Overcoming Orthodontia Pre-Occupation

by Charles Sutera, DMD, FAGD

We live in interesting times.

On one end of the spectrum, we have the image-conscious patients who will do absolutely anything to create what they see as a perfect smile. On the other end of the spectrum, we have a growing body-positive movement determined to eschew the unhealthy demands of marketer-created body image.

Properly treating patients across this entire spectrum requires a strict adherence to the best health outcome for every case.

Whether you have a patient who wants to push things too far, or one who wants to leave well enough alone, a thorough review of the health and functional reasons for addressing – or not – an overbite can go a long way toward an optimal outcome.

For the Overzealous

Years of training may leave some mystified as to why a patient would request a procedure that could result in injury, but fashion and aesthetics goes a long way toward understanding their motivations.

And those fashion trends vary from culture to culture, region to region.

Though, in our overly connected world, you shouldn’t be too surprised by cultural norms that may seem unusual in North America. There’s a lot of them. For example, the “snaggletooth” (yaeba) look is popular in Japan, and the Mentawai people of Indonesia favor a look of sharpened teeth.

So, what to do with such a request?

Stick to the oral health facts.

Potential damage and associated health impacts

Snaggletooth: When it comes to a trend like “snaggletooth,” the primary consideration is that, regardless of the method chosen, you will be creating a haven for excessive bacteria growth. Deliberately creating an overlapping or overcrowded look carries the same dangers as a naturally overcrowded mouth.

Some side effects include:

  • Tooth decay
  • Gum disease
  • Bite misalignment
  • Excessive enamel loss
  • Mouth ulcers

Sharpened teeth: While tooth stripping is common practice in preparation for fitting crowns, veneers, and other treatments, that’s not what we’re talking about here. Filing teeth to a sharp point requires going far beyond the accepted enamel loss associated with standard dental procedures.

Some side effects include:

  • Tooth sensitivity
  • Tooth decay
  • Periodontal or pulpal problems
  • Tooth yellowing
  • Weakening of the tooth structure

Overcoming Correction Bias

On the other end of the spectrum, you may encounter patients who would benefit from intervention, but are resistant due to body-positivity beliefs or dental anxiety.

Overbite or deep bite may be such a case. A patient or a patient’s parent may argue that overbite is normal and should be left alone.

While it’s true that some overbite is normal, you may be able to persuade a reluctant patient with some simplified facts:

When an overbite measures too far out of the normal average, it causes mis-alignment of the upper and lower teeth when the jaws are closed (malocclusion).

Untreated overbite can result in functional problems, including:

  • Tooth damage, decay, and loss. Because misaligned teeth may be hitting in odd places, patients can experience thinning enamel, which can lead to tooth decay, tooth fracture, and tooth loss.
  • Gum damage and disease. If an overbite is severe enough for teeth to come into contact with the gum line, it can cause gum recession and gum disease.
  • Difficulty speaking.  Our front teeth play a large role in forming various words, particularly with “f” and “s” sounds. When someone has a drastic overbite, it sometimes can affect pronunciation.
  • Sleep apnea.  Studies show that if overbite is preventing the lower jaw from entering into a relaxed forward position when sleeping, it contributes to sleep apnea.
  • Jaw pain from TMD. A misaligned jaw can result in chronic jaw pain and headaches and may contribute to the development of Temporomandibular Joint Disorder (TMD).

Demystify Treatment Options

It can also help to discuss treatment options, as they’re often not as dramatic as some people may fear.

For children, the name of the game is prevention. Because a child is still growing, both the skeletal and dental causes of an overbite can be addressed. So, reassuringly, in children, treatment has to do more with guiding the growth to improve it.

Treatment in Children and Teens

  • Removal of baby teeth to make space to improve the position in the adult teeth
  • Growth modification device such as headgear or a palate expander to help guide the bones of the jaw to grow in a more ideal proportion
  • Braces to apply gentle pressure to the teeth and improve the position of the teeth and jaw
  • Retainers to hold a position so that the overbite does not change during growth or from other behavioral factors

When it comes to adults, the skeletal structure is fixed, so treatment cannot leverage the power of growth. In adults, an overbite is improved by adjusting the alignment of the teeth.

Treatment in Adults

  • Braces and Invisalign under the direction of a dentist or orthodontist to move the teeth into a more favorable position
  • Teeth removal if the teeth are excessively crowded, to create space for the rest of the mouth
  • Surgery only if the overbite is excessively mal-positioned (less than 1% of cases).

About the Author

Dr. Charles Sutera , DMD,  FAGD, is a doctor of dental medicine, TMJ specialist, board-certified in moderate dental anesthesiology, and renowned for high profile cosmetic dental reconstructions. He is a Fellow of the Academy of General Dentistry and is the founder of his dental practice, Aesthetic Smile Reconstruction.