Please tell me if this is completely insane (estimate from orthodontist)

[Anonymous]

Our dentist did DS's palate expander and my out of pocket was less than $500.

[Anonymous]

Anonymous wrote:Don't fall for the the two-phase BS:

http://www.ncbi.nlm.nih.gov/pubmed/15179390

"After a second phase of fixed appliance treatment for both the previously treated children and the untreated controls, however, early treatment had little effect on the subsequent treatment outcomes measured as skeletal change, alignment, and occlusion of the teeth, or length and complexity of treatment. The differences created between the treated children and untreated control group by phase 1 treatment before adolescence disappeared when both groups received comprehensive fixed appliance treatment during adolescence. This suggests that 2-phase treatment started before adolescence in the mixed dentition might be no more clinically effective than 1-phase treatment started during adolescence in the early permanent dentition. Early treatment also appears to be less efficient, in that it produced no reduction in the average time a child is in fixed appliances during a second stage of treatment, and it did not decrease the proportion of complex treatments involving extractions or orthognathic surgery."

Thanks for posting this. (not the OP)

[Anonymous]

Anonymous wrote:I think some of the kids getting expanders and such prior to middle school are getting hosed. My child needs braces, but dentist said he wouldn't recommend it until most if not all of DC's adult teeth are in. Dentist is very well respected and recommended pediatric dentist in NOVA. 8 -10 years old for anything- expanders, braces, etc., is just too young for orthodontics in my book.

I never got braces as a kid, and eventually straightened them as an adult. 4 months of an expander, 12 months of mental braces on upper jaw, 8 months on lower jaw, and a permanante retainer on the bottoms once the braces came off. Teeth were really jacked before I got the braces, and now they are still straight 8 years later. Every circumastance is unique, but I'm highly skeptical of this "phase 1 and phase 2" approach orthos are pushing on parents, especially at such young ages when jaws and teeth are still growing.

Also- find an dentist that also does ortho. When I had my teeth done as an adult, my regular dentist did them. I'm sure this helped cut costs. Think it ended up costing $3200, with the expander (granted, I had the work done back in 2006, so costs may be 4K or more now).

That's a big generalization. Every situation is different. I know I would have been much better off if my parents had not waited until I was 13, nearly finished growing, plates fused. My ortho pulled teeth, had me in awful headgear, I was in braces for 4 years, and after it was all over things shifted everywhere and my mouth is a mess.

My DC's palate was so narrow that it affected his nasal passages and ability to breathe through his nose. He had become a mouth breather. The expander has improved that by a lot.

Our costs for the expander were about 700 out of pocket, in a fancy part of NoVa.

[Anonymous]

Anonymous wrote:PP here- and no, expanders can be used beyond ages 8-11. As mentioned, I had one as an adult for 4 months (maybe longer) before my braces were put on. Any dentist or ortho saying otherwise is lying and just taking advantage of a parent who doesn't know any better and is fearful if they don't purchase the expander now, it will forever affect their child's teeth.

My best friend growing up had a palate expander in 8th grade.

There is a lot of quackery in orthodontic care, and parents pay a lot of money for it. Not a lot of evidence-based practice out there.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think some of the kids getting expanders and such prior to middle school are getting hosed. My child needs braces, but dentist said he wouldn't recommend it until most if not all of DC's adult teeth are in. Dentist is very well respected and recommended pediatric dentist in NOVA. 8 -10 years old for anything- expanders, braces, etc., is just too young for orthodontics in my book.

I never got braces as a kid, and eventually straightened them as an adult. 4 months of an expander, 12 months of mental braces on upper jaw, 8 months on lower jaw, and a permanante retainer on the bottoms once the braces came off. Teeth were really jacked before I got the braces, and now they are still straight 8 years later. Every circumastance is unique, but I'm highly skeptical of this "phase 1 and phase 2" approach orthos are pushing on parents, especially at such young ages when jaws and teeth are still growing.

Also- find an dentist that also does ortho. When I had my teeth done as an adult, my regular dentist did them. I'm sure this helped cut costs. Think it ended up costing $3200, with the expander (granted, I had the work done back in 2006, so costs may be 4K or more now).

That's a big generalization. Every situation is different. I know I would have been much better off if my parents had not waited until I was 13, nearly finished growing, plates fused. My ortho pulled teeth, had me in awful headgear, I was in braces for 4 years, and after it was all over things shifted everywhere and my mouth is a mess.

My DC's palate was so narrow that it affected his nasal passages and ability to breathe through his nose. He had become a mouth breather. The expander has improved that by a lot.

Our costs for the expander were about 700 out of pocket, in a fancy part of NoVa.

Actually, you don't KNOW this to be true. You think you might have been better off, but there is no way to know.

[Anonymous]

Anonymous wrote:OP here - thank you, everyone, for the responses. The consensus seems to be that the price I was quoted is inflated. I knew getting braces was not going to be cheap, but I was a bit startled to be quoted nearly 10K for pre-braces work (which I'm guessing means the whole thing will top out at 20K+ ?). I will shop around. I've also heard good things about Dr. Gerlain. Has anyone used Darlene Byrd? She's been recommended, but I'm told she's expensive, too.

Thanks again.

We have been happy with Dr Byrd's work, especially on one child with a underbite. She struck me as being expensive when we signed the contract but not $20,000 expensive.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Don't fall for the the two-phase BS:

http://www.ncbi.nlm.nih.gov/pubmed/15179390

"After a second phase of fixed appliance treatment for both the previously treated children and the untreated controls, however, early treatment had little effect on the subsequent treatment outcomes measured as skeletal change, alignment, and occlusion of the teeth, or length and complexity of treatment. The differences created between the treated children and untreated control group by phase 1 treatment before adolescence disappeared when both groups received comprehensive fixed appliance treatment during adolescence. This suggests that 2-phase treatment started before adolescence in the mixed dentition might be no more clinically effective than 1-phase treatment started during adolescence in the early permanent dentition. Early treatment also appears to be less efficient, in that it produced no reduction in the average time a child is in fixed appliances during a second stage of treatment, and it did not decrease the proportion of complex treatments involving extractions or orthognathic surgery."

Thanks for posting this. (not the OP)

This, this, this. People, you are being sold a bill of goods.

That'll be $6000 please.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think some of the kids getting expanders and such prior to middle school are getting hosed. My child needs braces, but dentist said he wouldn't recommend it until most if not all of DC's adult teeth are in. Dentist is very well respected and recommended pediatric dentist in NOVA. 8 -10 years old for anything- expanders, braces, etc., is just too young for orthodontics in my book.

I never got braces as a kid, and eventually straightened them as an adult. 4 months of an expander, 12 months of mental braces on upper jaw, 8 months on lower jaw, and a permanante retainer on the bottoms once the braces came off. Teeth were really jacked before I got the braces, and now they are still straight 8 years later. Every circumastance is unique, but I'm highly skeptical of this "phase 1 and phase 2" approach orthos are pushing on parents, especially at such young ages when jaws and teeth are still growing.

Also- find an dentist that also does ortho. When I had my teeth done as an adult, my regular dentist did them. I'm sure this helped cut costs. Think it ended up costing $3200, with the expander (granted, I had the work done back in 2006, so costs may be 4K or more now).

That's a big generalization. Every situation is different. I know I would have been much better off if my parents had not waited until I was 13, nearly finished growing, plates fused. My ortho pulled teeth, had me in awful headgear, I was in braces for 4 years, and after it was all over things shifted everywhere and my mouth is a mess.

My DC's palate was so narrow that it affected his nasal passages and ability to breathe through his nose. He had become a mouth breather. The expander has improved that by a lot.

Our costs for the expander were about 700 out of pocket, in a fancy part of NoVa.

Actually, you don't KNOW this to be true. You think you might have been better off, but there is no way to know.

I don't know it to be true, but I don't know how I could have been worse off.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I think some of the kids getting expanders and such prior to middle school are getting hosed. My child needs braces, but dentist said he wouldn't recommend it until most if not all of DC's adult teeth are in. Dentist is very well respected and recommended pediatric dentist in NOVA. 8 -10 years old for anything- expanders, braces, etc., is just too young for orthodontics in my book.

I never got braces as a kid, and eventually straightened them as an adult. 4 months of an expander, 12 months of mental braces on upper jaw, 8 months on lower jaw, and a permanante retainer on the bottoms once the braces came off. Teeth were really jacked before I got the braces, and now they are still straight 8 years later. Every circumastance is unique, but I'm highly skeptical of this "phase 1 and phase 2" approach orthos are pushing on parents, especially at such young ages when jaws and teeth are still growing.

Also- find an dentist that also does ortho. When I had my teeth done as an adult, my regular dentist did them. I'm sure this helped cut costs. Think it ended up costing $3200, with the expander (granted, I had the work done back in 2006, so costs may be 4K or more now).

That's a big generalization. Every situation is different. I know I would have been much better off if my parents had not waited until I was 13, nearly finished growing, plates fused. My ortho pulled teeth, had me in awful headgear, I was in braces for 4 years, and after it was all over things shifted everywhere and my mouth is a mess.

My DC's palate was so narrow that it affected his nasal passages and ability to breathe through his nose. He had become a mouth breather. The expander has improved that by a lot.

Our costs for the expander were about 700 out of pocket, in a fancy part of NoVa.

Actually, you don't KNOW this to be true. You think you might have been better off, but there is no way to know.

I don't know it to be true, but I don't know how I could have been worse off.

Well, earlier treatment might have meant more total time in braces and could have cost more, which is what OP may be facing.

[Anonymous]

OP just needs to shop around.
OP, what about your dental insurance?
It may be worth it to switch plans. Many plans require a 1 year wait before they will cover treatment, but your ortho may say it's OK to wait until coverage kicks in.

Ours did, so we waited and the palate expander that would have cost 2300 ended up costing us 700 out of pocket.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think some of the kids getting expanders and such prior to middle school are getting hosed. My child needs braces, but dentist said he wouldn't recommend it until most if not all of DC's adult teeth are in. Dentist is very well respected and recommended pediatric dentist in NOVA. 8 -10 years old for anything- expanders, braces, etc., is just too young for orthodontics in my book.

I never got braces as a kid, and eventually straightened them as an adult. 4 months of an expander, 12 months of mental braces on upper jaw, 8 months on lower jaw, and a permanante retainer on the bottoms once the braces came off. Teeth were really jacked before I got the braces, and now they are still straight 8 years later. Every circumastance is unique, but I'm highly skeptical of this "phase 1 and phase 2" approach orthos are pushing on parents, especially at such young ages when jaws and teeth are still growing.

Also- find an dentist that also does ortho. When I had my teeth done as an adult, my regular dentist did them. I'm sure this helped cut costs. Think it ended up costing $3200, with the expander (granted, I had the work done back in 2006, so costs may be 4K or more now).

That's a big generalization. Every situation is different. I know I would have been much better off if my parents had not waited until I was 13, nearly finished growing, plates fused. My ortho pulled teeth, had me in awful headgear, I was in braces for 4 years, and after it was all over things shifted everywhere and my mouth is a mess.

Sure- I did say every circumstance is different. However, there is no validity to an ortho insisting on expanders before the teen years, or some BS about needing to do it before DC's palate fuses. As I said, I had an expander as an adult for 4 or 6 months, and it defintley widened my jaw so there was more room and my dentist could move teeth into place once my braces went on. You can expand the jaw at any age. My teeth have not shifted at all since the expander and braces came off.

[Anonymous]

Just wanted to make a general comment that from my experience with orthodontic treatment as an adult, pricing varies WILDLY between NW DC and close-in suburbs. I got an estimate from a NW DC orthodontist to handle my very bad occlusion/crowding case for 13K. That was in 2007. Then I found a great doctor in Falls Church who did the same thing for 9K. If you are OK with going outside of the district line, you may save quite a bit.

My orthodontist's name is Dr. Fleming.

[Anonymous]

My 10 year still does not have all his teeth in. Dentist says we fave to wait before seeing ortho. Is that the case
?

[Anonymous]

Anonymous wrote:PP here- and no, expanders can be used beyond ages 8-11. As mentioned, I had one as an adult for 4 months (maybe longer) before my braces were put on. Any dentist or ortho saying otherwise is lying and just taking advantage of a parent who doesn't know any better and is fearful if they don't purchase the expander now, it will forever affect their child's teeth.

My kids had their palate expanders in middle school - age 11-12, after all their teeth had come in.

[Anonymous]

Anonymous wrote:In our (parent's) age, braces were done during/after puberty. What is now known as "phase 2". Also the trend then was to pull teeth that didn't fit the mouth/jaw. Lots of kids had teeth pulled.

The newer thinking/trend is to make room for the teeth you have. So this involves expanding the palate of some kids because do to various issues many kids have a crossbite which can lead to a narrow palate. Not as much a problem with baby teeth, but adult teeth are much larger and then there isn't enough room for them. You can only use a palate expander before about 11 years old. After that the top of the palate hardens and it can no longer easily be manipulated to encourage new bone growth and could require surgery to change.

So the current thinking for kids with narrow palates is to use a palate expander around 8-10 years old. This spreads the palate along the top middle of the roof of the mouth and creates space among the teeth. But usually the spaces end up in the front and then you have to use some short-term bracketing (braces) to shift the space to where it will be needed for the adult teeth.

Then this sets up for an easier (or possibly avoidable) second phase later on after the adult teeth are all in. No way to 100% predict how that will go, but phase one generally shortens the 2nd phase substantially.



If your kid just needs a lingual arch placed, I would start with your children's dentist first. In that way it could possibly be covered by dental insurance which has higher reimbursement rate than orthodontics (many people have no orthodontic coverage, we have 50% coverage up to $3500 and then we are on our own for the rest). My daughter had a lower primary molar pulled last year at 9 and the adult tooth doesn't emerge until 11-12 so she had an arch placed by the dentist at that time to preserve the space until the adult tooth comes in. The lingual arch is a standard dental treatment and if that's all your kid needs 9/10 times it will be way cheaper through the dentist vs the orthodontist.

PP above, your answer is so helpful . Can you offer me any advice for my DC ?


my child ( 12 1/2) has just started complaining yesterday about what looks like an impacted upper Canine ( emerging on outside of tooth row ) . I have been asking his dentist for 2-3 years if he thought he had an overbite ( if his front teeth were too prominent ) and if it was a sign of something wrong that his adjacent upper teeth had big spaces ( I never had braces and have straight teeth / no gaps)

My DC's dentist has been telling me ( every 6 months for 2-3 years) at each visit , " no , looks like he has lots of room , lets wait and see what the adult teeth look like "

Two months ago I saw XRY's at his visit and asked " why are those teeth up their on top?" ( canines) and he sai d" oh, those are coming in"

Today they broke the gum on side and baby tooth is firm ( impacted)

My questions:

1) why did my DC's dentist not foresee this and do an extraction of the baby tooth in time and give my DC an expander ? ( he is now 12 1/2 )

2) who are the best orthodontists in the area as obviously, I can't keep taking him to this same dentist

3) same for Oral surgeon, cause i guess my DC needs that too

Thanks