NHS adult ortho advice

Anon1999

Hi,

I seek advice regarding being referred to the hospital for NHS adult orthodontist treatment.

I was referred to an orthodontist when I was 17 and offered jaw surgery to correct an overbite. At the time, I had an irrational fear of dentists, and a few other things were happening in my personal life, so I refused treatment.

Now, I'm 23 and will graduate as a clinician this year. I feel overwhelmingly self-conscious and have speech problems that make it incredibly difficult for my patients to understand me.  

I am also under max fac for TMD, which I believe has been exacerbated by the overbite. The max fac consultant thinks I will qualify for NHS adult funding as I need multidisciplinary care, and major surgery is needed to rectify the bite. He advised I ask my dentist to refer me to the appropriate hospital specialist.

I have since spoken to my dentist, who believes orthodontic treatment on the NHS is only available to under-18s. So, I'm unsure of what to do next. 

I'd really appreciate any advice you can provide.

brook2jack2

Nhs dental treatment for over 18 is only  available where it is a complex case requiring both surgery and braces . So , on the face of it , you will qualify . Your dentist will have to refer you to the hospital orthodontic department for a joint maxillofacial/ orthodontic assesment rather than to a general practice orthodontist who cannot see over 18s. 

Waiting list is likely to run into several years 

Brie

You may have to push to have this done - just the same as so many things with the NHS right now as they are overwhelmed.  

That aside - I'd say go for it. 

I had my jaw done 30+ years back at the age of 25 when I was finishing uni.  Not by the NHS but in another country where I was living at the time.  The actual surgery was probably less stressful than wearing braces overall.  The only issues I had with it was that it meant having my jaw wired shut so effectively no food for about 7 weeks.  So I was eating a lot of broth, strained cream soups, milkshakes, etc   I tried to have very very milky mashed potatoes but that didn't work in that, unusual at that time, there had been no teeth removed so if it couldn't go between my teeth I couldn't have it.  Net result was I lost quite a bit of weight (not a bad thing in itself but not sustainable).   I still had a social life, I could still talk with a tiny bit of effort but well enough to ace a job interview.   There was pretty bad bruising & swelling to the face for about a week but I didn't have to look at myself so that was fine.  I was surprised by the number of people who came up to ask me what had happened and then would happily chat about how they had something similar or their brother did etc etc.  

Best of luck with it all!!! 

Anon1999

brook2jack2 said:

Nhs dental treatment for over 18 is only  available where it is a complex case requiring both surgery and braces . So , on the face of it , you will qualify . Your dentist will have to refer you to the hospital orthodontic department for a joint maxillofacial/ orthodontic assesment rather than to a general practice orthodontist who cannot see over 18s. 

Waiting list is likely to run into several years 

Thank you for your response. This is as I a thought. However, my current dentist is reluctant to refer, so I’m unsure how else I can access this assessment? 

Toothsmith

Why are they reluctant to refer?

With your history, I can't see any reason not to, other that it can be a right royal pain in the !!!!!! to get a referral through the system these days! 

Be a little more assertive, (but polite) and I'm sure they'll give in! 

As said above though, it's likely to take a fair while!

theoretica

Can your max fac consultant or secretary provide guidance on exactly where you should be referred/and wording to use? It sounds as though your dentist hasn't come across this before, just doesn't know what to do, and may not have time to research - so making it easy for them may help, if your other consultant knows the answers.

Anon1999

Toothsmith said:

Why are they reluctant to refer?

With your history, I can't see any reason not to, other that it can be a right royal pain in the !!!!!! to get a referral through the system these days! 

Be a little more assertive, (but polite) and I'm sure they'll give in! 

As said above though, it's likely to take a fair while!

I had a consultation with the dentist today. I relayed the max fac consultant's advice to her. Again she was reluctant to refer but agreed to try to put a referral in. However, considering my age, she doesn't know whether the system will allow her to submit the referral, and even if it does, she believes it will be denied. If this fails, I'm not sure what Plan B could be.

Toothsmith

These sorts of treatment aren't normally done until a patient is older than 21 anyway (Because you need to be sure all facial growth has stopped) - so at 23 I would think it highly unlikely you'll be considered 'too old'.

She might have to be careful to tick the correct boxes to indicate it's severity.

If it's not accepted - It might be worth trying to see another dentist who may be a bit more positive about getting you through the referral system, or even go back to the Max Fac chap who's looking after your TMJ, and see if he can be of any help getting you referred. Either through him referring you, or giving some sort of letter to your general dentist with more details of what is required for the referral to be accepted?

Anon1999

Toothsmith said:

These sorts of treatment aren't normally done until a patient is older than 21 anyway (Because you need to be sure all facial growth has stopped) - so at 23 I would think it highly unlikely you'll be considered 'too old'.

She might have to be careful to tick the correct boxes to indicate it's severity.

If it's not accepted - It might be worth trying to see another dentist who may be a bit more positive about getting you through the referral system, or even go back to the Max Fac chap who's looking after your TMJ, and see if he can be of any help getting you referred. Either through him referring you, or giving some sort of letter to your general dentist with more details of what is required for the referral to be accepted?

Thank you for your reply. She said it would also go against me that I refused treatment back in 2016.

The max fac consultant advised to contact the ortho provider I was referred to at 17 and ask them to refer me to the correct team. I contacted them, and the original orthodontist replied, informing me that the referral can only come from the dentist I am registered with.

brook2jack2

The dentist cannot refer you to an orthodontist in general practice  if you are over 18 , but they can refer you to a hospital dentist for a joint consultation orthodontic/maxillofacial. It's just a question of ticking the right boxes on the referral form. 

Toothsmith

@brook2jack2

Might it work if the OP went for a private consultation with a Specialist orthodontist - then asked the specialist orthodontist to refer them in to the hospital orthodontics system via NHS? 

I know that's probably an unnecessary fee, when a general dentist should easily be able to do it - but the original dentist does sound like they don't really understand the system, and a specialist orthodontist certainly would.