Pros and cons - discuss!
(okay, a little more info…)
two kids - 10 and 13. 10 year old has one tooth left to lose, 13 year old has all permanent teeth and has for several years. Both need orthodontia. We've had consults with two practices.
Practice A is a young guy, joined the practice group maybe five years ago, says they need to have palate expanders, both of them, upper and lower, followed by braces, retainers, and possibly another device for my late thumb sucker. Urgently feels both need to get started immediately, especially the older, as the window for jaw correction is closing. 24-30 months of treatment, $6000 each.
Practice B is an older guy, teaches at a major university medical center, solo practitioner for probably 30 years. Thinks expanders are way overused (and rubbed his fingers together in a money symbol while saying this), does not see a need for either of them to have one. Wants to wait until all teeth are in for 10 year old. Doesn't feel urgency for either of them, even the thumb sucker. 18-22 months of treatment, $4500-5800 each.
I know people who have used both practices and they both are highly recommended.
I'm seeking out a third practice for an extra opinion. I come from a family of medical professionals (although I am not one) and have a conservative view of treatment, so I'm inclined toward practice B. It's not about the money (of course, that's a huge sum, either way), but I avoid additional treatments if they are truly unnecessary. Moreover, for me, it's not about the cosmetics but rather the health of the jaw and teeth, which can be a big problem over years of misalignment and wear. I come from the years before palate expanders were a thing - they would just pull teeth (which no one has recommended, by the way). I never had orthodontia of any sort.
What are your thoughts on palate expanders? I realize that each case is different, so I'm not asking whether you think my kids need them, of course, but rather did you go through this? If you did not have them, do you regret it? If you did, do you regret it? Would you make the same choice again? What are the pros and cons you've seen, what were the concerns you had? What have your experiences been?
Thanks all for the input. I do think they are too old for the expanders. Plus, to be honest, their teeth are not terribly out of alignment. My son's bottom jaw is crowded, but honestly, the teeth are tilted in and look as though a lot more room will be created by pulling them up and straight. My daughter's teeth are not crowded at all - in fact, there are gaps. I was actually shocked the first guy wanted to do expanders. My dad is an oral surgeon and I spent a lot of years working with him, so there is a part of me that smells bullshit on the first guy (and he's the relative of a very close friend, so I was very open to whatever he had to offer). I'm no expert, but I have enough knowledge to read x-rays and know what the measurements mean. I know a lot of people really need expanders, no doubt, but the second guy doesn't even want to take teeth out in lieu of them. He simply believes there is room and he's been doing it for a lot of years. And his response of rubbing his fingers together , suggesting a lot of guys do it for the money, benefits him in no real way - if he wanted to talk me into expanders, it'd be easy to do and he'd benefit. We are definitely going to do a third consult, just to be sure. Your input also helps! Thanks!
There is one good study out there. They looked at adults that had had 2 step ortho. (Expander +braces). Vs braces. The outcome was the same. Adult teeth were aligned just fine either way.
That being said my daughter has an expander at 9. Her teeth would not come in as there was no space. . It cost $3000 for the expNder. It worked. But she will need braces later.
I am a fan when they are needed. Because these also weren't "a thing" when I was growing up, and my teeth were straight, I wasn't referred to an orthodontist until I was 14 or 15, which frankly was too late. I had a cross bite that in retrospect was terribly obvious so I don't know if my dentist was asleep at the wheel or what, but signs of the misalignment and under bite are clearly there in all of my school photos.
Anyway...I had a palate expander and lower braces put on in high school. Although my palate expanded wide enough that I could fit a stack of 4 quarters between my front teeth (attractive LOL!) it didn't solve the problem. I then had surgery the summer before senior year - a few mm of bone were removed from both sides of my lower jaw, which was then re-set and screwed back together with plates and wired to my upper teeth for a couple of months. Awesome way to go back to school. It was major surgery and I was in the hospital for 4 days, the first 24 hours in the ICU with tubes up my nose and down my throat so that I could breathe through the swelling. It was a huge deal, hugely expensive and something that I hope my kids can avoid.
Because of my experience, I was more than happy to go ahead and start the corrective work that my younger boys needed at an early age. The older of those two is now 11 and had braces at age 7 that were on for over a year, along with a retainer. The dentist was able to catch his growth phase in a way that he was able to get his lower teeth under and behind his top teeth without an expander. Not sure what phase II will entail.
My youngest is age 9 and was slow to get his molars in, so he had some baby teeth pulled a few months ago to let those come in and will start extensive work this summer. He will start with an expander and then will have head gear added on that will pull his top jaw forward as it widens. Hopefully that will re-size and align the jaws for a while, then he'll have more work done when he's around age 13.
Some kids actually need another round of intervention at age 18 as well. Hopefully not, but I'd still go for this over surgery for them. Anyway...I'm a fan of them but by no means does everyone need them. My two oldest didn't and it was never suggested for them. If you can clearly see the misalignment (underbite, or lower teeth outside the upper on one or both sides) then I would go with option A unless your 3rd opinion agrees with option B as well.
My son, turning 11 today, just finished his phase I with an upper expander and nighttime head gear. The original plan was to do 2 phases of braces b/c he had a pretty severe over bite. He has also lost all baby teeth.
The expander has done such a great job that the over bite has been corrected and his eye teeth have come down that there is no need for phase I of the braces at this time. The ortho is actually giving him 3 months without anything to see what his teeth will do and says we may not need to do anything else at this point but maybe again at 13 or 14.
I was quite surprised with what the expander and head gear did for my son and it was a less expensive route than phase I of braces.
I think the third opinion will help. Ask your dentist for his opinion as well.
Orthos used to pull teeth to make room and now, that's unheard of. Palate expanders are what are commonly used now. I will say, I have a sibling who is a dentist and it is ALL ABOUT the sales. Dentists make TONS of money selling and upselling their services. It's the reason dental insurance sucks these days.
Good luck - my kid has a crammed mouth of teeth and will need extenders. Lucky we have someone in the family!
This is just an FYI. As long as your children have an Affordable Care Act compliant health plan, this will cover a substantial portion of their orthodontia. I don't see a big difference in the cost estimates you are getting from the two practices and I assume they are just estimates.
There is truth to the jaw thing being a matter of timeliness. Depending on what they need to do.
My son needed a herbst device to help extend his lower jaw, due to overbite. It was for about a year-18 months that he wore that. He wore the braces for about 2 years. (simultaneously)
Retainers after removal of hardware is standard practice today, along with, in most cases, a permanently affixed lower retainer.
The jaw thing may be urgent due to growth spurts/patterns. If they can catch your son in his large growth spurt window, it speeds the process along and makes it easier. If they don't catch it early enough, it may not achieve what is needed (due to slowing of growth) and surgery might be needed at some subsequent point. My son had the herbst installed at age 14 or 15, and achieved what was needed. He had not yet hit the fullest of his growth spurt at 14. If your son is in the middle of his, that would be something to consider.
(A Herbst device is essentially "headgear" that is fitted entirely inside the mouth)
Neither of my kids had palate expanders. That doesn't mean yours don't need them. I don't know if they do or not. Our orthodontist is in his 40s. Not brand new, not old school. We did pull a few of daughter's teeth when she was 10 or 11 (she hadn't lost her baby teeth and the permanent ones underneath were growing sideways rather than up... so making space encouraged them to find the path of least resistance). She still has one baby molar left, but had her braces installed last week (she's 13 now). The removal of the incisors was successful and the permanent teeth turned up and came in where they should have.
The rest of her work will be done with the braces themselves, no additional devices. Both of their treatments cost in the neighborhood of $5,000, including retainers after treatment. As their office explained it, a large part of the fees are simply due to office time. They are scheduled for visits regularly to make adjustments, and follow up (and pre-care for our daughter who has been being monitored for over 2 years without any actual orthodontic treatment, other than x-rays and monitoring how her sideways teeth are coming in, whether we needed to pull others, when she would be ready for braces, etc), and any minor repairs that may be needed, along with xrays, etc.
What does your regular dentist say about the proposed treatments? Normally, even though they are not orthodontists, they might have some general idea of if something sounds out of line.
-- ETA--
If you think your *medical* insurance will cover orthodontia, don't count on it. We do have a supplemental dental policy, and that still only covers up to 70%, but has a maximum benefit that is lower than half the overall costs. Our medical policy (which is pretty high end) covers NONE.
https://www.aaoinfo.org/news/2014/11/affordable-care-act-...
I had an upper palate expander when I was 16. I had it in for about 6 months. It was definitely needed in my case. My teeth didn't follow a normal curve. The back teeth curved inward and then back out closer to the molars. They did not do an expander on my bottom jaw since the curve was correct, instead they pulled a tooth on the left side to allow for better spacing. Originally the expander was going to done first and then surgery to correct the rest of the issues, but insurance denied the surgery, so we ended up doing braces....three years worth. Looking back, I would have much rather had the surgery to get it done and over with. Once everything got aligned, I had much fewer headaches. I used to get them daily in the lower part of my skull and would have a lot of pain in my jaw. I still get frequent headaches, but not due to my teeth anymore.
My daughter had a palate expander because her mouth was too small for all her teeth. Her father had the same problem, but had 6 permanent teeth pulled AND had braces. She had the expander and about one year of braces and she was done. I also had two opinions on this and they were in agreement.
My daughter had an expander in for about 6 months. Her teeth did not line up when she bit down so it was needed, my step kids also had them for the same reason. I think our situation is more genetics then thumb sucking, etc.. I don't think the expander is a faster way of creating more room for teeth since it only widens the jaw.
My daughter is 8 and got her braces on last June. The dentist, the orthodontist and myself agreed that she did not have enough room for her adult teeth to come in and having the braces on has helped that. She started teething at a very early age and started loosing teeth at an early age. She has only needed them on the top teeth not the bottom.
I just wanted to add that my orthodontist rarely uses retainers (since most people wont wear them), she will leave the braces on longer instead. Our total cost is less then $2000. and she will have them off by August or so.
My daughter got hers about 2 months ago. She had a overbite and her side bite was way off due to the pacifier. The only reason we got hers done now was that her permanent under teeth would hit the roof of her mouth and hurt. Within the 2 months she has had it I have noticed HUGE difference in her bite. I only paid 600 (insurance did cover some of it) and the dentist is hopeful that this will create some room for her other permanent teeth and we might be able to avoid braces all together.
My kid had an upper palate expander, and he had been a thumb sucker. The explanation that the orthodontist gave made sense to us - maybe I should have questioned it, after reading your post. The ortho was recommended by the pediatrician after I said I wasn't happy with someone else we saw (based on a friend's recommendation). The first guy was an orthodontist who was part of a pediatric dentistry practice, and he just couldn't wait to tell us what all our son needed (having never examined him or talked to us, only to the dentist and maybe looking at X-rays). So the second guy seemed reasonable and calm, more like your B guy.
I get that you're stuck between a younger guy with more recent training (good) but who's trying to build a big practice (maybe good, maybe bad), vs. a more experienced guy (good) without as much new training (maybe not good). It sounds like you trust the older guy more, so I'd let that be a guiding factor - it's not the money so much as the waste.
I think it's okay to take your current X-rays (which you own - you don't need to pay for new ones) and have a 3rd opinion person look at your children. I'm not sure I'd have the younger one start until all teeth are out.
I had 7 years of braces and 8 adult teeth pulled to get all my teeth to fit into my mouth.
From 5th grade through 11th grade - it was painful - I thought they'd NEVER come out!
Expanders hadn't been invented yet.
Our son had expanders starting in the 3rd grade and then had 2 years of braces and was finished by the end of the 6th grade.
All his teeth fit in his mouth!
He wears retainers faithfully every night (he's in 10th grade now), his teeth are straight, easy to keep clean and they are beautiful.
You might want another (3rd) opinion but I think expanders are the way to go.
You probably should have started sooner - 2nd and 3rd grade are prime time for this.
If you get the teeth straightened out while the jaw bones are growing, it's much easier to deal with and a lot less painful.
I honestly think your older child is too old for an expander. Most of the time they start them on them when they're 8-9-10 years old and growing their adult bones. Your boy has very little adult growth left.
The younger one...if his jaw is too narrow he needs the expander. Whether it's too iffy or not. That's their best hope to get his bones to grow right.
So you're going to have to decide what the outcome is going to be. I'd sure want to give those bones the best chance for growing the right way and to get further apart if they really really need it.
