My 'pre-story' - lots of thoughts and questions!!

[Buttercup22]

I have already been in contact with some of you so thought it was time for an update as I have now attended 3 consultations and I will 100% get my braces next month. Just need to decide which way to go...

First consultation: It went really well. I was very nervous but talked with the orthodontist before he had a look in my mouth and he made me feel really relaxed about everything. He said everything could be fixed which was very reassuring. I knew that I would need two premolars extracted but I was also told that the crowding issue can easily be fixed with braces alone. It is just so severe that it will take a long time but he reassured me that he has dealt with much more complex cases and seemed very confident. My issues did not seem to phase him and I was completely relaxed and ready to begin my treatment once leaving (..but is that because I heard what I wanted to hear? ..that there is an easy solution to the problem?). There was no mention of surgery or anything like that.

Second consultation: I was not nervous about my second consultation because of how well the first one went (people who have been supportive of my fears here already will be shocked to hear that I'm sure). I think it was the fact that if I didn't like what I heard I could go with the first treatment plan. I didn't feel like I connected well with this orthodontist as well as the first. He took his work very seriously but said it was such a complex case that he would need to think of the best way to proceed, but once again the problem could be fixed so I left feeling reassured. However, I am definitely not going with the second ortho. It seemed like he did not have enough experience dealing with a complex case such as mine.

Third consultation: Once again, I was not too nervous about the consultation as the first one had put my mind at ease. However, I left feeling defeated and questioning everything. He was clearly a very experienced orthodontist who knew exactly what he was talking about. This consultation was exactly like my first except he gave a more detailed explanation of problems and possible complications. I did appreciate his honesty as I would hate beginning treatment, find out something is not working and wasting my money. He suggested I may need surgery to correct an open bite caused from grinding (which you can't notice at the moment because of severe crowding). The other two consultations never mentioned surgery. This orthodontist knew exactly what he was talking about and even showed me pictures of a bite similar to mine that was corrected with surgery. The difference was amazing. I just don't know if I can go through with surgery, I'm anxious enough as it is. Even if I considered surgery, I would not choose to begin treatment with this orthodontist either. He did not seem to acknowledge my fears and worries but it was clear he did want the best results. The only other thing that concerned me was that he did not mention trying to correct the open bite with braces alone which makes me questions his approach. He said I would need to make an appointment for x-rays before he could decide if surgery would be a good idea, and that if I am not comfortable with surgery he would still straighten my teeth. However I don't want X-rays taken until I have decided on my ortho, as once I have spent money, I feel that I will be fully committed so I want to be sure.

So....
I am leaning towards the first ortho. I feel that I would be most comfortable and at ease visiting him over the next 2 years. I am still worried about surgery/no surgery. I think I might call and ask him about this. I wonder if he did not bring up the subject of surgery because of how nervous I was at the initial consultation. Or if he believed he can genuinely fix this without surgery? Or if he will not mention anything like this until X-rays are taken. I'm very unsure, can anybody take a guess? On the other hand, this ortho said he had treated more complex cases and was very confident - I really trusted that he could sort this all out. Now I am questioning what if he can't do this without surgery. Or what if the problem is fixed but I develop jaw problems a few years later and have to be re-braced? This is such a big deal to me that of I'm doing it, I'm gonna do it right. I wonder why he didn't mention my open bite?7

I have some questions:
- Will I need to have X-rays taken to determine if there are jaw development problems that cannot be fixed by braces alone?
- If so, should I have been told this at my first consultation?
- Try to put yourself in my shoes. How would you guys feel about all of this?
- I know this is my own decision, but putting yourself in my shoes, would you trust your gut and go with the ortho that did not mention surgery but that I instantly felt comfortable and confident with, and who I felt I could trust. I have not had any doubt that I would choose this ortho until the surgery issue arose today... This ortho also did not need to think about how or 'if' he could the problem, he instantly reassured me that he could and he really seemed to care and was less business-like unlike the other two.
- The first ortho suggested extraction of two upper premolars, and would try to straighten my lower teeth but may need one lower premolar extraction, but we would decide that at a later date. Would this imbalance of lower teeth cause problems? The second ortho suggested two upper and lower premolars, but I don't think I need two bottom teeth extracted, even if it was to balance the uppers being removed. The third ortho suggested extractions and to consider removing the upper molar with a root canal depending on what the x-Ray shows. I don't think I'm comfortable having a molar extracted even if it is an unhealthy tooth. Does anybody have any opinions on this?

Apologies once again for a long post. I'm surprised at how calm I am and how I STILL want to go ahead and deal with all of this. Thank you to those who welcomed and supported me on his forum, if it was not for you guys I definitely would not have gone through with consultations!! I'm just feeling overwhelmed now and could really use some guidance in making a decision so my story can finally begin

[prairiehouse]

I wouldn't let how the ortho made you feel be too big of a part of the equation. You won't have that much contact with them, and in the end, you're there to get a better occlusion. It's very questionable how much of their bedside manner can tell you about their ability to give you a better result. Communication is obviously helpful, but I look at more as a luxury after a certain point. That point being a clear mutual understanding of your goals.

Orthodontists know that most patients are scared of the idea of surgery, and therefore it wouldn't surprise me if some orthodontists don't bring it up, or are less likely to strongly suggest it. It's a business after all, and they don't want to scare away customers. A medically acceptable result without surgery might be their requirement as far as their responsibility as an orthodontist goes. And hey, many people just don't find the risks of surgery acceptable. So in the end, some of those patients are still getting what they want.

The fact that one of the orthos didn't even mention surgery makes me question that orthodontist's motives. The surgical alternative should always be mentioned if it's a medically valid option. Although possibly in your case it isn't.

These orthodontists are all educated (assuming this took place in North America, and they are all actually orthodontists, and not dentists doing orthodontic work (although I am not saying that a dentist isn't capable, but it's less certain), some maybe more than others, but I'd do some research on their credentials if you really want to know how informed they are in comparison to each other, and not rely on how detailed they were with you. See if they teach part time, etc.

Your 3rd consultation mentioned the surgical option, and even seemed to emphasize it, which he probably knows could scare off a potential customer to another orthodontist that seemed more encouraging about the possibilities of a non surgical result. Not even mentioning the surgical alternative would probably make an orthodontist seem even more confident in its success, because the client will probably think that the fact that he didn't even mention it means that it isn't necessary.


Not knowing anything else about these orthodontists, I'd probably go with the 3rd one, even if you don't like idea of surgery. I'm not saying that you have to go through with it, but even if you decide not to go the surgical route, I don't see why he wouldn't be able to give you as good of a surgical result as the other 2 orthodontists. It seems like he might have been the most honest, and/or most thorough of the 3, based on what you've said.

[Buttercup22]

Thank you so much for the advice. I will definitely take it on board! There is just so much to think about right now. I'm so scared I'll make the wrong decision...

I should also mention:
1st ortho - least expensive
2nd ortho - more expensive
3rd ortho - most expensive

I actually think the 1st ortho gave the most in-depth examination. The thurs ortho just gave more details about possible complications. I just wonder the first did not seem very concerned about what I presented with, whereas the other two did. That is why I presumed he would be my best option - he must have dealt with the most complex cases and have been successful as he did not express as much concern and seemed like he could treat me effectively. That is my gut instinct. He also told me not to worry and reassured me that I was in good hands as he had years of experience with cases even more complex.

Another way I see it is the third ortho might strive for perfection, even if it means suggesting invasive surgery where not completely necessary. It would certainly benefit him to have achieved so many 'perfect' results. To be honest, I do not feel comfortable with the idea of returning to him, regardless of whether or not surgery goes ahead. His approach is too direct for someone like me with dental phobia, whereas I think I would be more comfortable negotiating the idea of surgery with the first ortho if it is recommended.

I just really need as much opinions as possible because I'm afraid that I might not be able to see things clearly because of my dental fear, and the thoughts of surgery terrify me. I really do appreciate your objective opinion on these concerns! I would rather honesty if it means not making a mistake that can't be reversed. I'm doing this once and I don't want any regrets and I am open to considering surgery if it's best option. This is the most difficult decision I have ever had to make

I should also note that all three are registered orthodontists who appear to be widely recognised and have good qualifications. I did my homework before consultations thankfully

[prairiehouse]

Something from my own experience, my oral surgeon didn't seem to go into that much detail, although I only had one surgical consult, and so I have no other surgeons to compare him to from firsthand experience. However, he seemed less detailed than some other surgeons based on posts I've read on these and other forums. He's also however maybe the top surgeon in the country for the type of surgery I got. I really wouldn't put much emphasis on how detailed the orthodontists were, as far as that being evidence of the kind of result that you'll get. Maybe the most detailed orthodontist was the least busy, and/or the most desperate for business? I don't know. The most expensive orthodontist might be able to charge the most because he's able to command that kind of fee. I don't know. I'm just saying that there are other reasons for why one orthodontist might be more detailed than another. I am however not saying that I think price is an indicator of a wide disparity in the result that you'll get from them. My orthodontist suggested surgery, but seemed to place more of an emphasis on the possible complications. My oral surgeon mentioned the possible complications, but didn't seem to place that much emphasis. That's why I'd recommend you do your own reading, and not rely on their reactions. Look at studies, statistics for complications, satisfaction rates, etc. You can draw your own conclusions from the evidence, rather than drawing conclusions from the conclusions they draw from the evidence. In the end, you're the one who they want to decide on whether you think the complications are acceptable. That's why my orthodontist and surgeon both told me about the complications, and the likelihood of them. They wanted me to have the information to decide. However though, at the same time, they are the professionals, and you should rely on them to some extent (as long as their answers still make sense to you). By that I mean, (not that you're going to, but some do!) don't go around looking for the one surgeon who will give you what you want, when the other 20 surgeons you've consulted with said that it was a bad idea. It's probably a bad idea in that case


Maybe consult with a couple more orthodontists and tell them about what the orthodontists so far have told you, and what they think about surgery. Which country do you live in? Did any of them go to much higher ranked schools? Are they part time faculty at universities? Do they have any recent publications? Maybe you could ask an oral surgeon too.

I'd say concern expressed (you may interpret that as confidence or a lack thereof) is as much personality and/or sales tactic. But I wouldn't say it's an indication of capability. Some capable people act (and/or are) outwardly confident, and others don't (or aren't). I wouldn't let that be a reflection of their true level of confidence. They may both see the case as 20% chance of failure (these are arbitrary numbers to illustrate a point), but one orthodontist might just place more emphasis on their client understanding the importance of that figure, and/or might see that 20% chance of failure as more significant. There are certainly many people that act confidently exactly because of the fact that many people, erroneously, see outward confidence (at least what we perceive as confidence, because obviously you can mimic gestures that project confidence, and not actually be confident) and mistake it as an indicator of ability. And for that matter, obviously internal, true confidence isn't even a reliable indicator of ability. That's why it's better to get down to the numbers and ask them specifically about the likelihood of the realization of your various goals are. Just so you aren't relying on their own feelings.


I would assume that if queried, each orthodontist would tell you that they have years of experience with similar cases (unless these orthodontists are very young). I also don't know how likely it is for an orthodontist to recommend surgery because of perfectionism, it seems contrary to what I'd expect of them (both from a business and medical perspective).



Anyway, as you yourself have essentially admitted, you don't want surgery. I'd try to be very aware on your part of that affecting your judgement.
Obviously decisions shouldn't be made out of fear. I am not saying that it's unreasonable to turn down surgery because of the complications, but it has to be because of a reasonable concern about real complications, rather than a vague, irrational feeling of fear.


Anecdotes are fun to read, but not very useful by themselves. I'd consult with more orthodontists (and an oral surgeon. My orthodontist referred me to an oral surgeon before I even signed on with him). I'd also read more about the procedure that the 3rd orthodontist recommended, and about braces alone in correcting your specific problem. At the very least you'll have better questions to ask the orthodontists and surgeon.


Edit, my case was different than yours. To me, not having surgery wasn't an option if I was going to go through with braces. You however may very well have a case where not going the surgical route will provide a completely satisfactory result. But surgery may still have the potential to provide the best result (and however, possibly the most complications). I'd go on more consults.

[Featheryy1221]

Before I started my journey, I spent 3 months debating between my three options, so it may take you some time to weigh the pros vs cons. That being said, my number 1 piece of advice is to pick someone you feel comfortable with. You're in this for the long haul and you want to at least make sure you at least like the ortho you're going to. Especially considering your dental phobia.
Make sure you go for someone that explained their plan for you well and seemed knowledgable. Also that you agree with their plan.

As for your question about x-rays, your ortho will get a better idea of their plan once they see the x-rays. And molds too.

It's hard to know what to do. And it's difficult since its a personal decision. If need be, you can always go for another consultation to see what a 4th ortho's plan would be. Could make it more complicated though. Haha.

Good luck!

[prairiehouse]

Also, I forgot to add that one orthodontist told me that most orthodontists charge more for surgical cases, so that could also be another reason that an orthodontist would be more reluctant to suggest oral surgery (because the price would go up for the patient, possibly what happened in your case, and why the 3rd orthodontist charged the most).

[djspeece]

I think prairiehouse makes a lot of excellent points. While chairside manner is nice, it hardly indicates competence. I appreciate candor, and put much less emphasis on how they make me feel. I am a nurse, and can tell you that some of the best physicians have lousy personalities and are a pain in the a$$ to work with sometimes, but they know their stuff and they get great results. I would personally avoid surgery if at all possible unless my desired result required it, and I was not looking for perfection (which I am not, even in my own case). I might suggest a second consult with #1 and ask him the questions you pose to us. Orthodontia is an elective treatment for most of us, and I think some orthodontists may have a good bit of "salesmanship" in their initial pitch. They know what you want to hear, probably make some sort of guess as to your quest for perfection vs. "good enough," and your understanding of treatment options. All of this obscures your assessment, of course. But I would want to know why #1 did not at least broach surgery.
I practically have to cross-examine my ortho for progress updates, I swear. He is quiet and probably strongly introverted, and he is much more comfortable with teenagers. Maybe I intimidate him or something, who knows. I have been told that I can have that sort of impact on others who don't know me well; I see myself as a fun-loving guy. But in any event he came strongly recommended, did not put any pressure on me to go with braces vs. implant (my options), and outlined a reasonable treatment plan. He rides herd on the chairside technicians, who sometimes get careless or don't follow his instructions to the tee. He's not mean by any means, but there is a right way to do things and he makes sure it happens. To me that is very important. I read here of some practices in which the ortho does not seem to be closely involved with each visit and I cringe.
Best of luck to you. You have great insights, and I think you need a few more data points, and you will make a good decision.

[BeautifulDisaster]

I can relate to your post, as I am on my pre-brace story, as well.

I consulted with three different orthodontists. One of them mentioned that I may be a good candidate for jaw surgery at the initial consultation, but he would have to study my x-rays first before making that conclusion. I paid the $250 fee for records and x-rays. When I went back for the evaluation, he had ruled out jaw surgery and said I'd have great results with extractions.

I don't think I would be comfortable deciding on an orthodontist if he didn't take the time to look over my x-rays...especially not in the case of potential jaw surgery or extractions. I actually ruled out the first ortho I saw because he came up with a treatment plan without checking my x-rays first. The nice part about taking x-rays is that one ortho's office will send them to another ortho's office if requested, so you don't necessarily have to pay the fee or take x-rays each time you consult at a different office.

In your case, like the sound of the first and third orthodontist. But I would definitely be interested in hearing what they have to say after they review your x-rays.

[sirwired]

It's not unusual for an orthodontist to request Full Records before delivering a treatment plan for a complicated case. In fact, I think it shows additional care going into formulating the plan, so there's no unrealistic expectations. Certainly x-rays are really valuable in a potential surgical case, as many of the necessary measurements cannot be made precisely without them.

In any case, except for the plaster models themselves, the photos and x-rays that are made as part of Full Records belong to you. They are usually digital, and you can take them between providers. You may be able to negotiate a small discount with other providers if you have current records already.

[TheProfessor]

Hi Buttercup,
I think all the other posters have made some good points. As a fellow dental phobe, I can say that comfort with the ortho was a big point for me. You should also ask your dentist for advice, while not trained in orthodontics, he or she will definitely know the reputations of all the orthos in your area and will have probably seen the results of many orthodontic treatment plans. Ask your dentist this question: 'If you or your child had teeth like mine, which of these orthodontists would you choose?' I asked this question and only did consultations with the two orthos that my dentist said she wouldn't hesitate to let treat her. Their treatment plans were pretty much the same, so I picked the one that I was more comfortable with even though it was slightly more expensive.

I hope this helps...

[Buttercup22]

Quick update - although I haven't replied in a while, I have seen all your posts and they have really helped me these past few weeks! Thank you all

I took your advice on board and went for a fourth consultation. This orthodontist did not recommmend surgery either and even measured my open bite with a ruler. The gap is so small that the ruler would not even fit between my top and bottom teeth on it's side.

I have read a lot about open bites and surgery is usually only recommended for a significant overbite that cannot be corrected with orthodontics alone. Obviously there are exceptions but that is my understanding.

I have decided that I am not going for jaw surgery based on 4 consultations, based on what I have read and the fact that many more severe open bits have been corrected with braces alone. I have chosen the fourth orthodontist as she was very professional and she explained everything in detail. Hopefully things will get moving soon - I will try to keep you all posted I hope I am making the right decision! Worst case scenario is that my bite reopens following treatment, and if that happens I will go through with surgery. I don't think I am ready for that right now anyway. I realised that my main fear around the possibility of surgery was that if I did not follow through I would always be left with that horrible feeling of 'what if I had went through with surgery..'. I think this came from the fact that I have been building up the courage for years to finally begin treatment and have been living with this feeling of having horrible teeth for so long. I suppose I was just afraid that this feeling would remain following treatment if I did not go through with surgery to correct the open bite - does that make sense? So I began to question if I should begin this journey at all if these feelings would still remain afterwards. I hope I am making the right decision, and I really think I have taken everything into account. I hope everything is going well for you guys too

[Buttercup22]

I can relate to your post, as I am on my pre-brace story, as well.

I consulted with three different orthodontists.

Any updates on your story BeautifulDisaster? It sounds like we may be braced around the same time! Can I ask if you chose the orthodontist who suggested surgery but then ruled it out? Or are you still in the process of making a decision?

Glad to hear that you definitely don't need surgery and that all of your questions have been answered. Good luck to you

[Anna5]

Good luck with your treatment! I hope you will get a good result without surgery. And I think you will because the ortho is confident.
I also had an open bite and was recommended surgery, but now my open bite is gone without surgery. There are many more success stories here on this board, so I think you can be hopeful!

[Buttercup22]

Thank you Anna Apologies for the late reply, I have been online quite a bit but have not posted or replied to anything in a while. I have been thinking a LOT about all of this as I am sure you can all relate to!

I am hoping everything will go to plan without surgery, I am also confident that it will. All I know is I am not ready for surgery, so I could have given it more time before getting braces, but I also realised that if I do not keep moving forward at this point, all of my irrational thoughts could return and cause me to be overcome with fear again! ...and then I will just back out. So I know that this is the best option for me. I really have thought it through. Can you remember if you felt the same way when you were about to get braced Anna? Congrats on closing your bite - I am so happy that you were able to achieve this without surgery. You have definitely given me hope Have you finished your time in braces? If not I would love to keep updated with your progress!

I have a brace date for next week!! At last!! I think it's finally time to start my real story