When not to Treat
This patient was referred to me for a Class II malocclusion on the right side. There was mild crowding, and her
chin was deviated to her left. The patient was happy with her smile. The dentist sent her to me because
her front teeth didn’t touch when she bit down.
Diagnostic records were obtained. The records included articulator mounted models which shows the bite
when the jaw joints are in the correct alignment. The top photo below shows how the bite looks when the
patient bites. However, when she bites this way, her jaw joint is not in alignment. The bottom photo shows
what the bite looks like when the jaw joint is aligned correctly. So essentially this young woman has two
bites.
When you put braces on a patient like this, the bite gets worse, which means it is more work to correct it. You can’t
determine this will happen by just looking in the patient’s mouth before putting on
braces. In other words, with mounted models, I was able to determine that we were dealing with a larger
problem than was initially apparent. The options (with braces) then became:
- Hang a rubber band or a spring on the left side and pull the lower jaw forward and further out of alignment.
- Remove an upper bicuspid and compensate for the bite problem with braces.
- Jaw Surgery
- NOTHING…DING DING DING DING!
This patient had perfectly healthy joints and muscles and almost zero tooth wear. She was happy with
her smile. She had a good bite of her back teeth, and the eye teeth worked fine when she chewed. Why
treat a perfectly healthy and esthetic situation. Orthodontics could make her bite and joint health
worse. I have spent a great part of my career learning to detect these types of problems BEFORE starting
orthodontic treatment. Relatively few orthodontists have this type of training.
Some of the happiest patients I have ever had are those for whom I say they don’t NEED orthodontics!
Robert L. Nisson, DDS MSD
Diplomate of the American Board of Orthodontics