Send us your photos and X-rays?

Why we cannot develop a treatment plan for you

Request for diagnostic material, photos, X-rays

Readers write to us regularly to ask if they can send us photos, X-rays or other diagnostic material so that we can “give them an opinion”, expertise, or counter-expertise on their “case”. They would like to know “what we think about their case” either before starting orthodontic treatment or while treatment is already underway with another practitioner.

We do not consent to such requests for the following reasons:

• It is too difficult to assess a case and its complexity solely from radiography(s) and/or photography(s). The evaluation of such images can sometimes provide some general information about a case but it cannot replace the other necessary and essential steps and procedures that are to establish:
  
  • Diagnosis: Identify the cause or origin of a condition or problem (malocclusion) from the signs and symptoms.
  • A treatment plan: therapy and procedures to address and correct the diagnosed condition or problem.
  • Prognosis: A forecast or estimate of the likely course of a disease or condition (malocclusion).

• A clinical examination is essential to properly develop any treatment plan and this is the responsibility of the orthodontist who will manage and treat a patient and this role cannot be transferred to another orthodontist.
• It is also necessary to:
  • know the patient’s “main complaint“,
  • discuss the patient’s expectations and wishes regarding orthodontics to ensure that they are realistic and,
  • to give them the information they need to make an informed decision about possible treatment.

• Orthodontics is not a pure or exact science and its practice is based on several elements that vary from one practice to another. The choice of the specific treatment plan chosen by the orthodontist will depend on:
  
  • its perception and assessment of the case,
  • the diagnostic means available (clinical examination and diagnostic equipment are essential),
  • his academic training, his expertise, his past experience with similar cases,
  • the orthodontic appliances and mechanics he uses and is familiar with,
  • access to other dental and medical specialists if necessary (periodontist, maxillofacial surgeon, prosthodontist, ENT specialist, etc.) in the most complex inter-disciplinary cases.
  • Patient: the patient’s main complaint, his wishes and expectations regarding orthodontics, his budget, the procedures he is prepared to consider or not (extractions, surgery, etc. if indicated?).
• Our vision of a case and our therapeutic approach (treatment plan, devices used, treatment goals, etc.) can be very different from those of another practitioner and, no matter what we think of a case or problem, we cannot “impose” our vision and approach on someone else just as another practitioner could not “dictate” how to treat a case. Even if one orthodontist proposes a certain treatment plan, it is not certain that another orthodontist will agree to treat the patient in the same way for the reasons listed above.

Your orthodontic treatment is not progressing or has not been completed as planned or desired?

We regularly receive questions from patients asking us if what happens during their orthodontic treatment is normal and they would like our opinion on what should be done. The most frequently mentioned problems and questions asked are :

• Teeth don’t move fast enough, why, and what to do to make it work?
• After a certain treatment period there are no or few visible changes, why and how to remedy them?
• The treatment ends and there are still many irregularities and still many corrections to make then how and when will the treatment end?
• The results do not match the patient’s expectations or what was originally expected. Why and how can these objectives be achieved?
• Treatment duration is longer than expected and patients are concerned about the total duration of treatment and costs. Why is it taking longer and will there be additional costs?
• What is the purpose of using a specific orthodontic appliance, why did the practitioner choose this appliance over another?
• Is it normal for teeth to move this way or that way?
• Will my teeth back up, will my spaces be closed?
• What type of retention device will I have? Why does my orthodontist use one retainer over another… or not?
• Why didn’t I have a retainer after my treatment?
• Elastics: when will I get them, why am I not prescribed them, what are my elastics for, how do I wear them, etc.?
• Will the treatment affect my profile, nose, chin, smile, cheeks, etc.?
• Will I need jaw surgery, extractions?
• Should I have my wisdom teeth extracted for orthodontic treatment?
• Financial issues: should I continue to pay if the treatment is longer, what happens if I move, if I’m not happy with the results, if I have broken appliances, etc.?

These questions and many others have all been asked in the past and we answer almost always the same thing, that the best person to answer questions specific to a particular case or patient is the orthodontist or practitioner in charge of the treatment. He (or she) is definitely the best person to answer because he (or she) has assessed your case, made the diagnosis, developed a treatment plan, planned the therapy and chosen the orthodontic mechanics (braces, strengths, retention, etc.) to achieve the treatment goals set at the outset. He will tell you if your treatment is progressing normally or not and what means he intends to use to achieve the goals.

You are not satisfied with the results of your orthodontic treatment and want our opinion

• The first thing to consider when evaluating the outcome of orthodontic treatment is to compare the result with the initial treatment goals established by the orthodontist and the patient (or parents) even before treatment begins and this can only be done by those involved.
  
• Apple or orange? In orthodontics, it is very often necessary to consider a form of “compromise” treatment or make limited corrections that will not achieve an ideal occlusion and function. This may be necessary for various reasons (patient requests, reducing the cost and duration of treatment, avoiding certain procedures such as tooth extraction or orthognathic surgery, not wanting to use certain types of orthodontic appliances necessary to make the desired corrections, lack of growth to correct imbalances between the jaws, etc.). In such a case, it is useless to compare the result obtained to an ideal occlusion because the goal of the treatment will never have been to achieve an “ideal” occlusion from the start. To make an analogy, it’s a bit like asking an artist to draw an apple but you’re disappointed not to get an orange as the final product!
• A question of communication: The key to avoiding such imbroglios and misunderstandings is :
  • for the patient to formulate and describe his expectations during the consultation before starting treatment and
  • for the orthodontist to explain what can and cannot be done and how treatment goals can be achieved.  It will then be up to the patient to decide whether or not to initiate treatment.
• The vast majority of orthodontists will be happy to discuss treatment options and give patients the explanations they need to make an informed decision about their treatment. If not, don’t hesitate to ask your orthodontist because you won’t get the information you need. Reading this column may help you…
• However, patients sometimes change their expectations during treatment and, although they initially wanted compromise treatment, they realize that it no longer meets their expectations and then want a result that is closer to the “ideal”. It is important to discuss this with the orthodontist as early as possible as this can have important consequences on the procedures (e.g. extractions, surgery, etc.), duration and costs of treatment.
• So… if you are not satisfied with the results obtained during your orthodontic treatment, the first thing to ask yourself is if the results obtained correspond to what was heard and targeted with the orthodontist at the beginning. If these objectives have been achieved, then the treatment should be considered a success.
• If the initial treatment goals have not been met, there may be several reasons and it is important that you discuss them with your orthodontist. Sometimes, and despite the good will of everyone (orthodontist and patient), it is impossible to achieve all the desired goals. This may be because of:
  • uncontrollable factors such as lack of growth, problems with teeth during treatment (root resorption, uncontrollable periodontal problems, etc.) or
  • lack of cooperation (wearing elastics or poor oral hygiene during treatment) that forced the orthodontist to complete treatment earlier or change treatment goals.
• In conclusion, even if we commented on the results of your treatment, this would only remain an opinion without having all the necessary elements to properly evaluate the whole. In addition, whether or not we agree with you and your perception of the results of your treatment, the fact remains that you will have to discuss all of this with your own orthodontist because he was the one who planned the treatment with you, who was in charge of your treatment and with whom you had a “contractual” agreement. Regardless of our opinion, we cannot impose it on other practitioners.

Note that this reasoning also applies to other areas of dentistry; if you have problems following orthognathic surgery, extraction, periodontal procedure, placing a dental restoration (“filling”, bridge, crown, implant, etc.), the person who did the work is the best person to consult to answer your questions.

Who does orthodontic treatment?

One of the first questions that comes to mind when we receive such questions is “what are the qualifications, skills and expertise of the practitioner” who is treating you?

• Many people refer to the person who does their orthodontic treatment as “the doctor”, a dentist, “the doctor”, a stomatologist, etc., as the “doctor”. In Quebec, Canada and the United States, a physician is a medical practitioner and not a dentist, a field reserved for dentists (general practitioners or specialized dentists). Doctors” cannot practice dentistry or orthodontics.
• The first thing to do for a patient considering orthodontic treatment is to ensure the qualifications and skills of the practitioner even before treatment begins. This could save a lot of hassle later!
• These qualifications can be easily verified with the various professional orders in each province or country (for example the Ordre des dentistes du Québec pour le Québec, the Ordre National des Chirurgiens-Dentistes de France, etc.) and this information is usually available online.

➡ To understand the difference between a general dentist who provides orthodontic services and a certified orthodontic specialist (orthodontist) who practices orthodontics only.

➡ Learn more about dental specialties and “non-specialties” or specialties that are not really specialties.

➡ Learn more about the questions to ask your orthodontist.

About the fees and costs of orthodontic treatment?

• There may be differences and variations in the cost of orthodontic treatment which is normal as several variables must be considered (for more information).
• We encourage patients or their parents to ask questions about all financial aspects of orthodontic treatment before it begins so that everyone is clear and there are no “bad surprises” along the way or at the end of treatment.
• What does the treatment include? This can greatly influence the cost or fees of orthodontic treatment; what types of corrective appliances will be used, is the duration of the treatment fixed, variable or indeterminate, the retention period included in the follow-up after the treatment (duration, appliances included?), breakage of appliances, unforeseen, diagnostic equipment, etc.

It is just as important to know what a treatment will not include as what it will understand; procedures performed by another dentist or specialist (extractions, surgeries, periodontics, etc.) unexpected, special appliances, retention, etc. Policies and how to present this information may vary from one practice to another and every orthodontist has their own personality and way of communicating but feel free to ask questions if you want answers.

“Just an opinion”!

• You must realize and understand that simply asking for “just an opinion” about a case or problem is indirectly equivalent to developing a treatment plan, even if it is incomplete, which we cannot do unless you are one of our patients that we manage at our clinic, which would initially require an orthodontic consultation.
• There may be legal consequences to making diagnoses and proposing treatment plans without having met and examined a patient and having used the diagnostic means recognized in the profession. To illustrate this point with an example, imagine that a practitioner proposes a “treatment plan” following the examination of photos and X-rays submitted to him but that this treatment plan is implemented and applied by another practitioner and that the expected results are not obtained or that there are complications, problems, etc. during or after treatment. Who will be responsible? Can the second practitioner who took the case based on the first practitioner’s treatment plan claim that the first practitioner was at fault because he followed his recommendations?
• There are too many variations in techniques, expertise, clinical experiences, etc. for us to agree to propose specific therapies or treatment plans without having examined and managed a patient.

Photos and X-rays online

• You can always put images (photos, X-rays) online on a website that allows you to host free images (there are hundreds of them) and send us the internet link (URL). If ever they are of general interest to the readers of this site, we could perhaps comment on them, without however “guaranteeing” it to you.
• It must be understood that if we responded to all requests of this kind, we would no longer have time to practice orthodontics!
• Please do not send us any diagnostic material by mail. We will not develop a treatment plan for you and will not return this material to you.

Thank you for your understanding on this subject.