Any dentists or orthodontists here? Need advice?

[Lovemusic33]

Hopefully I won’t out myself.

Dd is 16 and was referred to orthodontist about a year ago, we went to a clinic who barely looked at her and got offered private treatment or a referral to the hospital as dd’s teeth are quite bad. We took the referral and went in today for what I expected to be preparation to have braces fitted.

Dd has a 12mm overbite and her bottom jaw is significantly smaller than her top jaw. We were told that it would be hard to sort dd’s teeth out as there isn’t enough room in her lower jaw. We were then told she would need surgery involving her jaw being broken and moved forward using pins/plates. We have been referred to a bigger hospital. I was a bit shocked but since being home I have googled and I’m worried sick about the surgery as the recovery time is pretty long. Dd is taking GCSE’s in a few weeks and although surgery probably wouldn’t happen for another year she will be half way through A levels and would possibly need 6 weeks recovery time which could effect her studies. Dd also has ASD and will not cope well with the whole thing, today was bad enough having xrays and moulds taken of her teeth (there were tears, gagging and shaking). She will also need wisdom teeth removing before surgery.

I’m now wondering if I should get a 2nd opinion? If I should allow for Dd to go through surgery? Or if there are other options (even just improving her overbite by 50%)?

The surgery looks pretty awful for what seems to be a small problem. She does have issues with earning, can take ages to eat something small but not issues with breathing or jaw pain. Her teeth are pretty healthy other than her not brushing hard enough.

Any advice?

I'm surprised she wasn't referred at a much younger age. Hope someone with more experience can help

Dentist wouldn’t refer her until her baby teeth had all fallen out, they were late falling out so she was not referred until almost 15 .

When we saw the first orthodontist at the clinic there was no mention of any surgery, not even tooth extraction, we were offered the clear retainers privately to correct her teeth or to be referred for a normal wire brace.

My dd got referred quite early to the orthodontist despite still having baby teeth. She didnt get treatment at first and came back annually for a check up for about 4 years until her teeth eventually qualified for treatment. She needed a baby tooth and 2 adult teeth extracted before her braces were put on.

I'd be more angry at your dentist tbh. Maybe earlier intervention would have helped to prevent surgery

Orthognathic surgery is not undertaken until growth has stopped so earlier intervention in this kind of case is not usually appropriate. Make no mistake it is a big commitment as fixed braces are usually required before and after the surgery. Only you and your daughter know whether her teeth are enough of an issue to justify this. The nhs has strict criteria for orthodontic treatment and so this long protracted treatment would not have been suggested if it were not appropriate. Clear aligned only correct mild discrepancies and so won’t be an adequate alternative.

I do feel angry and confused. Dentist extracted one of her front baby teeth and then told us to come back when the last back one had come out (which we did) they then referred us. Dd wants the surgery but I don’t think she realises what it involves and how it may effect her studies. She does get bullied a lot, sometimes for her teeth as her overbite is pretty noticeable. She has so much going in that teeth haven’t really been our main priority, she has hypermobility syndrome and we have been trying to get more help with that, she has issues with mobility, issues with her feet not growing and now it appears her bottom jaw may have stopped growing way too early .

I’m not clear what you are angry about? You were referred appropriately and now have the decision as to whether you and your daughter want to proceed.

I imagine she's angry as the first orthodontist didnt mention surgery

Is your daughter still growing? My son had similar issues, I believe, and was originally told he’d need a major operation to put it right. However, when we saw the orthodontic surgeon he gave my son the option of block braces to move his jaw (which he was thrilled about!) as he was still growing- he was also 16 at the time. After the block braces he had a wire brace to correctly line up the teeth and is now just using a retainer at night- his jaw and teeth look fab. My son was adamant he wouldn’t have the surgery and tbh I don’t blame him.

The first orthodontist would not have been in a position to offer nhs treatment as it is obviously a complex case and so referred to a specialist for an opinion.

I’m having this surgery in my 40s. I regret not having it done earlier in life SO much. It’s great that she can get it done while she is still young.

I would definitely see if there is some kind of middle ground option. My daughter had the twin block style braces to expand her arches mentioned by a PP but they do need to be during a growth spurt so possibly too late for a 16year old girl. It sounds a lot to go through at an important time at school even without her other difficulties.

Dd also had a block appliance to change her bite before she got fixed braces

I would absolutely have the surgery. My DD went to the orthodontist at age 10 for a massive overbite (not as large as your DD but significant). She had a twin block and is now on braces.

The difference in her profile is amazing. Her teeth no longer protrude and looking at pictures from 18months ago, I cannot believe the difference in how she looks. Her confidence has rocketed and her smile is amazing.

My friend had the surgery in his 20s and it was tough but so worth it for him.

Yes, I’m angry because I wasn’t told she would need surgery, the first orthodontist we saw seemed pretty sure that she would just need wire braces fitted, they referred us because they were no longer dealing with the more complex cases (concentrating in their private patients).

Niknak that’s good to hear, how big was his overbite? I really don’t think my daughter will cope well with the surgery, she’s bad enough when she has a bruise or a mouth ulcer, she really can cope with discomfort and has a lot of sensory issues with her mouth and food. Hopefully we can discuss other options when we speak to the specialist.

If she has sensory issues than I would think something like a twin block in her mouth would be more distressing than surgery. They are like Victorian torture devices - my DD could barely speak properly the entire time they were in (8 months) and struggled with eating and moving food around her mouth. They are basically two massive pieces of plastic in your mouth 24/7.

I’m not sure if she’s still growing, my guess is she isn’t due to her issues with hypermobility she’s hardly grown in the last year.

I think it’s the recovery time which worries me and the swelling, she suffers with anxiety and I’m not sure how she will cope with being out of action for 6 weeks with a swollen jaw.

I’m to push for the blocks and then a brace to partially correct and then let her decide when she’s older if she wants surgery. She’s very young for a 16 year old due to her having ASD and I don’t think she realises what the surgery involves.

I wouldn’t underestimate twin blocks. They are dreadful and painful to boot. Plus it clearly takes a lot longer than surgery to achieve the same result.

Personally I’d opt for a nightmare 6 weeks than a hellish 8-9 months 🤷🏼‍♀️

Twin blocks will only work in a growing patient and as mentioned are very difficult to tolerate.

Obviously I’m very worried about putting her through surgery if it’s not really necessary. I also have the issue that the hospital that’s going to do the surgery is quite far away, I am a single parent and have another child who is severely autistic, I don’t have much support and no one who can look after my other dd so I would have to take her with us and find accommodation near the hospital.

@Lovemusic33 I had this surgery when I was 16. You cannot have it until you've stopped growing so they couldn't have done it earlier, and it sounds like it's such a big overbite they couldn't have done it with blocks. I was back at school after 2 weeks so minimal disruption. If you've got any questions I'll be happy to answer.

Firstly she doesn't need surgery

Orthognathic surgery is always a choice. If you are undergoing orthognathic surgery you have to really want it. How does your DD feel about her teeth?

The hospital orthodontist will know if twin blocks would be suitable for your DD, they won't correct all overjets. An orthodondist would always opt for twin blocks if possible over orthognathic surgery!

With a 12mm overjet there's very little that can be done without surgery apart from basic straightening. However I think anything other than orthognathic surgery is likely to make the problem worse.

She won't have surgery until she is at least 18. She will need braces first and she needs to have stopped growing. You can have the surgery at any point, so if she doesn't want it now she can have it at 25, 40 etc.

The first orthodontist probably doesn't deal with orthognathic cases therefore wouldn't have necessarily been able to say whether your DD needed it. They referred appropriately to a specialist

The hospital orthodontist is most likely a consultant orthodontist. They will have masses of training under their belt. They know what they are talking about

Being referred earlier wouldn't have changed anything. It's likely the orthodontist would have said "come back when all your baby teeth are out"

At the end of the day this isnt your decision. Its your DDs choice, and will be done when shes an adult. You dont put her through the surgery she does. Yes the surgery recovery is a lot. Your DD will be swollen and sore for weeks, and be on a soft diet etc. She will most likely have years of braces and then retainers for life. It is a lot and it's totally up to your DD whether she wants to go through that or accepts her teeth as they are.

Not once in all of this have you mentioned your DDs opinion.

I have mentioned my dd’s opinion, she has said she would like it corrected but we were not really given much information on what the surgery would involve so at the time of dd agreeing to surgery she had no idea about what they would really be doing or re over time. They are planning on doing it when she’s 17, she’s not 16 until 2 weeks time, they said it will take 2 years from start to finish (from when they fit the braces, through surgery and then the braces being taken off).

As I said before, dd gets bullied a lot, occationally she has been bullied for her overbite, the only physical issues she has is with eating (it takes her a long time to eat) and she has a slight lisp. We will speak to the specialist, I just want her to understand what surgery means before she makes the choice.

My understanding is that not correcting an overbite will lead to issues with the teeth in the long term but the orthodontist can advise you on that. The surgery is honestly nothing compared to a lifetime of comments and difficulties eating and speaking.

Oh I see, sorry I missed that OP!

17 is very young.

If she is 15 I actually think she is a bit young to be starting the process. Orthognathic surgery should always be 100% on the patient, but you are right at 15 she is potentially too young to understand the implications. There's no reason they have to do it at 17, and it would be better to wait till at least 18 after her A levels. Its a lot of recovery for a 17 yr old. Ime it's normally more like 3/4 years of braces

Most people who undergo the surgery are very keen. And therefore the recovery isn't so bad and most patients cope really well, that's why I say you have to really want it. Like the PP said above 6 weeks of pain/soft diet isn't so bad if the outcome is something you really want but it has to come from your DD.

Orange your right. It’s a awkward age, she’s almost 16 (gcse year), she’s chasing a place at oxford so A levels are going to be important plus she’s taking 4 instead of 3. Although she’s very academically able she’s very young for her age due to her autism and other issues. We won’t be rushing into anything and she won’t behaving anything done until after her GCSE’s.