Dentist Disagrees With Orthodontist-HELP

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#1 Post by **miasmama** » Fri May 26, 2006 5:47 pm

Hi everyone I am new here. I'm 22 years old in need of braces. Please bear with me, this post is a little long but I really need some help! I have some major crowding. The orhodontist says I have to get 4 teeth pulled (bicuspids) before he can put the braces on. I have already had all 4 wisdom teeth out about a month ago. When I went to my dentist for a check up and cleaning I told him that the orthodontist wants all 4 teeth out before putting on the braces. My dentist told me HE does orthodontics (which I never even knew) and said I would NOT have to get my 4 bicuspids removed and by not having them removed I would have a better outcome. He said if they were to be removed there is a chance of TMJ and also my smile (after getting the braces removed) would look more "collapsed". He said he would rather see me with a full smile that looked better than that if I had the teeth removed and the braces on.. He said the only reason to removed those teeth is that it makes it easier and faster than if they were not removed before getting the braces on. He said it would take 6 mons to a year longer wearing the braces with out removing the teeth. My dentist said he has done several cases just like mine with out removing the teeth and the outcome always looks better. He said there is enough room since my wisdom teeth were pulled to straighten my teeth and push them where they need to go.
Now supposedly this orthodontist is "very good" and not to mention expensive. Looking at the numbers, it would ALSO cost less if my dentist did the orthdontics than if the orthodontist did it. And thats not including the cost of extractions on top of it!
I don't know what to think! I am almost wanting a third opinion. But I trust my dentist more than this orthodontist whom was recommended by the oral surgeon. See I thought most adults have to get their teeth out, from what I have read and also knowing someone my age that has braces and got the 4 teeth out. Did anyone not have to get their teeth out and have good results? And if so how long did you wear the braces?
Any help or advise is really appreciated!

#2 Post by **phanta** » Fri May 26, 2006 6:06 pm

I think you should get more consultations. I went to 5 different orthos before committing, and very happy I did. 1 out of 5 turned out to be a complete whacko, the other one offered a treatment option I didn't like.

The other 3 gave me a much better option and all 3 basically agreed on the same thing, so I was comfortable with the treatment plan, and then just chose the doctor I most felt comfortable with and the price that suited me (which wasn't the lowest out of 5, but everything else worked in this Dr's favor).

I wouldn't be able to commit to such an expensive and lengthy treatment without getting more than one or two opinions. And I don't think price is any indication of how good a doctor is. I was very anxious to start the treatment but It took me 3 months to find the right ortho.

Sorry can't help about how multiple extractions turn out, but make sure you're confident about the doctor you ultimately choose.

#3 Post by **ingyandbert** » Fri May 26, 2006 6:39 pm

Personally, I'd go with the dentist/orthodontist. You've already indicated you trust him, and what he says makes a lot of sense. I have a very small mouth and had crowding issues. My teeth are being straightened using Damon braces and NO extractions. Previously, I was told I'd need extractions. After just 4 months, my teeth are just about straight (just the fine-tuning remains). I believe in keeping natural teeth wherever possible even if it means a longer time in braces. It sounds like one reason the other ortho wanted to do extractions was to shorten treatment time and make things easier for him. I'd go with your regular dentist. JMHO.

#4 Post by **miasmama** » Fri May 26, 2006 9:40 pm

Hi everyone

and thanks for the replies. I think I may continue to "shop around" and see what a few other orthos have to say. Its been quite nerve racking trying to figure this out. I have been saving money just to fix my teeth. Years ago my crooked smile never seemed to bother me but now that I am older and always smiling at my daughter I want to have a bright, straight smile to flash around. So I think its very important that I be "choosy" about who is working on my teeth. My dentist is wonderful and I think I may end up going with him, I definately trust him and what he is saying. And actually he said the same thing that one of you posted in your reply that the orthodontist "should just tell me that he wants my teeth extracted because its easier and faster for him" and personally I didn't find the orthodontist to be very friendly, personally, and I hate to say it but I think he is all about the money. There is this other orthodontist a few people have recomended, I think I am going to make an appointment with her...I hope I can get another free consultation. I already have my records done and the cepho x-ray. Luckily I do have insurance but you know it only covers so much. I will keep you all updated on how it goes. Thanks again!

#5 Post by **Flora2006** » Fri May 26, 2006 11:07 pm

I am glad to hear that you decided on shopping a bit more before settling with a certain ortho.

Finding a good ortho is so important...especially since this is a long term commitment. You do not want to be stuck with someone for a few years who you won't like...so shop around until you find someone you really like and feel comfy with.

Your dentist sounds great. If you really trust that he can do orthodontics, than go for it

Good luck and tell us how the "shopping around" goes

#6 Post by **Dark_angel** » Sat May 27, 2006 3:20 am

I had 4 teeth extracted but my dentist did the extractions so obviously agreed, my case was discussed with more than one orthodontist and i have a family friend who is in the profession and he never disagreed with the extractions.

Maybe to help you decide you could look at some of thier cases, that way you can see the before/after as well as noting what extractions / appliances they had.

#7 Post by **KittyW** » Sat May 27, 2006 9:17 am

Miasmom,

Definitely get another opinion. I had very crowded lower front teeth. Years ago a former dentist said he could fix them by pulling one out. I had a bad feeling about it and told him thanks, but no thanks. Fast forward to Dec. 2004...my new dentist asked if I had ever considered braces. He pretty much insisted that my dental problems, including fractured molars, worn front teeth, root canals etc. were all related to my malaligned bite. He referred me to my ortho. After the consult he said he could fix my lower teeth without pulling any teeth! I was thrilled, but skeptical. 17.5 months later after wearing Damon 3 braces, the braces are off and my teeth look great. None pulled! If you can save your original teeth, it is usually best to do so.

Here's a link to my before and after pics. I hope they give you encouragement. I am absolutely beyond thrilled with the outcome! viewtopic.php?t=11098

#8 Post by **bbsadmin** » Sat May 27, 2006 10:47 am

I concur that you should get more opinions from ORTHODONTISTS.

Your dentist means well, but many dentists who "do orthodontics" don't have anywhere near the training that licensed orthodontists do. I'm not toally dissing dentists, because some of them do a very good job with orthodontics. But some of them don't.

Definitely get a bunch of opinions before having any teeth removed. Also, you may want to try to see someone who does Damon brackets, because often with Damon treatment no extractions are done.

#9 Post by **Chris** » Sat May 27, 2006 2:01 pm

I also have to agree with the all of the posters, get more consultations, it will help you make a wise decision.

I decided not to settle on a dentist I saw who did orthodontics too, even though I liked his approach very much. Just recently I came across one of his patients in retainers...she raved about him and the results were very good. So you never know. Yes, orthodontists have more experience. But I've been "damaged" by experienced dentists in the past so I don't put all my trust in experience either. Its a tough call to make.

There are many different approaches to achieve good results. Make sure you have all your questions written down before you go see the orthos.

Your profile, your bite, how much crowding you have, all come into play when the orthos make their decision about extractions or no extractions. I have seen great outcomes with both! Nobody wants good teeth removed, sometimes its necessary, sometimes its not. Have the orthos show you before and after photos and ask them to show you what you can expect as the end result. Ask the "extraction" ortho why he feels that it would be essential to do extractions in your case. I had a few orthos tell me that we had several options to correcting my teeth. Good Luck!

#10 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.

#11 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!

#12 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

#13 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.

#14 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.

#15 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?