Today was our consultation appointment with the Orthodontist. Kaleb did great! He normally has a bit of white coat syndrome and freaks out as soon as the Dr. or nurse gets close. But today he did great! He was cooperative, friendly and polite! I love it when kids act like they were raised to act! They took a panoramic view xray of his mouth/jaw and then some actual photos of his face and his teeth.
After the photos and x-rays we spoke with Dr. R about what he suggests to correct Kaleb's dental problems. Kaleb's problems will require 2 phases of treatment. Phase 2 will happen once his baby teeth are all gone and his permanent teeth are all in. This is probably 3-4 years down the road. And doing Phase 1 treatment will make phase 2 easier and we willhave better results. But Dr.R wanted to show us what the problems are before discussing Phase 1. It is kind of a laundry list.
* Crowding on the bottom which is preventing the eruption of a tooth
* Teeth on bottom that have not come in yet are allowing his other teeth to shift out of place
* Molar not yet erupted- unknown reason
* Recessed lower jaw
* Overjutted front upper teeth with large gap
* Crowding on top which is preventing the eruption of a tooth
Here are some photos to illustrate the above points. The Molar in the back that is "missing" is not truly missing. It is simply not through the skin/gum yet. (you can see it on the xray. It is tooth marked with the # 1) Dr. R says it could be a variety of reasons from overcrowding to it being stuck in the jaw bone. We need to wait to see what happens in the next few months with this tooth as it's placement it crucial in the use of the first appliance Dr. R wants Kaleb to use.
The other missing incisor in the front is again not "missing" but rather just not able to push up because of over crowding. You can see it on the xray as well. Dr. R thinks that because Kaleb actually had that tooth knocked out instead of the other tooth pushing it out is the reason the permanent tooth is not through yet. (Kaleb had a series of mouth injuries that resulted in him prematurely losing this tooth). But this tooth is critical in that it is missing. Because it is no longer there it is enabling the other 4 front teeth to shift over making his bottom teeth off the mid line.
This photo shows the missing upper incisor. As you can see on the Xray the tooth is under the gum but there is no room for it to come through. If we do nothing that tooth will continue to come in but it will turn and come in sideways. We need to gain some space on the upper jaw. 
And lastly the front teeth for whatever reason are overjutter (buck teeth/stick out) and have a gap between them. Over crowding of the teeth from the molars forward cause the front teeth to jut out. Again... we need to gain some space in the upper jaw.
So Dr. R went over the treatment plan he has to correct Kaleb's issues. Phase 1
Step 1
We have to wait 4-6 months to see what is gonna happen with the lower molar that is not through the gum line yet. We have a recheck planned for January to reevaluate that tooth. We need that tooth to be in place so that the 1st appliance can set against it. We are hoping that in the next 3-4 months we will see that tooth erupt through the gum line.
If the tooth does not come through in that amount of time we will go back to the dentist (who referred us to Dr. R.) and they will do "gum contouring" to expose the tooth and investigate why it is not erupting. Once they figure out why then there are other courses of action that could include pulling the tooth. We want to avoid that.
So keep Kaleb in your thoughts that this tooth will work its way through the gumline by the end of January.
Step 2
Kaleb's first appliance is called a Schwarz appliance. It looks like a retainer that is removable. Only it has a mechanism in the center that we will turn daily/weekly that will help us gain space in his lower jaw. The point of this appliance is to slowly push the teeth into better position and move soft tissue. I am not sure it this actually encourages jaw growth or not. He would wear this all the time except for eating. It is removable, in fact he removes it so we can adjust the mechanism. Here is a picture of what the appliance looks like in a mouth. Notice the BEFORE and AFTER.
Step 3The second appliance would be a Palatal Expander. This one is glued into his mouth and can not be removed. We would again adjust the mechanism daily/weekly to gain space for his teeth. Here is a picture of what his expander would look like. Notice the BEFORE and AFTER pictures.
Basically the reason for doing the 2 appliances is to gain space in the jaws to avoid removing permanent teeth later. Our Dentist was right that Kaleb will benefit from early intervention. Kaleb's jaw is still mold-able and is still growing so these appliances are only effective for children of Kaleb's age. Step 4
Kaleb will also get some braces on the front upper teeth at some point to help hold the position of the teeth once we gain some space in the jaw.
He may require other appliances and or braces during the 1st phase of his treatment. We will have to see how Kaleb's mouth responds to the treatment.
Phase 2
This is basically full braces with an appliance glued to the top braces that pull his lower jaw forward. This is timed with an age appropriate growth spurt that will enable his body to grow more lower jaw bone and correct his recessed jaw and help his teeth become aligned for a proper bite.
Honestly I can't wrap my mind around Phase 2 yet because I am still trying to figure out how to pay for Phase 1. LOL! We do not have Orthodontics Insurance. Honestly I am not sure such a thing exists! LOL But we do have a few months to save for Phase 1 since we are waiting for Kaleb's tooth to grow in. And Dr. R does offer payment plans and even outside financing. We are trying to avoid both those options because if we pay in full at time of treatment we receive a 5% discount.
Also Dr. R. has a discount for Phase 2. Basically they will take 50% of your phase 1 payment and apply it to Phase 2. This is a blessing and a curse. A blessing because it is a big chunk of money but a curse because if they discount it THAT much then what is the whole fee????
Sigh. I hope that Kaleb is happy with his smile and appreciates our efforts to get him there once phase 1 and 2 are complete!
