Orthodontist 2nd opinion needed

tank666

Hi

My daughter is currently undergoing orthodontic treatment for braces under the NHS. We are in dispute with the orthodontist about whether or not she needs extractions. (We think she does)

He is very defensive and said he will only do it if we get a 2nd opinion? Can anyone advise what procedure we must follow to get this arranged through the NHS? Or do we just randomly contact different orthodontists in the area? 

Thank you. 

Browntoa

Expert dentist says not needed 

Non expert parents say she does 

You need to approach another dentist for a 2nd opinion, this is likely to be a private consultation and will cost you 

brook2jack2

You are entitled to a second opinion on the NHS , but you will still have to join the waiting list to do so. The other problem is your daughter is half way through treatment , if the first orthodontist says she does not need extractions you cannot force them to do so and a second orthodontist would have to take over treatment mid way , which is something they do not like to do. Your own dentist will have to refer you for the second opinion. 

You can get a second opinion privately but that does not mean that the first orthodontist or any other orthodontist has to do that treatment plan . Dentistry is an area where there are no solid right way and wrong way to do treatment , each dentist/orthodontist will have a different approach and you can get a variety of treatment plans which are equally valid. 

The pendulum has very much swung away from extractions in orthodontics and far,far,far fewer teeth are taken out now than twenty years ago . In many cases it is gold standard not to extract teeth unless in extremis. 

Most people would be much happier with a non extraction treatment plan , particularly if a highly trained orthodontist has recommended it. 

Mark_d

It sounds like you don't trust your dentist's expert opinion.

I wouldn't try forcing him to do something he doesn't believe in.  If you want a dentist who does what you ask, rather than what they feel is best, then I suggest you look for a suitable private dentist.

Do you feel it is right that NHS funds are wasted on cosmetic work that a qualified dentist feels is not necessary?

tank666

brook2jack2 said:

You are entitled to a second opinion on the NHS , but you will still have to join the waiting list to do so. The other problem is your daughter is half way through treatment , if the first orthodontist says she does not need extractions you cannot force them to do so and a second orthodontist would have to take over treatment mid way , which is something they do not like to do. Your own dentist will have to refer you for the second opinion. 

You can get a second opinion privately but that does not mean that the first orthodontist or any other orthodontist has to do that treatment plan . Dentistry is an area where there are no solid right way and wrong way to do treatment , each dentist/orthodontist will have a different approach and you can get a variety of treatment plans which are equally valid. 

The pendulum has very much swung away from extractions in orthodontics and far,far,far fewer teeth are taken out now than twenty years ago . In many cases it is gold standard not to extract teeth unless in extremis. 

Most people would be much happier with a non extraction treatment plan , particularly if a highly trained orthodontist has recommended it. 

Thank you for confirming we are entitled to a 2nd opinion on the NHS. To give some context my wife had braces and has almost identical features to my daughter. My daughters mouth is beginning to protrude in exactly the same way as wife's did - she then had extractions which rectified this. Obviously if 2nd opinion says extractions aren't required that's fine will be happy with that.

Any idea who I contact to arrange this as seem to have hit a brick wall. Already tried the British Orthodontic Society and the NHS patient advice and liaison service without success?

To those questioning why we are challenging this sometimes dentists / orthodontists can be either wrong or negligent you know. My own Mother successfully sued her former dentist for maltreatment over a long period which ended up in her requiring root canal surgery.

I would therefore prefer to get a 2nd opinion to ensure doing what is best for my own daughter.

tank666

Sorry Brook2jack2 misread your post will get in touch with her dentist to arrange many thanks 

Brie

I suspect your wife had her braces some time in the past.  30 years maybe?  Things have changed significantly in that time particularly with UK dentistry.  Now no offence but the dentists (including orthodontists) where considered to rather second rate by dentists in other countries.  And a major complaint was the unnecessary removal of perfectly good teeth.   

I had major orthodontic work nearly 40 years back before coming to the UK and one of the last things my orthodontist said to me was if I ran into any real problems to not go to just an ordinary practice but to try to get to a university teaching practice where things would be more up to date.  

brook2jack2

When I first qualified , many years ago , we routinely removed first premolars in alot of orthodontic treatment . We used removable braces which needed extractions to work. 

In the last decades fixed braces have become the gold standard which are capable of much more subtle movements . Also arch expansion is much more routinely used ie using the growth of the jaws to solve problems.

Technology has come along way with improvements in brackets, wires and chains allowing very precise movement of teeth.

For this reason the way people have problems treated orthodontically has changed massively over the last few decades. On the NHS general dentists no longer do orthodontics and it is all led by orthodontic specialists . Indeed most dentists would not refer to an orthodontist who routinely had treatment plans with extractions. 

Your childs treatment will be on hold whilst waiting for your second opinion. In our area the waiting list is two years plus. A second opinion will wait the same as anyone else.

If your childs problem is what I think it is it is important to take advantage of the pubertal growth spurt to guide jaw growth. Waiting too long will make extractions inevitable as the optimal treatment will not be possible. 

Taking teeth out to create space is an "easy" option that doesn't require as much skill as a non extraction plan , in the majority of cases. It has fallen out of favour for many good clinical reasons. 

Toothsmith

I'm hardly taking any teeth out nowadays for ortho patients too. Very much out of fashion 

welshdent

with respect, mot wanting to extract teeth isnt negligent. The orthodontist has all your daughters models and scans. They will know what is and isnt possible for orthodontic movements. I suspect they got defensive because you were challenging their knowledge and experience off the back of one non identical situation. You may believe it to be similar. but I would be reasonably confident there will be significant variation as no 2 people are the same. Even identical twins have variations. 

By all means get a second opinion, but that wont mean this orthodontist is incorrect in their assessment and just giving a more desirable answer wont mean that is the correct one.