Braces—Yikes!

[bisimpson]

So the other day our dentist mentioned that it was probably time to get a sales pitch consultation from an orthodontist for braces for our daughter.

First, we don't have great dental insurance, so all of this comes out of pocket.

Second, in the past we have taken anyone who has "Dr." before their name at their word. But we're beginning to come to the conclusion that we might not have the same level of concern about teeth than say someone who has spent their entire adult life pondering.

We're aiming for healthy, but not necessarily concerned about perfect. I think most of the dentists that we've seen in the past have been aiming for perfect.

Any thoughts as we approach a decision about braces?

[HPstache]

I'm saving up for my boys to have braces (very likely) using the HSA.  A little less painful when you know it's tax-free dollars and usually dollars that are added to by work or heavily subsidized.

How much are they tell you?

[Trifle]

I'm right there with you.  Our DD just had braces put on three weeks ago.  We never thought we'd get braces for one of our kids (we don't care about perfection) but were persuaded -- by a jaw surgeon we consulted -- to try them for therapeutic reasons to treat her TMJ disorder. 

Charge was $6000.  Our dental insurance covered $1500, so we were out of pocket $4500.  I'll tell you in two years whether it helped the TMJ problems.  :/

[Slow2FIRE]

Do they have valid reasons for your child to get braces?

Every time I find a new dentist, the first thing they do is try a sales pitch on me for braces.  Typically, I tell them I don't care about aesthetics and they tell me about a minor benefit that doesn't seem worth $3000+ to me.

[Gone_Hiking]

I would definitely ask the dentist why your DD might need braces.  There might be valid reasons.  However, if it's all about perfect and attractive smile, then, seems to me, the decision is up to you.   Best of luck - I feel for you.

[MsPeacock]

My older son had severe under bite and crowding. He’s actually has two rounds of braces. The first from about. 7 or 8 for 3 years, and the second now in his mid-teens. The first made significant corrections to the underbite and those changes are easiest when the kids are young. He definitely needed braces. He’s also needed something like 18 teeth extracted (baby teeth and two adult teeth). The dentist delayed referring us until I insisted because his adult teeth were erupting through his pallet. He absolutely needed braces.

Younger son has had consultation with the same orthodontist - who shrugs and says “nothing now, check again in a year or so”

My point being that not all orthodontists will automatically recommend braces for all kids who walk through their door. Ask around and find someone with a good reputation. Your dentist is presumably NOT making money off referrals to an orthodontist. Get a second opinion if needed. It is also much wiser to correct orthodontic problems when young.

[ETBen]

I actually had a nearly exact same experience as MsPeacock. It’s my youngest that needed them, for similar reason, and extractions. The orthodontist explained and showed why it was necessary. It helps that I had the same problem as a kid and didn’t get them fixed until later, ugh. But my oldest doesn’t have perfect teeth and they said don’t bother yet.

[pecunia]

I had braces in my 30s.  The same level of correction that could be done when I was younger was not really possible unless they broke my jaw sliced it longitudinally and reset it.  I saved my teeth.

My parents did not have the money for braces when I was young.  Corrective medicine is good.  An ounce of prevention is worth a lb of cure.

[catccc]

Much of the time it isn't just about vanity.  We are about to have our 7 year old seen about a notable underbite. If not corrected it could lead to premature enamel wear (which leads to decay), TMJ, and even sleep apnea!

I would shop around, though, and hear out different orthodontists' plans of action.  I know someone that raves about what her orthodontist has been able to do for her daughter without employing braces.

It might be worth paying out of pocket for better insurance just for the braces.  Lots of plans have orthodontia coverage for children, and while most plans have waiting periods before coverage can begin, many also will eliminate the waiting period if you already have some other dental coverage.  I switched jobs and my preferred dentist was suddenly out of network.  With the work I had planned to get done, it ended up saving me $ to pay for secondary insurance out of pocket.  I carried it for about a year, and it saved me hundreds over what it cost me.

[Pigeon]

I'd get several opinions, and see if you can get each ortho to give options.  My sister had a kid with very crooked teeth.  She ended up getting a lot of opinions.  Some of the orthos had some very extreme recommendations.

I have one kid who had one tooth coming in at a wonky angle because of a wisdom tooth that was not coming down.  The rest of her teeth are near perfect.  The ortho's top suggestion was surgery to remove the wisdom tooth, followed by a full set of braces for at least 2 years, more likely three, for about $8,000.  He did the panoramic x-ray overlaid on the "ideal" set of teeth, and other than the one offending tooth, he struggled to show me where there was any difference at all. 

I asked if there were other options.  For Plan B, he grudgingly admitted that we could do the same surgery to remove the offending wisdom tooth, and make a small appliance to pull the wonky tooth into place.  He figured that would take about 6 months.  The cost was under $2K.  Plan B it was for us.

I was left alone with his office manager, who had worked for him for over 10 years.  Turns out she was the sister of a high school friend of mine.  She admitted that Plan B made perfectly good sense, and that the ortho almost never told any parent that the kid didn't need a full set of braces.

Plan B ended up only taking 4 months, and dd's teeth are beautiful.

If I had a kid who had noticeably crooked teeth or teeth that were cause some type of genuine physical problem, I would shell out to get braces for them, but I wouldn't blindly hop on the train.

[NextTime]

I'm right there with you.  Our DD just had braces put on three weeks ago.  We never thought we'd get braces for one of our kids (we don't care about perfection) but were persuaded -- by a jaw surgeon we consulted -- to try them for therapeutic reasons to treat her TMJ disorder. 

Charge was $6000.  Our dental insurance covered $1500, so we were out of pocket $4500.  I'll tell you in two years whether it helped the TMJ problems.  :/

They fixed my TMJ issues. I had a constant dull throbbing headache for over a year. Doctors couldn't figure out the reason. Then my mother mentioned reading something about TMJ issues.

I got an appointment with the ortho and he told me my top teeth were causing my lower jaw to be pulled back causing tightness and headaches. I was in my mid-30's.

The charge was $5000, but I got a 10% discount for paying it all up front, so $4500. Then my insurance gives $2200 lifetime per person for ortho, so I ended up paying $2300 out of pocket.

[whitewaterchica]

I had braces in my 30s.  The same level of correction that could be done when I was younger was not really possible unless they broke my jaw sliced it longitudinally and reset it.  I saved my teeth.

My parents did not have the money for braces when I was young.  Corrective medicine is good.  An ounce of prevention is worth a lb of cure.

I had a similar experience. Wore braces in my late 20s to correct issues that would have been more successfully resolved as a child. I, too, opted not to have surgery. I am pleased with the results but wish it could have been addressed when I was a child. People keep mentioning perfection but unless you know the experience of being mocked for your teeth from family, classmates, strangers, etc... you don't really understand. It took me a long time to stop covering my mouth when I laughed or talked.

[Dave1442397]

I went to two orthodontists to get an opinion for our daughter. The first said he thought she only needed braces for cosmetic reasons (I'll say), and the second explained exactly why she needed braces and what was likely to happen if she didn't get them.

After getting some reviews from Yelp & Facebook, I went with the second orthodontist. Total cost is $5900, which is all out-of-pocket, so I'm using my HSA account for that.

It's been 11 moths since she got the braces, and the improvement is very noticeable. I really like the orthodontist and her staff.

[mm1970]

So the other day our dentist mentioned that it was probably time to get a sales pitch consultation from an orthodontist for braces for our daughter.

First, we don't have great dental insurance, so all of this comes out of pocket.

Second, in the past we have taken anyone who has "Dr." before their name at their word. But we're beginning to come to the conclusion that we might not have the same level of concern about teeth than say someone who has spent their entire adult life pondering.

We're aiming for healthy, but not necessarily concerned about perfect. I think most of the dentists that we've seen in the past have been aiming for perfect.

Any thoughts as we approach a decision about braces?

My husband had braces, I did not.  I have a bit of an overbite and a big gap in my front two teeth, but otherwise I'm good.  My teeth aren't bad in a way that stereotypical teeth are (like British), and they aren't crooked.  I think that having reasonably good teeth is a marker these days.

My brother got braces, he had crooked teeth.

Our dentist is recommending braces for our 12 year old, and thus far, I've been ignoring them.  Not a fan of the upsell.  But, he has a gap (like me), and a large-ish overbite.  So, the danger with the overbite is breakage if you play sports or fall on your face.  We will likely get him braces to correct the overbite.

I have a recommended list, and basically have been asking my friends for their recommendations - whether they think they've been getting the "upsell" or not.  Will likely go through consultations this summer. 

In the end, the majority of dental insurance sucks anyway and doesn't cover orthodontic work at all.  So we'll be using the HSA I expect.

[honeybbq]

I would consider braces, if recommended by an expert, to be part of the routine care administered to my child.

Having straight, properly aligned teeth gives them a head start on a life time of good oral hygiene - straight, easy to floss and clean teeth will be healthier and provide a lifetime benefit of lower dental costs.

.... Not to mention the self esteem issues of the child (potentially).

Now, if it's just a slight gap, or one little problem area, no. But definitely go for the consultation.

[ysette9]

In the US at least, having straight teeth is a class indicator. Having decently straight teeth is an expectation for middle-class kids. You can argue all you want about whether that is right, judging a book by its cover, and so forth, but that is just the reality we live in. Be aware of that when making decisions.

I had a lot of big, crooked teeth and my orthodontist did a lot of work in a short amount of time when I was a kid. I am very grateful for that now that I understand what it would have been like had I not had those corrections. My husband had straight-looking teeth and didn’t have anything done (grew up poor, partially in a poor country before immigrating). As an adult though the misalignments that weren’t really visible caused additional wear to already fragile teeth. He had one dentist even ask him if he was bulimic as his teeth are that bad. To have caps put on to ensure he still had his teeth by 40 (as his dentist described), he had to first have braces to correct the underlying west issue. He had relatively little movement done in more time and with more discomfort than I had as a kid.

Morale of the story: do it young when it is faster and easier. Even straight-looking teeth may have other issues we lay people may not appreciate.

[maginvizIZ]

I live in San Diego, and took a day trip to Tijuana for the weekend... SO MANY DENTAL OFFICES THERE.  I casually checked prices... $1500 out of pocket.  No insurance. Just made me think... Save $3500 by flying out of the country? hmmm....


Clearly you need to do research... But it may be worth looking into.

[maginvizIZ]

I live in San Diego, and took a day trip to Tijuana for the weekend... SO MANY DENTAL OFFICES THERE.  I casually checked prices... $1500 out of pocket.  No insurance. Just made me think... Save $3500 by flying out of the country? hmmm....


Clearly you need to do research... But it may be worth looking into.

For braces that need frequent appointments for adjustements?? Doesn’t seem economical when you need to fly every 6 weeks.

Could you get adjustments locally?  It seems the bulk of the expense would be to get them on & off, right?  I don't know.  Just throwing out ideas!

[OccamsPhaco]

In the US at least, having straight teeth is a class indicator. Having decently straight teeth is an expectation for middle-class kids. You can argue all you want about whether that is right, judging a book by its cover, and so forth, but that is just the reality we live in. Be aware of that when making decisions.

Nailed it. Teeth are something that are very noticed by everyone in this country. I seem to recall an article indicating that HR departments view straight, white teeth as a strong indicator that a potential hire will be a good employee.

Here's a link to a study that found something similar:
https://www.ncbi.nlm.nih.gov/pubmed/25263144
From that study:
"RESULTS:
The photographs of persons with ideal dental esthetics were, on average, evaluated as superior with respect to intelligence and likelihood of being hired than were the photographs of the same subjects with nonideal dental esthetics. For the characteristics of honesty and efficiency, no significant differences were observed in the evaluations between those with ideal and nonideal smiles (P <0.05).

CONCLUSIONS:
Persons with ideal smiles are considered more intelligent and have a greater chance of finding a job when compared with persons with nonideal smiles."

Here's another study with pretty disconcerting results:
https://www.sciencedirect.com/science/article/pii/S0889540611005324
"Results
The subjects’ photographs with ideal smile esthetics were consistently rated higher on average than the same subjects’ images with nonideal smile esthetics. The differences in ratings between ideal and nonideal smiles were significant for perceptions of athletic performance (P = 0.0141), popularity (P <0.0001), and leadership ability (P <0.0001), but not for academic performance (P = 0.0548)."

People actually think you're a better athlete and leader if you have nice teeth. It's more than a cosmetic procedure.

[Sibley]

I didn't have braces, am ok. My sister didn't have braces, and is definitely not ok. I really do not know why she didn't have them a child. She's currently in the middle of braces, just got the bottoms put on. Tops were a year ago or so? She has permanent tooth damage because her teeth were misaligned, and had to remove 1-2 teeth to alleviate overcrowding.

There can be VERY good reasons for braces. I'd get the consultation at the very least.

[Trifle]

I'm right there with you.  Our DD just had braces put on three weeks ago.  We never thought we'd get braces for one of our kids (we don't care about perfection) but were persuaded -- by a jaw surgeon we consulted -- to try them for therapeutic reasons to treat her TMJ disorder. 

Charge was $6000.  Our dental insurance covered $1500, so we were out of pocket $4500.  I'll tell you in two years whether it helped the TMJ problems.  :/

They fixed my TMJ issues. I had a constant dull throbbing headache for over a year. Doctors couldn't figure out the reason. Then my mother mentioned reading something about TMJ issues.

I got an appointment with the ortho and he told me my top teeth were causing my lower jaw to be pulled back causing tightness and headaches. I was in my mid-30's.

This is great to hear, thanks!  Yes, that is our daughter's exact situation.  Her lower jaw is being forced into an unnatural position, putting strain on the joint.  She has pain, headaches, and occasional dislocations. The surgeon said braces were not guaranteed to help, but he thought there was a good chance. 

[NextTime]

I'm right there with you.  Our DD just had braces put on three weeks ago.  We never thought we'd get braces for one of our kids (we don't care about perfection) but were persuaded -- by a jaw surgeon we consulted -- to try them for therapeutic reasons to treat her TMJ disorder. 

Charge was $6000.  Our dental insurance covered $1500, so we were out of pocket $4500.  I'll tell you in two years whether it helped the TMJ problems.  :/

They fixed my TMJ issues. I had a constant dull throbbing headache for over a year. Doctors couldn't figure out the reason. Then my mother mentioned reading something about TMJ issues.

I got an appointment with the ortho and he told me my top teeth were causing my lower jaw to be pulled back causing tightness and headaches. I was in my mid-30's.

This is great to hear, thanks!  Yes, that is our daughter's exact situation.  Her lower jaw is being forced into an unnatural position, putting strain on the joint.  She has pain, headaches, and occasional dislocations. The surgeon said braces were not guaranteed to help, but he thought there was a good chance.

I never had jaw pain or dislocations so hers sounds worse than mine. Just constant tension headaches and jaw soreness. It took about 2-3 months for the headaches to stop.

Good thing is, the first few months with braces are when most of the major movement occurs. The teeth are pulled forward and outward. The last year and a half is more for the aesthetic straightening. So if it works, the relief should come fairly quickly. At least it did in my case. It only took about 2 months for the headaches to subside.

After such a long period of clenching my jaw, it took awhile to train the muscles to relax. It was very frustrating. I still have issues with clenching my jaws and getting tension headaches when I am stressed. But that's more of a common human issue than TMJ problem.

[NextTime]

I live in San Diego, and took a day trip to Tijuana for the weekend... SO MANY DENTAL OFFICES THERE.  I casually checked prices... $1500 out of pocket.  No insurance. Just made me think... Save $3500 by flying out of the country? hmmm....


Clearly you need to do research... But it may be worth looking into.

For braces that need frequent appointments for adjustements?? Doesn’t seem economical when you need to fly every 6 weeks.

Could you get adjustments locally?  It seems the bulk of the expense would be to get them on & off, right?  I don't know.  Just throwing out ideas!

Absolutely not.
The cost is for the expertise and time of the specialist, not the little metal brackets that they put on the teeth. Bad ortho can utterly ruin your mouth, it’s the tiny little adjustments along the way that seem like nothing, but they’re the difference between success and total disaster.

Ortho is fucking complicated. Do not underestimate it.

Yeah. In my case, it was a flat up front cost.

I doubt the actual braces cost more than a few hundred dollars, if that.  Over a 2.5 year period, I went to a looooooot of appointments. Don't remember the frequency, but they start off close together and then move further and further apart. As was just said, You are paying for expertise and time.

[bisimpson]

Thanks all, I really appreciate this. This is all super helpful. It's great hearing stories.

I think the answer is to take the consult with a grain of salt and make sure there aren't any other options. We haven't had the consult yet; I'm just gearing up for the hard-sell. I just imagine leaving and my wife going on about getting a dip-tet.

We spent a year in the UK—and it was pretty obvious that they had a different take on these types of things.

And I still need to look into the HSA.

[Dave1442397]

Thanks all, I really appreciate this. This is all super helpful. It's great hearing stories.

I think the answer is to take the consult with a grain of salt and make sure there aren't any other options. We haven't had the consult yet; I'm just gearing up for the hard-sell. I just imagine leaving and my wife going on about getting a dip-tet.

We spent a year in the UK—and it was pretty obvious that they had a different take on these types of things.

And I still need to look into the HSA.

The HSA is handy - at least you're paying in pre-tax dollars. My insurance company would have paid $1000 of it if we had gone with someone in their network, but there wasn't anyone all that close to us. For the sake of $1000 I went with an orthodontist that gave me warm fuzzies.

[okisok]

I had standard metal braces as a kid, but never got a retainer. So my teeth are much better than the snaggle-toothed mess they were, but they've drifted.  One tooth is so far out of alignment that it's damaging the tooth above it.

My dentist said I was a good candidate for Invisalign, since it was only those two teeth and a few cosmetic gaps. He quoted $5200, split into two easy payments!! I shopped around and found SmileDirect. $99 trial kit (which was on sale for $25 during Black Friday) to see if you're a good candidate. Or they can hook you up with a local dentist. I skipped that option, since my dentist had already cleared me, and I would continue seeing him for the duration...just not get the braces from him. It was $1850 for the total cost, and I paid for it with my FSA. (They contacted my insurance to see if they would be covered, but alas, no.)

I couldn't be happier with them--except to have never had braces in the first place :) You take pictures and send them in periodically to check your progress. They send me email & text alerts when it's time to put in a new set of aligners. They shipped me everything I needed in one box--all of my aligners, labeled by date I would use them; a removal tool; lip balm; and several tubes of whitener that I can use in conjunction with my aligners. About six weeks before your time is up, they email asking about a retainer. They're $99, replaced every six months.

All this to say, shop around. My mail order braces are doing the same job the expensive dentist-ordered ones, for less than half. At my last dental appointment, my dentist said they were working well.
You can talk to your insurance carrier, too, to see if they have recommendations.

[Dave1442397]

For adults, there's always the DIY method :) 

I wouldn't try this on kids, but... https://amosdudley.com/weblog/Ortho

[Le Barbu]

One of the reasons we live a mustachian lifestyle is to be able to afford this kind of expense with not much financial considerations. Our 2 sons had some kind of orthodontic that cost +/- 2,500$ each so far. No way we were going to cheap on this! Next step will be mostly estetic...

[ambimammular]

Just a word of warning about the online braces. I can't speak for all of them, but some do NOT take care about where your jawlines are. They may push teeth around so they are in neater lines, but then also push their roots to being exposed. This is info coming from my pediatric-dentist brother. We talked all kinds of options over with him when my 8 year old was needing her cross bite fixed. My bro has seen some bad things, some from regular dentists making adult sized holes on tiny children's teeth.

A good orthodontist will ensure that the teeth stay grounded. 

Also, to give you a baseline price, the cross bite fix cost us $3300. That was 5% off for paying upfront. This was for the double helix appliance, consultation, all the adjustments, any mishaps etc. It's all inclusive.

[formerlydivorcedmom]

My teeth always looked fairly straight, but I had a slight overbite.  My parents and I decided I didn't need braces because it was mostly cosmetic.  Turned out that I actually had a tongue thrust issue, so my bite continued to get worse.  By the time I was 32, I desperately needed braces because my teeth were barely able to touch, which made chewing a bit difficult..  Braces at 32 is AWFUL.  My teeth have drifted a bit since I got the braces off, but the new orthodontist I consulted (old one retired) said it wasn't worth the price and pain for me to do another round.

I'd definitely ask the orthodontist (or orthodontists) why they recommend any particular thing.  They should be able to tell you the consequences of not getting something fixed.

Also, @Trifele , my daughter had similar jaw issues when she was 7 and got braces.  They really helped her for a few years, but as she's grown, the issues came back.  We went to see new orthodontist when she turned 12, and ortho recommended we see a TMJ specialist and get the jaw corrected first.  She's halfway through a six-month treatment of wearing an appliance to try to correct the jaw.  That is $6k out of pocket that we are hoping medical insurance will reimburse us for...and then we'll have another $3.5k in braces when that's done. 

I figure my family angered the tooth gods somewhere along the way...