Things to consider BEFORE getting braces

I am sharing these tips with you in order to hopefully help you out. I wish I had known these things before embarking on my orthodontic journey but unfortunately I had to learn them after painful and costly experiences.

1.      Do your research! Have a list of questions and concerns ready. Get acquainted with the types of braces available on the market.

2.      If you’re thinking about getting braces, go in to see at least two orthodontists. Trust me, you’ll thank me later!  There are several reasons for this:

a)     The orthodontic treatment takes a very long time and you need to find a professional with whom you can communicate properly. 

b)     Since you’ll have to go in on a monthly basis, you would obviously not want to dread those appointments, not to mention that any kind of treatment is easier to take if you understand exactly what the doctor is trying to do and why.

c)      But beyond these points there is a reason that may not be quite as apparent when you’re just starting the treatment: it is crucial that you feel confident verbalizing concerns and questions regarding your treatment. As the treatment progresses, it is important to know that the orthodontist who is handling your care is listening to your wishes and taking them into careful consideration, as much as it is medically possible.

Let me give you an example: I have heard of several cases of patients who halfway through their treatment were confronted with the news that all of a sudden it has become necessary to extract healthy teeth. After asking for second, 3^rd and even 5^th opinions on that and finding out that other specialists consider the extraction not only unnecessary, but actually detrimental to the patient in the long run, those patients had to communicate to their orthodontist that they refused to have the extractions performed and that they were looking for an alternative solution. Unfortunately, many of them were confronted with a furious orthodontist who would not listen to any patient concerns. To prevent that unpleasant situation from happening, it is best if you can get a feeling of how much your prospective orthodontist is willing to listen to you and to subsequently harness his professional skills into obtaining the results that you’re looking for. 

3.      Make sure that you’re getting the treatment that you are looking for!

This is not a call to be presumptuous and to try to tell your orthodontist how to do his job. After all, he is the one who has the medical knowledge and the skills necessary to correct your smile, so it’s only normal that he, as the expert, should have the last call when it comes to establishing the strategy for your treatment. That being said, however, oftentimes there are several ways to get to Rome and it is important that your orthodontist be as mindful as possible of your wishes.

I think an example is in order: I have very crowded teeth, yet I am reluctant to have any extractions, other than my wisdom teeth, since I cannot quite rationalize to myself pulling an otherwise healthy, viable tooth. I am aware that sometimes it is physically impossible due to the lack of space to align the rest of the teeth if the patient is unwilling to sacrifice some of his teeth. The first orthodontist I saw told me upon examination flat out that I had to have 4 teeth pulled before she could put braces on me (two on the upper and two on the lower jaw). I started asking questions and thus I found out that my lower jaw line is a bit too far back due to my overbite and if I were to have two teeth pulled from my mandible that would result in an automatic and irreversible further pushing back of my lower jaw line that would actually damage my profile.  So I would go from a normal profile with my lips closed and crooked teeth to straight teeth and a mangled profile. With this less than thrilling prospect in mind, it’s easy to understand that I wanted to avoid extractions. I went in to see a second orthodontist who took prints, photos and X-rays of my teeth and after running a series of calculations said that she wanted to at least attempt to align my teeth without any extractions. Even though she could not guarantee that everything will fall into place without extractions, given the very crowded initial situation of my teeth, I appreciated her effort to try to not only take into consideration my desires but also to attempt to obtain for me the best medical result in the long term.  Needless to say, I went with the second orthodontist. 

4.      Try to get a feel for the priorities of your orthodontist.

First off, I want to make it clear that I harbor genuine respect for doctors in general and I think that the vast majority of orthodontists are driven by the loftiest of motives. That does not exclude, however, the odd possibility of  a professional who succumbs to the business side of his practice. 

5.      If in any way possible, try to find out if there’s a chance your initial orthodontist will not be able to see you through your entire treatment (e.g. is his/her contract running out soon?) In that case, pick someone else as switching orthodontists mid-treatment can be difficult, expensive and it may cause significant delays in your progress.

And, finally, here are some questions to ask during your first appointment:

1.      What is my diagnosis? If you get different answers from different professionals regarding your bite, for instance, that says something about the proficiency of those who misdiagnosed you.

2.      What results can you get for me? Ask at least about 3 things: (1) the smile/ alignment of the teeth, (2) the bite and (3) the profile.

3.      Are those results permanent? What is the chance of the initial problems recurring?

4.      Please explain your treatment plan. Basically, in layman terms, how are you going to go about fixing my teeth?

5.      Who will handle my monthly activations? Will the orthodontist himself/herself do it or will an assistant take care of it?

6.      What exactly will my activations consist of? Will my arch be exchanged every time? If not, how often?

7.      How long will I have to wait between activations?

8.      Do I need to pay extra for my arch being changed or is that part of the monthly activation charge?

9.      If a medical mistake happens during an appointment, who will cover the costs for fixing it?  For example, if the person performing the activation accidentally removes or damages some brackets, who will cover the cost for having them replaced?     

10.  What are your opening hours? Are there any times were you close down your practice for a prolonged period of time such as vacations?  (The unavailability of your orthodontist may prolong the time in between appointments and thus prolong your total treatment time.) 

11.  Do I have ways of contacting you in a major emergency situation? If such an unlikely situation arises, will you be able to help me either by seeing me on a really short notice or helping me to get an urgent appointment with another orthodontist?

Luckily, major orthodontic emergency situations are rare and definitely having a bracket fall off or a wire poking your cheek are not such cases as you can clip that wire yourself with the nail clipper and wait for your next appointment to get it properly fixed.  But I have heard of cases where people were involved in situations that required immediate orthodontic attention such as severe teeth trauma resulting from car accidents, falls, sports accidents or acts of violence.  In such situations, in order to minimize the negative impact of the trauma, it is best if your orthodontist can assess the situation immediately in order to initiate the appropriate treatment.  One of the orthodontists I have seen would close down the entire practice for 2 to 4 weeks at a time, 5 to 6 times per year, leaving an answering machine as the only contact method. Let us just say that given that otherwise completely understandable vacationing pattern, I did not feel protected against all types of contingency.   

12.  How should I clean my teeth during the treatment?

13.  How long will the treatment take?

14.  How much will it cost? What payment options are there? Can I see a price list in advance to get an idea about how your services are priced? (In this way, you can avoid unpleasant surprises by discovering potentially hidden costs.)

15.  Will I have to have extractions? Will stripping be necessary? Will I need to wear elastics between my jaws?

16.  What side-effects can I expect?

17.  Finally, discuss contention options, duration and costs.