It's not always about braces

I guess the common perception of an orthodontist is that we fit braces. Of course that is a big part of what I do but I don't advise braces for every patient I see. Take two cases that I have seen this week.

S is 12 and not bothered by the appearance of his teeth. He is pretty adamant that he doesn't want braces, he has thought about this and lists several very valid reasons why. His teeth are a bit crooked, but not too bad and the main reason for doing treatment would be aesthetic. That's not to say appearance isn't important, but in S's case he was happy with his appearance. In his case treatment will still be possible if he changes his mind when he gets a bit older, even when he is an adult.

In this situation the patient's opinion is key. Wearing braces is a big responsibility and is not without risks. I need patients to be on my side to make the treatment easier for all of us. Apart from a few specific situations (for example where treatment timing is critical or dental health is an issue) I will never persuade people into treatment they don't want.

C is also 12 and has a very different situation. Her teeth aren't very crooked either but four of her adult teeth have failed to develop and one is in a poor position, that's her x-ray above showing the milk teeth remaining in position. Orthodontic assessment in a case like this is essential to plan what to do. If her teeth were really crowded we would remove the milk teeth and use the space to straighten the front teeth so that there won't be long term spaces, but in C's case this would be too complicated and wouldn't actually improve the position of her teeth by much, in fact she'd probably end up in a worse situation. So I didn't suggest braces for C either, she needs to take care of all her teeth, including the milk teeth that remain as they can sometimes last for years. Her dentist can plan how to replace these teeth when they are eventually lost but orthodontics can't really offer much to her.

So just because you need to see an orthodontist it doesn't mean that braces is the immediate or obvious solution. As an orthodontist I am trained to understand the development of the teeth, the jaws and the face, as well as knowing how to correct problems that can occur. So be honest with me about how you feel, listen carefully to my advice and don't be afraid to ask questions.

Goodbye to the Tooth Fairy

The end of an era was reached last week as my younger daughter lost her last baby tooth.

Also known as milk teeth, or more correctly deciduous teeth, your first twenty teeth are shed to make way for the adult, or permanent teeth. Generally the first one is lost around about the age of 6, and the last one about the age of 12. However there is a large variation and two years either way is fairly normal, and as long as the normal sequence of teeth erupting is followed this is not of any concern or consequence. My daughter was particularly young, being 9 years and 7 months.

I am sure you will know of the tooth-fairy tradition of leaving the tooth for the fairy to collect, who leaves money in exchange. In some countries there are variations, like a tooth-mouse, but it's a fairly popular tradition worldwide. The first visit from the tooth fairy when she was aged 5 caused much excitement. Over the years she has developed a little routine of leaving a note for the fairy, who usually replies, so we now know that our fairy is called Lilac, lives somewhere nearby under a mushroom, and has all sorts of excuses for non-attendance like a sprained wing or a trainee fairy!

This is her last letter along with the tooth and the tooth box. I did think that at the age of 9 and with an older sister she might have realised the tooth fairy secret, but she was genuinely upset that the fairy would never visit again, to the point of tears! Awww!
Thankfully this time the tooth fairy attended on time and left a lovely letter, complete with lilac ink and a picture.

The tooth fairy was good enough to let me keep the teeth, shown in the picture at the top. Three are missing, I know at least one was swallowed, not sure where the other two went! I'm pleased to report they are all healthy, thank goodness, being the daughter of two dentists would you expect anything less?