Cost of Teeth Braces

[recovering spendaholic]

When my 18 year old daughter was 6 she fell off a high wall in the school playground onto her face and smashed the front of her mouth - it was a right mess but they sorted her out at the specialist facial department of the hospital and said that she would need follow up care when she was older, as there had been some damage to her top jaw. Anyway at age 13 she was referred by the facial clinic to an orthodentist who fitted specialist braces and a spring thing across the roof of her mouth. Her teeth straightened up well and her bite was also fixed, but I was unhappy about the colour of her teeth which were very grey looking and generally discoloured. After she had the braces off the orthodentist said that she should wait until she was older and then look to get them whitened.

In the last year, since she started getting her wisdom teeth, her front teeth have crossed over again and look quite crooked, and the disolouration is also worse. She is really self conscious about her mouth and it has really impacted upon her self esteem. I asked our regular dentist if she could be referred back to the orthodentist but he said that as she is 18 now then she is not entitled to any corrective treatment on the NHS. He said that he is a qualified orthodentist and could put a brace on for her at a cost of around £2500 - £3000, but that specialist whitening might not work well because the nerves in the front teeth are damaged from the fall. She has always looked after her teeth and has never had any kind of cavity, nor ever needed a scale and polish. I cannot believe that she cannot get orthodentic treatment on the NHS - is this correct? She is still in full time education. I am worried for her because she is really despondent about her teeth, and I have to say (although I don't tell her) - they do look pretty awful.

Do any of you dentists out there have any advice on where to go with this?
Many thanks.

[Teerah]

Hi Jane,
its difficult to assess what would be the best course of treatment for your daughter without actually seeing her in person. Regarding the orthodontics firstly, did your daughter have to wear a retainer for any length of time, where there any concerns at the end of treatment that the result might not be very stable? It is important to note that ALL orthodontics relapse to a certain extent and there is no evidence thatthe eruption of wisdom teeth has any bearing on the extent of the relapse as it has been shown to happen just as much where wisdom teeth are missing. If it were my patient and the result was as bad at this stage as you imply, I would refer her back to the orthodontist who treated her but thats just me.Incidentally if your dentist is planning on treating your daughter for orthodontics then he should be on the specialist list (http://www.gdc-uk.net/searchregister/) for orthodontists.
It can be difficult to whiten teeth that have discoloured due to nerve death/removal, there is a technique called internal bleaching which bleaches such teeth individually if they have had root canal treatment but the results can be unpredictable. You daughter may require veneers or all ceramic crowns to improve the appearance overall and this could also fix the overlap if not too severe but to get a good result she would have to pay privately as cosmetic treatment is not covered by the NHS.

[Toothsmith]

Usually, after such intense treatment in the hospital, the consultant who did it signs you back to your dentist with the phrase "If ever you wish me to see x again, please refer him/her back."

Consultants like to keep in touch with their more 'challenging' jobs.

With all that has happened here, I would definiately say that this was worth a re-referral back to the consultant.

If there are a lot of root filled teeth, then these teeth always have a much higher chance of being damaged by orthodontics (The roots can start resorbing (Sort-of dissolving)).

It is highly likely that leaving it alone will be the best thing to do, but I really think you need to see the consultant again. This case is really above specialist level.

[MightyMen]

Is your daughter a student by any chance?

I don't have any expertise on this matter, but I'm pretty sure I was told quite a few times that students are entitled to free treatment on the NHS up until the age of 19.

The internet seems to agree with me too! http://www.dentalhealth.org.uk/faqs/leafletdetail.php?LeafletID=29

[Toothsmith]

Is your daughter a student by any chance?

I don't have any expertise on this matter, but I'm pretty sure I was told quite a few times that students are entitled to free treatment on the NHS up until the age of 19.

The internet seems to agree with me too! http://www.dentalhealth.org.uk/faqs/leafletdetail.php?LeafletID=29

Whether you qualify for NHS orthodontics depends upon something called the index of orthodontic treatment need (IOTN for short).

It will be more to do with that, rather than her age that the orthodontist will be going on. If it's already been corrected, but things have just started to cross over a bit, then it won't be considered serious enough to warrant NHS funding.

I still say you should get back to the original consultant though. With so much work done on the teeth, there is an awful lot to muck up by treating something inappropriately.