Q&A with orthodontist Dr Anton Bass
Q. Tenabrist: We’re all seriously stressed out with my daughter’s braces! We were told from an early age that my elder daughter would need orthodontic work to correct her jaw, and that if it wasn’t sorted with braces while she’s growing she would need an operation at 18 or afterwards. So she started wearing one aged eight (initially one of those over the head wire constructions at night), moving on to a removable one and two-piece plastic things, some you screw tighter once a week. Now she’s 13, and she’s been with a one-piece bionator for a while.
She’s supposed to wear it as much as possible – at least 15-16 hours per day – but it’s as much as we can do to get her to wear it while sleeping, ie 8-9 hours. I would describe her attitude as passive resistance. She hates the thing. I’ve just been told by her orthodontist that she will have to move on to a Delaire mask with a fixed metal bit in her top jaw for 3-6 months. And that there’s no point doing it for any less than 16 hours per day. And that if this doesn’t work (ie because she doesn’t wear it enough) she will almost certainly need the jaw operation at 18.
At what point do you say, this whole brace thing isn’t working, it’s damaging my child? Given that she has the brace for medical reasons, not merely cosmetic, are we right to insist that she persists, even against her will?
A. Anton Bass: I can see why you and your daughter are stressed! It sounds like every form of treatment and appliance has been used on your daughter and in some instances it sounds like opposing types of appliances, which I find a little confusing. Also, it is my opinion, that a 13-year-old girl has completed most of her growth and these type of appliances may not be successful at this stage.
You should do what is best for your daughter’s general well-being, psychological included, and your relationship with her. She is old enough to understand the situation and make some of her own choices. I would never treat a patient unless they are 100% on board with it. After all, none of this is life-threatening.
I have many patients who just weren’t ready for treatment in their early teens, but have returned as young adults, been great enthusiastic patients and we have achieved wonderful results.
And the reason for these results? They were ready.
Q. Drummersma: My daughter is 14 and she had beautifully straight teeth until a year ago, at which point they started to shift and twist behind each other. Our dentist dismissed her concerns, saying “there’s no such thing as perfect teeth”. What do we do now? My daughter doesn’t like watching them get progressively worse but we have been told we need a referral from a dentist to see an orthodontist.
A. Anton Bass: Unfortunately, it’s one of life’s certainties, like death and taxes, that teeth will progressively shift and become crooked.
There are two courses of action I’d recommend for your daughter: the movement could be stopped with upper and lower retainers, often just worn for one night a month. Alternatively, she could have her teeth straightened, perhaps with clear removable braces, and then wear a retainer to maintain the straight teeth.
If your dentist won’t refer you to an orthodontist, you can always refer yourselves. You don’t necessarily need a referral to see an orthodontist and these days I see more and more patients who “let their fingers do the walking” and found us on the internet or by word of mouth.
Source: Mum’s Net interview.