Orthodontist advice please after hospital refused surgery

[theinnergame]

Good afternoon! Very frustrated after an orthodontist visit with my 17 year old today.

In March, NHS referal to orthodontist, who examined dd and referred her to hospital for surgery (to break her jawbone and reset, something like that, not possible to realign her teeth without this). But hospital has refused the surgery saying orthodontist needs to speak to his mentor and sort it out (I think this means without surgery, but haven't been able to see the letter as hospital did not send a copy and it's in orthodontist's briefcase having not yet been scanned by his office). Office called us in to see him. He took more scans (3D digital) and xrays (including sending us to hospital for some) and will send this to his mentor - who is a Very Busy Man, so to manage our expectations has advised that it could take 4 or 5 months to hear back from him.

At this point the mentor might advise him how he can do it, I guess? But he's not confident because he says it's very hard to do and get the high standard of result that he would want without the surgery. He said we could take it back to our dentist and get referred to a different orthodontist... but surely their referral to hospital will also be rejected? He says we can't appeal/reapply to hospital as they are dealing with him (contractually). We could go private but could cost £6k or £20K-£30K, he said (we don't have that sort of money). And I wasn't to keep discussing to clarify as it would delay the people waiting for their appointments... He says hospital has been rejecting a lot (and we both agree there is likely a financial constraint at play there).

I'm not sure what will happen in 4-5 months when the mentor replies - will he say "sorry I can't do it" so we may as well walk away now, or what, or could it be that the mentor will have helped him see how to do it? I'm not sure why the extra scans/xrays were done today and not before the hospital referral. Or will he do a straightening job that just isn't that good (or maybe it will be good enough?). She's in her A level year so not keen on a lot of disruption either.

Here's my query - can I speak to the hospital at all? Is it worth trying a different orthodontist? Any advice! She has teeth growing outside of others, and none meet, and there is an overbite too (they had to wait until all through and covid delays hence no earlier action). She doesn't smile much especially not for photos.

What a nightmare. When is your daughter 18? Will she still qualify for this treatment then, or will they remove it because she is an adult? Just wondering if they are delaying intentionally.

No, that's not an issue, as they go by date referral received by orthodontist.

Are you in the UK? This sounds very odd with all the mentor business. Are they a specialist orthodontist or a general dentist? Who did you see at the hospital? Just the surgeon or the hospital orthodontist aswell? Any idea what her IOTN is? Might be on some paperwork. (UK dentist, previously worked in maxfax)

Is this NHS uk? Sounds odd.

If so you can speak to PALS at your local hospital and ask them to look into this and provide clarity. You are also entitled to make a request to view medical records and documents so could access those fairly easily.

Thanks for your support.

Yes, it's England specifically and the orthodontist - we haven't been to the hospital as the referral was refused.

I was already planning on speaking to PALS about that refusal, and a colleague has suggested the GP because of the hospital connection.

I will also be seeking paperwork as we have none currently - I used to work in DP so aware of rights.

And I think I will speak to our dentist about whether we should look at referral to a different orthodontist.

Bit fed up about it all really. Like I need all this on top of work, and poor dd was so happy when she was referred that finally she might get sorted out!

As me good point about IOTN, will ask dentist for a copy of referral - we didn't get that either which should have iotn - it did for older daughter (who never got seen because of covid).

I think perhaps getting a second opinion from another orthodontist would be a good idea? The hospital seem to be questioning your current orthodontist’s treatment plan. Breaking a jaw and resetting is quite extreme, I think I’d want a second opinion anyway.

No advice sorry. I'm surprised how quickly you were seen. My two DD's took 4 years to even have a consultation.

DD1 sees a local orthodontist. She has now had a brace for 3 years.

DD2 has to go to a hospital 30 miles away as hers is a complex case.

What is the mentor stuff? I don't understand that at all. I worked in an NHS orthodontist for years. Plus general practices where they had specialist orthodontists. Never heard of a mentor? Unless you were seen at a teaching hospital by an undergraduate student?

Why has your DD been referred so late if it's assessed she's so severe she needs to have her jaw broken? My DD was assessed a grade 5 (most severe) and her jaw was re-aligned by means of an orthodontic appliance (which I understand is more effective as a younger age, so that's why I'm wondering if referral was done before and it's something that doesn't happen that often, hence reason for checking).

This doesn’t make sense.

You say none of her teeth meet but then say there’s an overbite. If the teeth don’t meet that’s called an “open-bite” and means there is no overbite.
Overbite = the vertical overlap of the front teeth, where the upper front teeth partially cover the lower front teeth.

One is the opposite of the other so you can’t have both.

Hi. I assume you mean your DC has been referred for an Osteotomy (Orthognathic Surgery to break the jaws).

When you say mentor, what does this mean?

If you’ve seen a qualified Specialist Orthodontist, they don’t need a ‘mentor’. They should be qualified enough to know what is achievable with orthodontics, and what needs orthognathic surgery. I would always advise my patient on both options (the latter being brutal but worth it if malocclusion is severe) and refer the patient along with relevant radiographs and records.

Why was the referral refused?

Sorry, just reading more into your OP.

Stating ‘the orthodontist has the radiographs in his briefcase’?! This is HUGE breach of data and confidentiality rules in the hospital, and I doubt any secretary would admit to that? Serious trouble if he removes his briefcase from the hospital (I assume he does everyday on his way home)!

Also - please do not consider private treatment! I would never recommend that for my patients - I would be ringing to consultant and asking them to talk me through why the referral was rejected and what the options were moving forward!

If your child is eligible for orthognathic treatment, they are eligible and should be offered treatment. It’s that simple?

When it comes to treatment times and waiting lists, that is not so simple.

One last thing - 17 is pretty young to be considered for orthognathic treatment (you’ve stated they were waiting for all permanent teeth to come through) so quite delayed and potentially still growing?

I had orthognathic surgery as an adult. However I saw the orthodontist at the hospital and he liaised with the maxillo facial surgeon regarding the surgery, so I was never referred to the surgeon for the op, it was all sorted out in one department.

There is a huge shortage of dentists, dental surgeons so they are pushing back I suspect - your poor DD.

GP unlikely to touch anything dental.

I would contact PALS, then your MP.

FWIW my dentist was training both a new dentist and a dental nurse when we went for checkups last month (NHS). Dentist was very pessimistic about state of things to come and so if there is any way to go private I would as your DD could otherwise be in limbo waiting for treatment for ages.

13 years of Tory underfunding has a cost.

I suggest you start playing the game. Push hard, but politely on all fronts. Write polite email to orthodontist, ask for copy of letter, write to hospital, write to mentor. Ask how this can proceed rather than stagnate.

Did you see an orthodontist in training?

Even if you didn’t you need to ask for a second opinion as the oral or max fax surgeons disagree with the management plan.

Not necessarily. DS has a huge overjet and overbite. His teeth don’t meet because his lower teeth touch his palate not his upper teeth. He’s currently got twin blocks to reduce.

Is the orthodontist you saw an overseas dentist? That's the only time I've heard of a mentor type situation. Or an Orthodontic therapist? They can't treatment plan though and I'm not even sure if they can refer so I wouldn't have thought it was that. I'm just really confused by the mentor thing.

@Maelil01 well, I'm not a dentist, was trying to describe what I say. Sorry it made no sense for you. I was only describing for some context. The issue as I see it is around processes, which seem odd to everyone else too (including you).

@Lottie4 I'm not so sure the "jaw breaking" is that severe. I think k it just sounds more dramatic. None of my girls were referred earlier because the lady of their second teeth didn't come through until 15 ish. And covid. The youngest two (this is the youngest) were referred from first dentist appointment after covid.

Mentor - this term was first mentioned to me by the orthodontist receptionist when she said the hospital had rejected the referral, and the orthodontist himself used it today. I know no more about it but presume it has the usual meaning of a professional who coaches you to improve I. Your profession. But I don't know. One of the reasons I started the thread was to understand if this was a usual arrangement.

I can't quite cover everyone's questions - he's not from overseas, in his 50s, not new (he said he's very experienced).

@Oblomov23 - yes this will need to be my approach but the MP is a no go as he is a buffoon.

Outing the location completely here but he is Sir Edward Leigh - a Thatcher protégée. So politely acquiring paperwork, contacting hospital, PALS and our dentist (nice enough but not great).

I believe you when you say mentor I just honestly can't work out what it is. If he's a qualified experienced specialist orthodontist there is no reason why he would have a mentor. In my 20+ years in dentistry as a dental nurse (7 years in an Orthodontic practice) I've never heard this term before unless in relation to overseas dentists or Orthodontic therapists. Or maybe someone who is very recently qualified as a dentist. So I'd query that with them. What exactly do they mean by mentor. You can also check the orthodontists status on the GDC website to check if he's actually a specialist or just a dentist with a special interest.

Go back to your own dentist and ask for a re-referral to another NHS Orthodontic provider.
Take it from there.
Sounds weird.

Thank you - only the letter in his briefcase but yes, not adequate security for personal data (health-related).

All your other points helpful too.

@Mukey oh thank you, I'll look him up now!

Thank you all, it's something of a relief to hear it's as odd as it felt. We also saw a dentist who took a range of photos and digital scan, a dental nurse who took frontal X-rays and then were sent to the local hospital for side X-rays (not the hospital that rejected the referral).

So on GDC his specialty is Orthodontics, first registered 1988, trained in London.

The other thing that seems odd to me is if the hospital letter knew about the mentor but this isn't a standard practice.

I'm going to stop speculating and gather the info. And ask the dentist for another referral to different town. I have little confidence in that place.

You've all been really helpful. Thank you.