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About Dr. Randolph Myerson
Expertise
Please limit your inquiry to questions about orthodontics (braces) and children's dentistry. I am both an Orthodontist and a Pediatric Dentist, having been trained in both of these dental specialty fields. Orthodontics is the dental specialty that treats problems of tooth, bite and jaw alignment using braces and removable appliances. Pediatric Dentistry is the dental specialty also known as dentistry for children, which deals specifically with the dental problems of this special age group from infants to adolescents. I am also experienced in Forensic Dentistry, the application of dentistry to law enforcement and identification using dental records.

Experience
I have been in the private practice of orthodontics and pediatric dentistry for over 20 years. Prior to that I served for three years on the Cleft Palate and Cranio-facial Reconstruction team at Children''s Hospital of Philadelphia and was an Assistant Professor of Dentistry at University of Pennsylvania School of Dental Medicine. I also served as a dentist in the U.S.Air Force, stationed at Andrews AFB in Washington, DC.

Organizations
I am a Fellow in the American Academy of Pediatric Dentistry, and a member of the American Association of Orthodontics, as well as a member of the American Dental Association and the Dental Society of the State of New York.

Education/Credentials
I received my BA in Biology from Frankin & Marshall College in 1969, and my dental degree from University of Pennsylvania School of Dental Medicine in 1973. In 1978 I received both my Certificate in Orthodontics from University of Pennsylvania School of Dental Medicine, and my Certificate in Pediatric Dentistry from Children''s Hospital of Philadelphia after completing a three year Teaching Fellowship in Orthodontics and Pediatric Dentistry in 1978.

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Dentistry - Braces for my child

Expert: Dr. Randolph Myerson - 11/6/2009

Question
QUESTION: My child is 7 years old. Her lower jaw is forward her upper jaw which cause her teeth to meet when she puts her teeth together. Her orthodontist is recommending that we put braces on her top four teeth in order to pull them behind her lower teeth. She said that she has a strong lower jaw and that it would not be possible to use braces to pull her lower teeth back behind her upper teeth. I am trying to determine is this method of correction is the best possible solution for my child. Her orthodontist has indicated that my child more than likely need braces and/or surgery when older to fully correct this issue.

ANSWER: The proper correction of this type of problem depends on the exact nature of the problem. There are three major causes of this problem. The first is a skeletal problem where the lower jaw is growing faster than the other facial components or perhaps the growth of the upper jaw is not keeping up with the remaining facial growth. These two skeletal type problems each require a different treatment approach which might involve growth modification or surgery. The second type of problem is dental in nature where the positions of the teeth are at fault and teeth must be shifted to correct the problem. The third and most common possibility is a combination of skeletal and dental causes and this requires a comprehensive approach to treatment planning. From what you indicate it sounds like your orthodontist has suggested the possibility of a combined orthodontic/surgical approach will be necessary. As for treatment at this point I cannot know what to recommend since I don't have any meaningful diagnostic information upon which to base an opinion.

---------- FOLLOW-UP ----------

QUESTION: Thank you for your quick response. The orthodontist took several X-rays and pictures and determined that the issue is a skeletal problem where the lower jaw is growing faster than the her upper jaw. It's not very noticeable, but the alignment does cause my child's teeth to meet together and their are concerns that she could damage her permanent teeth. The orthodontist felt that my child's upper jaw and facial structure was symmetrical and thought that the best approach was to use braces to move her upper teeth back a little bit so that they are positioned behind her lower teeth to avoid them hitting each other. I inquired about her moving my child's lower teeth instead and she indicated that because the jaw is forward it would be better to move the lower ones. I ma trying to weigh the effects of having her upper teeth close behind her lower teeth with letting them stay the way they are.

Answer
Actually, I would suggest using orthopedic mandibular restraint with a chin cup to "hold back" the growth of the excessive lower jaw while the remainder of the facial skeletal complex catches up. This can be very effective, especially in rapidly growing children with a mild skeletal dysplasia. I would not be overly concerned about the teeth meeting as long as there is no evidence of excessive wear or chipping of the incisal edges.

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