Orthodontic Evaluations - No Referral Necessary

 

Contemporary Orthodontics & Dentofacial Orthopedics

James R. Waters, DDS, MSD, PA

Board Certified Treatment for Children, Teens and Adults  

My dentist has not referred me (or my child) to an orthodontist 

so can I assume there is no orthodontic problem?

Almost daily I see new patients that had been waiting on a referral for braces before finally deciding to come in knowing that something doesn’t look correct.  Many times we can simply assure the parents and/or patients that there is no real problem and that their dentist may be waiting for teeth or such.  However there are also many times that a real problem is brewing and should be addressed early.  General Dentists are not always in tune with the developing occlusion; they focus on restorative work, oral hygiene and the overall health of individual teeth (many patients may not get a full exam until there is a problem found by the hygienist).  Orthodontists are specifically trained for 2 to 3 years beyond dental school to see more of the whole developmental picture; to identify evolving problems and plan interceptive treatments to curb potential damage to the teeth and/or supporting tissues.

This additional training and experience allows early identification of problems including but not limited to potentially impacted teeth due to early crowding, congenitally missing or malformed teeth, ectopic eruptions (teeth erupting in the wrong location) and even seeing malocclusions that typically cause TMD (joint pain) and/or damage to the teeth but not be obvious to the dentist. 

Take the following patient for example; the older sister of a patient in treatment with a history of 6mo checks with her children’s dentist.  A complimentary panograph was taken due to the appearance of a narrow arch.  Note the large mass on the lower right of the radiograph (completely un-related to the narrow arch we were investigating); a benign but aggressive tumor destroying the bone and placing the teeth and jaw at risk of fracture.  Oral surgery was required immediately to remove the tumor and allow healing before teeth would have been inevitably be lost and before the jaw fractured.  The patient has since healed and is doing well thanks to identification and removal based on a chance visit.

In the same week I saw both of the following patients without referral because the parents felt teeth were not coming in on time.  In the panographs taken below you can clearly see the problems.

Both patients now require surgery to expose the impacted teeth and pull them away from the adjacent teeth while forcing them to erupt.  Both cases had a good chance to prevent the impactions by working early to restore the size of the bone before the canines tried to erupt but by the time we saw them, it was too late to prevent. 

Kids may be the obviously example of hidden needs but teens and adults also can have significant functional problems not addressed by their dentists.  Consider a poor occlusion that causes heavy wear to the front teeth.  Given time, the heavy wear on the teeth adds up and can literally destroy the front teeth.  The 47 year old adult below asked about the wear for years until the dentist advised him there was no room to place veneers.  Instead of giving up, we used braces to open the bite and restore space for the restoration of the severely worn teeth.

Before Treatment

Braces used to open the bite and space for veneers

Following restoration with veneers

In another patient, instead of allowing this wear for 30 years, a 15 year old with the same bite presented with the complaint that she did not like her smile but the dentist told her there was no problem.  Braces were used to re-open the bite and restore proper function before the teeth were worn down beyond the point of requiring repair (mild reshaping was performed following braces to mask the worn edges and allow a younger appearance).

Before

After Braces

Another common issue with teens has to do with the way adult teeth erupt behind the baby teeth.  Leaving the baby teeth too long will cause permanent teeth to rotate or deflect over other teeth; in fact much of the crowding we see in teeth can be traced back to retained baby teeth.  This is especially detrimental in cases with over-active musculature.  Consider the case below showing the upper teeth leaning back which in turn constricts the lower teeth causing crowding and holds the lower jaw back preventing full growth.

 

Before treatment.  Note the lower jaw is pushed backward causing a receded chin at age 8.  Additionally, the upper teeth are back which creates less space for the un-erupted teeth (in fact, this patient already has an impacted canine).

 

During initial treatment the front teeth are being aligned and brought forward.  You can see where the impacted canine was exposed and a chain bonded under the gums to pull the tooth back away from the front teeth and into correct position.

 

Following treatment, you can now see how the lower jaw has come forward and the teeth aligned with the previously impacted canine in position.  Had we not been able to treat as a child, we would not have been able to fully correct the facial profile and would not have been able to align teeth without removing some of the permanent teeth.   

Ultimately there is nearly an infinite combination of issues that will lead to an orthodontic malocclusion and the Family Dentist simply does not have the time to focus on every scenario.  An accredited Orthodontic Specialist is trained just for identifying and treating malocclusions hopefully before they lead to more extensive damage.   

So why would you wait to be referred to an orthodontist when it is the orthodontist who is the one that can identify the problems in the first place?  It is far more beneficial to have an orthodontist screen patient (always at no fee) and decide who may benefit from modern orthodontics and when it is the best time for any treatment.

This is the reason the American Association of Orthodontics, the American Dental Association and the American Board of Orthodontics all recommend patients be screened by accredited Orthodontic Specialists before age 7. 

If you have questions or comments concerning this or any orthodontic question, please feel free to make a complimentary new-patient appointment at either my Steiner Ranch location or my North-central Austin location on West 35^th Street and MoPac.

Dr. James R. Waters is a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian graduate from the prestigious Saint Louis University Orthodontic Program receiving the J.P. Marshall award for clinical excellence in 2001.  He holds a Bachelor’s Degree in Science, Doctorate in Dental Surgery, a post-doctorate certificate in Advanced Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics and a Master of Science Degree in Orthodontics.  Dr. Waters and his wife of 18 years live in Austin, TX with their 4 children where he has a thriving, multi-faceted Specialist practice with locations in Steiner Ranch and North-Central Austin.  You can learn more about Dr. Waters at BracesAustin.com.