Ever wonder if ortho/staff are not doing great?

[Shelleyt]

I know the general consensus is "the ortho always knows best" but surely I am not the only one who regularly wonders if their ortho (or the assistants) is doing the right thing? I mean if you think about it... it's not like all regular dentists or even physicians always do the right thing or are all competent, so how can you always count on the ortho?

So far, my appointments are always 45mins-1hr longer than scheduled and the assistants constantly can't do things you would think they wouldn be able to easily do (such as open/close bracket doors) I just got home from my appointment and two of the wire ties (not ligs-these tie brackets together) fell out. When I started as a patient, they did an itero scan that ended up taking over two hours and looked like a mess when I saw it on the screen. Twice I have asked them to double check to make sure all the doors are closed before I left, and both times they realized one or more were still open

None of this would bother me if I was seeing results. But it's been four months and I am not seeing hardly any change at all. I was scheduled to have the extraction/exposure procedure for my impacted canine in early January, but today she mentioned there is not enough space and it would "probably be sometime closer to April or May." Originally, I was only going to get upper braces to bring down my half impacted tooth. The ortho estimated that would take 4 months total. I'm at four months and the tooth is only 75% in now. I seriously am concerned that the treatment I am receiving is not up to par.

Sorry for all the complaints. This is a board certified ortho who is constantly featured in the "best of" lists, but I am just terrified that I am spending all this money (13k+) for no results, or even that if I do get the results, it is going to take twice the time. Is it worth going to another ortho for a second opinion/progress check? I have lingual so I'm worried it will be hard to transfer if it came down to it.

[Tyrantblade]

Seems like you may have cause to see about getting another consultation to see if another ortho/staff would do better.

As expensive as treatment is, we should all get a great Orthodontist and staff, and if things are constantly not up to par, why not see if you can find better?

I know sometimes my Orthodontist/staff isn't "perfect" and some adjustments are slightly rough (sometimes closing the door is more painful than usual); but I always feel like they do adjustments at a regular pace and until something goes wrong I trust that they are doing good because I have no reason to worry so far.

[djspeece]

I think that the vast majority of board-certified orthos are very competent in their field, but I suspect that many lack management, supervision, and leadership skills required to run a tight ship. I was very pleased with my ortho, Dr. Andrew Schwartz, in these regards. His techs seemed fairly experienced and technically competent. He'd sit down, do his assessment, and then type in his findings and orders into an electronic record and verbally tell the tech what needed to be done. After she was done, I had to be checked out by him before I could leave. I had one Damon bracket that gave them all fits when they tried to open it but they would get it eventually, sometimes asking for help (which I appreciated). They had good hand-eye coordination (as a nurse I think I can assess that pretty well) and pleasant personalities. I have been told by Kipepeo (my SO whom I met through this board) that my face projects a message that "I am available to chat or to hear your woes" and sometimes that brings on interesting results. I do like to chat it up with strangers. In the ortho's office, one of the techs would tell me about her issues and then complained about how hard it was to get powerchains over Damon brackets as she was replacing them. I just let it slide though. When I was about to debraced, I was having a mold made for Vivera retainers and they had a very tough time getting it done -- I think it was related to something in my mouth -- tongue got in the way, or something. I even had to come back for another go-round. However, my ortho comped the upcharge for the Vivera (Invisalign) retainer due to inconveniencing me, and ended up making a mold of my teeth using another technique that required him to put extra hours in to get the mold just right.
As far as changes go, they are excruciatingly slow. That is a good thing, of course. Don't evaluate the ortho based on speed. Four months is really not that long in ortho time. Ask him to give you an assessment of what has changed -- they may be too subtle for you to notice, but may be foundational to the final result. My ortho did provide an overview of the plan from time to time but didn't talk a lot about it. My progress was very slow, so much that I needed an extra year to close gaps. Apparently my bones are very dense and I have long roots. So sexy, I know. He was explaining it to me, and of course he could not resist saying "Well Dan, some people are just more dense" and then laugh at his little joke. As did the techs, of course. But I brought that on myself. I think it was on my second or third visit I would test his sense of humor. So I bought a set of those goofy teeth things that fit on top of your normal teeth. Some had overbites from hell, others had teeth missing, and so forth. So I picked the one that was the most horrendous, and surreptitiously inserted them once I was in the chair but before he came over. He asked how I was doing, and I partially covered my mouth and said "I don't think these braces are working" then removed my hand and smiled. To his credit he just laughed a little and said "Yeah I bet you've waiting a while to pull that stunt." What this has to do with your question, I do not know.
If you do have concerns, I would ask him directly about what is going on. I think sometimes they assume we know more than we really do -- I suspect many adult patients are better informed than adolescents. I would bring up the issues with the techs as well if they are flailing around. You are paying a lot of money to avoid amateur hour. Mistakes and miscues happen, but they should be the rare exception and not the rule. Best of luck to you!

[SinkFullOfDinner]

I feel your pain Shellyt. I wouldn't place too much emphasis on how long your appts have been running since you have linguals. Appts for those just take longer. My ortho commented on that early on, and the assts mention it frequently. They always book more time for mine and it seems like they take forever. It's part of the reason that they charge more - more chair time for both of you. So many things that would otherwise be routine are in reverse or upside down or involve slots that are vertical instead of horizontal. Just think about how much more awkward it is for them to put a power chain on linguals compared to running it across traditional braces. Unless your ortho's practice does a LOT of lingual cases, the techs just don't handle enough cases to develop muscle memory. Even if they do, it's slower. Now, that doesn't mean the plan or mechanics are off, just that they can't fly through the appt with their eyes closed.

As for progress, welcome to the world of individual variability. It seems some people on this board have progress that's lightning fast (I hate them...no, I'm just envious...no, I'm happy for them...really...not really...I hate them), while others are more stubborn. Mine have moved slowly and at times reluctantly. I wish it were different, and early on I wondered if they were getting it right, just like you. But eventually they've been going exactly where they should, so everything appears more or less correct and I don't spend as much time worrying if they know what they're doing. It's just excruciatingly slow and bad luck on my part. Sure, they may tweak here or there and maybe even have done something slightly differently in hindsight after seeing how your case responds, but they can't always predict your specifics, and the ability to tweak plans is part of the benefit you're getting by choosing a highly regarded, board certified ortho.

I don't know if this helps, but I just chalk it up to it always taking the techs longer to do simple things with linguals, and you just have the same bad luck as me and many others when it comes to cooperative genetics. Hopefully things speed up for you, but even if not you'll eventually get there (I'm also telling myself this...kind of my own SNL Stuart Smalley reaffirmation). Good luck!

[Shelleyt]

Thanks for the awesome responses everyone! I am going to give it a couple more months and see how things go and then if I am still feeling the same I will get a second consult. One point I forgot to mention is that I did get a sort of "video progression" from the lingual bracket/wire maker that shows where I am supposed to be at different stages and let's just say my teeth look nothing like the model says they should at 3/4 months. But I hear ya on the "some are just slower" point so I will test my patience until I'm sure something is wrong in my obsessed head really regretting the extra $$ spent on acceledent since it doesn't seem to be moving things along any quicker.

Lingual still seem worth it if I eventually get the end result, but I am so impatient! Such a vice!

[djspeece]

That's a good plan but please try to find time to talk to your ortho before getting a second consult. I think sometimes the advice to get a second opinion is premature -- give your ortho the chance to make things right by you. Best of luck to you!

[Trickycoolj]

Are you perhaps getting the new assistant every visit? I've noticed since I'm such an "easy going" patient at the regular dentist I always end up being the training patient for new assistants for both fillings and invisalign attachments (I'm notorious for breaking them off). My dentist is super particular about her methods and follows a specific checklist and I'm always the person she seems to like to use to teach that method. I don't know why she seems to have a revolving door for her second assistant. I think she's a perfectionist that demands as much from her staff. (see my story post about my refinements getting stashed away by an assistant for 2 weeks without telling anyone and delaying my treatment, TL;DR she got fired) At this point I'm so familiar with the attachment bonding process for Invisalign I did the coaching on the most recent unplanned visit!

As mentioned above, someone can be a great practitioner, but might not be the best office/staff manager/trainer. I see that in a lot of industries. The best engineers rarely make the best engineering managers.

[hend]

Hi,
I put braces five months ago, but the base metal of the two front teeth slanting. This led to make these two teeth slanting. I asked the doctor and he replied that it would be amended, but I feel it is getting worse. I don't know that is right. do any one have experience about that?

[Shelleyt]

Unfortunately, I'm four months further into treatment (8 total) and the concerns persist. Absolutely nothing has changed. Not only have I gotten no results, but every single time I come in for an appointment I have waited a minimum of 30 mins from my appointment time to even get in the chair (average is 45- two weeks ago I waited over an hour). I mentioned to one of the assistants that I was concerned that the one tooth the ortho has failed to rotate into place enough to put a bracket on (yes- even after 8 months she hasn't managed to get a bracket on every tooth) and she told me that even she thinks the ortho is doing it wrong. The final straw was when I visited the oral surgeon for a follow up recently and he told me the ortho has not correctly been pulling down the impacted tooth. When I insisted the ortho fit me in that day to fix it as the surgeon instructed, she admitted it had not been done correctly.

I am going to a consultation with a different ortho this week to see what his thoughts are on next steps.

[SinkFullOfDinner]

It pains me to hear the update, shelleyt. It certainly sounds like you've been more than patient. The fact that your surgeon confirmed your concern probably made you feel both furious about the error and loss of time, but also a little bit relieved to know that you weren't nuts to keep bringing it up. I usually just assume that I'm nuts, and that whatever "omg, why is that happening" observation that I make is part of the plan!

The one (and only?) good part is that your ortho acknowledged that it had been done incorrectly instead of getting defensive or making up some justification for why her approach and the surgeon's are just different paths to the same result. I'd probably be looking at a possible switch as well, unfortunately. If you do make a switch, hopefully the history will put you in a good position to get the maximum amount of credit back on the treatment cost. I assume the main challenge will be finding an ortho who has a lot of experience with linguals. All the best luck to you in getting back on track, and either finding a new ortho that you're confident in, or finding a path back to a position of trust with your current one.