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Wow, I didn’t realize that they use pre-made arch wires in specific shapes.

I guess this is just another part where an orthodontist is like an artist, or at least like a plastic surgeon: s/he has to make a decision which arch shape suits the patient best, as it affects the underlying bone structure and in the end, how the face looks.

Just a quick note - I’m transferring posts from my old blog here one by one. For the latest posts scroll down or click on “My Dental Braces Story” topic. (I know it’s a little weird but I wanted to keep the original adjustment dates in the order they happened).

I went to 5 different orthodontists in Toronto, Canada in the space of 2.5 months at the beginning of 2006. I was only interested in getting ceramic braces, but I was quoted metal as well and below is an outline of the quotes I received. All amounts are in Canadian dollars.

Dr. #1 (the one I ultimately chose):
Metal: $4,800
Ceramic braces: $500 extra per arch, so I paid $5,800 (still paying)
Payment plan: If metal, $600 down, then 28 monthly payments of $150.
If ceramic, $1,600 down and then the same 28 monthly $150 payments. The price difference for the ceramic braces had to be paid upfront, basically.

Dr. #2:
Metal: $4,500
Ceramic (both arches): $5,000
Very nice doctor, but I didn’t like the suggested treatment plan.

Dr. #3:
Here I didn’t get a formal quote but a verbal estimate, VERY approximate - something along the lines of “It’ll cost you about $5,000-6,000, plus surgeon’s fees to install the implants, not sure exactly how much.” I’d love to see a person who doesn’t care about that extra thousand dollars. Of course there are people like that, but not an average person anyway. You’d think a doctor expecting his clients to not care about $1,000 would have a nice office, but his was a dump!! I wasn’t impressed at all.

Dr. #4:
Metal/Ceramic: $7,500 - same price for either choice.
This doctor suggested the same treatment plan as Dr. #1, however he doesn’t fit the implants himself, so I’d have to go see the surgeon.

Treatment would not only be less coordinated (I’m probably wrong in thinking this, but I’m more comfortable with my ortho doing the entire treatment himself), but it would also be quite a bit more expensive. The surgeon this ortho works with charges $250-$350 per implant, plus X-ray fees. And considering how much trouble I’m having with my implants, all that going back and forth would’ve cost me a lot more than the quoted total estimate of approximately $9,400-11,000. In hindsight, I’m very happy I didn’t choose this doctor, since I had so much trouble with microimplants and every time would have to go to an outside surgeon. The fees would just pile up!

Payment plan: There was a choice of doing it ANY which way I liked, with any size down payment, even $0, then the rest of the amount broken into I think 28 or 32 months.

Dr. #5:
Metal: $5,500
Ceramic: $6,000
Payment plan: flexible, similar to #1 and #4.
Here again, I’d have the same treatment plan but would have to go to an outside surgeon. But my biggest problem was a very condescending attitude of the doctor. He talked to me like I was 12 and he’s the school principal or something. Jerk.

Most orthos offer 5% courtesy discount if the balance is paid in full UPFRONT. That just wasn’t enough of an insentive for me. All offered no-interest financing.

Edited on Feb 22, 2007 to add:
I realize most of the time doctors and such are chosen based on personal reference, but if you’re starting
from zero, hopefully my “selection process” will help you find a good orthodontist.

Original Post

I went through a lengthy process when choosing an orthodontist. Having read a lot on the Internet on what I might expect, I put together a list of questions asked prospective doctors and their receptionists (before making an appointment). The process was long mostly due to the fact that I couldn’t get appointments immediately. I had to wait from 1 to 3 weeks to see each of the Ortho’s I picked.

One of my 1st pre-requisites was that the initial appointment was free. This may or may not matter to you, but I wanted to see several doctors because I read that you’ll get as many treatment options as you see orthodontists. I wanted to compare my options (very happy I did). If the initial exams weren’t free, this might be a costly proposition. Some of the fees ranged from $50 to $250, and included either a 10-minute consult or full records with x-rays and moulds. I wasn’t ready to commit several hundred dollars even before starting the treatment. Also, what if I totally hated to doc and still had to pay? It would feel that much worse.

I found a list of orthodontists at http://www.cao-aco.org, Canadian Association of Orthodontists. You can search by location. When I had my prospective list ready, I called the offices and asked the following:

1. Do you charge for an initial consultation?
If they said NO to this, I kept on asking.

2. Do you offer Invisalign? Ceramic brackets? Inspire Sapphire brackets?

3. Do you use recycled braces? Brackets or wire?
Most were SHOCKED to hear that some of the doctors practice these and I’m not even sure it’s done in Canada at all, but since I read that some doctors do it, I figured I should ask - better safe than sorry.
If the answers to the above were: 1) no fee; 2) yes; 3) no, I’d go ahead and set up an appointment. I ended up seeing 5 Orthos over a 2-month period.

During the initial appointment I had several questions for the doc, so I’d ask him this (all 5 were men):

1. Will those “invisible” braces work for me?
It would not work for me, since I had large gaps between molars that had to be closed. Invisalign works better for more superficial frontal cases.

2. Can I have ceramic braces on both uppers and lowers?
Not every Ortho will allow this. I was lucky to have this option, I think. Still not sorry I have ceramics on both arches. They look better and hurt less, even though they’re slightly bulkier than metal. Treatment time does NOT increase, they assert as much force as the metal.

3. Do you offer Inspire brand clear sapphire braces?
This is really only suitable for super-white teeth, otherwise these brackets will stand out and your teeth will seem more yellow.

4. Will I need headgear or other appliances? If so, how long will I need to wear it, and how many hours per day? When, in the treatment process, would the headgear be introduced?
It seems that headgear is pretty rare nowadays and is only used for pretty severe cases, but who knows… I wanted to be sure.

5. Will any teeth need to be extracted?
This is often the case. I had to have 1 tooth extracted to have an even number of teeth in each quadrant.

6. Will the treatment change my facial profile in any way? If so, how?
4 doctors said “NO” to this, however one of them said that the treatment will improve my profile by bringing the lower lip slightly towards the back. That kind of freaked me out. I like my strong jaw that sticks out to the front a bit and I didn’t want to end up with a flat face (I read some horror stories about this).

7. How long (how many months/years) will the total treatment take?
I got estimates from 12 to 24 months depending on offered treatment options. My treatment options were to make spaces for implants where my teeth have drifted and partially closed the gaps, or close the spaces up without the need for the implants. Opening up the spaces takes less time, but I hated the idea of the implants, bone grafting etc. I opted for closing the gaps and treatment time for that was estimated at 18-24 months.

8. How often will I need to come to your office for adjustments?
Typically, it’s once every 8 weeks with most doctors. I now have to go in every 4-6 weeks because of the micro implants. They require closer supervision.

9. What is the total cost? Do you accept insurance? How is the cost broken down? Is there a discount for a larger cash payment up front?
I didn’t have any insurance so this really didn’t matter to me, but most people will care so be sure to ask. I’ll write about the cost in more detail next.

Feel free to download this List of questions to ask your orthodontist (PDF, opens in a new window). You can print it out and I left enough room after each questions so you can mark answers right there.

When I was fitted with braces, they gave me a Welcome package which included a sheet with general treatment guidelines. Here’s a few important points:

Soreness of Teeth
After you have the braces placed, there may be some soreness in your teeth and they may feel loose. This is nature telling you the teeth have started to move. You can use a simple pain remedy or just wait for the soreness to go away. The inside of the cheeks and lips may also be irritated for awhile. Orthodontic wax can be used to relieve this discomfort.

Eating with Braces
With care, you can probably eat most foods and do not damage.

However, we would recommend you do your best to avoid:

Be careful with
Foods with bones - cut the meat off the bone
Food with pits - remove pits from olives, cherries, peaches, nectarines, etc.
Hard food - cut in small or thin pieces (apples, pears, carrots, celery, crusty breads)

Without care
You may do damage by bending wires, breaking brackets off teeth and loosening cement under bands. Should braces become loose or broken, please let us know as soon as possible and we will schedule a repair appointment for you. Broken appliances that go unrepaired may cause damage (incorrect tooth movement) and could lengthen treatment time.

Co-operation
Successful treatment (straight healthy teeth) depends a lot on your co-operation. This means wearing appliances, headgear and elastics as instructed; taking care not to break appliances/braces; reporting breakages as soon as possible; and proper cleaning of the teeth.

Family Dentist
Please remember to visit your dentist at least every six months while undergoing orthodontic treatment. He/she will check your teeth, do any necessary work and clean your teeth thoroughly. (THIS IS VERY IMPORTANT!)

Root Canal
A tooth that has been traumatized (injured) from a deep filling or a blow can die over a long period of time. Occassionally, these undetected teeth flare up during orthodontic movement and require root canal treatment (removing the dead nerve) by your family dentist or recommended specialist.

Root Resorption
Shortening of the root of teeth. Orthodontic treatment (movement) may cause root resorption. Trauma, cuts, impaction or other factors have also been known to cause root resorption. Shortened roots are no disadvantage under healthy circumstances (good oral hygiene). Tooth life may be shortened if oral health (brushing) is poor.

Retainers
Once braces are removed, retainers are necessary to hold the teeth in their new position. The average retention period lasts a minimum of 24 months but this may vary with each individual and will be discussed at that time. Office visits are every six months.

Patients who do not wear their retainers as instructed often see shifting of their teeth which can only be corrected with braces. Also, broken retainers need to be repaired immediately to prevent movement of the teeth.