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Dentistry/Class III malocclusion in 13 year old


QUESTION: My daughter (who until her last check-up was told she had a normal bite) is now diagnosed with a Class III malocclusion on the right.  Her exam reveals "moderate rotations and spacings in the upper and lower dental arches, space between the upper front teeth, improper interdigitation of the posterior teeth, lower midline to the left 3 mm, and shift of the lower jaw to the left side."  Her appearance is normal and she has no complaints about her teeth (no pain, etc.).  She is a rather immature thirteen-year old and "doesn't want braces."  Her oral hygiene is only fair.  If we opt to not do the braces, what is the likely prognosis?  Can these problems be fixed orthodontically when she is an adult if she so chooses?  Thanks!

ANSWER: Thanks for posting this most interesting and relevant question. Let me start my response by stating that the following is a very general reply. Let me explain. Since I've not had benefit of an examination of your daughter's specific situation other than your description, my comments may or not apply to her specifically.

There are reasons for initiating treatment at this time, and there are reasons for not doing so right now.  First, the reasons for treatment. When teeth are not properly aligned there is a risk of excessive wearing down of the enamel and damage to the health of the teeth. In addition there is the possibility of a shift in the jaw leading to uneven jaw growth. This may already be happening, even in the absence of complaints. Right now it may be beneficial to utilize the spaces that are available between the teeth to shift them into acceptable positions. In time those spaces may disappear so that advantage may be lost if treatment is significantly delayed.

Let's consider some of the reasons why it may not be appropriate to initiate treatment at this time. Patient motivation and cooperation are essential to the success of treatment. Excellent oral hygiene is essential to the success of treatment. If those important aspects are not in place there is a very significant risk of failure and damage in spite of the best intentions and treatment available.

As for the prospects of treatment delayed until adulthood that will depend on the degree to which any permanent asymmetry in jaw development occurs. The possible loss of interdental spacing may also impose certain complications in treatment prognosis as well. The future is not just difficult to predict, it's simply impossible.

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QUESTION: Thank you, Dr. Myerson, for your prompt reply!  How does a Class III malocclusion lead to a shift in the jaw?  Is 3 mm considered a signficant shift?  If not, how many millimeters is considered signficant?  I am wondering if a "watchful waiting" approach (allowing time for my daughter to mature emotionally) might be reasonable.

ANSWER: When teeth are in their proper bite relationship the jaw can close straight on with muscular balance and symmetry.  When teeth are not in their proper bite relationship the misaligned teeth cause the jaw to close off to one side or the other to achieve a "best fit" bite relationship. This deviation in jaw position can result in uneven growth at the jaw joint leading to a permanent skeletal asymmetry. I would consider anything more than a 1 mm deviation to be significant.
I would suggest delaying treatment until oral hygiene and motivation are drastically improved. This in no way suggests a "watchful waiting" approach. It requires an active plan to improve both aspects of patient compliance such that treatment can be successfully initiated within 1-2 years so that it doesn't impact on the later years of high school and graduation.

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QUESTION: Sorry - one last question - would Invisalign be an option?


Invisalign has certain limitations regarding what it can accomplish. Since I haven't examined your daughter I can't know what technique would be appropriate for successful treatment. Perhaps an evaluation with an orthodontist who provides Invisalign treatment will give you an answer to that question.


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Dr. Randolph Myerson


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.


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.

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.

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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