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Dentistry/Herbst for 15 year old girl


Yesterday I took my 15 year old for an orthodontic consult.  The recommended treatment plan was 9-12 months in a Herbst appliance, followed by 12 months in braces.  The ortho did not guarantee the Herbst would work, but "promised" that dd's jaw & smile would be greatly improved at the end of treatment.    

His diagnosis reads:  excess overjet (severe); moderate anterior open bite; jaw joint clicks were not evident; retruded lower jaw.

After hours of internet research, I am not at all comfortable with the Herbst.  Ortho said he couldn't guarantee it would work for her, as she is no longer actively growing.  (no recent changes in shoe size or height)  

She has no jaw pain.  She does not have a "buck-tooth" appearance and is attractive.  She does have crowding in the upper jaw which has caused one tooth to be slightly turned.  Lower jaw has one tooth slightly turned as well.  

We wouldn't consider surgery as an option right now because she has no TMD symptoms such as pain or clicking.   

Is it possible to straighten her teeth with braces WITHOUT moving bone (herbst or surgery)?  If not, she will probably opt for doing nothing.  We tend to be in the "if it's not broken don't fix it" camp.

Does doing nothing seem like a reasonable decision?  We respect and appreciate your professional opinion.  Thank you very much for taking the time to educate those of us with reservations about using this device.

Sharon - I am sure that you realize that I cannot be totally sure what I am telling you is exactly correct,but from your description it sounds like your daughter's problem is not mostly related to the position of her teeth, but the jaws. It sounds like she has a discrepancy in the size of the upper to lower jaws. The orthodontic treatment suggested will not correct the problem in a child near the end of puberty.  Surgical correction of jaw size is probably the correct approach.  I fully understand your feelings about doing surgery, but if the problem is not properly addressed and corrected now, as she gets older, she will probably develop problems with jaw functioning.

So doing nothing does not sound appropriate. You need to have her examined only by a board certified oral and maxillofacial surgeon to fully define the problem and come up with an appropriate treatment approach. I know this is not what you want to hear. If you have further questions or need names of board certified oral and maxillofacial surgeons near you, get back to me.  


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Joel S. Teig, DMD, Diplomate ABOMS, retired


I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.


Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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