really struggling, need honest feedback (pics included)

[purplepetunia]

I'm really struggling and would like your honest feedback. To recap: I'm 50 years old. Got my braces on almost two years ago, January 27, 2010. Had three teeth pulled (two upper first premolars, one on each side; one lateral incisor on lower front). Ceramic uppers, metal lowers. Have had Trans-Palatal Arch (TPA) since almost the beginning. Have worn elastics since March of this year (night only). Original treatment time was 24 months; orthodontist now says it will be a few months longer.

I was delighted with my progress my first year of treatment (2010, see pic below). However things seemed to have completely stalled/regressed since the beginning of 2011. I have been very concerned about the large gaps & triangles between my upper front teeth which developed in Feb-March 2011. I have spoken to my orthodontist about my concerns several times now, and he is unresponsive both in his actions and words. The last time he changed up my treatment was 10/6/2011 when he placed a stronger powerchain on my uppers. Prior to that, the last time he did something different (elastics notwithstanding) was over a year previously, in mid-2010, when he installed a stronger archwire on my uppers.

Additionally, since the beginning of 2010 my orthodontist has seen me only every OTHER visit. My appointments are usually every 5 weeks, so this means he only looks inside my mouth every 10 weeks. On the other visits, the tech simply changes out my power chain (same-strength) and sends me on my merry way. This concerns me especially because I'm getting so close to the two-year mark when I was originally supposed to get my braces off. I wouldn't mind going past the two year mark, but what's really causing me a lot of anxiety is the seeming lack of action on my orthodontist's part to try anything new to close the gaps. I also wouldn't mind a greater level of discomfort if it meant progress, but for the past year my teeth are rarely sore after appointments, which to me means nothing is happening (they were sore the first year).

I have other concerns as well (receding gum line on upper right front tooth as well as the bottom edge of that same tooth being lower than surrounding teeth) but I would be happy to just get my major concerns addressed at this point. As I said I have spoken to my ortho a few times now about my concerns. I am always very polite but the most I get in response is a talk about how teeth move more slowly when you're older (I get that) but he still refuses to try something new or to see me every 5 weeks instead of every 10 weeks.

Is this normal? If not, what can I do about it? Are there additional things he can/should be doing to close those gaps?

I have an appointment next week. At this point I am so frustrated and fed up that if my ortho doesn't try something new to close the gaps and says he doesn't want to see me for another 10 weeks (which would put me past the original treatment time), I'm prepared to ask for a copy of my records so I can get a second opinion.

Please give me your honest feedback, even if it means having to say something not particularly positive about what's happening with my teeth. I'm open to suggestions on approaching this differently with my ortho too. At this point I'm regretting getting my teeth pulled in the first place due to the gaps, but I realize there's nothing to be done about that now. I want to take positive action and need specific advice on how to go about doing that.

Thank you.

[CoryDaniels]

[quote="purplepetunia"]I'm really struggling and would like your honest feedback. To recap: I'm 50 years old. Got my braces on almost two years ago, January 27, 2010. Had three teeth pulled (two upper first premolars, one on each side; one lateral incisor on lower front). Ceramic uppers, metal lowers. Have had Trans-Palatal Arch (TPA) since almost the beginning. Have worn elastics since March of this year (night only). Original treatment time was 24 months; orthodontist now says it will be a few months longer.

I was delighted with my progress my first year of treatment (2010, see pic below). However things seemed to have completely stalled/regressed since the beginning of 2011. I have been very concerned about the large gaps & triangles between my upper front teeth which developed in Feb-March 2011. I have spoken to my orthodontist about my concerns several times now, and he is unresponsive both in his actions and words. The last time he changed up my treatment was 10/6/2011 when he placed a stronger powerchain on my uppers. Prior to that, the last time he did something different (elastics notwithstanding) was over a year previously, in mid-2010, when he installed a stronger archwire on my uppers.

Additionally, since the beginning of 2010 my orthodontist has seen me only every OTHER visit. My appointments are usually every 5 weeks, so this means he only looks inside my mouth every 10 weeks. On the other visits, the tech simply changes out my power chain (same-strength) and sends me on my merry way. This concerns me especially because I'm getting so close to the two-year mark when I was originally supposed to get my braces off. I wouldn't mind going past the two year mark, but what's really causing me a lot of anxiety is the seeming lack of action on my orthodontist's part to try anything new to close the gaps. I also wouldn't mind a greater level of discomfort if it meant progress, but for the past year my teeth are rarely sore after appointments, which to me means nothing is happening (they were sore the first year).

I have other concerns as well (receding gum line on upper right front tooth as well as the bottom edge of that same tooth being lower than surrounding teeth) but I would be happy to just get my major concerns addressed at this point. As I said I have spoken to my ortho a few times now about my concerns. I am always very polite but the most I get in response is a talk about how teeth move more slowly when you're older (I get that) but he still refuses to try something new or to see me every 5 weeks instead of every 10 weeks.

Is this normal? If not, what can I do about it? Are there additional things he can/should be doing to close those gaps?

I have an appointment next week. At this point I am so frustrated and fed up that if my ortho doesn't try something new to close the gaps and says he doesn't want to see me for another 10 weeks (which would put me past the original treatment time), I'm prepared to ask for a copy of my records so I can get a second opinion.

Please give me your honest feedback, even if it means having to say something not particularly positive about what's happening with my teeth. I'm open to suggestions on approaching this differently with my ortho too. At this point I'm regretting getting my teeth pulled in the first place due to the gaps, but I realize there's nothing to be done about that now. I want to take positive action and need specific advice on how to go about doing that.

Thank you.[/quote]

Honestly, I would just go get a consultation at another ortho...find one that is very respectable and tell them whats going on and maybe what they can offer you....Believe me, I went to one ortho and he told me that i had to get regular braces for 2 years and might have to get an extraction...went to a more respected ortho...damon braces (clear) for a little over a year with the option to go with invisalign after my crossbite is corrected.

[ArchWired28]

Very honestly, in my opinion, the gaps as shown on the last pic are not acceptable. I would have been very upset if it were my teeth. On the other hand, moving teeth takes time and seeing you every 5 weeks without changing anything in the treatment itself may not make a difference. If i were you, I would have asked if the ortho is sure that the gaps will be fully closed and how much time it will take to fully close them. If I get a satisfiable answer (i.e. not simply a "you are older" blow off but anything substantial), I would wait for as long as he says (I am assuming it won't be anything over 6 months). However, if I once again get a blow off, I would have gone for a 2nd opinion right away. You don't have to ask for the records straight away, I think, you can just let them look at you. An ortho will know what's going on just seeing your mouth. And based on what you hear, you can make decisions and if needed, request a copy of your records. Good luck!

[Snowglobe32]

I would go see another ortho as soon as possible. I actually thought your "now" pictures were the "first day of braces" photos.

You also stated that he is unresponsive when you voice your concerns. And you only see him every 10 weeks, with the assistant changing things in between... I would find that unacceptable.

In the first picture, I can't tell since you head is tilted, but were your arches off and uneven at that time? I am trying to figure out where your midline was and it seems off to me.

On the positive side, your teeth seem to be pretty much in line in the current photos. From what I can guess in the pictures, you bite looks okay. Is it okay? And with the gaps closed and some reshaping, I think they will look great.

Get another consultation and show them the 3 pictures. If you want to approach this with your ortho again, I would call and schedule an appointment time so you can go in to talk and he isn't distracted with other patients.

Have you done any background work on your ortho? Does he have or had any complaints against him? Usually your state dental board can tell you.

My original estimate was 22 -24 months. I think I am at 26 months now and I am questioning what the deal is. I have an appointment scheduled in over a week to discuss my recent scans, xrays and photos so hopefully we can figure out what is going on.

I think my bite is okay but because I will need bonding and reshaping, my teeth don't look perfect to me. So, when I look at my teeth, they aren't perfect but when the ortho/assistants look at my teeth, they see straight teeth with great arches. In their head, they can see the final result but in my head, I see that I need bonding and reshaping. So, who knows, maybe your case is the same, just do a few more tweaks and things will be fine.

Good luck!

[klobird]

I think I would make an appointment with the office manager. Take your pictures. Explain your expectations (extremely reasonable expections--to have the teeth come together without gaps and triangles) Then ask her/him to spell out the plan for your teeth, and how it works, and what they use, and how long it will take to accomplish what you expect. Tell her/him that you are not satisfied at this point. (However, being rude or mean will hurt your cause). And if the manager goes off on a tangent, or is dodging your questions, keep pulling him/her back to your questions. Don't back down--you deserve answers!!

You paid a whole lot of money to get an acceptable result...they owe you a full explanation....

Well, that's what your fellow senior would do....

[kreyFL]

If you were my Mama...I would be so upset for you. The pictures were kinda shocking. I can see how beautiful your smile is going to be...once the gaps close and it gets straightened out but it does seem drastic right now.

I think as a patient with orthos we have a tendency to be understanding of their vagueness...atleast I am. I almost expect to get the 'no answer answer' from my ortho with every question I ask. However, I know that if I got frustrated or upset at any time, he would be very understanding of that and do what was necessary to make me feel at ease. I think a second opinion is a good idea...however, I do see the light at the end of the tunnel here and want you to just keep your head up and stay positive. I would ask - on your next visit - to speak in private before you go to sit in the chair. Maybe bring a little list of your concerns or a print out of your post. Asking for a de-brace date is one thing - asking for a clear understanding of what is going on and what the progress plan is from here on out is another and perfectly acceptable. As a consumer, you have that right. The receding gum does concern me...and if that was happening to me, I would probably get in with my dentist BEFORE my next ortho appointment - just to have a clear idea of what he thinks is going on from a hygiene, gum loss, bone loss stand point. I dont think there is any knee jerk reaction needed...but I do think you're gonna have to speak up loud and clear about your fear and -to be blunt- anger at this point. I would also not accept anyone, from this point forward, other than your ortho. Good luck hun - keep us posted!

[BracedSurgeryStudent]

WOW! That is shocking. No offense but might I ask "What is WRONG with your orthodontist?" At my place, no matter how busy the ortho is, the assistant wont touch me aside from taking the wires off to change my colours Even if it means we have to wait an hour, then we wait, no biggy. AND Kathy wont schedule me for an appointment on a date she knows the orthodontist isnt in or is on vacation.

I honestly think you need to go to the Office Manager about that, bring in the pictures as well and present your story. Or, you can also get a second opinion if you life. But that looks unacceptable. I mean you didn't even have gaps at ALL in that first picture.

Also i wanted to ask if you flossed on a regular basis. Because it could also be that you are forming periodontis and that is the reason for the receeding gum line and the triangles and spacing. I know because my family members had it and presented as such and since it seems as though your orthodontist is kind of neglectful it would not hurt to go for a Periodontic exam with a cleaning and see what they say and if I am wrong you can do what I said above.

Best of luck.

[CountessDeSangre]

Second opinion, right away. This is unacceptable to me and I would not sit and wait for that first orthodontist to make some dental magic that may or may not even happen.

[purplepetunia]

Wow. Thank you all for the very honest and helpful feedback. I'm really grateful to everyone who took the time to read my post, look at the photos, and provide thoughtful replies. Although my suspicions have been confirmed that the situation is unacceptable, I actually feel better knowing that my concerns and anxiety are legitimate and reality-based. It gives me the confidence to take more positive action and be a stronger (yet always polite) advocate for myself.

Since a lot of you had questions, I'm going to respond to each message as an individual post.

With gratitude.

[purplepetunia]

Honestly, I would just go get a consultation at another ortho...find one that is very respectable and tell them whats going on and maybe what they can offer you....Believe me, I went to one ortho and he told me that i had to get regular braces for 2 years and might have to get an extraction...went to a more respected ortho...damon braces (clear) for a little over a year with the option to go with invisalign after my crossbite is corrected.

Thank you for sharing your experience CoryDaniels.

[purplepetunia]

Very honestly, in my opinion, the gaps as shown on the last pic are not acceptable. I would have been very upset if it were my teeth. On the other hand, moving teeth takes time and seeing you every 5 weeks without changing anything in the treatment itself may not make a difference. If i were you, I would have asked if the ortho is sure that the gaps will be fully closed and how much time it will take to fully close them. If I get a satisfiable answer (i.e. not simply a "you are older" blow off but anything substantial), I would wait for as long as he says (I am assuming it won't be anything over 6 months). However, if I once again get a blow off, I would have gone for a 2nd opinion right away. You don't have to ask for the records straight away, I think, you can just let them look at you. An ortho will know what's going on just seeing your mouth. And based on what you hear, you can make decisions and if needed, request a copy of your records. Good luck!

ArchWired 28, thank you—this is very helpful. My scheduled appointment is this Thursday 12/15. Based on the replies I've rec'd so far, I think I will go ahead and schedule appointments with two other orthodontists in the area (recommended by friends) to get 2nd & 3rd opinions regardless of what my current ortho says/does on Thurs. That way, even if he provides what seems to be a satisfactory response, I can confirm the treatment plan with two other respected orthos. And if he blows me off again, I'll have laid the groundwork to move on to a better situation.

Doesn't it seem weird to you though that my ortho has only changed up my treatment (stronger power chain on 10/6/11) once in the last year, even though I've had the gaps for at least 8 months (and have been voicing my concerns about them for the last 6 months)? Wouldn't it be normal to keep trying something new (more than once) if the gaps aren't closing over an 8-month time span? (I've never made complaints about pain or overall discomfort which I could see might make an ortho hesitant to increase the force being applied to a patient's teeth, so what other reason could there be? ...just thinking aloud here)

Thank you!

[ArchWired28]

purplepetunia

it does seem strange to me, especially knowing that your ortho will not get any additional money if your treatment takes longer. I would imagine he would want you to be done ASAP (as well as any other ortho for that matter I know there are a lot of aggressive tricks to close the gaps, maybe he's a bit hesitant to pursue them due to possible issues of bone loss or root resorption. In any case, these issues must be discussed the sooner the better. Because, I am assuming, the last thing you want to hear is that your gaps are not going to completely close and that you need veneers on the top front teeth, or be debraced with gaps.
Good luck, and keep us updated!

[klobird]

Purple--You sound very intelligent and you have a really good plan in place...you deserve satisfaction, and nothing less.
Best wishes to you!

[purplepetunia]

I would go see another ortho as soon as possible. I actually thought your "now" pictures were the "first day of braces" photos.

You also stated that he is unresponsive when you voice your concerns. And you only see him every 10 weeks, with the assistant changing things in between... I would find that unacceptable.

In the first picture, I can't tell since you head is tilted, but were your arches off and uneven at that time? I am trying to figure out where your midline was and it seems off to me.

On the positive side, your teeth seem to be pretty much in line in the current photos. From what I can guess in the pictures, you bite looks okay. Is it okay? And with the gaps closed and some reshaping, I think they will look great.

Get another consultation and show them the 3 pictures. If you want to approach this with your ortho again, I would call and schedule an appointment time so you can go in to talk and he isn't distracted with other patients.

Have you done any background work on your ortho? Does he have or had any complaints against him? Usually your state dental board can tell you.

My original estimate was 22 -24 months. I think I am at 26 months now and I am questioning what the deal is. I have an appointment scheduled in over a week to discuss my recent scans, xrays and photos so hopefully we can figure out what is going on.

I think my bite is okay but because I will need bonding and reshaping, my teeth don't look perfect to me. So, when I look at my teeth, they aren't perfect but when the ortho/assistants look at my teeth, they see straight teeth with great arches. In their head, they can see the final result but in my head, I see that I need bonding and reshaping. So, who knows, maybe your case is the same, just do a few more tweaks and things will be fine.

Good luck!

Thank you for your very helpful response, Snoglobe.

Regarding my being looked at only every 10 weeks by my ortho, is it ever acceptable for an orthodontist to skip seeing the patient when the patient comes in for an appointment? Just wondering what others' experiences are—does everyone here see their ortho every appointment? My ortho saw me at every appointment the first year of treatment. Seeing me every-other-appointment began early 2011 and continued throughout this year. The first time it happened, I called the patient coordinator because I thought it had been a mistake. She said it was normal for the ortho to skip seeing a patient ONE time mid-way through treatment. But he has continued seeing me every other time since then. Twice I called ahead and said I wanted to see the ortho anyway even though I wasn't scheduled to, and he seemed perturbed both times I did that.

Regarding my midline, my upper front teeth are left of center and my lower front teeth are right of center. However my current ortho has never mentioned this or addressed this with me. I only know this b/c I recently dug out my first ortho consultation which I had gotten a few years previously when we lived in a different state. (The only reason I didn't go ahead with that ortho at the time was b/c we moved.) My upper midline is still left of center. What should my ortho be doing and telling me about this? It's not mentioned anywhere in his treatment plan. My lower midline is now permanently fubar b/c of having the one front lower tooth pulled as per my ortho. Before I had the one tooth pulled, I questioned my ortho about the asymmetry that would result, and his response was that "no one will ever notice" and I accepted that at the time. However as my treatment has gone on and I have learned more about teeth, midlines, etc. I now regret getting just the one lower tooth in front pulled. (To give him the benefit of the doubt: I do have a small facial structure and I am 50 years old; perhaps my ortho felt that was the only way he could get enough room in the lower jaw to straighten my teeth which were crowded.)

I also had an overbite which has been pretty well corrected via the elastics (I think), pulling my lower arch forward and my upper arch back. I do feel that my bite is comfortable and have no issues with that, except for the upper right tooth protruding a little lower than I would like (which I hope will be fixed by end of treatment).

I did research my ortho before signing on. He had (and still has) no complaints/disciplinary actions filed against him according to the state dental board. He has a huge practice and is very well-known in the area. I know several people who have gone to him and were satisfied. Additionally, my own 18-yr. old son goes to the same ortho as me for Invisalign and we have been satisified with our son's treatment. (In fact, our son has seen the ortho every single appointment these last two years, never once has he been handed off to the technician like I have.)

For a while I was asking myself if it was something about me, but I can honestly say I have been consistently friendly and polite during all my visits. When I ask questions or attempt to advocate for myself, I am always very respectful. I do get the general feeling my ortho doesn't like being questioned AT ALL, and my husband, who has come with me on a couple of recent visits, has the same perception.

Snoglobe, thanks also for sharing your experience. It's very helpful to hear. My ortho (and my dentist) said I will probably need bonding when all is said and done to fix the triangles (which I am being told will remain to some extent even after the teeth are finally touching). I am fine with that as long as my teeth are eventually touching, which at this point they are not.

I would just like to get back to the feeling I had during my first year of treatment, when I felt confident with the direction in which things were moving and confident in my ortho. I can be patient as long as needed, but my patience is running out because I've lost confidence. Something just doesn't seem right.

Thank you all for helping me to figure out how to move forward from here.

p.s. Snolobe good luck to you also; let us know how things go at your next appointment!

[purplepetunia]

I think I would make an appointment with the office manager. Take your pictures. Explain your expectations (extremely reasonable expections--to have the teeth come together without gaps and triangles) Then ask her/him to spell out the plan for your teeth, and how it works, and what they use, and how long it will take to accomplish what you expect. Tell her/him that you are not satisfied at this point. (However, being rude or mean will hurt your cause). And if the manager goes off on a tangent, or is dodging your questions, keep pulling him/her back to your questions. Don't back down--you deserve answers!!

You paid a whole lot of money to get an acceptable result...they owe you a full explanation....

Well, that's what your fellow senior would do....

Thank you klobird for the very specific suggestions. I think my plan is at this point to go to my appointment next Thursday as scheduled and first see what the ortho has to say after evaluating me. If he suggests doing nothing and/or not seeing me for another 10 weeks, I think I will ask to speak to him in private on the spot, moving forward with explaining my expectations/concerns and asking him to spell out a more specific plan based on my concerns. If he is unwilling or unable to meet with me privately at that time, I will do as you suggest and make a subsequent appointment with either him or the patient coordinator (my ortho doesn't have an office manager that I know of, just the patient coordinator).

I also plan to go ahead and set up the two other consults with my friends' orthos as soon as possible. (Tried calling both the other orthos today but they are all closed on Fridays.)

I want to give my ortho one last chance to come through on his own at Thursday's appointment, even though I'm not real confident at this point. What do you think of that approach?

And I agree—it doesn't pay to be rude or mean in these situations.

p.s. Regarding the triangles, I have been told repeatedly by my ortho that even when they get my teeth touching, the triangles will not close up completely and I will probably need bonding. I am not happy about this, especially since I didn't have any triangles before braces, but am willing to accept smallish triangles as long as my teeth are mostly touching.

Thank you!