Pulling away from the school, I check the rear view for cars-- and for a glimpse of Joseph's face.
He's looking out the window-- his expression, a blank.
"Honey, so you'll probably have to wear braces-- but it won't be forever. Maybe a year or two-- tops."
"I really don't want braces, Mom."
"I know, Bud-- but if you need them, we gotta do it. Hey-- remember how that orthodontist we saw a couple of years ago told us you had a 'subtle underbite'? He thought you'd need to wear head gear, and then braces."
"Yeah, I know," Joseph says in a resigned tone.
"Well, he also said we could wait a while-- so listen, I'm going to ask this guy about the timing for all of this. And if we can wait a year, then I think we'll probably do that... but Honey, if this orthodontist says we need to do something soon, then you'll likely get braces this year."
Though I really hope we can wait. It's a lot of money...
Twenty minutes later, Joseph is lying back in a fully-reclined exam chair-- his new orthodontist bending over him.
I take a seat several feet away, and watch gloved fingers move swiftly over my son's teeth and jaw.
"Hmmm... " the orthodontist says, fingers still moving, "the spaces between his top front teeth have kept those teeth out in front of the lower ones."
"You see, if we look at his profile, it's perfectly normal, nothing like, say, Jay Leno's-- but if we look at the rear molars, he definitely has an underbite. And a tricky one, at that."
Immediately, I'm out of my chair and peering into my son's mouth.
"Oh, yes-- have a look... right over here," the orthodontist says, pointing a gloved finger at Joseph's left rear molars.
"See how that second-to-the-last top molar is hitting the the last bottom molar? Well, it's not supposed to do that. And I'm afraid it's much more pronounced here than on the other side. This asymmetry is what makes it tricky."
"Let me show you with a model."
He walks over to his desk and picks up a pair of false teeth. Joseph climbs out of the exam chair and joins us, looking fascinated -- and a little nauseous -- as the orthodontist demonstrates how his bite is off, how his jaw is moving forward.
And how, over time, it will probably get a whole lot worse.
"All right then," I say, "what's the treatment plan-- and when can we start?"
"Now, Joseph is going to do a lot of growing over the next number of years, " the orthodontist begins slowly, "and because of this, we'll need to wait until he's done growing before trying to correct the issue."
"Excuse me?" I ask, staring at the man-- shocked.
"I'm sorry," he responds, an unmistakable note of sadness in his voice, "but you see, as Joseph grows, his lower jaw will likely continue to move forward... and well, trying to correct the misalignment before he's finished growing won't permanently correct the problem."
"And how do you correct the problem?"
"I'm afraid that he'll likely need surgery on his jaw-- at around age 20."
At first I don't say anything-- I can't.
Joseph steps away from the orthodontist's desk, goes to a corner of the room and sinks down onto several over-sized, stuffed animals lying there.
He leans back into soft fur, then turns his head away from us.
"Wait, wait- " I sputter, "the other orthodontist talked about head gear, about braces- I don't understand- "
"Head gear would be used to move the top jaw out-- Joseph doesn't have that issue. And braces won't affect the growth of his jaw. This is something that shows up in about 3 to 5 percent of the population
"Is there anything we can do now?"
"Well, we can take full x-rays to get a baseline-- so that we can monitor the issue- "
"But, is it possible that this won't be an issue-- that it won't get any worse?"
"Yes, that's possible," he responds, "but highly unlikely. It's more likely that the lower jaw will continue to grow forward-- more so when he goes through periods of rapid growth."
Before leaving, we set up an appointment for x-rays in a few weeks-- and a follow-up consultation in January.
"No rush," the orthodontist tells the young woman who sets up these appointments.
In the car, I tell Joseph that we'll do the follow-up, get a second opinion, and go from there.
"It's gonna be fine, Bud-- just fine."
After bringing him back to school, I try telling myself the same thing over and over.
But I'm furious.
Why does he have to worry about this, too?
I get home -- where Ryan is waiting -- and break down.
Then I go to the laptop, google "child with an underbite," and find out that this orthodontist's "wait-until-he's-done-growing-and-see" approach is the standard of care for this thing.
And then I see photos of older teens and adults who have waited and seen.
I also discover that the cost of the eventual corrective surgery is approximately $25,000-- and that insurance often doesn't cover it.
My son is dealt yet another blow-- and again, I'm helpless to stop it.