is multiple phases the same as putting braces on the bottom teeth b/c that is the most pressing and then putting braces on the top teeth a period of time later, but keeping the bottom braces on?

 

Both my boys have had that. My younger boy had the bottom braces on for almost a year before he got his top braces on. My older boy had a similar situation, but it wasn't as long between getting top and bottom braces on.

In our case "multiple phases" meant a whole process of getting whole mouth braces on, not having braces for a year or two, and then having them again a couple years later. We went in for a consultation, and they told us our daughter would defintiely need two phases if we started at that time (she was about nine) but couldn't tell us anything about what the second phase would cost or what it would take. I guess that kind of makes sense (hard to say what will happen as permanent teeth come in). But DH said no way in heck was he going to commit to starting treatment when the place couldn't give us a clear explanation of all costs up front. We decided that both of us were happy with the results we got with starting treatment after all baby teeth were lost for ourselves, so we would just do the same with our kids unless absolutely medically necessary. I had to have two permanent teeth extracted to make room for orthodontic work and it was no big deal...probably less expensive and less painful overall than palate expanding? I certainly don't miss them now! ;-)
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I haven't read all the replies, but I've been through some horrible stuff with my dd's orthodontics. Have you gotten more than one opinion? I would make sure to do that. From what I have learned, I would avoid pulling adult teeth and I would be very interested in using the palate expander. I would not just let him blow that off if that is what will get your dd the best result.

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I forgot this detail about the second tech who made it so my dd didn't gag - she mixed the goop herself and did it really thickly.  She explained that it was not exactly the "usual" mixture but would work anyway and is necessary for gaggers (because less of the stuff slides toward the back of the throat.) Of course she knew what she was doing.  It could be a choking hazard if they mix it too thickly so, obviously you want someone experienced, but I thought you should know.

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I want to bang my head against the wall over this orthodontics stuff for dd. She is 8 and only has 4 adult teeth in front on top and 3 on the bottom front. She has obvious crowding and bite issues. Her baby teeth crossed over each other in front like an X. So we've known since she was a year old we would most likely be doing orthodontics at some point.

 

Last month we were told 1 bottom adult tooth extraction, palate expander for up to 6 months, then braces top and bottom for 6 months to a year.

 

Fishy? Hm. I'm not in a position to judge. Seems like you'd not want an extraction with only 3 on the bottom so I think your question is a reasonable one. That said I have NO idea about orthodontics so I'm just in the same boat as you.

 

Well, I had a few questions about the extraction, which I think is reasonable when they are talking about removing a healthy adult tooth for aesthetics.

 

I'd be more--why remove it now when we don't know what is going to happen with the other adult teeth? Or can they see those? I think you're right to ask questions to understand the treatment you're getting. However it also doesn't sound "wrong" because teeth sometimes don't make sense to me either. Like you, I basically have to rely on recommendations.

 

So he back pedaled on that and decided to skip it for now. Let's see how the uppers respond to palate expander + braces simultaneously. We were supposed to have her get the impressions then but our consult took so long, they had us reschedule. At that point, I was aggravated. We drove 30 miles, let's get the ball rolling, ya know? Whatever.

 

Not fishy but irritating for sure. I hope you didn't get charged twice for the same thing.

 

Fast forward a few weeks to today. We go in to get impressions of the uppers for the palate expander. They put in spacers in between her molars to make room for the brackets. Then she did the impression. Crying, hyperventilating, gagging, coughing caused air bubbles.

 

For a child her age, sounds seriously frustrating but not fishy.

 

Take 2 was no good as well. So Dr looks in her mouth and says let's just do bands on the molars (no impressions needed for that) and braces. Uppers only still.

 

Does not sound fishy.

 

I'm asking what about the palate expander? Does she need it or not? If not, why did you recommend it in the first place? He says it would have been better but we don't want to traumitize her with repeated impression fiasco so let's see where we get with braces. So we leave having done 2 unusable impressions and have to go back again to start a whole new treatment plan that didn't even require today's 2nd impressions appointment! See? Head banging.

 

No, that seems reasonable, because it is likely a combination of her age, anxiety, and individual gag sensitivity that caused the impressions to be unusable so what's the point of putting a child through that again? That makes sense to me. It's an art as much as a science anyway precisely because biology is so individual. So that does  not strike me as weird. I know they changed the fluoride they gave my DD2 because she was spitting uncontrollably. It's not the more effective fluoride but it was the best for HER.

 

Am I just a dummy or does this sound ridiculous? Right now, I'm questioning the whole thing. (1) I wrote them this huge check and feel like we are just spinning our wheels. (2) I think dd is too emotional/ high strung/ immature/ whatever label you want to give, for this intervention.

 

As I understand it you get SO much more out of it when you're young.

 

I still supervise her teeth brushing and flossing because she doesn't do a thorough job on her own. And we have prepped her for this impression thing for a while. She knew what to expect.

 

In all fairness, I doubt that you can really fully prep someone for that, even an adult. People don't know their own gag reflexes.

 

(3) Why not wait til all her adult teeth are in and see what needs to be done at that point? He did throw around the easier mobility aspect since she's young but that was in reference to the palate expander which apparently, she suddenly doesn't need since she couldn't take a usable impression.

 

Same principle applies to braces though, that I know.

Btw, I am trying to get a 2nd opinion. I am having a hard time getting a recommendation. I don't want to just pick one from the phone book. But everyone I know has used this one. Everyone loves him.

 

So, if you've read all that, does it sound fishy to you? Like he's just trying to make money? Or is it common to change treatment plans on the fly if kids can't tolerate a particular aspect of the process?

 

No. Braces are really common and I don't know any dentists who are short patients so I would guess that two unusable impressions which they may not be able to fully bill for are bad enough. I do think it's common to find different things that work. That said, boy do I feel for you and while I'm typing this out I'm thinking, "I would have had it up to HERE if that were me!"

 

Eta: sorry! I meant to post this in chat!! I may XP later.

:grouphug:

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My FIL is a dentist. I have a child with sever sensory and anxiety issues. I would not go back to this ortho.

 

1. A good ortho assistant will be able to do impressions on a fearful child w/o them gagging. Our first ortho told me, "I hiregirls who are great with kids. I can teach them the skills. My girls stay with me forever because I treat them well." His girls were the best. My son never had issues with the assistants.

 

2. Never, ever pull adult teeth until all other options have been tried. Never. My FIL is adament about this. I truely believe the work our first ortho did helped save several adult teeth.

 

3. Kids are getting work done earlier & in two phases now because it's less painful with better results. The expander done early, before the top jaw fuses together, can give you the room for adult teeth that you won't have if you wait.

 

The reason we changed ortho's is our first ortho, who we absolutly adored, had a stroke and could no longer practice. He sold his practice to a young guy, who we also liked, but he didn't have the experience needed and was wishy washy when we questioned him. My FIL insisted we go with someone who had more experience. My older kids both had unique issues though. When my 3rd is ready we will check out the young guy again and see.

 

So that being said,

 

4. I wouldn't go with an ortho that is wishy washy. He should know the best route and if he (and his assistants) are good they can help a child through their fears.

 

5. Keep getting opinions until two match up. I have the luxury of having my FIL to give me his opinion and I found someone who aligned with his thoughts.

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One of my kids had a palate expander, it really was not very painful. Less painful and less involved than the braces. (Posting this because a few people who have not done palate expansion seem to be hypothesizing that that would be very painful).

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We delayed treatment.  It was suggested we go in when dd#3 was 8.  We decided to wait.  When she turned 12 we made an appointment to speak with the ortho.  The expander was installed and after 4 weeks she was done expanding.  She goes in beginning of May for the braces. Ask what would happen if you simply delayed treatment for another year.  What would be the pros and cons.  One pro might be her maturity to handle the gagging might improve.

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DD the older had an underbite -- palate expander and head gear at 7 (a different head gear than I've seen for overbites) and then braces at 11.   From my understanding, the main purpose of the palate expander in her case was to give some thing for the head gear to pull against (pulling the upper teeth forward to get in front of the lower teeth).  And then the main point of the braces was to bring her upper and lower teeth into correct alignment -- being out of alignment due to the move (not for cosmetic reasons) but that had to wait until all her adult teeth were in.  

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FWIW, there's s lot of research suggesting two phases of braces does not result in a better outcome or shorter treatment times. I had some pubmed links in an earlier post, but lost them on edit. We had two orthos want to do two phases of braces, and one who wanted to wait until her baby teeth were all out to do it all at once. We went with the latter to reduce the time she would be in braces for the sake of her enamel, and it ended up working great to do it that way. A palate expander may still be used, but that doesn't have to mean braces twice, even though orthos like to recommend it that way.

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My DS is 9, and has had his palate expander for 15 months. He just moved to wearing it at night only. 

 

Our orthodontist's office is pretty amazing (he was recommended by our dentist). I, too, had worried about impressions, and tried to prep DS for it. Imagine my surprise when it came time for them, and the office didn't use goop to make an impression! Instead, they had this wand with a laser (I think?) on it that they used to take pictures of his mouth. The pictures were used to make a 3-D model of his teeth, and they used that to make his retainer. Amazing! And so, so much less traumatic! This article seems to be about the same kind of machine our dentist used. 

 

If you have a sensitive kid (like I do), finding an orthodontist with one of these machines is completely worthwhile. (Where were these things when I was a kid??)

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I have two kids in braces right now.  The oldest only needed one round of braces and will have hers on for awhile.

 

My younger child got a palate expander at 9 and braces on the 4 front teeth (adult) on both top and bottom for a little over a year.  We look at the pictures of her smile/mouth from when she first got the expander to now, and the change is amazing.  She gets it all taken off/out this week, and we are so excited.  The expander made a huge difference for her, and I can't imagine doing that without the braces at the same time.  It was definitely the best decision for this child.  I fully expect that she will need a 2nd pair of braces in a few years, but maybe we'll get lucky - the work we did now could possibly prevent the need for braces later, but I'm not holding my breath.  It would just be a pleasant surprise if we get that lucky. 

 

If your ortho really felt that your child needed an expander, I would try to follow-up on that some more, either by trying for new impressions again or going to someone else for an opinion.  Good luck to you!

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My DS is 9, and has had his palate expander for 15 months. He just moved to wearing it at night only.

 

Our orthodontist's office is pretty amazing (he was recommended by our dentist). I, too, had worried about impressions, and tried to prep DS for it. Imagine my surprise when it came time for them, and the office didn't use goop to make an impression! Instead, they had this wand with a laser (I think?) on it that they used to take pictures of his mouth. The pictures were used to make a 3-D model of his teeth, and they used that to make his retainer. Amazing! And so, so much less traumatic! This article seems to be about the same kind of machine our dentist used.

 

If you have a sensitive kid (like I do), finding an orthodontist with one of these machines is completely worthwhile. (Where were these things when I was a kid??)

Thanks for the link. It might be worth it to call around to find an ortho with that technology.

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I have taken my son (almost 11) in every for year for the past three years for free pre-treatment consultations to see how his teeth are progressing.  I live in a fairly small community, but both orthodontists offer free yearly or twice-yearly consultations until treatment starts.  My son has a very crowded mouth, but neither ortho would put braces on until he has enough adult teeth, around age 12.  And the last one I saw said they try at all costs to avoid extractions....and they certainly try and let things progress and not do it prematurely.  I know many kids who have gotten braces and it's all been around 11-13 years old...I've never heard of an 8-year old getting braces, but maybe your daughter has a very unique situation.

 

I believe I would feel the same way as you. I would try to get a second and possibly third consultation, and they should be complimentary until treatment starts.  My dentist told me of some parents who will visit two or three orthodontists, not only to get their pre-treatment opinions, but also to find the doctor that feels best to the family.  So I recently did that, and am so glad I did, as the second ortho was ions more helpful and thorough, not to mention friendly, than the first.

 

This. I was going to type it all up, but AspenSong beat me to it. Our daughters' orthodontist keeps telling us to just wait until the baby teeth fall out on their own. She told the girls to use their tongues to wiggle out loose teeth. No way will she put braces on at this point, even though their teeth are crooked. Oldest is 11, twins are 9. I'd look for a second opinion, if I were you. HTH.

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Adding a little bit to our experience...

 

Oldest daughter saw orthodontist every 6 months for about 2 1/2 years before actually getting braces.  She was definitely in that category of needing braces, but don't rush things until all permanent teeth ready.

 

Middle child's mouth was a disaster.  Saw a couple of ortho's for consults.  The one we went with recommended palate expander, but we had to wait for awhile until her back molars came in.  As I said up above, that was at 9.  Another ortho we consulted with is the "go to" guy in our community.  He uses Damon braces, kept calling palate expanders "barbaric," and was definitely a salesman.  He has a great reputation and is excellent at what he does, but he was too pushy for us (and traditional braces were significantly cheaper).  Anyway, he went into this long explanation about how too many orthos are now doing 2 phases for kids when it's not really necessary, etc...  Then he took one look in child's mouth and immediately said that she would need 2 phases - it was pretty funny.

 

All this to say that what's best for one kid is not necessarily best for another.  There are various options available, and I would always recommend getting more than one opinion.   I am so happy with our ortho outcomes, and I wish the same for everyone else.

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I agree with delaying, unless they are causing her pain or can do more harm. My son had a palate expander at 10/11 along with a Frankle appliance and braces. He didn't like the treatment either, and typically he was pretty good about things. He lost weight, and was uncomfortable during most of the experience. After the first round of treatment they wanted him to start the second round right away because his adult teeth had come in.  He cried, and I wanted to cry for him. I said no, against much opposition from the ortho. We waited an entire year, and it was a completely different experience for him at 12/13, he had to go in for a Mara appliance for 12 months and braces for 12 months, he has been a rock star, completely different level of maturity. 

 

I also had to take into consideration that he was going to have to have a relationship with a dentist his entire life and I didn't want one round of treatment to sour him from seeking help/assistance when he needed it. I am SOOO glad I waited. 

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