Orthodontists Need to Stop Treating Malocclusions and Start Treating People

Start Treating People

A few days ago we had a 49 year old man consult with us regarding what he thinks is a poor outcome from previous treatment of his underbite (lower front teeth ahead of the upper front teeth).   Fifteen years ago he had orthodontics to fix his underbite by removing lower first permanent molars and pulling back the lower front teeth until the lower front teeth were behind the upper front teeth.   He was unhappy with the very tipped back appearance of the teeth.  I have to admit all I saw about his smile was his tipped back lower incisors.    The orthodontist had done a very good job at doing what I call “making teeth fit on jaws that don’t fit”.   I’m sure that the orthodontist was thrilled that he’d been able to resolve such a serious malocclusion and not have to resort to surgery.   The result was not esthetic, but the lower teeth were no longer ahead of the upper teeth.  

However, once we scratched the surface a bit there were much more serious issues that we soon discovered.  This man’s tongue was severely scalloped indicating it needs more space.    A scalloped tongue can also be associated with Obstructive Sleep Apnea (OSA).   His neck circumference was visibly greater than 17 inches which is another risk factor in a male for OSA.    When I took his BP it was 180/119 with a pulse of 80 BPM.  He was completely unaware of this and also unaware that a high reading like this is highly correlated to OSA.   

We immediately referred him to the ENT/Sleep physician we work with for patients with sleep/breathing disorders.    After he consults with the physician and receives any immediate treatment that might be necessary, we will be talking with this patient not only about the esthetics of his situation, but how we might alleviate any sleep/breathing issues that were recognized.  We will be treating the person – not just the teeth.

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