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3 orthodontists, 3 opinions


xixstar
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Oy - I went to as second orthdontist to get an 2nd opinion and then decided to get a 3rd too just to see if 2 would agree. And well -- they kinda do and don't. 

DD is 9.5 years and has a very narrow upper and lower jar. She didn't start losing baby teeth until very late and it is very clear that there isn't enough space for all the adult teeth to come in.  Also present is some crossbite issues, not moderate, and also possibility for underbite to develop as the grows. 

So now we're wondering what is the best plan of action - anyone have feedback if they've gone with one of these options?


Opinion 1: 
Make space by pulling teeth. Wants to pull 8 baby teeth - 4 on top and 4 on bottom -in the near future (she said to still assess when the right time to pull is).  Then probably need to pull 4 adult teeth (canines) when they come in.  She does not believe that a palate expander will provide enough space with how narrow dd's mouth is.

I can say telling a mom you want to pull out 12 of your child's teeth is a little intense. This is the orthondontist in the same office as my dentist - when I mentioned this plan to my dentist, he agreed that pulling teeth would be necessary. One note, pulling teeth have more coverage with dental insurance whereas orthodontia work has little coverage.

Opinion 2: 

Pointed out that upper jaw is much narrower than the average and that her teeth width is a little wide than average, which sounds like a bad combination. Upper and lower palate expanders and then retainer. Also list some brackets and bands. 

She is confident that this will provide enough space but did concede that they may still need to pull teeth if it doesn't. May also need a second phase with braces later, not certain just yet. 

Treatment plan was written in a way that I could easily understand. 

Very friendly office - this is one of those ortho factory places that have the whole system completely dialed in and are extremely efficient and child friendly. Everyone I know uses them. They were awesome to work with - made it all so easy. 

Opinion 3:

Upper palate expander, possibly headgear at night for jaw, a few months with braces and then probably will also phase 2 of full braces too. Honestly, I think option 2 will need a second phase of braces, they were just conservative in saying so.

He mentioned that we should take DD to ENT because she is nighttime mouth breather and this is adding to the narrow palate -- wish someone had mentioned this was a problem sooner. He didn't say fixing it would solve the narrow palate issue but it could help some.

While I liked the orthodontist, this office annoyed the heck out of me. He gets lots of reviews for being more conservative than other orthodontist offices. It took 3 appointments to get a treatment plan and that was mailed to me and not explained by the orthodontist.

His treatment plan was filled with all the technical terms which I wish he had been present to explain. He listed that an alternative plan is to remove 4 teeth.

Honestly, this place really tried my patience but for some reason I'm not writing them off completely. Option 2 orthodontist asked about mouth breathing and mentioned a EN, as a side comment, but his guy made it a point of why that was important factor.


Other useful notes: 

Price was the same between Option 2 and 3. Don't know the cost of option 1.

Part of me agrees with option 1 - it is *clear* that there is not enough space for the teeth coming in and maybe sometimes pulling teeth is the better options because it's not like the teeth are just a little tight (well they are) but there isn't space for entire teeth that need to come in. But pulling so many teeth is kinda freaky. 

Also - my oldest had a palate expander and I didn't feel like it actually did that much for his teeth and felt like we ended up spending more money than needed, so I am a bit biased on that. But DD's upper and lower jar are much more obviously narrow than my oldest's was.

I've been in analysis paralysis for several weeks and it's time to get all this figured out. 

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I would avoid pulling teeth and go with one of the palate expander options (probably #2).  Even if a tooth or two need pulling after doing the palate expander, that's better than pulling several teeth.  Keep in mind that the window of opportunity to do the palate expander will probably close at some point in the not-too-distant future.

 

ETA, there is some type of device I can't remember the name of, AF-something, that comes to mind re: mouth breathing/ENT.

 

We had a positive experience with the palate expander and one of my younger kids will probably need one.  (And on the really wacky science side, if y'all don't mind, there are lymph vessels back behind the mouth someplace that drain from the brain that were newly-discovered in 2015.  My palate-expander kid always had issues, but the palate-expander time period were happy days for him.)

Edited by wapiti
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Opinion 2 seems like a happy medium. It starts with trying to expand palate before considering pulling teeth, and you like the atmosphere in the office. 

 

Opinion 1 seems aggressive.  Oldest dd had a ton of teeth pulled due to her small palate and I wish we had sought other options. It was pretty rough on her and while she now has a beautiful smile I think it could have been accomplished without pulling so many teeth. She had 8 removed. 

 

Option 3 seems ok but the communication seems shaky. Honestly if they can't impress you now when they are trying to get your business, how will it be once treatment begins? 

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I’ve been to several orthodontists for myself and kids. It really seems like pulling teeth should be a very last resort. My dd is nine and a half as well and seems to have similar problems. She has crowded large teeth. jExpanders were the best option and even after the palate has been expanded the orthodontist plans on leaving it in place until she’s ready for braces. Expanders can make a lot of room.

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Just to give a different plan- DS has a very narrow jaw and lots of crowding. Our ortho and dentist both recommended that we wait until all the baby teeth came out ( he was a very late with losing teeth) and do braces after. They wanted to give his jaw extra time to grow as they hoped them they would either not have to pull teeth or do very little. DS got his braces on at 13. They did end up have to remove 4 teeth as he his jaw was still small and his teeth were in the roof of his mouth. Palate expanders were notan option as they would not add enough room for DS. His jaw was extremely small. By doing this plan, we did not have to remove nearly as many as a few other ortho wanted to do. DS Is finally nearing the end of his ortho treatment. His was told that to be in treatment for 30-36 months and that has been correct.

I have to say that I am very pleased with the progress DS’s teeth have made and I am so happy we did this plan over the other suggestions.

 

Perhaps, call the second and ask what the plan could be if you choose to wait for the baby teeth to come out. Also, check out a few more. I want to say originally we had 8 opinions. I wouldn’t use number 3 and the first sounds a little agressive.

Edited by itsheresomewhere
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I have no opinion on the substance of the treatment plans, but if you can't stand the staff at Option 3, I would write them off for that reason alone.  You spend waaaaay to much time with the ortho's staff, and in his office, to have to deal with that.  It's not like a dentist that you probably see twice a year, tops; you're in the ortho's office sometimes monthly, and you need it to be easy to schedule, easy to reschedule (stuff happens) and pleasant to visit.  

 

 

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We haven't had the same kind of issues that you are facing, but we have had four kids in orthodontics and have dealt with two different orthodontists (due to a move), plus another that gave us a consult.

 

We've been told that pulling teeth is a last resort now, unlike when I was a teen, when it was fairly common. DD15 did not have space for her 12 year molars to come in, and our dentist thought the ortho would want to pull teeth. Instead, the ortho had us have her wisdom teeth removed (earlier than the typical time frame).

 

Three of my kids have had a palate expander, and it did widen their mouths. I am absolutely no expert, but I would tend to try the palate expander and wait on pulling teeth to see if it is really necessary later.

 

I can see why the advice of the third ortho was appreciated, and it sounds like a good idea to get the ENT consult they recommend. But it sounds like working with them would be frustrating, so I'd lean toward ortho #2.

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I had braces over 30 years ago so I know orthodontia has improved drastically since then but I've had 19 teeth pulled.  (4 permanent, 12 baby teeth and then 3 wisdom that they thought they had left enough room for but no such luck).  My mouth was a mess.  But pulling teeth was pretty much the common method of making room back then.  While I haven't had long term problems from it, it was pretty traumatic. And for that reason alone I would shy away from that option if there are other avenues to try.  Research I've read while dealing with my own girls' small mouth issues suggests this isn't the preferred method any more.  

 

Option 2 sounds like the best option in my book.  Reasonable plan,  good communication.  You are going to spend far more time with treatment than you wish, you want a place that makes you feel comfortable.  I will also say that the palate expander made a dramatic difference in my oldest girl's mouth.  Teeth that were stacked behind others now had enough room to sit correctly.

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Did #1 explain why pulling baby teeth was necessary at only 9yrs old? My DS had to have his last baby teeth pulled out, but he was 14 at the time. He was late to get his first teeth as a toddler and late to lose the baby teeth.

When his permanent molars did come in, there were issues that present with baby teeth only. I would hesitate to extract so many teeth so young.

I would probably go with #2.

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Well, this is just my opinion, but I would go with an option that either eliminates or reduces the number of teeth to be pulled.

 

Also, you didn't mention this, but your dd is at an age where she is about to hit her puberty growth spurt. They change so much during that time. It is quite possible that het mouth/jaw will grow wider and be able to have space for teeth. I've seen it happen in a couple of my kids where around age 10 a dentist/orthodontist tells us the mouth is too small, only to have them hit puberty and grow, then never got that comment about a small mouth again.

 

No advice, just some things to consider.

 

Not always a popular opinion, but we chose to do nothing. Dd hit that growth spurt, and her mouth - which had seemed too small for her teeth - grew bigger and wider. The teeth that were coming in overlapping all magically straightened out. The canines that were coming sideways out of her gums slowly came down into the correct position over the course of 3-4 years. We didn't take her back in to get orthodontic evaluations until she was done growing and all her permanent teeth were in at 13.5 yrs. At that point there was no comment about a small mouth. We were told that her bite and back teeth were perfect and she just needed a short course of treatment (9-12 mo) for a few cosmetic issues with her front teeth (bottom front teeth were slightly crooked). 

 

We chose to wait with younger ds as well. And we can already see (at 12) how much his jaw has widened and his teeth (which overlapped in a crazy way) have almost completely straightened out. He still hasn't hit his big growth spurt so we will probably be waiting another year or two before we take him back in to get evaluations and estimates. But his teeth and bite look so good already. It's amazing what a difference a few years make. But every dentist and orthodontist I have ever seen swears to me that this never happens and that you have to intervene early. Maybe it's our family genetics, but I'm so glad I didn't pay all that money to put my kids through unnecessary treatments.

 

I'm always on the side of waiting to see what happens as a kid grows versus the kind of aggressive intervening you describe in option number 1. And you spend way too much time at the orthodontist to deal with an office that is unresponsive like option number 3. In your place, I would lean toward option 2. I like that she sounded flexible and acknowledged that she can't perfectly predict what will happen as your daughter grows. 

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I have no opinion on the substance of the treatment plans, but if you can't stand the staff at Option 3, I would write them off for that reason alone.  You spend waaaaay to much time with the ortho's staff, and in his office, to have to deal with that.  It's not like a dentist that you probably see twice a year, tops; you're in the ortho's office sometimes monthly, and you need it to be easy to schedule, easy to reschedule (stuff happens) and pleasant to visit.  

 

Their staff is all nice, it was just their new client procedures that annoyed me. 

 

I went to Othro #2, got an appointment within 2 weeks of calling, and they did complete photos, xrays, assessments, made molds for us to be able to start right away and sat down and explained everything, all within 30-45 minutes appointment. At no cost at all. 

 

The 3rd office, I had to wait almost a month for an initial consultation that are only scheduled in the middle of the day.  At that appointment, I only got to meet the orthodontist in his office and he took a 2-second peek at dd's teeth and the one xray I had sent over.  Then they needed another appointment for the full panel xrays and take photos - and you have to pay for all that and the price tag was rather high compared to it being free at the other place.  Luckily, I was able to send over the full xrays from option 2, but they still needed their own photos.

 

I took my kid out of school for what felt like nothing for that first appointment. So then we go back for photos, I was expecting to get to talk to the orthodontist then over the treatment plan but nope -- he wan't in the office until later that week and then they MAILED it to me.  So basically, it took 2 months to find out their treatment plan - and well, I wanted someone to actually talk to me about the actual plan before I sign off. 

 

Yeah okay, that place really has annoyed me. They have a reputation for being more affordable, but that wasn't the case either. 

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I would go with number 2. Pulling 12 teeth seems extreme. The last guy is a clear no.

 

I was kind of amazed at what our ortho accomplished with ds simply by expanding his palette. Firstly, those baby teeth start popping out pretty shortly after the palette starts widening. Ds had a few off kilter adult teeth that looked like they wouldn’t be able to emerge, but once his palette was widened, they came right down.

 

I had one office tell me he’d need 2 phases and extraction. He ultimately needed a simple retainer widener, and 18 months of braces. Pretty huge difference.

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She sounds similar to our DS. We had various opinions on what to do as well. One doctor was adamant that there was no way a palate expander could make enough space and another was convinced it could.  A third said there was no need and to wait and see how his jaw developed as a teen.

 

What we did:

Pulled a bunch of baby teeth at about the same age as your DD is. It was definitely necessary to pull at least a few at that time. Then we did phase 1 braces about a year later (wanted to wait for some teeth to drop) to straighten what we had and make room. Phase 1 braces were on for about a year.

 

Phase 2 braces were put on when DS was almost 15. Even then, he didn't have all his teeth yet but they wanted to get started while he was still growing. He's hoping to get them off in the next few months which would be a little over 1.5 yrs in phase 2 braces. 

 

He had no palate expander. The third doctor was correct- as DS entered puberty his jaw developed and he had plenty of room for all his teeth. I can't say the same will happen with your DD, but we are glad we avoided the pain and stress of a palate expander. Had we gotten one, I'm sure he also would have had space for his teeth and I would have thought it was due to the palate expander, but I would have been wrong. He had severe crowding around age 8-12, a crossbite, but no underbite issues. We pulled no adult teeth like the first doctor had planned.

Edited by Paige
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I would go with Option 2. My son had expanders and didn't end up needing to have any teeth pulled. He also didn't need headgear. Woohoo! He spent 3+ years in 2 phases, but I think it was worth it. Now we need to get those wisdom teeth out before they come in and mess everything up. 

ETA: They were able to go right into Phase 2 and use the wires already on his teeth from Phase 1, thereby saving us some money. His Phase 1 went on at age 11. 

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I had 4 adult teeth pulled before orthodontics back in the day because it was standard procedure.

 

Option 2 definitely sounds like the best plan. Palate expander is no big deal, and you like the office. You will spend a LOT of time there, so I would decide based on the office you feel most comfortable in as opposed to the cost.

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When we had a similar situation about four years ago, we went with option 2. We had to have an early wisdom tooth removal so that 12 year molars had room to come in, but ds only had to have those removed.

 

Ds11 is in a similar boat. We have also had to help some deciduous teeth along because permanent teeth were erupting cheekside.

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Your child was me at that age. Seriously tiny mouth and all kinds of issues. I had an overbite. My dentist was pulling baby teeth left and right. I’m traumatized for life and scared of dentists now. My parents got super frustrated and took me to an ortho. He had a different plan.

My ortho did headgear, an expander, and two rounds of braces. I’m so happy with my smile and I got to keep all my teeth. And he didn’t even pull any more baby teeth.

My son has the same issue. Our ortho will do an expander (herbst) appliance. I think that’s the name of it. It’s the “new†headgear apparently. It will bring his lower jaw forward and give him more room. It will correct his overbite and then he’ll get braces to straighten things. Ortho feels confident we’ll have room for his teeth.

All that to say I might get another opinion. I got 5 or 6. I felt comfortable with this ortho and my son gets started in January.

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My son had many of the same issues.  He started orthodontics the month after he turned eight.  First he had a palate expander and, over the course of a year and half, five baby teeth were pulled.  The teeth were pulled gradually and only when there was adequate space for the permanent teeth to move in.  After 2.5 years, he received full braces and continued with head gear.  It took almost 6 years (from the time he started orthodontics) but everything moved where it needed to be and he has space for all of his teeth.  A few months after he finished braces, he had all four wisdom teeth surgically removed because they were already impacted.  It has been 5.5 years since he had his wisdom teeth out and he still wears a retainer 3 nights a week.  He will be 20 in 2 months and has a beautiful smile and no issues with his bite.  We are glad we went with a slow and steady approach.

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Agreeing with others that the tooth pulling option seems very old school to me.  It came up in conversations when looking for an orthodontist for my oldest (the only one I have in braces at this time) because my DH had over 12 teeth pulled.  All of the offices told me that pulling healthy teeth was a last resort at this point and they all wanted DD to do a palate expander.  Also, due to a move right before we were about to begin treatment, I had 6 consultations for her so lots of doctors in two different areas against pulling teeth.  

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From our experience with multiple kids with 3 different orthodontists, I would say that option 2 is the best option.

 

My son had that option and did so well with it that he never needed phase 2 braces. The upper and lower expanders along with a few brackets behind his front upper and lower teeth, allowed for the rest of the baby teeth to come in straight.

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I haven't read the other responses.

 

We received three similar opinions for my ds aged 10 and went with the first, although I think only four teeth were pulled. The others wanted expanders of two different types, plus braces for some portion of that time, then a retainer, and then another round of braces. I saw myself in an ortho's office for years and years. This way we are only doing a retainer for a couple years until his baby teeth finish coming out on their own, and then they will do the braces.  To me, this was the conservative approach, however, again, we did not have so many teeth to pull. My mouth was also overcrowded. I am really skeptical that they can "make room" for as many extra teeth as our family tends to have with just an expander. I can totally see adult teeth coming in and throwing the others off alignment (this happened with my wisdom teeth as a teen).

 

 

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I would do nothing and wait for the growth to hit.

But I hate dentists and orthodontists especially. We were also recommended braces at that same age, and when that orthodontist found out braces were not possible just then as DS was going overseas, he looked around and...recommended palate expanders. I said no thanks and walked out of there, went to a different city to get a second opinion and what do you know, not necessary. DS will need braces but I’m bracing ;) for the upsell. I want to go in and let them know I can totally afford whatever they’re selling just please don’t recommended unnecessary nonsense. Ugh.

Reminds me of the year one dentist told DH he had some 20 cavities and another told him he had none. I wanted to tell that dentist they should agree on a smaller range of numbers to put in that hat when they get their licenses....

Edited by madteaparty
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I have no advice for you. DS had some issues with spacing. One ortho said he needed six teeth pulled at age nine. We got a second opinion who said everything looked fine - come back at age 12. He’s lost 5 if the 6 teeth the first ortho wanted pulled in the year since we had the consult. I’m glad we didn’t pull them.

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Yup, I'd say #2. Their approach sounds reasonable, and you had a good experience with them.

 

It's been awhile, but we had a similar experience with both of mine and went with the one that seemed the most reasonable and had the best staff. Five years of visits to them proved that we made the right choice. Most of our dentist's staff went there, and we also had a bunch of recommendations from friends.

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Your child was me at that age. Seriously tiny mouth and all kinds of issues. I had an overbite. My dentist was pulling baby teeth left and right. I’m traumatized for life and scared of dentists now. My parents got super frustrated and took me to an ortho. He had a different plan.

My ortho did headgear, an expander, and two rounds of braces. I’m so happy with my smile and I got to keep all my teeth. And he didn’t even pull any more baby teeth.

My son has the same issue. Our ortho will do an expander (herbst) appliance. I think that’s the name of it. It’s the “new†headgear apparently. It will bring his lower jaw forward and give him more room. It will correct his overbite and then he’ll get braces to straighten things. Ortho feels confident we’ll have room for his teeth.

All that to say I might get another opinion. I got 5 or 6. I felt comfortable with this ortho and my son gets started in January.

 

 

Very similar experience, so much so that it's only in the last 18 months or so that I can go to the dentist without panic.  

 

Try option 2 first. 

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I would also go with #2. Pulling that many baby teeth would be traumatizing. If plan #2 doesn’t work and teeth still need to be pulled later-fine. But give the jaw a chance to grow and expand first and then problem solve from that point.

 

 

Sent from my iPhone using Tapatalk

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Our kids’ orthodontist is adamantly against pulling teeth. He’s a third generation orthodontist and extensively studied the effect of teeth pulling while he was in graduate school. He prefers to widen the palate.

 

ETA Our kids did get their wisdom teeth removed after braces but that was it. When I was a kid, I had molars and some bicuspids removed. My kids’ orthodontist could tell just by looking at my profile.

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I havent read all the responses but here is my opinion. Option 1 is a no way, never, get your hands out of my kids mouth. My FIL is a dentist. My son had similar issues. My fil said never pull adult teeth unless it is a last resort. And never, ever pull canines. One of his son had his canines pulled and FIL said it was the biggest mistake and he always advises patients against it. My son ended up having 3-4 baby teeth pulled, then the palate expander. The ortho wasn't sure there would be enough room but that was his 1st priority with phase 1.

 

Long story short son just got his phase 2 braces off a couple weeks ago and his (huge) teeth are beautiful. (They are all there too.)

 

ETA: It is my understanding that headgear is old school and not used anymore so I would think twice about Dr. 3. There is a device (my son had it) that is put in the mouth for 3-6 months that does the job of headgear. I cannot remember the name. It looks like a tourture device and takes some getting used to but it works and you do not have to worry about your kids "remembering".

 

When my sons adult canine came in they came in as fangs. The ortho was fine with that. I was surprised how quickly they went into place once the braces were on.

Edited by Plateau Mama
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We haven’t had the exact situation but I would vote for Option 2 of the three you mentioned.

 

We ended up with an orthodontist that I had kind of rolled my eyes at before we went. Very kid friendly place, video games in the exam room, a whole system of earning prizes, very slick feel. But after going there I felt like it was so worth it and I realized why everyone loved them. Super easy staff. Easy to schedule and to reschedule. My son had a horrible time with breaking brackets and wires and we were always able to get in very quickly to be seen and have it fixed. The place was so friendly that the other kids were almost jealous that they didn’t have to go. I would hear “why does H. get to go play Pacman and get free ice cream and we don’t?†Um...because he has to have orthodontics and you don’t? 

 

Also, being able to explain things thoroughly and simply is really important. And I’d be impressed with the way it sounds like the second person admitted to some uncertainty about what else he might need. It’s good for doctors to admit it when they aren’t totally sure of what might happen. 

 

I was a little skeptical of earlier treatment, although at 10-11 my son wasn’t that early these days. My oldest had a mouth that looked like he would definitely need orthodontics and then as he grew they all straightened out. But my second son had a pretty severe underbite and a crossbite. The question I asked was “What is the downside to waiting?†I wanted to hear that there was a problem with waiting, not just that “Oh, you’ll need it eventually so just do it now.†Our guy gave an answer that convinced me that it could cause more problems to wait so we went ahead with it. And in the end he had only 10 months of braces and headgear at night and had beautiful results. He may need further treatment in the future but we were really happy we did it. 

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I havent read all the responses but here is my opinion. Option 1 is a no way, never, get your hands out of my kids mouth. My FIL is a dentist. My son had similar issues. My fil said never pull adult teeth unless it is a last resort. And never, ever pull canines. One of his son had his canines pulled and FIL said it was the biggest mistake and he always advises patients against it. My son ended up having 3-4 baby teeth pulled, then the palate expander. The ortho wasn't sure there would be enough room but that was his 1st priority with phase 1.

 

Long story short son just got his phase 2 braces off a couple weeks ago and his (huge) teeth are beautiful. (They are all there too.)

 

ETA: It is my understanding that headgear is old school and not used anymore so I would think twice about Dr. 3. There is a device (my son had it) that is put in the mouth for 3-6 months that does the job of headgear. I cannot remember the name. It looks like a tourture device and takes some getting used to but it works and you do not have to worry about your kids "remembering".

 

When my sons adult canine came in they came in as fangs. The ortho was fine with that. I was surprised how quickly they went into place once the braces were on.

Headgear is very old school now. DD got braces on last week and has that appliance thingy that replaced it.
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My youngest had a very high and narrow palate. It was extreme enough that the midwife commented on it at birth and then went bright red (we have it on video) because she didn't realize that she had said out loud that she was going to need braces when she was older.

 

The dentist that we used was pretty conservative and just wanted baby teeth pulled as needed to make room for adult teeth. The first four adult teeth that came in pushed out 7 baby teeth and filled up all of that space. The next adult teeth came in behind the adult teeth that were already there (because their space was already taken up), so the dentist pulled 5 baby teeth to make room. Then the next set of 4 adult teeth came in as fangs in front of the adult teeth that were already there. So the next 4 baby teeth were pulled. That still didn't allow for quite enough space. That was when we were sent for ortho opinions, although the dentist had been sending us for ortho consults periodically for the past year. He suggested that we get the ortho plan from the ortho we were consulting with and from one other.

 

The ortho who'd been consulting wanted to pull four adult teeth (two on top and two on bottom) and do braces with headgear and retainers with headgear after that.

 

The dentist thought that was too extreme and recommended we ask another.

 

That one also wanted to pull four teeth, but then wanted to do expanders and braces. No headgear.

 

The dentist asked us to go see one particular orthodontist that he recommended. He was pretty far away, but he said that if this ortho also recommends pulling all those teeth, then it's the right thing to do. He was worried that pulling any teeth on the bottom would cause the lower jaw to recess further.

 

That ortho was awesome and we decided to go with him. The braces system that he used also expanded and he did it without pulling any adult teeth. He used Damon system braces.

 

 

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My oldest ds had a very narrow jaw. His baby teeth were crowded. He was also late in beginning to lose teeth. The first orthodontist we saw when he was 9 wanted to pull 6 teeth to start then do braces for at least 5 years. We went with orthodontist #2 who suggested a palate expander. He wore it for 18 months then when most of his adult teeth came in (sometime around high school), he wore braces for 18 months. Was going to be 12 months in braces but he had an adult tooth in the roof of his mouth not coming out where it was supposed to so needed to be dragged into position with a chain.  No adult teeth were pulled, only the one baby tooth not pushed out by the adult tooth in the roof of his mouth.

 

He has great teeth now.

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I wouldn't pull teeth yet.  My mother did that with me when I was in grade school and I have gaps on the top and the bottom.  They aren't noticeable when I'm talking to people.  However, I know they are there and they are harder to keep clean.  I wish she would have waited to see if they had to be pulled.  She didn't do braces with me, only a retainer, so maybe that is why the teeth were pulled.

 

I would consider if she has to have something done right now.  I've seen that happen a lot lately that very young children have ortho work done and then they have to do it again when they hit their teens.  Is that an option?  Wait and see? 

 

Otherwise, I would do a palette expander.  We did that with my daughter and she hasn't needed anything else.  She had a pretty small mouth, also.  They didn't pull any teeth with her and she will not need braces.  

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