Braces for Teen, Jaw surgery

My 16 year old has been diagnosed with a significant overbite. His pediatric dentist had not recommended braces or any interventions. When we switched dentists (he aged out), the new dentist was surprised this was not recommended earlier. We met with an orthodontist and he recommends jaw surgery (!) to correct his overbite, and that his jaw is already formed as he said, we stop growing at 16. Has anyone else experienced this?  Had I been informed earlier I would have gotten my son into the care of an orthodontist sooner and could have avoided surgery altogether. I think my son is still growing per my kitchen wall growth chart (!), but would like to try traditional methods before moving to this extreme measure. If this had been a "normal-ish" time, it would be better. With everything going on in the community and the world, my kid is a bit fragile these days, feels overwhelmed and depressed, and I do not want to add surgery to his list of concerns.  My son has anxiety and has had therapy for about 1.5 years. This kid never has even had a filling.  We are really caught off guard by this news. Any words of advice, other than getting another opinion (I am on that) . Thank you.

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RE: Braces for Teen, Jaw surgery ()

Feeling for you and your son in this time.

I don't know if this will be helpful to you, but I was also diagnosed with an overbite and had jaw surgery recommended to me as a teen. I had been seeing the same orthodontist throughout my youth, and into my teens. Unlike your son, I had LOTS of dental and orthodontial woes by that time. I had surgeries, removals, fillings, braces and more. I guess when my jaw stopped growing they felt this was the next step. We didn't pursue any treatment at the time because surgery seemed pretty extreme for something that wasn't causing any pain or real distress in terms of my self-esteem.

Later in my 20s I thought I'd revisit the idea, so I saw maxillofacial surgeon, and another dentist and orthodontist, to discuss. It sounded to me like they would have to undo all of the previously done orthodonture, move my teeth back to where they were before, THEN do the surgery, THEN do another round of braces. For a 25 year old it was too expensive, too much of a commitment, but I could have done it then. I asked an orthodontist again just last year, and they said I could still do it, but it would be a cosmetic thing, not covered by insurance if I don't have TMJ. Could have done it then, too.

I don't know the level of urgency with which this was recommended, it may be that your son is in pain, or can't stand the look of the overbite. Maybe that's a good conversation to have with him. You can talk through the benefits and risks together. It may turn out you have time to decide if it's the right thing. And maybe if it is, you can wait a year.

Sending peace and a big smile--with an overbite! 

RE: Braces for Teen, Jaw surgery ()

Hi there! I'm not a dentist or orthodontist - but I do have 2 kids one almost out of braces and one about to get them, and here's what I've learned about orthodontics - in MANY cases it's subjective. The first ortho I took our dd to said she needed 8 teeth pulled. I wanted a second opinion. Guess what? The second ortho said NO teeth would need to be pulled. Now, an overbite can be a big deal, but the fact that your old dentist never mentioned it seems odd, and surgery seems extreme. So my advice is get another opinion from a different ortho. We love ours (Dr. David Johnson) but if you want someone close to where you are you might look in the archives for recommendations. Don't give up yet! Good luck!!

RE: Braces for Teen, Jaw surgery ()

My son is 9. He was diagnosed with a small crossbite when he was 8, and so I got a crash course on this whole "pre-braces" thing, which wasn't a thing when I was young. The thinking is, before the age of 10, kids' skulls are soft and malleable so if you want to move things around, you should do it before the age of 10. For my son, this involved a palate expander and a short stint of braces that is still continuing. And it's true, everything moved so quickly it was like he was made of playdough. When he is a teenager he might have to get braces again, but for now, we have moved things around to make space so as to prevent more drastic intervention as a teenager. I also got a crash course on how every single dentist and every orthodontist has a different idea for how to treat a person's teeth. I've read posts on BPN that accused dentists of negligence by not treating something, or conversely, trying to cheat you of money by overtreating. The truth, I believe, is that there isn't ONE prescribed way to correct someone's teeth, and a LOT comes down to the provider's experience and preferred way of doing things. One orthodontist we saw suggested these huge head gear things for my son, one said we should do nothing, and the third suggested something in between. The oldest (and I think the wisest) of the orthodontists was the one that told me that if you ask a hundred orthodontists what to do, they will give you a hundred different answers. Your son might truly be too old for a light intervention (I was told the skull stops being as flexible at 10, and 16 is much older than that), but maybe his overbite isn't that bad? Go see a few more orthodontists and get more opinions before you rush forward to do something. I definitely would not rush into surgery, especially not during a pandemic.

RE: Braces for Teen, Jaw surgery ()

Glad you are getting another opinion.  We got conflicting opinions on our kid and his dentist (Katsura) was very reasonable about what to suggest to do or not do.

Our son did go for orthodontics at I Song (in Albany), they were helpful and kind and did a great job, when he finally did decide to go with something.  But it wasn't surgery.

RE: Braces for Teen, Jaw surgery ()

Please get a second and maybe third opinion.

When our daughter was 18 months old, we were told she'd need braces. In addition to somewhat crooked teeth, she has a baby tooth that is fused to the jaw bone (technical term is ankylosis), with the adult molar in that space simply missing, and due to an injury her upper front teeth have weakened roots.

We have taken her to two well-respected orthodontists.  The first wanted to remove the ankylosed tooth and the three corresponding molars in the other quadrants of her mouth, then fit her with full braces. Part of his reasoning is aesthetic, part is distrust of implants. The second orthodontist wants to cap the ankylosed tooth to make it the same height as the surrounding teeth (to stabilize them), and otherwise leave it in place if possible until she's 20, at which point she would get an implant.  As for braces, he wants to do the minimum because of the risk of further weakening her front teeth.

Clearly there is a big difference regarding how much or how invasive the intervention should be.  When we got the first opinion, I posted my concerns on BPN and got several replies from adults with ankylosed teeth saying we should go the low-intensity route.  Our dentist concurs with this.  My experience with surgery has been that there are often unanticipated problems, some of which appear only years later. 

Is your son bothered by the overbite, and to the extent regular braces can't fix it, will he have long-term problems?

RE: Braces for Teen, Jaw surgery ()

My daughter has a underbite. Got braces early on to straighten the teeth but that did not help her underbite. It was not extreme but she did wanted corrected and doctors said it will get worst with age.

She made the decision to have surgery when she was around 23, it required braces again for like 6 months t prepared for the surgery.... it was a process. The surgery requires extreme desire to do it, because the recovery is really difficult. Weeks without solid food, great hygiene to avoid infections. I would say 6 weeks of recovery... call me if you would want to chat (510) 282-9633

RE: Braces for Teen, Jaw surgery ()

Hi concerned parent! 

My sister had an overbite and had the surgery at 15 after a year of braces. It was a game changer for her. She loved the results and really helped her confidence and self esteem. The recovery was hard because her mouth was basically shut for a few weeks and could only eat by straw, but was worth it. 

RE: Braces for Teen, Jaw surgery ()

Ten or so years ago my husband went to a dentist or orthodontist who told him that he needed to break his jaw and give him plastic surgery (or something along those lines) to correct his bite. No other dentist had ever told him anything similar. We switched to a new dentist who gave him Invisalign and told him it's not a big deal. His teeth are not 100% perfect, but they don't bother him in any way. So sometimes they are wrong, and you are smart to be getting a second opinion. I would also make it known to them (if true) that you aren't looking for perfection or maximum intervention, but just a reasonable healthy way to address the situation. And not to be paranoid, but worth noting that most dentist/orthodontists offices have been closed for a while because of the covid shutdowns and some are probably desperate for business. That can influence people's thinking, even subconsciously.

RE: Braces for Teen, Jaw surgery ()

Hi, Marghi- I completely empathize with the difficult situation you and your son are in. I had a similar jaw surgery when I was 18 (many moons ago) on my upper jaw and it came after years of orthodontic work (retainers and braces). My surgery was delayed several times to make sure I had stopped growing. Unfortunately, that resulted in the surgery happening right before I started college and I ended up moving into the dorms with my jaw wired shut and I was subsisting on a liquid diet. I have had dentists tell me the way my surgery was done has changed significantly and is now less invasive, but I don’t know the details. I would suggest that if the surgery is needed (I had TMJ, so it was beyond cosmetic), you find out about pushing it back until your son has stopped growing and you consult with a maxilofacial surgeon who will work in conjunction with your son’s orthodontist. If you want any more details, feel free to message me. I am hoping you get the information you need to make an informed decision.

RE: Braces for Teen, Jaw surgery ()

It sounds like getting braces first would be worth a try. Orthodontists can want teeth to be "perfect" when they maybe just need to be "better." I bet braces can still do some good (I know adults who have gotten braces). Even still, I feel for your son. It can be difficult to have to get braces so much later than most. (My older child had to have braces her senior year, and it was kind of a bummer for her.) My younger one is scheduled for jaw surgery this summer (they are 16.) Even though we have decided to do the jaw surgery, based on our child's situation, I would say that the professionals can think things are necessary when maybe they are not. I would look into braces first, and then think about the jaw surgery. Also, the decision about whether or not to have the surgery doesn't sound urgent. You can almost certainly put it off for at least a year or two until your son is more ready emotionally. Good luck to you both! 

RE: Braces for Teen, Jaw surgery ()

My stepdaughter put off doing anything about her crooked teeth for years because she was advised it would require surgery.  Last year she consulted a new dentist and got invisalign. The treatment isn't even completed and her teeth look much better already; she is very happy. 

RE: Braces for Teen, Jaw surgery ()

thank you all for your replies. We did a second opinion, but went back to original ortho as we are doing the "head gear" and NO surgery route. No teeth pulling either. It seemed the least invasive. And whilst school is in Distance Learning mode this Fall, he can wear his headgear around the house, get in more hours with this. I appreciate your kindness as we navigated this. I had braces as a teen, it was not a big deal, so I was troubled by the surgery aspect of orthodontics. ^cheers^

RE: Braces for Teen, Jaw surgery ()

You are right, having phase 1 orthodontics treatment would’ve made a difference for your son. Sorry to hear it was not caught sooner. We went through the same thing although we caught it earlier. Have you discussed with Ferrari Orthodontics in Kensington? If anyone can figure out how to avoid the jaw surgery, it would be Dr. Claire Ferrari. She’s the orthodontic specialist that patients seek out when the situation is complex.