10 Things Your Orthodontist Won't Tell You

The real number is probably even higher, since that figure doesn't include patients who get orthodontic treatment from general dentists. Indeed, there is no law that prevents any old dentist from practicing orthodontics, and more and more dentists have been taking on orthodontics as a way to increase their business and client base.

How to make sure you're seeing a trained orthodontist? Look for one who is a member of the American Association of Orthodontists, which means he or she has an average of four years of dental school and a minimum of two years in an accredited residency program. Another good sign: voluntary certification with the American Board of Orthodontics (the group's Web site lists the organization's 2,026 members).

2. "My fees are negotiable . . ."
Getting orthodontic work done isn't cheap. Minor adjustments, which might require treatment for three to six months, can cost between $600 and $1,500, but the median fee for full-scale treatment is $4,400 for a child and $4,800 for an adult — even more in pricey areas like New York City. If you have only partial insurance coverage or pay out-of-pocket, your bill can run high.

The good news, though, is that orthodontists offer a variety of payment plans. Many allow patients to pay through monthly installments with no interest, and with some orthodontists, you can negotiate the fee itself. Last spring Lisa Madsen, 39, sought the opinion of two orthodontists when she wanted to correct her bite. She felt more comfortable with the diagnosis of the first, though his treatment was more expensive. "I took the lower quote to the [first] orthodontist and said, 'Can you work with me?'" says Madsen, a stay-at-home mom in East Windsor, Conn. The result: He reduced his price by $300.

Some orthodontists will give a discount, usually 5 to 10%, if you pay the total in cash or with a credit card at the beginning of treatment. One woman even said her orthodontist offered a family discount of $300 per patient after the first one was treated.

3. ". . . but your final payment may not be so final."
Most orthodontists charge an all-inclusive fee, which covers appointments and appliances from the beginning of treatment to the finish. But often patients end up shelling out hundreds of dollars more for broken appliances, retainers and appointments that extend beyond the scheduled treatment time. Orthodontists can also charge extra for X-rays, molds and missed appointments.

Just ask Marianne Eagan. After her son finished with braces four years ago, his orthodontist installed a permanent retainer on the back of his bottom teeth. But when it cracked a year and a half later, Eagan, 47, a research assistant in West Lafayette, Ind., had to pay $130 for a new removable retainer. When that one wore down, she had to pay for a second one. Not long after, she got braces herself and applied what she'd learned: When her orthodontist prescribed a splint to relax her jaw, she asked that the cost of a second splint, made to her new corrected teeth, be included in the contract and the original fee. Her advice: "Make sure you have everything written down in your contract." Also, read the fine print for extra costs — and leave a few hundred dollars in your budget for unforeseen bills.

4. "My treatment might not be the right treatment."
Even orthodontists admit that straightening teeth is not an exact science. There are often clear approaches for common conditions, such as buck teeth and cross-bites, but more-complicated cases may involve judgment calls: whether it's necessary to pull teeth, for example, or to perform jaw surgery. The wrong approach could prolong treatment or make the problem worse.

In fact, if you go to two different orthodontists, you will very likely hear two different opinions about how to treat your teeth. If the orthodontist suggests invasive treatments, like pulling several teeth to create more space or jaw surgery, and you don't feel comfortable, it's a good idea to seek a second or even third opinion. In some cases there may be a less invasive treatment — polishing off some of the enamel between teeth, for example, to create more space. Be sure to inquire about alternative treatments and the possible risks each option poses. And ask the orthodontist if you can see pictures of cases similar to yours that were treated in the same manner. Or better yet, talk to former patients: Some orthodontists keep a list of people who have gone through the same treatment and are willing to talk to potential patients about their experience.

5. "Your child won't die if he doesn't get braces by age seven."
The American Association of Orthodontists recommends that all children see an orthodontist by age seven. Advocates of early treatment argue that skeletal problems, such as a severe cross-bite or narrow jaw, are much easier to correct when the jaw is still growing, making a second treatment — often required when patients are in their teens — easier and quicker. Orthodontists sometimes recommend early treatment of severe cases of buck teeth or crowding, for example, on younger kids who feel embarrassed or are teased at school.

But some orthodontists say that not every child should be treated so early. Often, later treatment is still needed, which can drive up the total bill. And early treatment does not guarantee easier treatment later on. Sometimes adult teeth can grow in a way that creates a whole new set of problems. "Kids are such moving targets," says William Gray Grieve, a Eugene, Ore., orthodontist. Early treatment, he says, "may or may not make it easier later on."

If the orthodontist suggests preventative treatment, ask for a clear explanation of the treatment and why it can't wait. Also, assess the maturity of your child. Is he going to be cooperative? Can the child handle the possible pain?