Calling all orthodontists: Need advice!

Parent Cafe
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<p>S (now 16) had an adult tooth growing sideways, threatening the root of the tooth next to it. Orthodontist sent him to oral surgeon, who exposed the tooth & attached a button/chain. The surgery, performed in January of 2007, went well. The orthodontist tightened the chain regularly, the tooth moved down into position, and the braces came off in October of 2007. S had trouble with his wire retainer bothering the roof of his mouth. In early January, 2008, he had a blister in that area that popped. The orthodontist’s office was closed, but the dentist was in … I called & asked where I should take him … dentist or orthodontist. They said either was fine. Since S had just had his routine dental exam a month earlier, I decided to go to the orthodontist. The care would be included in the fee I paid, plus it seemed to be related to his retainer.</p>

<p>The next day, I called the orthodontist, explained what was going on, and got an appointment that afternoon. They told me that they adjusted his retainer & he should be fine. A few days later, he was still having trouble, so we went back. I insisted on being in the exam area (parents are not generally invited back). The tech couldn’t figure out what the problem was. I explained that his retainer really hurt, it was rubbing the area where he’d had oral surgery, and I asked if maybe there was scar tissue there. She looked & seemed to think all was well. The orthodontist’s new partner came over & I explained everything again, including the fact that he was having problems with the area where he had oral surgery. She looked in S’s mouth, examined the retainer, and had the tech make a couple changes. </p>

<p>S had trouble from time to time, but when I asked him if he thought we should go back or see the dentist, he said it didn’t really hurt … it bothered him, but it wasn’t actually “painful.” He got a blister last week & it popped. We had a routine dental exam early this week, so I told the hygienist about it. When she looked at it, she immediately told me she wanted to take an xray to see what was going on. A little while later, the dentist came out & told me he has a very large cyst & would need at least 1 root canal.</p>

<p>We saw the endodontist today. He was amazed that S didn’t feel pain from this … he told him he should be in the CIA, he handles torture so well! He said that the tooth that had been moved is abscessed & that formed the cyst. He checked his teeth, and fortunately only that tooth is affected at this point (#10, I think it is). He is going to do a root canal next week (after S has a few days of penicillin, just in case). He said that hopefully, the cyst will drain on its own once the root canal takes away the source of the fluid. It may take up to 18 months; he’ll monitor S during that time. If it doesn’t drain properly, he’ll have to remove it surgically. Of course, there is a chance the teeth on either side (which are in the cyst zone) will be affected in the meantime or by the surgery. In other words, there still may be a lot more trouble ahead. </p>

<p>My question is … what went wrong here? Obviously, I didn’t take this seriously enough & insist that the thing bothering his mouth be taken care of. However, I know nothing & figured it was his retainer. I DID mention the fact that he had surgery in that spot, though, and that makes me wonder if the orthodontist and/or tech should have examined the sore more carefully. S DID go in with it when it was bothering him & he did show them. Should someone in the orthodontist’s practice have realized that a sore on the site of the surgery was something important, something that should be followed up on … after all, S went in with it & showed it to them. Or would they reasonably figure it was the retainer, like I did?</p>

<p>I do NOT plan to sue, by the way. However, I do plan to write a letter to the orthodontist. Frankly, in the dozen years I have gone to his office with my kids, I have noticed a lot less hands-on involvement by the orthodontist than had been the case when we started there. This is a very popular practice that has grown by leaps & bounds. The orthodontist recently hired a young doctor to work with him. Mainly, though, everything is done by the techs & the doctor rarely even supervises. I am concerned that problems like we experienced are more likely to happen in this new environment. The orthodontist is a great guy who is very proud of his good reputation … so I feel like he would want to know what transpired. I just want to be able to convey what I think should happen in the future. But I guess I want to know what I should reasonably expect should happen in a case like this. Maybe I am off base & it is something that no one really could have expected. I do realize that the root canal would probably still be necessary even if we’d known sooner. The cyst might not have progressed to the teeth on either side, though … although there is no way of knowing that for sure.</p>

<p>Any thoughts would be appreciated.</p>

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<p>kelsmom - while I don’t have any thoughts to help you, it does alarm me to hear that this can happen to kids who have had that (what I call) tooth yanked down. My daughter had it done five or six years ago… I hope that’s long enough to erase her risk of it happening. But she hasn’t had any of the problems you’ve talked about.</p>

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<p>My S2 also had the “tooth yanked down” surgery on both I-teeth that were embedded in his gums (all the way under his nose actually). It has been six years now. He has no idea where his retainer is so that wouldn’t be a clue for us. Hope the root canal clears everything up for your S.</p>

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<p>kelsmom you can’t blame yourself here. You went with your son and spoke to his ortho about it. Son really wasn’t complaining of pain. As much as we like to think we an be all knowing sometimes when it comes our children, we really can’t, especially when it comes to medical issues. </p>

<p>I think the ortho would want to know so that in the future they can look at patients that have had surgery a bit more closely. I’m not an ortho or dentist, but would imagine this is something that they should have at least recommended you see your dentist about if the retainer adjustments didn’t clear up the problem. </p>

<p>This all sounds very painful to me. I think I’ll show my 14 yo S who is NOT good at keeping the teeth super clean with his braces. </p>

<p>I hope your son does well with his surgery.</p>

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<p>PM sent…</p>

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<p>Thanks for the support! I received a pm that was informative, and I have decided to call the ortho & talk to him about it.</p>

<p>I am no expert, but I don’t think this is at all normal for people who have had their teeth yanked down. There are a lot of these surgeries done. I wouldn’t worry about it for your own kids … but I definitely think you should let them know that if they ever get any kind of sore on the site of their surgery, they need to get to the dentist & get an xray. I was told that it can take years for this to show up, so just put the bug in the kid’s ear to be aware of anything involving that area in the future.</p>

<p>It seems this type of problem is rare enough that missing it is understandable. I can accept that. I will let the ortho know so that he can train his staff to be on the lookout for any complaints that involve the site of an oral surgery.</p>

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<p>I think the oral surgeon is responsible for a poorly done job. The ortho should take better care of his/her patients also. My kids are never seen by a tech. Hope all clears up well.</p>

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<p>I do not think the oral surgeon did a poor job. The tooth abscessed while being moved … which was after the surgeon did his part of the job. If someone “should have” been watching afterwards, that would have been on the ortho’s watch. He was the one who did the pulling. However, given the number of kids who have this work done without issues, I’m not sure xrays to monitor progress would be a normal course of action. To be honest, if the tooth hadn’t been moved, it would have eaten the root of the tooth next to it (the one it was aimed for while up in the gum) … or it would have had to be dug out like an impaction. Either way, that would have meant NO tooth for S. It seems to have been the movement that contributed to the problem. To be honest, I don’t know if the movement schedule (when & how much) contributed, though.</p>

<p>The thing I don’t like is the “miss” on the part of the ortho’s staff. When I first went to that ortho, the kids always saw him during their visits. As his practice grew, that stopped. I was already paid up, so stayed. If I had another kid, though, I would find a less “successful” ortho.</p>

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<p>I realize things out of the ordinary happen, but the thing that bothers me is that the orthodontist does not see the patients. My kids’ ortho sees them at every single visit, even if for just a short peek during the retainer phase or whenever. She supervises all activities of the techs at every visit.</p>

<p>On a side note, we had trouble of our own this summer. Son has had braces off for 2 years, and is soon to be a senior. Seems his bottom jaw started growing out of proportion to his upper jaw by one millimeter. Due to that, he had to have braces put back on his teeth so they could pull the top and bottom teeth back to correct placement. Very unusual situation to have happen. The ortho put ceramic braces on him (realizing it is his senior year and would be less conspicuous) and all treatment is free. Also, second son, a soon to be junior is having the same problem (not yet as bad) and she will also treat him for free when the time is appropriate. Luckily I was able to quick get senior photos before the braces went on.</p>

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<p>A little off topic but…watch those permanant retainers that are left in after the braces come off. A neighbors’s S noticed his upper front tooth was turning sideways. He went to the Ortho. who discovered that the permanant metal retainer behind his teeth had become bent over the years since the braces were removed and caused his front tooth to turn ( a lot). </p>

<p>Now he is almost 22 years old /college senior and will have to have braces put back on (at Mom and Dad’s expense) to correct this crooked tooth.</p>

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<p>S also went to one of those wildly popular ortho’s (a father and son practice) with multiple tech’s working in the practice. However, every visit and all procedures were checked by either father or son before the patient left the chair.Also, parents routinely went to the examining space, it wasn’t discouraged,except by the kids themselves!.They had xray facilities in the office too and it seems to me S was xrayed every now and then during the time he was a patient, especially as the treatment was winding down.I hear what you are saying about staying b/c you were paid up, S’s procedures took 12 months longer than originally planned and I was paid up way way in advance.I wouldnt have wanted to start paying anyone else either.
So lucky for you the other specialist found the problem and S doesnt have to suffer any more. You might want to consider a new ortho practice for the next child</p>

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<p>I put a call in to the ortho today, but he is out of the office. He will call me Monday. I plan to let him know that the lack of doctor-patient interaction is a real problem … and could possibly have been a factor in S’s issue not being caught. Even if this particular problem might not have been caught regardless, I still think the evolution of his practice from one in which he actively oversaw treatment to one in which he is more or less a doctor-on-consult to his techs is not a positive development. BTW, S did get xrays when the braces came off … it took a different kind of xray to find the problem (roof of mouth). However, I will ask ortho to look at S’s last set of xrays again to see if he should have noted anything (in case only the TECH looked at it!).</p>

<p>I also called the oral surgeon & talked to him. He gave me two reasons why the cyst might have developed. The one that probably is the case involves the development of the tooth at the time the surgery/pulling down process began. S’s adult teeth were LATE (like end of 2nd/beginning of 3rd grade before the first baby tooth fell out). Ortho waited as long as possible to start moving the canine tooth, but the time came when it had to be done (sideways tooth was almost meeting root of tooth next to it at that point). That may well be the reason this happened. At any rate, the oral surgeon wants to see him prior to the root canal & to work in tandem with the endodontist. I really do like this oral surgeon, and I feel confident that between him & the endodontist, S is in good hands.</p>

<p>No more kids, no more orthodontists … but I will not be recommending this ortho to anyone.</p>

<p>JDA, my niece had a misalignment of her jaw that was too severe to be corrected with ortho treatments. She had both jaws broken & reset last summer … terrible pain, long recovery. However, she looks amazing now! She feels better, too. Misalignment can cause physical issues, too. Thank goodness your S’s condition was caught & wasn’t too difficult to fix. How nice that he is getting the “good” braces … and for no extra charge (over & above the small fortune you already paid, of course!).</p>

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<p>delete post</p>

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<p>packmom, thanks for the warning regarding the permanent retainers. D had her braces off about 5 years ago, but her bottom teeth keep trying to “slide back” The ortho told her this week that he’s going to put a permanent retainer on once it gets straightened out again. </p>

<p>Our ortho has become much more popular since D started there 7 years ago. His office is amazing. The patients don’t want to leave because he has all kinds of pinball machines, arcade games, etc. He does see his patients at each visit, even if for just a second. The techs do most of the work.</p>