Do you know any orthodontics consultants that specialise in very complex cases?

[LaCerbiatta]

Basically I need the best orthodontics consultant around. Happy to pay whatever and go wherever. Any recommendations would be really appreciated.

16 yo dd has complex and unusual (almost unseen) issues with her teeth that means that some of them, at the front, will just not come out.

She's being followed at the NHS since she was 8, has had 4 operations and basically 8 years o force being applied to her teeth with only limited success. It's now come to a point where we need to consider more creative, drastic solutions. She'll be starting 6th form soon and we're so concerned about the impact this is having on her confidence and mental health 🙁.

Although we do trust the NHS team we feel we also need to get a second opinion. Thanks so much!

I had very complex ortho needs as a teenager (including supernumerary, class III malocclusion, a very small top palate etc etc). I was treated at Guy's in the orthodontics school, on the NHS, as there was a medical need. IOTN is here: www.guysandstthomas.nhs.uk/our-services/dental/specialties/specialities.aspx#na

Which hospital is she being treated at? I would say you need a specialist hypodontia clinic, a restorative/Orthodontic joint clinic which specialises in missing or impacted teeth. Any dental teaching hospital should offer it, and many bigger hospitals also ha e joint restorative/Orthodontic clinics.

I don't think a lot of recommendations for practices on here are going to be of much use. Supernumerary teeth, class 3 jaw relationships, impacted canines/gold chains etc are all relatively common and have a set management pathway.

Your DDs case sounds more complex, multiple unerupted teeth with no cause is rare. It sounds like a lot of the usual management options have been tried. I'm really not sure there's any one out there who can magic up an Orthodontic solution, and moving forward I would prepare yourself for more of a restorative approach.

Have they definitely confirmed there's no underlying cause?

As the mother of a DD with complicated teeth I would say you need a referral to the oral maxillofacial unit.

DD had some teeth and jaw missing, had a bone graft, major brace work and eventually a Maryland bridge. She got her new look at 18, on the day of her prom!

Here is a during and after pic.

Thanks all. She is being treated at the oral maxillofacial unit at Addenbrookes in Cambridge and we trust their expertise but we've found at times, in these 8 years she's been followed there, that their response has been a bit slow and reactive. We took the initiative at several points of requesting second opinions, additional scans, etc, and that has pushed things along.

So as an example, right at the beginning of her treatment she had gold chains pulling the front teeth down and nothing was happening. They did for a long time and would not do an x-ray or consider why things were not moving. So we went for a private appointment where they found one of the lateral incisors was blocking the front tooth and no amount of pull would bring it down. That led to change in direction in her treatment, another operation, etc. And the same thing happened at other points as well.

So that's why I just want a separate opinion, have someone else consider the options, maybe come up with a reason why things are not moving, or suggest a different scan or direction. I just can't sit back and watch nothing happening when she's so depressed about this and will be going to 6th form soon :(

Thansk again for the recommendations and thanks Cormoran (I'm a big fan of yours! ;)!) for sharing your dd's beautiful smile!

My son has severe special needs and teeth beyond any dentist's wildest dreams, and he is treated at St Thomas's where they have a special hypodontia clinic.

www.guysandstthomas.nhs.uk/our-services/dental/specialties/specialities.aspx

We were referred by Great Ormond Street but if you could get referred there I'm sure they could help. Some children with rare genetic conditions (including mine) have really, REALLY complicated teeth issues.

PS I meant to say I think you'll get the best people on the NHS for something like this. IME, with a disabled child with a million and one really complicated things wrong with him, there comes a point where it's so rare it's not worth a private doc bothering with.

I know you've already slightly exhausted your NHS options, but I wouldn't hold out hope that private will mean better as in my experience the reverse is true for severe problems of this nature.

UCLH Eastman Dental Hospital in London has been mentioned already and they are really good.

I have an ongoing problem with my jaw and jaw joints and have been with them for about 4 years now. (Dental and oral surgery team). Had a couple of operations and they seem to know their stuff.

Also, on a completely different note I wanted to say well done for doing all you can for your daughter and getting her the best care possible. I would not be where I am today (having horrendous problems with my jaw, mouth opening and teeth) if my parents had bothered to do that, instead they left me with no treatment whatsoever.

Thanks Yes you're right, we've been told before no private practice would want to touch her case as it's so complex and will take so long and that's not what we're after. We just want a second opinion that we can take back to her consultant.

We've done that before with a consultant from Guys and although we didn't follow his advice, it gave us some reassurance on what options were available. Also I think it gave her team at Addenbrookes a bit of a push, if that makes sense? like being a bit more proactive rather than waiting for things to happen

It's nice to hear so many of you recommending the Eastman dental hospital. I'm planning on emailing them with details of dds case and asking for a recommendation for a private appointment.

Thanks for the kind words @ElectraBlue and so sorry you're going through complicated interventions as well. Anything related to your mouth is so painful and has such a big impact on your image and well being. Hope your treatment is going well and will come to completion soon.

Yesterday dd was saying that maybe replacing all her front teeth with implant was the best thing 🙁. Even the teeth that are out are so wobbly and sore from being handled and pulled so much that she can't even bite on a sandwich 🙁

@LaCerbiatta

Thanks for the kind words *@ElectraBlue* and so sorry you're going through complicated interventions as well. Anything related to your mouth is so painful and has such a big impact on your image and well being. Hope your treatment is going well and will come to completion soon.

Yesterday dd was saying that maybe replacing all her front teeth with implant was the best thing 🙁. Even the teeth that are out are so wobbly and sore from being handled and pulled so much that she can't even bite on a sandwich 🙁

Your poor DD, my daughter couldn’t bite into anything hard, like an apple, for her first 18 years, so I totally get it.

Hope she finds a solution.

And like a child choose to wear a prosthetic rather than worth the pain of a damaged limb, maybe tooth removal is her solution?

Just reading that is making me shudder 🙁. But I think we'll need to consider all options, including that...