Brenton Glassell, DDS

There could be a wait for approval of treatment depending on what insurance you have. For private insurance, sometimes a Prior Authorization (PA) must be submitted before any dental/ortho work can be initiated, and that process can take weeks. For state sponsored plans, especially ortho, a state consultant must approve the case before any ortho treatment can be started. In many states, these consultants are back up due to the high volume of submitted ortho cases. I know that most states have around a 2 month wait period to hear back from the consultant. If you do not have insurance, or if you think there may be another issue, I would call the ortho office to get clarification on the wait period. Hope this helps!

You do not need a referral from your general dentist to see an orthodontist. Dentistry is not like medicine, where you must get a referral from the family doctor for insurance to pay for a specialist's treatment. My suggestion would be to ask your dentist who he would recommend, and also you can ask peers in the community who they have used and their experiences with that particular orthodontist. You can directly call the orthodontist's office to set up a consultation. Good luck in your search!

If you have had an increase in space from when the braces came off, my assumption is that you may have had a space between the front 2 teeth before braces were placed. If the retainer is not worn properly, the teeth can relapse, or go back toward their original position. This is very prevalent with patients who have a space between their front teeth before treatment. I would suggest a consult with a well qualified practitioner who can either make a retainer or place braces for a short period of time to close the space. The most important part of the process is retention. I would highly recommend a permanent, or fixed, retainer behind the upper front two incisors in order to keep the space from opening again. I would also recommend a removable retainer to wear every night as insurance in case the permanent retainer were to break. Good luck!

Its is difficult to accurately diagnose what would be the best treatment option for you, but I would advise getting a second opinion. You are missing your upper right lateral incisor and have a peg lateral on the left. If you open up space to make a "normal-looking" tooth for the peg lateral on the left, your midline will shift even more to the right like you said.  Two options are: to remove the left peg lateral and close the space (will need to get restorations on the canine teeth to make them look like laterals) or to open the space where the right lateral should be and plan for an implant in that area. Both options will shift your upper midline to the left which will match your facial midline. I cannot advise you which option is best since I haven't seen a full set of records. Hope this helps!