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What would you do?

misskittykat

My daughter (13) has a very small mouth and lots of big teeth.  The orthodontist has recomended 4 teeth being removed.  We've known this would happen for a long time as she was unusually early with her teeth so has been seeing the orthodontist and hygenist since she was 9.  They were ready to do the work last year but I decided to up sticks and move to the other end of the country to be near family so delayed the treatment.  The old orthodontist was a mum from her school.  It was a small practice, very close to our old home and my daughter felt comfortable there.

The new orthodontist is the biggest flashiest practice I've ever seen (we have no choice of where to go so can't change).  They terrified the life out of her when she went with the amount of people in the room etc. He referred her on to have teeth taken out by GA as he could see how distressed she was and knew she wouldn't cope with having them taken out by them.  We've just been to the dentist connected with the hospital and this has traumatised my daughter again.  We had to leave before I could sign any consent and discuss risks of a GA.

My daughter is adament that she does not want to have her teeth out.  I know this is her anxiety talking and I've left it for now.  I've promised her that nothing will be done without her agreement.  

The orthodontist has now called and asked we go back to see him to discuss.  Part of me believes she has the right to choose but the other part of me thinks that I am not doing my best by her.  The two lower teeth could stay however the two top teeth are actually behind her two front teeth which not only looks unsightly, could cause problems as she ages because its not possible to clean them as well as they should be.

My initial thoughts were that we delay again for another year.  She has had a very difficult year with my moving and a change of schools and her anxiety is at a peak.  I can't discuss with friends/family as they don't really understand how difficult being on the spectrum is.  Any thoughts?

  • Thanks.  I'd thought of doing a time chart thing but a story might be better.  We're actually going back to the Orthodontist in a couple of weeks to discuss as the dentist wrote him a long letter about what happened!  I am going to ask what the implications are if we leave it until she is 15/16.  I know the hospital won't do a GA once she's turned 16 but they may reconsider if its in her best interests to wait.

    In the past 10 months, we've moved from one end of the country to another, lived with my sister before getting our own house (so moved twice) plus my new job was full time (I'd worked part time before) and she moved from a school of 600 ish to 1800 and she's had continous healthcare appointments (including a diagnosis).  It was no wonder she fell apart and I think I need to work on repairing the impact of that before we consider extensive dental work.

  • Hi Miss Kitty Kat,

    It does sound like a dilema, if you do decide to go back, would it be worth making up a Social Story for her to understand what will happen, they can be so useful when children havent been somewhere before and if you include the actual pictures of the dentist, the enviroment even right down to your car, it may help her make sense of things a little easier when she's there because she knows what to expect thus lowering her anxiety and allowing her feel like she is in control. It might be good to add in things like how she can take in her favorite toy/blanket. The more visual the better. Dentists do now have to make reasonable adjustments under the Equality Act so even asking for the last appointment of the day or an appointment first thing before the clinic starts may be a good thing to ask. If they do seem resistent the Equality Act gives you some clout and support.

  • I've tried to be blunt but she can't imagine future pain because she's never experienced tooth ache and in her eyes, they are her teeth, she has a choice.  I think I will go in and see the orthodontist alone and see what he suggests.  I think we'd only get her in the car to go if she was drugged!

  • Hi Coogy

    I think the treatment suggested is the best option. The first orthodontist referred her to a consultant who said that taking the teeth out rather than pulling them forward was the best option because they had too far to come and I agree as did the second orthodontist, its just getting her to agree.  I think even if we could get the teeth out and then wait for braces would be a better than doing nothing, I just need to get my daughter to agree!

     

  • Hi misskittykat

    I've just had a similar issue with my son only the orthodontist wanted to do work we didn't agree with, but were told their was no other alternative. My dentist also didn't agree and re-referred me to have a second opinion at a private practice. Turned out this private chap was the surgeon who would operate on him. He re-xrayed and concluded the work didn't need to be as extensive and their were alternatives. Given that my young son was being prescibed bridge work and the removal of over 6 teeth, it seemed wrong so we were glad we sort a second opinion. He's now had the surgery, but much less intrusive and with no prosthesis necessary. Also the original orthodontist was working from x-rays over a year old!

    If something feels not quite right then go with your instinct. Get a second opinion even if you have to traval to a teaching hospital or specialist centre outside your county. At least then you will feel fully informed and happy that the option offered is the best one for your daughter.

    Personally i'm glad we delayed, but you know your daughter best and you must do what you feel is right for her. If delaying is what you want and shes's not suffering as a result then delay while you research further.

    Can I ask, have they considered taking teeth slightly further back and using a chain/brace to pull the teeth behind her front ones into their proper place? My other son has had this done and now has eye teeth where they should be rather than in the roof of his mouth. Worth asking about this option perhaps.

    Re her trauma, can i suggest you ring the practice before hand and explain her condition. My practice let my boys sit in a quiet smaller area so as to keep sensory overload at bay. Also my dentist is aware of their Aspergers and acts accordingly to accommodate their needs. Good luck. I wish her and you all the best.

    Coogy xx

  • It is a risk but do you think that being blunt with her regarding the risks of keeping teeth may be the best course of action.

    If she knows that the risk of keeping teeth will lead to more complications later on, she may see things more clearly.

    I would emphasis to her that you will do whatever you can to make the environment less daunting and discuss ways you can do this, but stress that it has to happen.

    My son needed an op recently, and was truly terrified, but knew he had no choice.  I made sure that the staff were fully briefed and make sure that staff knew not to rush him, and not to overwhelm him with their presence.  Also to be direct and honest with him. 

    Later on he said that he was glad for the honesty, as it meant he could still trust us.

    Don't be afraid of going to the clinic yourself and putting your son's needs on the table.  My experience is that doctors are grateful for any suggestions that make the process easier for all concerned.