amanda with street smile solutions street smile solutions.com and today we're going to talk about
treating and diagnosing and treating anterior open bites in adults and i just did a video a
few minutes ago on kids so if you have a kid go ahead and look at that video first if you have
an adult you can look at this video by adults i'm meaning anyone that's no longer growing so it does
not mean age 18 it could mean as young as age 8 or 9 in girls our um as young as 11 12 13 and boys
so unless you know their skeletal age and you've done either done some type of hand
wrist evaluation or you've received growth charts from the pediatrician you don't know
if this is a preteen or a teenager so do that first and i have tons of videos on how to do that
please view the kids version that i just posted for more information we're going to assume that
your patient is no longer growing is an adult presents with the anterior open bite and what
to do so i see these all the time in my private coaching practice with my vip and all the cart
clients and concierge clients and everyone's always excited to get started and one of the
biggest frustrations i get you know whether you submit to invisalign or clearcorrect
is they'll make it look like it's easy and it's not so it's not always predictable um
and it's not always easy and you could fix it and it might completely bounce back open when
you stop treatment take those attachments off and everything so it is probably one of the biggest
mistakes you can do when taking a case is one of these really tricky cases that looks easy but
actually ends up being hard and i've seen doctors who've basically gotten in trouble by doing these
whether with insurance companies things relapsing and the patient asking for their money back or
with state dental boards because they didn't do what they needed to do in order to diagnose it
this is where there's a big difference between an orthodontist and a general dentist because we know
better right so whenever i get any type of open bite i'm going to do a lot a lot of diagnostics
and i'm going to ask a lot of questions and the answer might be no we can't treat you without
surgery i know it's not an answer that people want to hear but if i don't think it can i'm not going
to try it you know because all it's going to do is cause more problems so first thing we're going to
do is we need to find out what caused that open bite and i know that if you've worked with me
and you've sent me one of these cases i'm sorry i can't help you with that invisalign clinch check
because we don't know what caused it we need to fix that first before we can jump into aligners so
how do you know that well first thing you're going to do always always always get a sap
and staff numbers if you want to know more about that you can go into my website excuse me not my
website you can go into my youtube site which you're probably on right now but you actually
have to go into the street smile solutions youtube site okay not just general youtube and within my
youtube site straight smile solutions there's a little magnifying glass towards the top putting
the keyword um where are we talking about ceph and all the information about staff and
african accepts are their own playlist tons of information about seth's once you get yourself
then you're going to need to get numbers for the theft that's really easy there's a variety
of different labs that will turn these around in less than a day once you get the numbers if you
have no idea what it means this is where you can work with us and we'll be glad to explain it to
you and help to create a good treatment plan once we see those numbers all right so that's the first
thing what else we also need to do an adult sleep questionnaire and ask a lot of questions you know
when do you first remember getting this a lot of people say i've always had it um have you ever had
ortho before it's a really good question yes no if they have my question is was it corrected during
ortho usually the answer is yes did it relapse yes a lot of times they had retainers still still
relapsed with the retainer is totally normal again they did not find the source of it and they didn't
treat the source first or concurrently and that's why it relapsed another thing you want to look at
is the mall and potty scoring seeing if there's either any oral or oral pharyngeal airway issues
nasal airway issues if you've got airway issues they need to go to the ent first and sometimes
they're going to need a surgery sometimes the ante is going to give you a releasing you can go ahead
and start the order um they may even need to go get a complete sleep evaluation in a sleep lab
this is where if you're not off you know already working with the sleep physician um you either
might want to start or you want to work with a dentist who's not going to poach your patient
perhaps there's dentists who's really into sleep who doesn't do ortho and won't post your poacher
patient that you could refer to for that i know this takes time everybody wants to start their
ortho but if we don't do things the right way it's not going to fix it's not going to be predictable
and it's not going to you know stay fixed so it's really important that we take our time
again looking for signs of mouth breathing both at night or during the day you can ask a spouse
to observe the patient multiple times during the night not just one time because things can change
how they sleep that's why i really like to get that sleep evaluation if you can because all of
this goes hand in hand with sleep issues and osa as well and checking for tongue thrusts clinically
asking them to read a poem or read a section from a book not telling them that you're looking
for tongue tongue thrust but looking for signs of tongue thrust obviously that's an easy one
so ultimately once you get all the information then we can go ahead and fix that sometimes it
may mean putting in some type of fixed appliance first or doing some type of removable appliance
therapy either during the aligners um some things you can wear over it at night time
or using maybe an oral myofascial malfunctional therapist concurrently that's usually out of
pocket it's not usually covered by insurance with a variety of different exercises as well as being
very aggressive with your attention usually i recommend a three to three upper and lower bonded
retainer as well as essex or vivera over that so hopefully this was helpful again moral of the
stories don't rush into your anterior open bike cases or you might get burnt all right thank you