Orthodontic fearmongering?
January 15, 2012 10:52 PM   Subscribe

Is my new dentist trying to convince me to get braces unnecessarily? Lots more agonizing inside!

I visited a new dentist last week, the only one in the area who accepts my health insurance. I chipped a front tooth on a beer bottle (classy, I know) and asked if it could be fixed. New Dentist immediately expressed a great deal of concern over the condition of my bite and said that my teeth, particularly on the bottom, are extremely crowded as a result of my small/narrow jaw. The fracture in my front tooth, she explained, is a result of my overly tight bite. She recommended that I have an orthodontic consultation immediately, and expressed that she would like to have me in braces within a month.

This seems a little bit...alarmist to me. I'm nearly 24 years old, and none of my previous dentists have ever expressed any concern over the state of my teeth and jaw. My bottom teeth are pretty crowded, but not unbearably so, and my upper teeth look straight enough to me. I also really don't want to go through the braces-wearing process at this point in my life if I don't absolutely have to*. I asked New Dentist about Invisalign but she said my bite issues are too severe.

New Dentist has an orthodontist to which she refers patients. I took the appointment she offered, but am really having some second thoughts. Is she somehow trying to convince me to pay for braces I don't really need? Is this just some sort of this-is-Los-Angeles-everyone-must-want-straight-white-piano-teeth thing? Should I consider getting free consultations elsewhere?

Finally, New Dentist quoted me a total price of $1750 including the retainers at the end, which seems unbelievably low for this area (southern California). I actually really liked New Dentist, but for some reason, the whole braces issue has me feeling uneasy. She was very emphatic that my bite is a mess. Does any of this sound sketchy to you, or am I merely looking for a reason to avoid orthodontia?

*Also, yes, I realize that it's a total first-world problem to "not want" braces as an adult. I feel incredibly shallow for worrying about how I'd look with braces on my teeth, but I can't deny that it will be a factor in my decision-making.
posted by easy, lucky, free to Health & Fitness (14 answers total) 3 users marked this as a favorite
Braces are a pain. They're literally painful, they can impact your self-esteem, and even though $1750 sounds like a steal for major orthodontic work, they're not exactly pocket change. Given all this, why would you not get a second opinion? Even if you pay out of pocket to get a consult with another dentist, I think it would be well worth the money to have your suspicions either confirmed or denied.

(And I have no experience in this area other than having braces as a teenager, but I would be just as skeptical as you are if a new dentist gave me the braces full court press after a lifetime of other dentists not mentioning it. It could just be that your other dentists weren't as conscientious--who knows?--but it never hurts to be a bit suspicious.)
posted by Bella Sebastian at 11:05 PM on January 15, 2012

Yeah, it sounds totally sketchy. If I were you, for sure I would get another consultation. I find it hard to believe that no prior dentist has ever expressed concern over your bite, and this one believes you need braces "within a month." And yeah, $1750 sounds ridiculously low. (For comparison, I paid $5K for adult braces to fix very slight crowding, plus almost $2K later for retainer work.)

You need to be able to completely trust your dentist -- otherwise you'll end up spending all your time second-guessing her and worrying. If your second opinion tells you you don't need braces, don't go back to the new dentist. In the end you'll probably save money.
posted by Susan PG at 11:09 PM on January 15, 2012

I had braces for SEVEN YEARS in my teens and several dentists have looked into my mouth since then and told me I needed braces. I know why; my teeth that came in after my braces went on came in a little sideways, and it's hard to keep some of them clean. I understand that. But you know what? It's also hard to keep teeth clean when there are braces on them, and frankly, I think my teeth have done enough time in bands and brackets. I've always politely refused any consultations. I think dentists and orthodontists really, really fail to inform patients about the increased risk of decay they have while braces are actually on and the damage that braces themselves can do to teeth. I have chips that happened entirely because of improperly applied cement, for example, and my first root canal will definitely be of the tooth that had a poorly fitted slightly-too-large band on it for all of middle school and high school. It's already been filled twice. I know it's only a matter of time, and I know my braces were to blame.

I think there is definitely a subclass of dentists that see braces as a total panacea for a ton of oral/dental/maxillofacial issues. Does this dentist have any yelp reviews? You can definitely see trends there; if this woman tells everyone to look into braces you may just want to say thanks but no thanks.

I do also feel like LA dentists are used to that perfect Socal smile and when you deviate from it at all they tend to really push you towards correcting that, with little regard for how much of their concern is health-related and how much of it is cosmetic. I have left dentists over their overly aggressive pushing of whitening treatments for that reason; I feel like it's a sign that they're concerned for my looks more than I really value or care about. Dentists down here see a lot of absurdly beautiful smiles and I think when you've got coffee stains or snaggly teeth it's unusual and weird here in a way that it isn't hardly anyplace else.

Haha, clearly this is me airing my own issues and history...but let me assure you that getting braces is not a zero-risk proposition for your teeth and you are absolutely right to approach this question with caution and skepticism. I strongly regret the time I spent in braces and when I have children with crooked teeth (which I surely will) I'll definitely be informed by my own terrible experiences with orthodontia and orthodontists as I make my decisions. I feel like my parents just trusted whatever the orthodontists said and in many cases it was way off base, or turned out to be downright false or the wrong treatment for me.
posted by troublesome at 1:52 AM on January 16, 2012 [6 favorites]

Seconding troublesome. Braces can solve some problems, but can also open you up to a whole new world of tooth decay.
posted by Balna Watya at 3:53 AM on January 16, 2012

Unless that beer was at the end of a long string of beers that led to you not remembering a thing, you probably have a good idea whether you hit your tooth too hard with it (highly plausible) or whether it just fractured for no good reason. I chipped a noticable chunk off a front tooth eating a granola bar once, and my dentist didn't start recommending braces.

IANAD, but if your jaws and teeth don't hurt, you can chew, and the appearance of them isn't bothering you, you don't need braces. And yeah, that amount is really interesting. It's a lot of money to part with, but it's absurdly low for braces, which is a worrisome thing in my book. If you even suspect you might need braces, really - get a 2nd opinion.

Dentists don't have as much to do now that we've greatly minimized tooth decay as a society- fluoridation, flossing, brushing and routine checkups should mean that most people have very little in the way of actual problems. A dentist friend of mine asked me to read a book that the marketing wizards behind 800 DENTIST sent her, and in addition to it being a commercial for their service (natch), the underlying assumptions in the book were that any dentist worth their salt and planning to retire young and spend their golden years tooling around in a Mercedes was looking for additional procedures to pimp to their patients.

Whitening and straightening (referral income) are the main services to sell if you're wanting to be within hooting distance of being ethical and not, for example, putting crowns on every molar in a woman in her late '70s who has breast cancer whether they need it or not (such as happened to my aunt)
posted by randomkeystrike at 5:42 AM on January 16, 2012

Another interesting story - my dentist (also my friend) asked us to take our son, then around 10 years old, to an orthodontist because his teeth were very crowded. I think she was recognizing a real potential problem, and the orthodontist was ethical enough to tell us after an X-ray and exam (which were free, by the way - they make it real easy to get in the front door) that he didn't have critical problems that necessitated them, but hinted that getting started now would "make things so much easier down the road."

Mrs. RKS and I didn't bite (no pun intended), because the ortho had said it wasn't critical, our son wasn't complaining, and our intuition was that at his growth rate, it would be like moving deck chairs around on a pitching deck. And we were right - his head, along with the rest of him, is 1/2 again as big as when he was 10 (he's 13 now), and his teeth look entirely different. He might still need braces, but I'm convinced that none of that work we might have done 3 years ago would have mattered, UNLESS he'd been in pain or having problems back then.

Moral of the story - even with a dentist and an orthodontist I trust, their bias is to put the patient in braces if they nod their head and then hold still. It's an interesting branch of medicine - there's no market in elective gall bladder removal.
posted by randomkeystrike at 5:52 AM on January 16, 2012

Why would the dentist quote you a price for the orthodontist's work? That right there seems sketchy. On braces generally, many or most orthodontists offer free initial consultations. Find one that looks promising and ask him "would braces have any non-cosmetic benefit?" No competent orthodontist is going to lie about this to make a few hundred dollars off of you.
posted by deadweightloss at 6:02 AM on January 16, 2012 [1 favorite]

Your teeth do continue to change as you age, so it's possible that they have changed significantly since your last dentist. Or you just have had dentists who didn't care. Or she's got a sketchy deal and you'll be fine. Personally, I need to get braces (again) because after my braces came off, my bottom wisdom teeth started coming in and pushed my other teeth together too much (my front 2 bottom teeth cross over now).

But definitely go to another orthodontist (or a few). See what the consensus is. Compare prices. Find out who you're comfortable with, if the consensus is that you need braces. See if invisalign actually is an option. They also have clear braces and they're pretty unnoticeable (my cousin has them and I never notice).
posted by DoubleLune at 7:16 AM on January 16, 2012

Regardless of the dentist's recommendation, your perception of her cozy relationship with the neighboring orthodontist, and the LA-has-perfect-smiles attitude you now live amongst, it is always a good idea to get a second (or third) opinion when a medical practitioner recommends something expensive, invasive, or both.
posted by juniperesque at 7:57 AM on January 16, 2012

Adult braces survivor here. Having braces as an adult was awful and I would encourage you to avoid them unless they are absolutely medically necessary. Also, when you have braces as an adult, the process of moving your teeth around actually affects the bone density in your jaw in a negative way..... Or so I was told by a dentist once upon a time..... So that's another reason to avoid.
posted by bq at 8:04 AM on January 16, 2012

I was in a similar boat as you- late last year I went in for my usual checkup and found out that the office I went to switched out their dentists and I was being seen by a new guy. New Guy Dentist noted that my bottom teeth were 'a bit crowded' and started pushing braces. This blew my mind- I'm 26 and nary one dentist has mentioned braces to me. Things started getting really shady when he told me I also had 'quite a few cavities' but was dodging on giving me the specifics of how many and where they were.

I found a new office who gave me a totally clean bill of health and laughed when I asked if they thought I needed braces.

Second opinion, second opinion, second opinion.
posted by shes_ajar at 8:12 AM on January 16, 2012

When I was about 20, a new dentist told me I should have braces. I didn't do it. Since then, I've been through 3 or 4 dentists (I move around a lot and have bad teeth!) and only the most recent has ever mentioned anything like it. AND he didn't push braces, he just commented that my bite was a bit weird. And it totally is, but I don't mind it, it doesn't look weird, and I see no reason to spend the money and go through the trauma.

Get a second opinion and/or, if you're happy with your teeth the way they are, forget about it.
posted by snorkmaiden at 8:16 AM on January 16, 2012

When I was 13 or so, a dentist INSISTED to my (recently divorced, financially strapped) mom that I MUST HAVE braces immediately or OMG life as we knew it would end. It put her in so much pain and worry, but there just wasn't the money, and as badly as she felt, there was no way at the time to afford them for me.

And a good thing, too. Thirty years on, my teeth are perfect and straight.

tl;dr: Nthing 2nd and 3d opinions.
posted by cyndigo at 9:26 AM on January 16, 2012

The first thing that I would suggest, after reading your explanation, but without seeing your bite, is for you to have a second opinion for the restoration of the front tooth.
Front teeth are a challenge to fix, because the look has to be perfect as well as all of the technical details.
In order for the restoration to be strong, it has to have a certain thickness, and the room between what's left of your tooth and your lower teeth might not allow for that thickness, so something has to give.
Usually we take away more of the broken tooth...but what if there still isn't enough room, or by doing that we expose the nerve? Your dentist may want to create the clearance space by moving the lower tooth out of the way if it is crowded and in the way, thus assuring a nicer result.
I send pt's for ortho consults all the time with the caveat that we can almost always do the work without ortho, but well aligned teeth make the job easier.
posted by OHenryPacey at 9:29 AM on January 16, 2012

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