Oral surgery and braces or wait-and-see?

December 5, 2013 11:09 AM

I need help deciding whether to opt for oral surgery and braces for my child, or to take a wait-and-see approach.

I recently took my son (11 years old) to the orthodontist for an evaluation to see if he would continue to need braces. He had his first set of braces when he was almost 9 years old, from the same orthodontist. Those braces were taken off, and he's been wearing a permanent retainer for maybe a year or so.

At the conclusion of the evaluation, the orthodontist showed me the x-ray, which revealed my son has moderate crowding in the upper and lower arches, teeth #6 and #11 are impacted, and teeth #C and #H are over-retained. The orthodontist says he would require oral surgery and a new set of braces. After their discount, dental insurance, and my FSA, this entire process would cost about $2200 out-of-pocket.

My wife wants to take a wait-and-see approach. Her thoughts are if he's not in pain, then everything is okay until that point. She doesn't want to put him through an unnecessary surgery, and feels like the money is not an insignificant amount. She is not against getting a second opinion, but I have to arrange it.

I feel like we're already invested in his dental care from the first round of braces, so why stop now? I also don't want the money in the FSA to go to waste (It's too much to spend in a month's time, because the amount was budgeted for braces.) We both also wonder if the orthodontist's first round of treatments contributed to the overcrowding, impacting, need for surgery, etc. and if he should be on the hook for more of this.

This decision has to be made rather quickly, as I'll lose the FSA funds if this isn't scheduled by December 31st.

My questions are:
1. Is surgery absolutely necessary in a case like this? Will his health be affected if he doesn't have the oral surgery?

2. Is there any way to determine the orthodontist's role (if any) in my son's current situation?

Any insights would be appreciated. Yes, you are not an/my oral surgeon, dentist, or orthodontist.

posted by Big Chief Little Pants to Health & Fitness (18 answers total)

If there was a situation that called for a second opinion from a different orthodontist, it's this one! Having the money burning a hole in your FSA account is a very bad reason to rush scheduling a very serious surgical procedure for your son. The fact that you've already payed a bunch of money for braces is also immaterial - that's a sunk cost that isn't regained or relost by rushing your next decision.
posted by muddgirl at 11:16 AM on December 5, 2013

I went to two additional orthodontists and oral surgeons respectively before agreeing to have my wisdom teeth removed. It was interesting to see how all four people I spoke with had identical opinions about the surgery, but differed when it came to whether or not I needed braces. It was comforting to see that consensus before I moved forward with surgery. Could you get some referrals from his friends' parents and get some other opinions before moving forward?
posted by These Birds of a Feather at 11:16 AM on December 5, 2013

Yeah but also, if you leave it until he is in pain, he could be 32 and in a lot of pain and trying to figure out how in the hell to get time off and money to pay for what is now really effing expensive and intensive surgery.

Which reminds me, I better get back on that hunt for an oral surgeon. Ow.
posted by like_a_friend at 11:18 AM on December 5, 2013

It's theoretically possible that the first round could have been done better, but the reason a lot of people wait until later than that is that differences in growth make a big difference in teeth. Has he had an expander, ever? Honestly, at those ages I'm pretty sure a lot of it is guesswork as far as how much space there'll be later, and sometimes the guesses don't pan out. But if you can possibly get in to get a second opinion, I'd do that, even if things still need done then there might be alternatives about what you're going to do.
posted by Sequence at 11:19 AM on December 5, 2013

When I was a kid, I had a tooth that grew right on top of another tooth. It looked weird, and I always got a lot of questions about why my parents weren't fixing my teeth.

Basically, it wasn't causing any pain or difficulty eating, and my mouth would continue to shift around until I was older. So it was choosing between 6-8 years of constantly adjusting a growing mouth, or 1 year of fixing an adult mouth.

It was weird having braces in college, but I'd prefer that to dealing with an entire childhood of orthodontia. YMMV.
posted by politikitty at 11:22 AM on December 5, 2013

Yeah, my wife's parents waited on some oral surgery and braces and it still eventually had to get done, but instead of doing it when she was a kid and missing a few days of school, we had to drop several thousand dollars and she had to miss a week of work and we're still paying it off. Definitely get a few opinions first, but if it needs done, much easier to do it now.
posted by Ghostride The Whip at 12:03 PM on December 5, 2013

get a second opinion. 9 seems really early to have braces, and having a retainer to keep your teeth in the same place as you are still growing seems....weird. i had braces as a kid, but i was 12-16 when i had them.

also, where are 6 and 11 impacted (assuming you mean the "fang" teeth on top?). mine were impacted in the roof of my mouth and pointed the wrong way. surgery sucked and the years of braces to get them partially positioned correctly was lame. but with stuff like this it's always easier as a kid.

however, get a second opinion for sure.
posted by misanthropicsarah at 12:08 PM on December 5, 2013

my boyfriend did not get the braces he needed as a kid. he is now staring down an almost $20,000 dental and surgical bill, all told, if he wants to get his issues fixed.

will it be the same for your kid? you can never tell, and neither can we. what i would do is take some of that HSA money and go get a second opinion from another orthodontist. ask the parents of your kid's friends who have braces - they may have a ortho they love. check people out on yelp - that's where i found my current ortho (see next paragraph), and i love him.

as a personal anecdote, i am on my second round of braces because the ortho i had as a kid apparently did a crap job. it was an easy fix, but despite all the work that gets done now, your kid may still need work later. it happens.
posted by koroshiya at 12:18 PM on December 5, 2013

also, you will probably be able to get an answer as to what role the current orthodontist had in this from the second opinion, i would guess.
posted by koroshiya at 12:24 PM on December 5, 2013

I would get a second opinion. Every dentist I've seen as an adult has told me that a significant portion of the orthodontic work I had done as a kid was unnecessary, and some of it did me more harm than good. I'm not saying AT ALL that that's the case with your kid, because I am totally not a dental professional and have never seen your kid's teeth. I'm just saying that too much orthodontia too young is a thing that is not impossible to have happen. Some of my friends who waited until they were teens got better results and have had fewer problems, and I kind of think my parents just pushed me, without any problems that were even affecting me at the time, through the same process as my sister to kill two birds with one stone.
posted by The Underpants Monster at 1:17 PM on December 5, 2013

The guy I worked for was of the "wait and see" variety. He didn't like the whole "catch teeth as they come in and wrangle them" form of orthodontia that some in our area were practicing. He was of the mind to wait till all the adult teeth were in (under 18 no wisdom teeth) before starting treatment, but would however place a palatal expander. (which needs to be done early). He would then would follow up yearly until wisdom teeth were removed. If I were you I would go at least for a second opinion.
posted by PJMoore at 1:17 PM on December 5, 2013

My eldest had her first set of braces at 9 in order to correct a significant under bite. We knew up front that she would be getting two sets. The first only to pull the teeth up and over (she never had any brackets on the bottom teeth), and she wore a removable retainer for about a year afterward. She's had six teeth pulled because there was significant crowding and the baby teeth weren't budging. Four were pulled at the beginning of her treatment and two more were pulled a couple months ago. She will be 11 next week.

She will need another set of braces probably within the 6-8 months as the rest of her teeth come in. I think at last count, we're waiting on a couple of molars to fall out and she's got two more that are dropping in were the canines were pulled.

My younger one (she turned 9 this past Tuesday)... Well, let's just say that when they took a panoramic xray of mouth, it look like somebody took her mouth and just shook it to see where her adult teeth might land. What a disaster. She's had four teeth pulled. One adult tooth immediately dropped into place. She's got a significant over bite, and her center line doesn't match.

I've known my dentist for over 20 years and I discussed at length the pros and cons of doing the two set deal versus waiting it out and then dragging everything into place. He was a huge proponent of guiding things in, and leaving room. Yes, it kind of sucks having teeth pulled. But, honestly, both girls rocked it and after the initial injection of local anesthetic, there wasn't a peep out of either of them.

Go get a second opinion, but don't throw the extraction idea out the window. One other thing - if you do choose to stay with this orthodontist, talk to them about your FSA. The guy that we go to was willing to work around the balance that we had in our account.
posted by dancinglamb at 2:36 PM on December 5, 2013

as someone with a small mouth who grew up having multiple oral surgeries and years of braces only to come out many years later with a bad bite, root resorption (i do not bite into apples or corn in the cob for fear that my teeth will fall out), and a myriad of other dental woes... don't do it. i've even had dentists try to recommend i get braces AGAIN even though that is what caused the root resorption in the first place! so i suggest that you get multiple opinions, ask what alternatives or real consequences there will be if you wait and see. dentists and orthodontists have a brute force technique that i am highly suspect is only 50% effective and often just leads to more work needed down the road. i am someone who has been there and had it happen over and over with years of pain and unsuccessful results - do not put your child through this unless it is absolutely necessary.

feel free to memail me if you want more details about the procedures i went through.
posted by cristinacristinacristina at 3:00 PM on December 5, 2013

I had braces as a teen and still need to wear a retainer in my thirties or my teeth will shift too much. My sister had several adult teeth removed so that the rest of her adult teeth could enter her mouth without as much pushing around and has never needed braces. (Though she did feel self conscious about the gaps between her teeth for a few years.) So I think teeth removal rather than braces can be a good way to go, but oral surgery and more braces, not so sure. Maybe when you get a second opinion, ask if removing some existing teeth would help the rest come in better and then wait a few years for more braces if necessary?
posted by Margalo Epps at 7:39 PM on December 5, 2013

My parents went with "wait and see," and now that I am an adult, I have been told "this could have been easily corrected when you were younger." I desperately wish my parents had been more proactive when I was young--do get a second or even a third opinion, but imho, it's best not to let kids grow up selfconscious about their smile.
posted by Edna Million at 8:19 PM on December 5, 2013

Thank you for all of the responses. I've done some research and I'll call a couple of places to schedule a second, and possibly a third opinion.

misanthropicsarah: The teeth are impacted in the roof of his mouth.

koroshiya: Thank you for the suggestion of using Yelp. I hadn't considered that.

dancinglamb: I was a little unclear on what you meant by "work around the balance" of the FSA account is your case.

cristinacristinacristina: I'll probably memail you soon.

One final question: When getting a second opinion, is it better for me to explain what I've been told by the first orthodontist, or let the subsequent orthodontists come to their own, independent conclusions? I've never had to get a second opinion before.
posted by Big Chief Little Pants at 7:08 AM on December 6, 2013

i would let him come to his own opinion. after he's finished explaining what he wants to do, then i would go into the fact that this is a second opinion and here's what i've been told before. although a good orthodontist might be able to tell what had been done before, or they may also ask for your kid's current regular dentist name so they can get previous records and compare from there.
posted by koroshiya at 3:20 PM on December 6, 2013

I was a little unclear on what you meant by "work around the balance" of the FSA account is your case.

In our case, there was a flat rate for what the braces and care would be. To that end, there was a monthly payment that would've been due out of pocket (outside of what our insurance paid for the orthodontia). We just paid out the lion's share upfront with the FSA toward the end of the year.

I apologize for not being clearer in my initial answer.
posted by dancinglamb at 8:50 AM on December 7, 2013