AIBU to hate myself for okaying DS's permanent canine tooth extraction?

[hollsh]

Have felt completely useless as a parent since yesterday, so been searching mumsnet for similar issues, but can't find anything that exactly fits... Hoping someone might be able to offer advice?

DS (15) has always had really bad teeth - not bad in terms of decay etc., but bad in terms of looking quite badly messed up. Baby teeth were late coming through, as were permanent, and then baby teeth blocked permanent etc. etc. We always knew he would need a brace - question was when not if. Got referred several years back to orthodontist. First one we saw seemed really nice, but just kept calling him back each year to check on progress of him losing baby teeth. It was getting to the point where we thought some baby ones might need to come out, but then they kept bumping his appointments - and then covid happened... Once they started appointments up again, they put him with a different orthodontist - as they said it would be an even longer wait for the original one. I wasn't mad keen on this plan (long story!), but we went along with it anyway, as the alternative wasn't great either.

They sent him to have 2 baby teeth removed, and then he had his lower brace fitted. So far so good. Then they said he would need 2 permanent teeth removed, and referred him to normal dentist for this. The appointment for this was yesterday.

About a week ago DS said he was worried as they would basically have to dig one of the teeth out. It sounds crazy but I hadn't really thought before about how impacted some of them were. I started panicking a bit at this stage, thinking maybe he should be having this done in hospital, so I decided to just double check it with the dentist when we got there - the other tooth seemed like quite a straightforward extraction anyway, and I didn't see any problem with them taking that one out, so I knew it wouldn't be a wasted appointment.

When we got there the dentist himself seemed quite apprehensive about it all, and I asked him whether DS ought to be going to hospital for the impacted tooth. He took two x-rays and then said he should be ok to remove them but that the impacted one was a canine so would have a longer root. No one had spoken to us about it being a canine extraction previously and, to be entirely honest, I was more concerned about it being impacted at the time. I don't think I was really thinking straight at this point, and already felt like I'd been making a bit of a fuss.

As it was, the whole thing was mercifully very straightforward, and DS did not even need paracetamol last night. But, after the initial worry passed, I started thinking it might look a bit strange having a missing canine tooth, so I hit google... And that's the point at which I started to feel completely useless.

Basically, it now looks to me (without knowing anything about this at all) that permanent canine tooth extraction should be an absolute last resort. And that even a very high, impacted, canine tooth can be brought down with some kind of chain device? So now I'm thinking why didn't they remove a premolar, as they have done on the other side, and try to bring the canine tooth down into the gap? And why didn't anyone speak to us about the seriousness of this? Shouldn't DS have been referred to the hospital orthodontics team to explore alternatives, if this really was such an extreme case?

I am literally sitting here shaking and crying that I have allowed this to happen. I feel so ashamed. DS is blissfully unaware of any of this and is just pleased he has no pain and is one step closer to straighter teeth. I know there is nothing I can do now about what I have already allowed to happen (that's obviously why I feel so terrible). I don't even blame them really - I blame myself for not being more 'on it' over something so serious.

Really I'm just looking to see if anyone has a similar experience and what I should do next? Should I query this with the orthodontist/dentist? It's too late to ask for a second opinion about what has already happened, but should I ask for one for the next stage? How would I even do this? Is this so bad that I should make a complaint? What about other kids? What should DS's future treatment look like? Should we push for a canine implant? (seems crazy, given they have just taken one out, but still...)

Obviously, the internet is a pretty scary place, and I have been reading stuff that says this will literally mess his face and jaw up - is there anything sensible I can read on the subject?

If you're still here, thanks for reading this far - and thanks so much if you are able to help at all!

Can you get a second opinion from a private orthodontist? There will always be some sort of solution. I have two missing lateral incisors that never grew in and am about to have orthodontic treatment followed by composite bonding to fox the appearance. It’s amazing what can be done so I think a second opinion might put your mind at rest

Hi. Dentist here. Don't panic! I think the main problem here is that you don't really seem to know or understand what is going on and what your son's actual treatment plan is. I know it's difficult as after so many appointments spaced so far apart it's easy to lose track of things. But I think as a parent you need to be proactive in trying to get a recap of everything and making sure you are understanding what is being said at the time and asking questions at the appointment to make sure it's all crystal clear. I also think the dentist/orthodontist should be recapping things for you as well as this is all part of the process of consent.

It seems like it probably was explained but maybe you forgot some of the details? Generally canines are never extracted unless it is a last resort. Are you sure it was an adult canine? And not an impacted supernumerary (extra tooth) ? Or a baby tooth?

Try and make an appointment with the orthodontist to find out what his overall treatment plan is. If this is not possible then make an appointment with the dentist. He would have been sent a letter from the orthodontist outlining the general treatment plan and indicating the teeth which were to be removed. So he also may be able to explain things.

Don’t know about the canine tooth issue itself but I had 9 teeth extracted as a child. 4 baby, 4 adult and 1 wobbly baby one that needed help.
My teeth today look absolutely fine now but I did need braces twice. Once as a child (that were removed prematurely because I couldn’t handle them any longer) and once as an adult (my choice).

I think you need to figure out what exactly is going on first with his treatment plan and then if not happy or convinced to then seek a second opinion.

My dd got 2 adult teeth removed in order to get her braces fitted (plus a baby tooth that had refused to come out). Her teeth look lovely now.

Her teeth were also removed by the normal dentist with just injections for numbing

my ds1 had the teeth behind his canines removed to make his braces treatment easier and shorter. He had sedation. It was fine.

Please don't worry. I had to have all 4 of my canine teeth out many, many years ago. I don't know enough to know why canines aren't usually extracted, but I am fine. It hasn't caused me any problems in life at all.
Do speak to your orthodontist and/or the dentist again though.

Don’t beat yourself up, it’s done now and it will be fine.

We were in a very similar position and nagged and nagged ds1s dentist about an Orthodontist referral which they ultimately agreed was necessary but everything got delayed even further due to covid. Ultimately we paid to see a consultant at the hospital and then paid for a private orthodontist and a private dentist. DS1 has a similar issue with an impacted canine but has still had to have a tooth removed on the other side of his mouth to make space for the canine to be pulled down with a chain. Its a really lengthy process though, is costing thousands and still might not work. Plus at 16 it’s very late to do it and he’s very conscious of his braces. He might need the canine extracting if it can’t be pulled down. Your DS may have been the same even if you’d gone through that process.

Glad he isn’t in pain and is ok.

It’s fine now and he’s fine. I had my canine teeth removed as a teenager and I’ve never missed them for a second. Having your tooth brought down by a chain sounds very painful. Also why is it only on mumsnet that people cry and shake?

*done

@LadyCatStark

It’s fine now and he’s fine. I had my canine teeth removed as a teenager and I’ve never missed them for a second. Having your tooth brought down by a chain sounds very painful. Also why is it only on mumsnet that people cry and shake?

Probably for the same reason it’s only on mumsnet people can’t resist responding to someone who is upset by being snide and pissy?

Weird eh?

I had a canine removed as a teenager in preparation for braces to even out my top teeth and my teeth are in great shape now.

Your DC will need to keep a close eye on his jaw if he's prone to overcrowding and impacted teeth - several years later I had all of my wisdom teeth out as they were impacted too.

Please don’t worry about the canine teeth OP.
I have a hereditary issue with my upper canine teeth - they would remain in the gums forever if they weren’t extracted (my father still has them in his 80s). So when I was 14 I had them removed under general anaesthetic. Before this I had 10 teeth (!!) removed at the dentists surgery over the years because my baby teeth took forever to fall out and my mouth was a mess. 2 years of braces sorted out everything when I was 14/15 yrs old.
It doesn’t look odd having no canine teeth and they serve no purpose for humans any more.

I think you need to speak to your dentist/orthodontist again, to clarify the treatment plan and reassure you. I was lucky to have the most amazing dentist. Perhaps if you don’t feel reassured after speaking to yours you should consider changing dentists?

@chilliplant634 I think the OP is probably feeling guilty enough already about all this, you obviously understand this all from a dental point of view but your post didn't come across as very kind to my reading of it.

OP I think it's completely normal to trust health care professionals and not to second guess their treatment plans. So sorry you find yourself in this situation. I don't have any dental advice but be kind to yourself!

I had a lot of teeth extracted as a child, "traintrack" braces twice (teeth moved after they came off the first time), a permanent retainer glued to the back of my top teeth after the second set of braces came off, and when that came off decades later my teeth moved AGAIN anyway! I had gaps, a missing incisor (so 2 canines but one was right next to my two front teeth so looked odd) and crossed over front teeth.

I gave in and had composite bonds done which are basically white filling material shaped into nice even tooth shapes and glued on top of your teeth. No filing needed and even my dentist said she couldn't believe how good they look and that she'd assume I had amazing orthodontic work done on my natural teeth if she didn't know better.

In conclusion: you haven't ruined your son's smile, there are solutions if he doesn't like the way his teeth look, and even if you did everything right like my poor parents with frequent orthodontist trips over several years, your teeth can still move around anyway and look like you never had braces. It'll be fine!

You're right that canine tooth extraction isn't very common but not unheard of. It really depends on how impacted the tooth was. In some cases an exposure can be carried out (what you're referring to as being brought down with the chain). However sometimes it really isn't possible due to how highly it's impacted or the position of it. In these cases, the premolar (tooth behind the canine) will fill the space where the canine should have been. To an untrained eye, you wouldn't even be able to tell the difference.

I agree the problem here is you aren't clear on the treatment plan and I'd urge you to speak to your ortho for some clarification. Sometimes these appointments can be a little overwhelming with lots of information and I guess parents just go with it as they're pleased their child is finally getting a brace.

Perhaps it was even a supernumerary (extra tooth). I'd recommend asking to see the x-rays too for a clearer idea of how impacted this tooth was. When you see a horizontal tooth lying stuck in the bone, it's easier to accept (if this was the case).

The good news is how well your son is coping! This is great and is a comfort to you. Please don't worry yourself at this stage. Arrange to speak to someone about his treatment plan to put your mind at ease.

I had to wear a permanent brace on both my upper and lower teeth for 4 years. Prior to it being fitted I had 4 teeth removed - 2 upper and 2 lower. The brace was then fitted and my teeth were moved back to fit the gap and aligned. 3 years after the brace came out I had all 4 wisdom teeth removed. So in total I've had 8 adult teeth removed. So yeah, you are totally being unreasonable.

I had loads of teeth out as a child because my teeth are very big and my mouth was going to be really crowded. I was younger so some were baby teeth, but four adult premolars were also removed. People comment on how nice my teeth look now!

you’re SHAKING over this?

Sorry, I really didn't mean to sound unkind! My main point was that you can't assume that something has gone wrong or that the wrong treatment has been carried out without actually knowing/understanding what the treatment plan is. There has obviously been a breakdown in communication/misunderstanding here which needs to be rectified and OP needs to be brought up to speed on what's going on.

I second what a pp mentioned that maybe exposing and bringing down the canine wasn't an option for some reason. It is also true that in the cases of missing canines orthodontists can move the premolar into its place and angle/modify the tooth to give it a very similar look.

My brother had the chain thing for years, it was a hassle looked strange and in the end the canine was still removed as it didn't work. I had similar issues and just went straight to removal. I think both of our smiles look pretty normal.
it can be so difficult making lifelong decisions for our children and this case you didn't even know there was a decision to be made as you weren't presented with the options so I totally understand why you're upset but I really think it will work out fine for your son.

Feeling out of control and/or pressured into a decision you don't really understand is horrible.

FWIW I had a number 3 tooth removed from one side and number 4 from the other side (both on the top) and then braces to straighten everything up, and it looks absolutely fine now.

Please don't worry. DD2 had 2 upper canines removed because they were impacted and the wrong side of the next tooth. Her premolars are being brought around into place and her orthodontist has said that 99% of people (non dental professionals) won't even be able to tell.

I had years and years of orthodontics as a child and teenager, and had teeth pulled at various points between the ages of 8 and 13 - I couldn't tell you which ones or how many, but having just done a survey of my mouth vs the standard number of teeth I seem to be at least 6 short (not including wisdom teeth). Speak with the orthodontist so you're clear on the plan of action, but there is definitely an element of trusting in the process - it will almost certainly all be worth it.

Thanks to everyone who has replied and sent kind words. Yes, it was definitely an adult canine tooth - the baby teeth that needed removing had already been done previously. I knew he was having 2 adult teeth removed to open up some space, due to overcrowding, and wasn't too stressed about this - it was the fact that one of the teeth was quite badly impacted in the gum that I was worried about beforehand. It was only at the extraction appointment I realised that tooth was a canine. I don't know why I didn't think about this beforehand - I was worrying, but not about that. I am 100% sure that yesterday was the first time anyone had told us it was a canine tooth to be extracted. I am also 100% sure that no one has ever said anything along the lines of 'we don't usually extract canine teeth but, in this case, we're going to have to'. No one has ever mentioned any alternatives or why they might not be viable. The ortho practice he goes to is NHS/private. We are NHS. They tried to upsell the private treatment on the first appointment, but this was never on the basis of extra treatments that weren't available on the NHS (if that's what the exposure/chain thing is?) - it was only ever put to us that appointments etc. would be closer together, and he could have a less noticeable type of brace, if we went the private route.

I'm not upset because I have allowed him to have permanent teeth removed (I realise this happens all the time), I'm upset because I've allowed him to have an adult canine tooth removed, and never queried this, when I realise now I ought to have done. However, it's not the case that there's a lot of information given to us at the ortho appointments, and we struggle to take it all in/retain it - the opposite, in fact, is true. The appointments are rushed, barely any information is given, and they seem to find any questions we do ask a bit of an annoyance. Because of the way the appointments work, I don't think I will be able to speak to the actual orthodontist about it until at least December time. I asked the dentist about the treatment plan yesterday - he said all he had was the letter telling him which teeth to take out and he couldn't comment further than that because he's not an orthodontist. I actually said something to him like 'I suppose there's no alternative but for that tooth to come out though, as you can presumably use a brace to move teeth horizontally but not vertically?' That was when he said he couldn't comment. Obviously I now feel like a complete idiot for saying this, since I now know that you can indeed pull a tooth down (although perhaps not this one, as one or two pp's have said might have been the case).

I could look at paying privately for a second opinion, but it's obviously been done now - and I would have to tell DS why I am taking him to someone else. Since it won't change anything that's already happened, I'm not sure that would help him. At the moment, it's only me that's worried about it - I'm not sure I should put that on him at this stage? And would I even be able to do this anyway, whilst he was still on the books with his current ortho?

It was the thought that he would have a canine on one side, but not the other, that first got me googling. Hopefully, it will be possible for them to angle the premolar in some way so it's not as noticeable, as one or two pp's have suggested.

I will definitely raise it with the ortho when we see him.