Dr. Joe Green:

I am not an orthodontist. I am a primary care dentist.

My understanding is that cases where the malocclusion is severe and the treatment is complex may include a planned episode of surgery. These are known as orthomatic cases where the orthodontists works in conjunction oral with maxillofacial surgeons. The vast majority of those cases are identified at the point of referral and the point of assessment. While those cases are prioritised within the current system, some of the surgery is dependent on the completion of growth in the jaws and that is not completed in most instances until the very late teens. Therefore, the surgery will be planned at the end of the teens rather than at age 12 or 13 which is the optimal age for the majority of children to have orthodontics. In a small number of cases, the planned approach will be that some orthodontic treatment is undertaken with a possible delay thereafter to allow growth to be completed followed by more intervention by the orthodontist and the surgeon working together. There are a small number of such cases, but they are dealt with on a priority basis within the system. However, they are in a parallel stream to most of the other cases where priority is determined according to the extent of malocclusion. There is serious management of those cases, but inevitably some of those adolescents will be treated right through until their late teens or even early 20s because of the nature of their condition and the physical limitations on what can be achieved in the early to mid-teens. It is not my area, but that is my understanding of it.