Braces Privately and Operation(s) on NHS?

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#1 Post by **rektik** » Tue Apr 13, 2010 12:20 pm

Hi everyone,

Thought somebody here would perhaps know the answer to this question.

Basically, I have just had an appointment with a maxiofacial surgeon, (and seen orthodontic consultant twice), I'm a bit gutted at the news that I will need braces for 2-2 and half years, and have 2 (yes 2!!??) operations; 1 to widen the top jaw, and the second to move the lower jaw back (as it sticks out slightly, I can't overbite).

Anyway until I now, I have fully realised I do not want the fixed braces, due to me finishing university this year, and starting a new job soon in a client facing environment, meeting new people everyday. It may sound shallow, but I think my confidence will be slightly knocked. I wish I could wear them but doubt I would last!!!!

So I have looked into lingual braces and am considering going privately (Eeeek costs a bomb!!!)... However, I wanted to know if anyone has had or is in a similar situation, particularly in the UK... This is because I only want to get the lingual braces privately, but then I want the operations on the NHS??? Would this be possible? I will be asking this at my next appointment but its going to be at least 6 weeks I would imagine!

As it stands I can get everything on the NHS (fixed braces and ops).

Thanks for any advice people!

#2 Post by **Emmauk** » Thu Apr 15, 2010 8:07 am

Hi

My situation is slightly different but i think the same would apply.

I am going to pay to have a brace fitted privately - i can only have ceramic no other brace has been recommended. I will be having 2 years of bracing followed by double jaw surgery - covered on NHS then back to finish off for 6 months private bracing then a years retainer.

I have asked my surgeon and two orthodontic consultants about this and they have assured me that the surgery is definatley covered on NHS regardless of me choosing private bracing.

Having said that apparently my case is quite severe so even at 32 years of age there has been no question as to if the surgery would be covered or not.

Do you know if the braces you would like are available to you, i was told that for me fixed normal/ceramic is my only option.

HTH

#3 Post by **rektik** » Sat Apr 17, 2010 6:15 am

Hi, thanks for your reply...

Yes you scenario is very similar to mine then (seems you maybe some way ahead of me!) I haven't been told whether or not my case is severe, but I'm gathering that after 3 consultations that would have told whether or not it was going to cost!!??

I thought that lingual braces can do everything that fixed braces do??? I really didn't want the fixed braces, because my lower lip would stick right out, and get gradually worse as my teeth move back into their natural position!

Hopefully, with lingual braces my lip would stick out a bit, but not as much with the braces being sat on the inside... Did you question lingual braces? What was the reason for you only being allowed this option?

Thanks.

#4 Post by **suzyscientist** » Sat Apr 17, 2010 12:09 pm

Hi,

Sounds like we have exactly the same problem! Although my consultant is trying to widen my upper jaw with orthodontics first. Just got to wait and see.

Anyway, I am going all NHS. I got referred from an NHS dentist first and saw an NHS consultant - I haven't seen anyone privately. The consultant told me that it isn't allowed to mix-and-match NHS and private treatment. Although my surgeon did both private and NHS surgery, the ortho didn't, so I would need to see another orthodontist away from the hospital the surgeon worked at. So, that meant I had to get private surgery as well. The surgeon and the orthodontist have to work very closely together to make sure your teeth are in exactly the right place for surgery, which makes sense I guess.

That said, I'm in Scotland and I've heard that different health boards have different rules. It's definitely worth asking.

If you need braces for 2 years then I think you definitely will need fixed braces. I was told that a retainer just wouldn't be strong enough to move my teeth and I'm only sentenced to 18 months.

I've got fixed metal braces and they actually haven't made any difference to the prominence of my underbite. I work in consultancy, so appearance is *everything*, and I actually find I'm getting much more respect wearing the braces than I was before - it's something to do with self improvement I think!

Good luck and hope it works out with your next appointment

Suzy

#5 Post by **suzyscientist** » Sat Apr 17, 2010 12:13 pm

Oh just re-read your message: lingual braces are fixed braces! Anything that is glued to your teeth is a fixed brace. The colour (metal, ceramic, clear) refers to the wire and the brackets. Sorry I misunderstood what you were asking

#6 Post by **rektik** » Sun Apr 18, 2010 3:18 am

Thanks for your reply Suzy,

That's really disappointing that they won't mix and match NHS with Private treatment? I thought this sort of thing would happen all the time (not just with braces and surgery).

Sorry I though fixed braces meant the full metal ones on the front only. I don't have an appointment booked yet, as my details are currently being transferred to a different NHS hospital nearer home. The first thing I'm going to ask is about the private braces... At the end of the day, to have the surgery, all I need is straight teeth. Therefore, I could simply get my teeth straightened privately, and then go to the NHS and show them my bite (which I guess will be much worse than it is now after their aligned correctly).

#7 Post by **sauerkraut** » Sun Apr 18, 2010 4:35 am

Hi rektik, I'm not in the UK so take this with a pinch of salt, but I think you'll find that the ortho and surgeon have to devise a joint treatment plan. They're working together on fixing your bite, so each of them needs input into what the other is doing. Which means, I reckon, that if there's any chance for your plan to work then you'll need an ortho who treats both private and NHS patients. And then you'll need a health authority which allows you to mix & match.

I can't imagine it would work for you just to turn up for the surgical consultation with (privately) straightened teeth because the teeth might not be lined up exactly how the surgeon wants them for the operation. It's also complicated by the fact that you need two operations. Again, the results of one will have an impact on what's done in the next, and the ortho and surgeon will need to work closely together on this.

Another problem is that you could well find your surgeon won't operate on a patient with linguals. I can only speak to what I've read on this board, but that seems to range from surgeons who just put attachments on the front, to surgeons who make the patient change over to normal brackets, to surgeons who refuse flat out to operate on linguals patients.

Sorry, I hope that doesn't all sound too negative. I do wonder if you're over-estimating the impact of normal brackets in your deliberations, though. They're very discreet and compact nowadays, and I haven't noticed that mine make my lips protrude at all. And it might seem difficult to believe at this stage, but other people really won't care about your braces. Braces on adults where I live are every bit as rare as braces on adults in the UK, but I have not had a single negative response from anyone. From most people the braces raise no reaction at all.

All of which is just to say: if you do find there is no alternative to the traditional braces route, please don't let it put you off. It really isn't as bad as you might think

!

#8 Post by **suzyscientist** » Sun Apr 18, 2010 4:38 am

I think it depends very much on the health board and on the surgeon. So don't give up hope! Each health board has different rules and I think surgeons have their own rules anyway

At the end of the day, to have the surgery, all I need is straight teeth. Therefore, I could simply get my teeth straightened privately, and then go to the NHS and show them my bite (which I guess will be much worse than it is now after their aligned correctly).

That's actually not the case - your teeth have to fit together perfectly after the surgery, this doesn't necessarily mean they just have to be straight. If you got orthodontics on its own and then went to see a surgeon, he/she would probably put you back in orthodontics for a while to move your teeth to where they should be after surgery. That's why a two-pronged approach is so important and why the surgeon and the orthodontist have to work together so closely.

Best thing to do is write a list of all your questions and take it to your consultation. Questions are good

Suzy

#9 Post by **Emmauk** » Sun Apr 18, 2010 9:48 am

Hi again

With my situation i asked if my ortho would mix my braces front 6 brackets ceramic and the remaining metal for both top and bottom - this apparently is not allowed in the U.K, its common practice in America but not over here, so i am going all ceramic.

I am very lucky in that i am allowed to use a private Ortho who will work with my surgeon as they both work NHS and private some of which is working together, i wasnt able to choose my Ortho or surgeon but thats fine the Ortho seems a nice guy and he is the one i will see quite a bit so im really happy overall.

I dont beleieve my surgeon would have operated unless i would use the Ortho based in the same hospital as other people have pointed out they have to work closely together for this to work properly. I think they have a lot of meetings to make sure both are happy with the progress, if i had to pay for my private Ortho to attend my NHS appointment i would think it would cost a fortune, I suspect there is someone who can treat you privately and work alongside the NHS surgeon its probably just a case of asking the right person.

What area are you in, i am Southend in Essex.

I did ask at my first Ortho appointment what brace options i had and he said fixed either ceramc or normal metal. I breifly asked about Invisalign and Lingual but he suggested that if i couldn't cope with metal to go for the ceramic's, i have my first appointment privately next month where he takes all my records and discusses the plan. I will have my moulds taken and the "before" picture then once i give the go ahead they will fit the first brace.

If your worried about the brace making your lip protrude more then its probably better to have normal metal braces if lingual or cost is an issue, i am under the impression that the ceramic brackets although more discreet are actually bigger/bulkier.

#10 Post by **rektik** » Sun Apr 18, 2010 5:18 pm

Thanks for your replies,

I can see I have a lot to learn about this entire process, as it seems to be no where near as straightforward as I first predicted

. I was simply under the impression that a jaw surgeon won't operate unless you have straight teeth, so I was thinking 'lets just get my teeth straight!'

Anyway, interesting Emma that you have been allowed to do this! I can totally understand that in certain areas this wouldn't be allowed (although it seems pathetic to me. I did however come across this article about the government planning on abolishing this law of no mixing and matching with NHS and private treatments:

http://news.sky.com/skynews/Home/Politi ... 1542?f=rss

Not sure if it has taken action yet? Probably not with this complete and utter sesame government (here in the UK)

Emma, my initial consultations were at Bournemouth hospital and i never asked these questions (regrettably), however because I'm only here for my education, I am moving back home in a months time to Bedford where my details are currently being transferred to (Bedford Hospital). I'm going to ask the same questions that you have done about private orthodontics and NHS surgery, hopefully I can somehow get the same outcome that you have managed to get!

Could you please PM me your email address? As if I cannot get my plan in Bedford, I think regular trips to Southend wouldn't go a miss!!

So if you could provide me with the ortho's/ surgeon's details that would be amazing! Thanks.

#11 Post by **rektik** » Sun Apr 18, 2010 5:23 pm

Sorry, to sauerkraut,

thanks for your help... I'm not entirely against the metal braces being inside my own mouth, but with other options out there I want to explore them first

I was even looking at a full of veneers in Budapest for £3000, just to get my teeth straight and chop 2 years of this bullsh*t which I cannot be bothered with haha!!

#12 Post by **sauerkraut** » Mon Apr 19, 2010 12:09 am

No probs, rektik

. Hope you manage to get something sorted.

I'm sure you'll do this anyway, but when you get your consultation remember to ask what the surgery will involve. If they are expanding your palate with SARPE (sometimes called SARME in the UK) then you need to reckon with wearing a fixed expander for several months, and you'll probably get a large gap between your top front teeth. Then there's the swelling and the liquid diet...

I'm sounding ever more like the voice of doom here but thought you'd probably want to know what you're getting into. Have a look at the orthognathic surgery forum on here, though. Some people go through quite a tough time but most of them don't regret it in the end. It's a couple of years of faff, but then your teeth and bite are fixed for a lifetime

#13 Post by **Emmauk** » Mon Apr 19, 2010 2:21 am

You wouldn't necessarily need to travel to Southend, you have the right to use which ever hospital you like for whatever reason.

Im sure there would be one closer to you that would offer the same situation i am in - its apparently quite common practice for a consultant to treat both private and NHS. I wouldn't get too carried away as you havent yet asked the direct question to your consultant, ask him first then if he cant help you go to the next closest hospital.

I can give you the info if you want it or you could always pm me if your not getting anywhere with your local hospitals.

#14 Post by **Jen8626** » Fri Apr 23, 2010 8:50 am

[quote="Emmauk}]

With my situation i asked if my ortho would mix my braces front 6 brackets ceramic and the remaining metal for both top and bottom - this apparently is not allowed in the U.K, its common practice in America but not over here, so i am going all ceramic.

[quote]

Not so! I have upper 6 ceramic and the rest metal and live in UK! My ortho said metal on bottom are better if you have a big overjet because ceramics are more bulky and more likely to snap off if you crunch on them :S

Jen x

#15 Post by **rektik** » Fri Apr 23, 2010 10:03 am

Cool, did you have to pay privately for these ceramic braces? Because you wanted ceramic braces on the front top, did the NHS do all braces except the ceramic? Or you just had to go and do the whole thing privately?

I've decided that I'm just going to go ahead and get the full metal ones and live it out for 2 to 2 and half years. This way I will save a mini fortune, and know that I have a clear and instructed process in place (with everything being done in one location).

It's weird because I've seen two different consultants, and 1 said I would need to have my top jaw widened (which I really am worried about) and then the lower jaw moved back... and the other said I would simply just need my lower jaw back. i am seeing a 3rd consultant in a months time and am praying they say the SARPE op is unnecessary!!