Do you think this is wrong of me?

[Jerseygirl]

Hi - so I'm just like many other adults who is very hesitant to commit to braces for 2 years. I DO want a nice smile and healthy bite but the commitment is overwhelming. When I think about how long ago I first considered this - I could have been in and out of braces twice by now!

When I originally began considering it - I met with several orthos. I am missing all four of my first premolars - they were removed when I was a kid before my first round of braces. Most said I had a fairly challenging case but certainly doable. I've been told I have:

2mm overjet
2mm anterior open bite
moderate lower crowding
severe upper crowding
bi-lateral posterior crossbite

My bite in front opened up slowly - I believe it began in my early 40s. It is now to the point where it is impossible for me to make my top and bottom teeth meet. But that really doesn't bother me. BUT I would like to have a more stable chewing surface on the sides of my teeth - meaning my top and bottom back teeth lining up better so forces are more evening distributed. I'd also like my top teeth straightened out - which I am told is the easiest to correct. The hardest is closing my bite.

My question is - do you think it is wrong of me to simply ask that we NOT close my bite and just focus on giving me a better posterior bite? As well as straighten out my front top and bottom teeth? Would an ortho argue with that you think? I assume that MAYBE this will shorten my treatment time some and that is a fair trade to me. I'd be more than willing to pay full price - meaning whatever the cost is, regardless of length of treatment. I see no real reason why I should have to have my bite closed. My dentist told me he sees plenty of people with open bites in front but they have normal posterior bites so they function just fine.

Thoughts?

[DrBill]

I will say as an orthodontist working with some pretty picky restorative dentists, most of my referring dentists are more concerned about how the front teeth relate than the fit of the back teeth. Why? It's a concept called protected occlusion.

If the jaw worked like an absolute hinge - moving straight up and down with no forward or sideways movement - it really wouldn't matter how the teeth fit, as long as they hit. But the jaw doesn't function that way - it can move forward, sideways etc - so lateral stresses need to be considered. In an ideal bite, the front (and sometimes middle) teeth disclude or separate the back teeth in forward movements (called protrusive guidance) and sideways movements (called canine guidance or group function depending on which teeth touch). In an open bite the front teeth can't provide this guidance, so the back teeth take all the stress. Front teeth are more approriate to take that stress. If you have lots of fillings, crowns, etc, proper guidance helps them hold up better.

Verical issues are challenging, and if you're an adult with posterior crossbite and severe crowding this complicates things further. 2 mm isn't a huge open bite, but you also need to consider why it's opening so late and where you're touching. Are you only hitting on your molars? Or is it just the four front teeth that are open? Would it require surgery or TADs to close? Does it look skeletal or habit related? Do the jaw joints look normal and could they be playing a role? These can all affect prognosis, treatment time, and stability of correction.

Most orthodontists want you happy. I've left open bites and crossbites when it's spelled out up front (like I mentioned above, if I had my choice, I'd leave a crossbite before leaving an open bite). Usually it's a situation where the treatment (ex surgery) is more than the patient wants to go through and they enter into treatment knowing the limitation and compromise from the outset. If your openbite looks like it would be challenging and lengthy to close or require possible adjunct procedures (ex surgery) you're not comfortable with, I think most orthodontists would respect your wish to do a more limited treatment if you're very clear that your expectations are in check. If it does NOT look like it would add a great amount of time to close, I think it would be fair to ask why not close it if you're doing treatment anyway? It's only in your best interest.

I would certainly discuss all this with the orthodontist you elect to have treatment with.

Good luck!

[Jerseygirl]

Hi and thanks for the response Dr. Bill. I will try to answer some of your questions. I've consulted, over the years, with a fairly large number of orthos and I use one oral surgeon who has removed two of my lower molars - due to fractures, not decay. No one has ever suggested jaw surgery for me. Why my bite has opened - I do not know and no one has ever really been able to say. But - - I have had a few people say it is possible my bite will open again after it is closed. Which makes sense to me - I mean once you close a bite, how do you prevent it from reopening? If it happened once, I'd assume it could happen again. I also have TMJD issues - which seem to correspond with stress in my life. Or any trauma - like keeping mouth open for long periods of time. Though I did have a cleaning a few days ago - and had no pain or spasm after.

I make VERY little contact on my back teeth - just a few hit, including my wisdom teeth which i use a lot chew with. But I make no contact at all in front - on any of my front four teeth top and bottom when chewing. I was told by one ortho that I have a tongue thrust but no other ortho mentioned that nor felt it was an issue. ???

I'm going to try to post photos here to show you - but these photos are a few years old. I've seen had another lower tooth removed - I believe it is number 30 but not positive. Maybe it was 34? Can't recall. It is two teeth in front of my lower right wisdom tooth. Another tooth I used a lot to chew on.

[Jerseygirl]

[Jerseygirl]

[Jerseygirl]

[Jerseygirl]

[Jerseygirl]

[Jerseygirl]

[Jerseygirl]

These are three years old! I bet I am worse now! And these look pretty darn bad! LOL
But do you know how many people say to me - you don't need braces!

[Jerseygirl]

Here are a few of me now - you will see the additional spot where I have one more tooth missing

[Jerseygirl]

[Jerseygirl]

[Jerseygirl]

I have become very talented with smiling and covering up just how bad my teeth really are.

[MisterChris]

[quote="Jerseygirl"]I have become very talented with smiling and covering up just how bad my teeth really are.

I can totally relate. For pretty much my whole life I have not been happy with my teeth and especially the bottoms in particular and spent many years refusing to smile and appearing in pictures with an expression looking like I was taking a mugshot lol. I then learned to smile while hiding the worst of my teeth. Last year, at 40 I finally decided it was either now or never and vowed to do whatever necessary to get everything fixed. One of my bottom front teeth in particular had gotten so bad that it was on its way out on its own, so in August I had it pulled and a few cavities filled then a few days later started my ortho treatment. I can honestly say that I wish I did it years ago and didn't wait as long as I did. By my first follow up six weeks later the changes were very obvious and now several months in I can see things getting more and more on the way to being where they have to be. I also have an open bite and at my last follow up my ortho put me in elastics with a "box" shape across the front of my mouth to close it. She said to me that closing it will be a little tricky but four weeks later I can see significant progress in that and my teeth can almost touch once again. My overall thoughts about my treatment has been how surprisingly fast things seem to move along. My advice is to go for it and aim for perfection with your treatment from the start. You might be pleasantly surprised at how quickly it goes but if after a significant amount of time you aren't seeing the results you would like, discuss with your ortho possibly modifying your treatment plan to cut down on the amount of time spent in braces. Good Luck! :)