Thursday, January 28, 2010

Teeth, Continued

In my last post (was it really that long ago?) I talked about how Dear Child had been to the dentist and lost yet another tooth.  What I didn't mention was that the dentist said he wanted her to have an ortho consult before we booked her upcoming dental surgery!

Accordingly, on Tuesday morning DC and I went to see an orthodontist in her dentist's office (how convenient!) and $35 later the news was that we would extract fewer teeth than originally contemplated.  There's no question that she comes by all her dental issues very honestly.  I blame it all on my father!  He had terrible teeth when I was little.  They were very crooked and so badly abscessed that, when they were pulled, the dentist refused to take more than a few at a time for fear of the infection spreading through his bloodstream and killing him.

It wasn't that he didn't take care of them.  He just had poor teeth and the crowding made cleaning much more difficult.  He grew up through the Depression (in farm country) and orthodontics were just unheard of in that time and place.  Eventually they all came out, he was fitted with dentures and things were much better.

Unfortunately, I inherited the poor teeth and also had a huge mismatch between the size of my teeth and the size of my jaw.  I had a (totally useless) appliance as a child, ortho complete with extractions and headgear as a young teen and ortho with jaw surgery and further extractions as an adult!

DC's oldest brother also had the same pattern of decay, decay around fillings, crowns and loss of crowned teeth that DC is currently going through.  Luckily, his teeth were quite straight and we never did ortho for him but he's only 30 and has dentures already.  (The other 2 adult kids had a normal number of cavities that didn't continue to decay.  My grown daughter needed about $4,500 of ortho in her mid-teens, however.)

Basically, the plan for my youngest daughter is to remove the top 4 baby incisors and shave down the sides of the eyeteeth (canines) to allow as much room as possible for the 4 adult teeth waiting to erupt.  There will likely still be some crowding, which could be eliminated by pulling the eyeteeth as well.  However, that would increase the chance that she would develop an underbite (because the pressure of the upper lip on the erupting teeth would tend to push them back) and we're trying to avoid that.

She's lost both of what will be lower bicuspids on one side and the lower canine is starting to drift backwards slightly, opening up a little room on the bottom.  They plan to take one of the matching teeth on the other side to allow that canine to drift back slightly as well.  When the bottom ones come in, the ortho feels they'll be fine.  They will attach a space maintainer to the 6 year molar on the one side though, to limit the amount of movement.

Finally, they'll fill all four of her 6 year molars, the only permanent teeth she has fully in to date.  Part of the problem with having so much decay in baby teeth is that the permanent ones tend to come in with decay "factory-installed" or to begin to decay while they are only partly erupted (with the decay starting under the portion of gum still covering part of the tooth, where you can't reach with floss or a toothbrush).

The biggest decision is really the material to use.  Amalgam (which does contain small amounts of mercury) is the cheapest and hardest.  If the fillings are still small enough we can also do them in a white material that doesn't contain mercury but isn't fully covered under our dental plan.  I'm seriously considering spending an extra $400 or so to have the more esthetically pleasing fillings.  For one thing, I have a mouth full of mercury based amalgam fillings and I'd rather not have them myself, let alone inflict them on DC.  I'm not at all sure that they're safe over the long term.  But it is more money and the surgery itself is expensive.  I don't have a final amount yet but it will probably be on the close order of $3,000 plus the extra charge for the white fillings.

It's a lot of money and we're in debt already.  But it's a long-term investment in DC's mouth.  If we can reduce or eliminate the need for braces down the line that could easily save us a $5,000 orthodontic fee  (a net savings of $2,000).  Plus, having the fillings done under general anaesthetic eliminates the need for 4 separate office visits and numerous shots of freezing.  This is important when you consider that she's terrified of needles.  I might get her to the office okay for the first filling but the next 3 visits would be horrendous.

So, how are we going to pay for this?  We have a dental plan that covers a lot of the cost but we're responsible for the rest  (the $3,000 figure I used being our portion).  They will work out a payment plan but it's between $600 and $1,000 per month if I remember correctly from the last time.  Luckily my Hubby has had a couple of good commissions recently that will be paid to him over the next few months and that's where the money will come from.  It means we won't be going deeper in debt, which is a good thing.  On the other hand, it means we won't be able to use that money to pay down debt, which is not so good.

I was told that it usually takes about a month to get in for the surgery.  So I pointed out that DC will be out of school for the duration of the Olympics and asked if there was any possibility of getting her in then (as the end of the Olympics is about a month from now).  They're going to check and get back to me.  It would certainly be easier to do it when she's off school anyway, rather than have her off for 2 1/2 weeks, go back and then have to miss several days.

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