Dentist Disagrees With Orthodontist-HELP

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#16 Post by **dena** » Sat May 27, 2006 10:30 pm

to me it seemed insane that different orthos had completely different ideas of how to treat the same patient. I figured they'd all basically have the same plan, but the three i saw REALLY differed from one another...and assured me that they were totally right. it's a scary thing, but i think once you read a lot of posts here and visit a few other orthos you'll begin to feel like you're learning enough to make an informed decision. I ultimately went with an ortho that had me have 4 teeth removed (also on top of the 4 wisdom teeth i'd already had out). but we discussed the "collapsed smile" thing at length and he showed me my teeth using his computer software and what they would/wouldn't look like, and he explained why some people dont want to remove teeth and others do.

Ultimately, in terms of having teeth removed, all the orthos i visited said it was necessary or would prob be necessary. so i figured that was prob going to be a foregone conclusion and went with my ortho, who explained things the best and with whom i felt most comfortable. so far i've been really happy there.

good luck and keep us posted.

#17 Post by **McGinley** » Tue May 30, 2006 6:23 am

I'm just over 4 years younger than you. My wisdom teeth are only beginning to come through. I had major crowing in my mouth and I got 4 teeth out. I think getting teeth out is better (well, for people in my boat) because it gets rid of crowded teeth and allows remaining teeth to have a comfortable amount of room to sit straight.

I think you should get more consultations, but that's going to cost a lot of money so maybe you should just do it with your dentist instead of your over-priced orthodontist!

#18 Post by **dena** » Tue May 30, 2006 8:17 am

McGinley brings up a good point that many of us might not have thought about. For me, all but one of my consultations with orthodontists was free. Actually, I didn't make appointments with people who would charge me for the initial visit. You should try to stick to that as much as possible so you don't have to pay tons of money for consultations. I did end up paying $50 for one...one that I didn't choose. But having that extra comparison was great. Also, I got to keep my pictures from that visit and that's what I've been using to measure my progress.

Good luck

#19 Post by **phanta** » Tue May 30, 2006 8:34 am

I only went to free consultations.

Some of them turned out to be very thorough and I wouldn't mind paying for them if they asked, but some were 5-minute general look-over, and I don't think anyone should be paying for that.

How in advance would you know what kind of consultation are you getting? When I asked how much time the doctor will spend with me, pretty much every receptionist said "depends on your case, the doctor will just look at you".

So I agree, ask in advance if they charge a consult. fee.

#20 Post by **mominbraces** » Tue May 30, 2006 1:33 pm

I have given much thought to this business of how
ortho's are handling adult extractions. I too had been
told repeatedly in my younger days that my teeth
could not possibly be straightened w/o extractions.
Eventually I started treatment with my children's ortho,
a fine fellow who said that extractions were the
worst possible thing for me, that he would straighten
my teeth w/o extracting even if it was the last thing
he did. As most readers of this board now know,
after 2 months in braces the ortho ordered 4
extractions. The story now is that yes, he could
straighten my teeth all right, but w/o extractions
there is a risk they will move right back to where
they came from.

So, back to the problem of the original poster. Whether
or not you do more consulations, I would press
the non-extraction doctors a bit harder. Ask what the
post-treatment prospects are, what is the long-term
stability of your treatment plan with or without
extractions. In plain English, do they have confidence
that your teeth will remain straight w/o extractions?
Ask if you'd need to need to spend time in some
other kind of device like an expander. I'll bet that
if you go with a nonextraction treatment plan, your
contract will have a disclaimer saying "extractions or
surgery a possibility".

It seems from reading these forums that there is
not an adult in braces in the world who does not have
a very similar extraction story to my own. I have
just about concluded that these nonextraction treatment
plans (that suddenly morph into extraction plans
midstream) are psychological devices for getting more
mature patents to come to terms with extraction.

#21 Post by **Regina Rose** » Tue May 30, 2006 3:38 pm

mominbraces, did you pick your "happiness police" orthodontist just because he was treating your child or did you also check out other orthodontists before settling on him?

Like you, I am facing the extraction of 4 bicuspids -- in my case, to correct a severe overbite and flaring of both upper and lower teeth. But my orthodontist was completely up front about the need for extractions. He told me exactly how much of a correction he could give me without doing them (not much!) and then what he could achieve if I went the extraction route (he drew a simple picture for me that made his point very clearly). He also encouraged me to get more opinions from other orthodontists (which I did, all recommendations from my very good dentist) and they all concluded the same thing -- that they would need about the width of half a tooth on each side to give me a decent outcome.

We also discussed some worst case scenarios involving extractions - flattening the profile can be unattractive and make noses look larger, fewer teeth can have an aging effect on the face, etc. He thinks this probably will not be true in my case, but still, you never know.

Regarding the psychological aspects of telling adults they need teeth pulled, again my orthodontist was completely up front and told me almost all his adult patients are upset about that. So what he often suggests is that he start treatment without extractions and go as far as he can in improving the teeth. Then the patient can decide if they want to stop there, or have the extractions and keep going. (A third option is to have some interproximal reduction, which can make a little extra room for more movement.) He told me that once his patients start seeing the positive changes, about 80% of them decide to go all the way and have the extractions.

Unless a case is truly borderline or unusually complicated, I really have a hard time understanding why any competent, reasonably experienced orthodontist cannot tell a patient ahead of time whether they need extractions or not and what the outcomes will be if they do or don't have them.

I have heard that the idea of extractions is often so scary that many adults will decide to give up the idea of braces entirely. Which makes me wonder: Is that why some orthodontists conceal that fact from their patients during the original consult? So that they don't lose a potential customer? IMO, that's highly unethical.

mominbraces, I don't want to make you feel bad about your doc, but what he's telling you doesn't make sense to me. You'd not in the middle of treatment; your treatment (like mine) has barely begun. What "changed" so drastically in the few months you've had braces that all of a sudden his "worst case scenario" has now become a necessity and something you must do ASAP?

#22 Post by **mominbraces** » Tue May 30, 2006 7:42 pm

Regina Rose, I chose my child's orthodontist for my own
treatment because he was highly recommended, is WONDERFUL
with kids and teenagers, and I thought competence should trump
all else. I figured as long as I was willing to make the
committment, go through the bracing, that was what
mattered the most. As impossibly naive as this may sound,
the minutiae of the ortho relationship (which was excellent
throughout the prebracing period), and other psychological
angst factors did not occur to me. Even if I would have found
the time to shop around, as a working mom I cannot logistically
manage the runaround to 2 different orthodontists. No doubt
there are probably lots of readers here who feel I deserve my fate

!

I was fully prepared mentally for extractions at my first
consultation, since as a child I had been told there
was no other way to correct my teeth. I was astonished
when the ortho insisted that we try to avoid this -and then
I guess just plugged in to euphoric visions of nonextraction.
The ortho WAS careful to have an "extractions possible"
disclaimer in my contract and my treatment plan, and right
before bracing he remided me of this. I now realize that
if I would have had my antenna up, I would have recognized
this verbiage for what it really meant: "We'll give it a try without,
so you'll have "closure", but we'll almost certainly extract anyway".

#23 Post by **KittyW** » Wed May 31, 2006 8:19 am

Just to reiterate...GET MORE OPINIONS.

As I said in my previous post, I'm a 46-year-old adult who had very crowded lower front teeth. At no time did my ortho indicate extractions would be necessary to achieve a successful orthodontic conclusion. I even asked about extractions at my initial consultation and he assured me that he could make the necessary corrections to achieve a fantastic result and he DID. I have no

"extractions possible" disclaimer

in my contract and my treatment plan either. It is my understanding that as long as I wear my retainers as instructed my teeth should maintain their position. My ortho is well respected and established in our area. If he has unhappy patients, what kind of advertising would that be?

As far as a psychological aversion to having teeth pulled, that may be true for some people. Had my ortho said I needed a tooth pulled, I would have sought at least 2 more opinions and if the others concurred, I'd do what was necessary. I mean, why put yourself through 2 years or more of braces to have a poor result?

The bottom line is every case is individual. We all have very different mouths, teeth and alignment problems. Do your research and get several professional opinions. Listen to your gut too.

#24 Post by **Duffle** » Thu Jun 01, 2006 7:43 am

Definately get another opinion as other posters have suggested.

But I just wanted to let you know that I had 4 extractions to correct an overbite/jet so a little different to your problem. I had one wisdom tooth extracted because of a persistant cavity but the others are impacted and aren't through the gum. I had my braces removed 2 weeks ago and I'm very happy with my teeth and I don't have a 'collapsed' smile that is often cited as a drawback to extractions. I also don't have TMJ.

#25 Post by **Chris** » Thu Jun 01, 2006 4:43 pm

I wish they had computer software with our photos in it and showing what the outcome will be with and without extractions. Sort of like that "hairstyle software" where you get to choose each on yourself.

Of course, you still wouldn't know how great your bite would be, only the cosmetic aspect.

This is a tough call, folks.

#26 Post by **Duffle** » Fri Jun 02, 2006 6:38 am

I can see where you're coming from Maryaten, but I'm not sure that a 'collapsed' look would occur in every case of a receeding chin. As this is exactly the problem I had and was corrected, as far a possible without surgery, with extractions and braces.

And whilst my profile has changed it's for the better and not a 'collapsed' look in sight. My upper jaw hasn't changed shape or moved it's just that there's less of an overbite pushing my lips forward, and my deep bite has been corrected so my chin looks a little longer.

#27 Post by **jaws** » Sat Jun 03, 2006 4:35 pm

Hi miasmama,

I'm a little late replying to this post, but I am one of those adult cases that was treated without extractions.

I went to two consults before getting my braces--one was an orthodontist who wanted to pull 4 molars, and the other was a general dentist who does braces, who recommended a relatively new procedure on me called 'Controlled Arch' (sorry to those of you who have heard this a million times!). The Controlled Arch procedure involves a particular type of brackets paired with top and bottom expanders.

I decided to go with the general dentist, since he had done my boyfriend's sister's braces almost 20 years ago and her teeth still look great. I completely agree that some dentists can perhaps be too inexperienced to do braces, but I also don't think that we should completely rule general dentists out.

Anyways, I am due to get my braces off in the next month or so, and I am happy with the results. My smile is more full and broad than it was before, and my bite is much healthier. I think that there are a lot of individual factors that orthos consider when deciding whether or not to do extractions.

Here are some pictures of my case:

BITE BEFORE:

BITE AFTER 1 YEAR:

BOTTOM BEFORE:

BOTTOM AFTER:

TOP BEFORE:

TOP AFTER:

#28 Post by **ingyandbert** » Sat Jun 03, 2006 5:46 pm

I'm 45 and am in Damon braces. I had previously been told I'd need extractions in order to straighten my teeth. But after Damons hit the market, I was told no extractions would be necessary. My teeth are straightening wonderfully, my arches have widened dramatically. I couldn't be more pleased. Anytime someone recommends extractions, I'd ask about other alternatives AND get a second opinion. I suspect a lot of extractions are done simply because it's faster for the patient and easier for the ortho. If extractions can't be avoided, then fine. But if they can, then they should be. JMHO.

#29 Post by **jaws** » Sun Jun 04, 2006 4:31 pm

Thanks Meryaten!

I actually thought my brackets were Viazis at first too, but they are actually 'Delta Force' stainless steel brackets. They are shaped in such a way that the ortho can change the lig configuration depending on what he/she wants. Here is a link:

http://www.orthoorganizers.co.uk/Produc ... #Stainless

They seem to have done their job!