Granola's braces journey-- retainer check 2/13/08

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#1 Post by **Granola** » Sun Nov 20, 2005 4:14 pm

I am 40 years old, and getting ready to begin yet another foray into the world of braces. I last wore braces as a kid, from about the age of 12 to age 16--four long years of full metal bands. Fortunately, braces and treatment have come a long way since then. My dentists have been telling me, over many years, that I could benefit a lot of wearing braces again.

Immediately prior to getting braces back then, I had to have eight teeth pulled (four permanent and four baby teeth). Around the age of 21, I also had my four impacted wisdom teeth pulled. Both experiences were kind of horrific, and I ended up with dry socket as a result of the wisdom teeth extractions (I remember it all too well).

Stupidly, and regretably, I was not compliant with my retainer way back then, and have a lot of crowding, especially of my lower teeth. I've been told the crowding will just continue to worsen with age (I can see it happening!) and make cleaning more and more difficult (it certainly has been, though I do take very good care of my teeth). I certainly don't like how they look. At the very least, the ortho I met with said I would have to wear a retainer indefinitely if I chose not to get braces just to keep things from worsening. That is, of course, not an acceptable option because it doesn't address the problem!

The crowding on the bottom has caused one tooth to get pushed very out of line, which is not only noticeable, but occasionally my tongue hits it and effects my speech momentarily. The crowding on the lowers has also caused my upper two front teeth to flare out (to me it seems I have buck teeth again) and look uneven, even though they are the same length. When I look at photos of just my teeth (as opposed to looking in the mirror) I can really see objectively just how uneven they are. I am really hoping having braces again can fix this. It will really help me keep things cleaner.

My teeth are generally healthy now, but I've endured two root canals in the past and have two crowns (by two different dentists). One is really ugly (half metal, half porcelain, you can see it in my pics, but it's never given me any problem) and one has come off repeatedly and I've lost count of how many times the same office has replaced it.

I'm worried it is going to get pulled off during my treatment (and will cost me $1,000 to replace).

Next week I am having some dental work done. I have an old amalgam filling that is cracked, and another amalgam one that is worn--both will be removed and replaced with composite. I will be very happy to have the last of the mercury fillings gone from my mouth!

The ortho I have consulted with in October 2005 recommended Invisalign for me, but given everything I have read here (and on another message board), I will probably not go that route. I have moderate crowding, and I thought Invisalign is best used with only mild crowding. I am leaning towards ceramics or metal brackets. I like the idea of ceramics (but the office I went to said they make your teeth look yellow, and told me they didn't recommend them--I found that odd since ceramics are often recommended for adults) but worry about the risks when de-bonding. My head is swimming with ceramics vs. metal, self-ligation vs. not--I don't know which is better.

I have only had a consultation with one orthodontist so far, and have scheduled the study models and x-rays as well as the formal consultation for January 2, 2006, mostly because my flex spending account doesn't kick in until 2006. This last week, I received pre-authorization from my insurance company (they cover just $750 of treatment).

However, today (11/20/05) I am having doubts about this ortho, and am going to call tomorrow and schedule consultations with several other orthos. I don't know why I was in such a hurry and didn't do this already. I should know better than to just have consulted with one (that is not like me).

One doubt I have is that, even though his office tells me he is board certified, I cannot find that he listed with the two organizations I searched.

Another thing that I don't feel comfortable with is that I have already asked quite a few questions of the office staff, and they seem slightly put out by it. That bugs me for obvious reasons. I like to be informed, especially with something like this involving my teeth, the only ones I'll ever have!

Lastly, I am curious to know if the cost of treatment that I was quoted is typical for this area ($5,700-$6,200). I live in a large city so the range being at the upper end doesn't surprise me, but since I don't believe I have a complicated case, it seems high.

I did like the ortho in general, thought he was down to earth and did not feel rushed out the door by him. I was asking him about what kind of plastic Invisalign trays are made with (because of my concern about plastics leaching chemicals into the body) and he was very responsive--he got in touch with the company, found out the info, and called me personally and spoke with me for about half an hour about what he found out. I'm bugged about his staff though, and can't imagine why he is not coming up as board certified.

Reading the forums here have reminded me how important it is to get several opinions (thank you to everyone here for that!) so now I will do that. Fortunately, I haven't committed to anything with the ortho's whose report is below.

I still have so many questions! I know these need to wait until the formal consultation once the ortho has my study models and x-rays to review.

Here is an excerpt from the the letter I received from the ortho:

CHIEF CONCERNS: Crowding
DENTAL AND SKELETAL FINDINGS:
Class I
Moderate upper and lower crowding
4 bicuspids & wisdom teeth extracted
Normal overbite and overjet (this is one thing I don't understand--does it need treatment? I do feel I have an overbite and an undesirable overjet, but he doesn't give a measurement)

I also am not clear at this point how to check whether or not any ortho I go to has any complaints pending against them. I had a bad experience with a dentist once and just want to make sure that whoever I end up with, it is not someone who has had repeated complaints.

I will be calling three board certified orthos downtown tomorrow to make consultation appointments.

Here are some photos of where I am beginning (again!).

#2 Post by **hannah164** » Mon Nov 21, 2005 12:55 pm

Welcome to the board Granola!

Congratulations on getting started with your journey again!

If the staff of your orthodontist isn't very friendly you might want to rethink your plans and meet with a few others. I go to an orthodontist who is not incredibly friendly and neither is his staff! They're very inflexible especially if your late and they are very unwilling to work around your schedule! They're also very rude!

One time they scheduled my appt. at the wrong time and wouldn't admit it was their mistake at all which it was and then they wouldn't reschedule me until the next day!

Its always good to have several opinions with different orthos! I wish I had done that!

Good luck and let us know how it goes!

-Hannah

Top braces: 4/28/04
Bottom braces: 11/16/05

#3 Post by **Granola** » Mon Nov 21, 2005 2:59 pm

Thank you so much for your welcome, Hannah!

I go to an orthodontist who is not incredibly friendly and neither is his staff!

I can completely understand why you are not so happy with this, and am sorry to hear it. I really hate when people treat one another like this, especially since without patients like you, none of them would have jobs.

So I did a bunch of research on the 'net yesterday, and made some appointments to meet three more orthos in the next couple of weeks (one tomorrow!). It is going to cost me some money (one charges $56 to meet with you, the other $40) just to meet them, which is hard to swallow as it takes a little bite out of my braces budget, but on the other hand I can completely understand them needing compensation for their time--who wants to work for free, after all? The one who charges $56 will waive the fee if I go ahead and get study models that day, which is a hard choice because I'll only have just met her. I may reschedule my meeting with her so she is the last ortho I meet in the next several weeks, that way if I think I like her best, I can perhaps get the study models done right then and save her consult fee.

One of the orthos I am going to consult with seems to offer more choices than the original ortho I met with--from her website, she has a link to the ormco site. I am hoping (and assuming) that means that she is trained to use Damon 3s, and/or the ICE ceramics. I just want to have as many choices as possible. I know the original ortho I met with does not offer any of those choices and it doesn't necessarily mean he is not as good of an ortho. I just suspect that he is not the best. Of course, determining who is the best is the tricky part.

I am so nervous about this entire process. It is funny because when I had braces earlier in life, I certainly didn't think about it! I went looking in an old photo album today for pictures of myself as a teen wearing braces, and found some, which was kind of fun to see.

#4 Post by **Granola** » Tue Nov 22, 2005 4:12 pm

Thank you Karen. As always, I really appreciate your input and advice!

I am more excited than nervous and doubting today. I met with an orthodontist today who I really liked. She spent a good amount of time talking with me, and said I am the only patient who has ever come in to meet her like that. I will go back on Monday for a formal consultation and one thing I really liked is they do digital x-rays right in their office. The office was extremely nice, the staff I talked with were warm, professional, but relaxed, and I had a great conversation with another patient in the waiting room who also had started with one ortho and ending up switching to this ortho, and is now very happy with how her treatment is progressing.

I also liked the choices that they had there. ICE ceramics with white teflon wire ties, or linguals, or metal, or Invisalign. The office was paperless and the ortho was showing me different treatment options (pictures of appliances on actual teeth) for crowding on the computer--it was nice to have the visuals instead of just hearing about it, which is how I process information better anyway. I also really like that they are open five days a week (and one Saturday per month), which means if I had something come up, like a wire needing to be clipped or a bracket that comes off, I'm not limited to just a few days a week to get that done.

What was a little funny is that she was surprised at how knowledgable I was with the various appliances, and technical terms. She kiddingly said "are you looking for work?"

#5 Post by **hannah164** » Tue Nov 22, 2005 9:43 pm

Wow Granola it sounds like you met with a very nice ortho today!

She and her staff, office, and choices sound absoluely terrific! If I had an ortho around here like that I would definitely be one of her patients!

Good luck with your decision!

-Hannah

Top braces: 4/28/04
Bottom braces: 11/16/05

#6 Post by **Granola** » Mon Nov 28, 2005 8:38 pm

Hannah--it really helps to hear your impression (ha ha) that the office I went to sounds good. I am supposed to go have a consult with two more orthos (which will cost me) and I have to say that I feel very good about this particular office, even if it is just my gut feeling.

Karen: It was a great appointment!

It is so hard to be in the "choosing an ortho" stage because it feels like such a major decision.

Today was my formal consultation with the same ortho I discussed above. I think I was there for two hours (and did not have to pay for this consultation)! They did digital panoramic x-rays and took digital photos (a copy of the photos was given to me, which was very nice). The treatment coordinator and the ortho both spent a lot of time talking to me about what my options were, what the plan would be, and the choice of materials.

The other ortho I had seen said I had a Class I malocclusion, but this ortho said it is Class II. She said my overjet is 3mm and my overbite 10%. She offered me Invisalign, ceramics or metals (or a combination of ceramic/metal). Treatment time was estimated at 12-18 months.

I will definitely not do Invisalign as I don't feel completely confident in utilizing a technique that has been around for less than 10 years (though I'm sure it works great for many people!)--that is outside of my comfort range.

My dilemma is ceramics vs. metal. I sure like the look of ceramics! I wish there wasn't so much conflicting info as to whether or not they would be ideal for me, in my case. The ortho definitely did not feel that having them on my uppers would be any different than metal, though she did recommend stainless steel on my lowers given the degree of crowding. The cost is the same for ceramic vs. metal.

The quote was about $300 higher than the range quoted by the last ortho, but given that I don't have to pay for x-rays, that almost offsets the cost difference. The ortho I saw today seems to have much better credentials than the first ortho.

Interesting, they are one of the few offices in my city that does linguals--it was very interesting to see how those work (on the model). But they cost twice as much as conventional braces ($12,000 was what I was quoted) but I'm not interested (nor can I afford it!).

They also offer suresmile but it adds $850 to the cost of the treatment. It was interesting to hear about how it works. I don't think I'll go that route though.

I asked if I had to have molar bands on, and she said she would feel fine using brackets on my molars. I will be really happy to skip the spacer step both in terms of treatment time and discomfort (so I'll be hoping I can keep those brackets on).

The only "bad" news is that I will have to have my lower teeth slenderized--I was hoping this ortho might not see the need for it but she thought it will be necessary given my crowding.

I really liked the environment of the office--it was immaculate and it was clear a lot of attention was paid to the ambience. I liked the fact that the bays were clearly separated and there was a lot of space between the chairs, unlike the other office I visited where people in the waiting room could see right into the treatment room and hear everything as well. People walking by cannot see anything going on in the bays. They treat a lot of adults so I'm sure that factored into it their design.

I am supposed to consult with the next ortho on Thursday. Hmm.

#7 Post by **OBG** » Tue Nov 29, 2005 9:54 am

Congrats on your decision. You are to be complimented on your analytical approach toward choosing an ortho. I think many of us have decided on braces and rush into the process. Have you ever thought of running for public office, we could use some politicians with your foresight. Please keep us posted as it would be interesting to hear your thoughts about braces THEN and NOW and how the process changed from when you first wore them.

#8 Post by **Granola** » Thu Dec 01, 2005 4:20 pm

Granola 'the choosing an ortho stage' is a huge one, and don't try and rush it, as you're going to be investing time and money over the next couple of years with this person, their assistants and office, so make sure you are well informed and choose carefully!

Good luck with your appointment on Thursday

Karen, thank you so much. It is good for me to remember not to rush it and take advantage of having the choices that I do. It is hard to feel one is making the right choice, even when trying to be well informed. Are there any thoughts you have about selecting the best orthodontist, from your experience?

Congrats on your decision. You are to be complimented on your analytical approach toward choosing an ortho. I think many of us have decided on braces and rush into the process. Have you ever thought of running for public office, we could use some politicians with your foresight.

Thanks for the compliment. Hmm, running for public office--I've always had an interest in politics, but certainly never thought of running for office. What made you think of that? Hmm--most people hate politicians, not sure if I could handle that!

__________________________________________________________

So I had both a dentist appointment this morning (with a new dentist) and my third consult with another ortho.

The dentist was great. I think I'll be really happy there (the second ortho recommended him). One of my teeth has a big problem and I need a crown. I am hoping to get in by some miracle before the end of the year, but it doesn't look likely. That will push back braces a few weeks more.

The ortho--that was interesting. Ask three different orthos, and you'll get three different answers! He recommended SARPE

and then braces. I really don't understand why the first two didn't see any need for surgery, and then the third would recommend what I see as a very drastic measure (and he didn't even think to discuss the risks with me).

The consultation went like this: I was able to bring the pano x-ray with me because the 2nd ortho had taken it to the dentist I saw this morning, and they gave it to me. He looked at my teeth and took measurements, checked my bite, and did his exam. I did notice that he was very gentle and that was a nice experience. We then walked to the consultation room and talked for a bit. I didn't have the sense that he was very organized in this meeting, especially for someone who has been practicing for 25 years. He explained that he could get my teeth straight, but would recommend SARPE to really widen the upper arch (but my lowers seem way more crowded than the uppers, to me). He felt that I could proceed with braces with or without the surgery, but the chances of relapse were greater without the surgery. I wish I had thought to ask if permanent upper and lower retainers might help to offset relapse. I suppose I can call the office with that question. He also mentioned that he would use an expander (the type turned every day with a key). Those scare me also!

He discussed the braces that were an option. I saved some time by explaining I had no interest in Invisalign as he started into that, and he said that he was relieved, because many people want it, but he has been overall disappointed with the results he gets using it.

Ceramics: He offers Clarity for the uppers, and plastics on the lowers. He only offers ligs, no wire tires (the 2nd ortho offers white teflon coated wire ties so staining isn't an issue).

SS (stainless steel) He uses either Smartclips (self-ligating) or regular stainless brackets. I was interested to feel all three to see if I can determine which feel smoother. The Smartclips seem to have a higher profile than the stainless, as do the Clarity brackets (which makes sense since they are larger than regular stainless brackets). The stainless did feel the smoothest to me, but I am guessing that no matter which one chooses, they all take some getting used to. Regarding treatment time, he estimated 12-18 months, and said in his opinion the self-ligating brackets would only lessen treatment time by four weeks.

He also talked a lot to me about grinding/tooth wear (which I have) and retainers vs. night guard vs positions. I remembered that, as a teen, post-braces I was given a positioner for retention to wear at night only, and I could not wear it because it required one biting into it all night long, and I couldn't do it (it felt excruciating). How I wish I had been given a normal retainer back then!

The office was old, and obviously hasn't been updated in many years. The price he quoted me was about $1,000 less than the other two orthos (so I think when an ortho has a recently renovated office, it is really reflected in the price!

Kidding). It begs the other question--in orthodontics, does one get what one pays for? The second ortho, who I like so much, says she is a little more expensive than other orthos in the area, but she limits the number of patients she sees in a day so charges a little more to make up for it.

Another thing was the x-rays and study models cost extra, including x-rays taken to document progress during treatment, whereas at the 2nd ortho (the one I liked) they do x-rays in house, and don't charge extra for the study models, so it kind of balances out overall.

Interestingly, when we walked into the consultation room, he asked me if I worked in the dental profession. I think I may have found my true calling.

That's two orthos in a row that have asked me that now. What's funny is that I don't think I know any more than anyone else who frequents this website (but obviously more than most of the patients that see these orthos)--actually I think I know a lot LESS than people who post here (but I'm learning fast). I am really grateful for all that I am learning from everyone who posts here (and for the research I've been able to do online).

So there goes another $40 (for the consult) out of my braces budget (but I know it is an important step in the process).

I have an appointment on Monday with the last (4th) ortho. I really liked the 2nd ortho so much that it is hard to imagine finding another person that I would like as much as her (and I liked the office so much also). Now that the specter of surgery has been raised, though, I'm curious to get another person's opinion. On the other hand, I'm not willing to go that route, so even if she offered it as an option, I'm not interested (and don't think the risk/benefit ratio is worth it.

If you made it all the way through this, congratulations!

You may now pick your head up off of the keyboard.

#9 Post by **OBG** » Sun Dec 04, 2005 1:41 pm

You really are doing a thorough job, that's why I mentioned the politician thing. Wouldn't it be nice if they were as thorough when spending our money as you are with yours? Campaign slogan- You are going to "straighten" things out!
I couldn't help notice your location was earth, at least you have a bunch of orthos to choose from. (Visited there once, bit crowded for me, must've been tourist season.)

Enjoying reading your posts - keep us informed.

P.S. - Surgery sounds a bit extreme. I was given the same option and chose just the braces and have never regreted that decision but that is obviously a personal choice. I would bet some of the people posting on this site would disagree with me.

#10 Post by **Granola** » Tue Dec 06, 2005 12:27 am

My 4th consultation was this morning (and then another doctor's appointment, then a trip to the dentist this afternoon to go "under the drill." Ugh, so glad this day is almost over.

I really liked the ortho I met with today. She seemed to really know her stuff, and was very down to earth. KK, you will love this--everything in her office was purple...the pens...the chairs...the waiting room leather seats and carpet...you name it!

I thought of you. I wasn't as impressed with her staff though. It became clear very quickly that the treatment coordinator was new at her job, and she couldn't answer some of my questions. Neither of the front desk staff (who were doubling as the coordinators) even knew what brand brackets they used, and one of them said she's been working in the field for 12 years. She didn't seem to be a people person.

The ortho will send me her report in a few days. She felt I could have a really good result with braces. She uses only self ligating (In-Ovations) metals and ICE ceramics. We discussed retainers also and I asked for about having SARPE recommended to me. She thought that was very aggressive and not necessary). I really like the idea of self ligating brackets (which apparently =less friction, so say the marketing materials) but I don't think that alone is reason to choose an orthodontist (the ortho I really like doesn't use them). As a side note, apparently the ICE ceramics don't have a metal center and are supposed to exert less friction on the archwire.

Apparently she sees 40-45 patients per day, compared to the 30 or so patients the ortho I really liked sees. As far as fees go, she is a few hundred dollars less than the ortho I really liked, but charges for study models and x-rays and repeat x-rays, and a final consult, whereas the ortho I liked includes study models and x-rays in their fees, and does them in house. I really did like this ortho, but in thinking about it today, I have a much better fit with the 2nd ortho. I'm not sorry I went to the 4th consult as now I will feel confident in my decision to go with the 2nd ortho. The 2nd ortho is closer to my home and just down the street from my dentist's office, so I can get the archwire taken off easily for cleanings.

Two of the staff at my new dentists office are patients at the ortho's office I will go to, and I was able to talk to them for a while today and they both seem really happy with their treatment. They both had/have ceramics and highly recommended them. Every time I decide to go with stainless, I end up hearing something like this, and wanting ceramics again! What to do, what to do. I guess I have a month or so to decide that since I have to wait until January for my flex spending account to kick in.

So I have made a decision! The second ortho it is.

I think I won't escape the spacers though--I will have to have at least three on the lowers because of my crowns (unless there is such a thing as a bracket that will stick to a crown! Don't I wish). That was the only thing that the second ortho said that didn't make sense--at the time of my consult, she said I could have all brackets, but I think she must have forgotten about my crowns.

I think I'm experiencing a preview of the kind of irritation I will be feeling once I get my braces because during the procedure today, the side of my tongue was irritated by all of the instruments in my mouth, and I had to do warm salt rinses tonight. Ouch!

#11 Post by **Granola** » Tue Dec 06, 2005 4:43 pm

I think you've been very thorough and maybe could write a piece about the questions you asked, things you compared between different offices etc, for people who are new to this!

Thanks so much! It would be fun to put something together.

I did bring a list of questions with me to each appointment. It isn't well organized or pretty since it was just for me, but I should post it here sometime.

My tongue is still really sore today, making it hard to eat. I keep thinking that this is the easy part, because I know in a few days that it will be better, whereas once I get the braces on, with the accompanying soreness, they are not coming off for a while! I am also having trouble opening my mouth wide from all of the injections I had to have to get me numb.

I did call and schedule today with the ortho I liked.

I still have a question about whether or not they will band or bracket my crowns on the lowers, because everything I've read says brackets won't stick, but of course I would love to avoid spacers.

#12 Post by **latichas** » Tue Dec 06, 2005 7:45 pm

hey granola
good job with all your research. I went to 2 orthos and now I feeling a little bad about not going to more because they told me 2 different things. My second orhto who I picked was more through, right down the street from my house, more expensive, suggested surgery, but came highly highly recommende. You have me thinking if I need to get bands because I will have 6 crowns on the right side of my mouth when I get braces. But only at 4 during my consultation. I am going to call tomorrow and ask because they only told me to come in on Jan, 16 for expanders and then on the 23rd for my braces. I will call and check on this tomorrow. Thanks for sharing you may have saved me some time. I appauled your questions and research.

#13 Post by **Granola** » Wed Dec 07, 2005 12:15 am

Hi Latichas,

I went to 2 orthos and now I feeling a little bad about not going to more because they told me 2 different things. My second orhto who I picked was more through, right down the street from my house, more expensive, suggested surgery, but came highly highly recommende.

I think it is a good that you saw the two people you did. I'm guessing you feel pretty good about the one you chose or you would've felt the need to keep looking. It is not an easy thing to sort through all of the information and aspects of treatment that one has to think about, and make a decision (especially if doing it in a relatively short period of time like I did). So I understand. I think choosing someone that comes highly recommended is really important.

About the banding--it's funny, I had two crowns at the time of consultation, and will have three by the time I am braced. Regarding expanders, do you know what kind you are getting? It seems like the pictures of the ones I had seen are attached to the molars by bands.

#14 Post by **latichas** » Wed Dec 07, 2005 8:22 am

Granola wrote:
About the banding--it's funny, I had two crowns at the time of consultation, and will have three by the time I am braced. Regarding expanders, do you know what kind you are getting? It seems like the pictures of the ones I had seen are attached to the molars by bands.
No Granola I do not know what kind of spacers I will be getting. I called my ortho's office today to ask them if I needed another appointment to get bands on my crowns and they said "no". That everything will be fine as long as I have my crowns done by the time I get my spacers. I noticed you have an extra appointment to get your bands on. They told me that they would do the bands when I got the braces. They also told me that some brackets can go on crowns. But she could not tell me if I would be getting brackets or bands.

#15 Post by **Granola** » Wed Dec 07, 2005 9:27 am

I see now--when you mentioned expanders (the kind that widen the jaw) in your first post, I thought you would have to have bands, but it sounds like you were referring to spacers.

The reason I am scheduled to have the bands on one day & the brackets another was they said if I did it all on one day, it would be a really long appointment, so they like to break it up. I'm thinking I might call back and just do it in one day, to save myself the hassle of running back and forth.

I will know for sure, once I go in for my study models, whether or not I'll need bands, and may reschedule things then.