Dr Amanda with Street smile Solutions Street smilesolutions.com and one of our questions
that came in today I'm going to make a live video yay because I need to do a demo so the
question is how do I put my patient in CR or how do I know that my patient doesn't have a CR Co
shift so that I can set up the ortho properly or make sure my patient is done and what type
of patient should I do this on so let's talk about the why behind that and then what type
of patients and then I'll show you the demo so the why behind it is sometimes when there's an
interference a patient's going to have a shift so in a patient that maybe has an edge to edge
bite they might shift forward and it might look like an underbite but it's really not actually it
might just be an edge to edge bite with a shift so it might look worse than it actually is so this is
actually a good thing in a patient that was class two had over Jet and a small lower jaw and maybe
you're doing some functional Appliance therapy be it Invisalign with ma twin block bionator
some other type of fixed functional Appliance sometimes they get muscle memory and they just
or like even just elastics it happens too so once we get muscle memory and sometimes they
just naturally slide forward and it's really hard to catch those especially if you have a patient
that maybe you've been doing one of these like a lot of elastics and all of a sudden you see like
a dramatic correction or maybe you haven't seen them a while it looks like it's corrected and
you're like wow good job you did such a good job with your Appliance and actually they didn't do
anything I've also had patients that are Class 2 that had appliances and they're so smart that they
figured out if they slide forward you're going to end the treatment and take the appliance away
and maybe put the braces on it's happened many times where they've cheated the system
really good Little Liars so um maybe they do it intentionally maybe they don't I don't know
um so the problem is if you don't get this right one of two things can happen for the class three
patients you might over treat you might say you need jaw surgery you might say you need to pull
out a lower tooth or two lower teeth you might pull out four teeth when you didn't need to maybe
just needed some lower IPR so you make the you think the case is worse than it is and you over
treat which causes major damage and now you're in big trouble later okay and that's on you for not
diagnosing correctly it is not on the patient for biting wrong okay you should have known
um the other thing is you need to make sure in the class three patients if you're taking a ceph x-ray
which I hope you are on every single class three patient that you're taking the ceph X-ray and CR
not in Co which can be tricky especially if you're Outsourcing the ceph yourself has to match the CR
okay it doesn't match the co because we got to get numbers off the CR okay okay so that's for class
three for class two it's a little more innocuous worse comes to worse um you know if they have a
Sunday bite and they slide forward whether they did it intentionally or manipulatively
um that you think they're done and then a few weeks to a months later you're like what where'd
this class two come from ours it was corrected class two doesn't relapse it only relapses when
that wasn't really corrected okay so then you just get to fix it again so it's not as bad except for
it can really make parents upset when you told them treatment was done and it's not and I see
this happening probably at least once a month with different doctors that show me cases my class two
came back I said class 2's can't come back sorry impossible so class threes can come back they can
get worse if you grow some more so anyways those are the different scenarios where I want you to do
it okay now um let's talk a little bit more about yes we talked about shifts so shifts are for class
three premature shift and slide often you'll see a symmetry asymmetry in the jaw asymmetry in the
midline doesn't you know always but it often comes with that okay for the class twos some
of you see nothing you usually don't see any asymmetry it looks perfectly perfect you're
celebrating they did a great job and nothing actually was done um so that is either way
it's bad okay so let's talk about how to do this now if it's a little kiddo you know like a six
seven eight they're not gonna be able to follow these instructions you're just gonna have to
relax your jaw make your jaw feel like jello and then you just kind of have to guide it into play
you know I'm gonna close the jaw for you and it's really kind of tricky okay also sometimes some or
or you can ah that's pretty much it okay but for an older patient you can try this okay so this is
actually a great tool it's called myospats um unfortunately with mile spots and use them for
myofunctional therapy these are left over from my mild functional therapy they're really expensive
and they literally are Xylitol lozenges that take forever to melt but when you stick your tongue to
the roof of your mouth it glues it like glues it you try to rip it off before it melts it will take
the skin off your tongue so once I end this demo I'm not gonna be able to talk anymore comfortably
so I'm gonna send it because I don't want to rip the tongue up rip the skin off my tongue so you
need to let the patient know that you need to let it melt um it's not too comfortable so I'm gonna
say as much as I can and then I'm going to do the demo so basically you're gonna put the mile spot
um it's better to go ahead and press it to the spot you want on the roof of your mouth so I'm
not going to do it but I'm going to show you how to do it as far back as possible so they don't
gag okay so you're gonna take your finger you're gonna press it back there and then you're gonna
hold it there for a few seconds and then you're gonna tell them to take the tip of their tongue
and put it on that spot now you better make sure that they can put their tip of the tongue that
far back first so see how far back they can go maybe mark it with like um one of those little
like interaural pens you know those little like little blue sticks that we use for dentures so you
can Mark the Spot that might be a good idea a way you know that their tongue can go that far back so
let me I'm super accurate here okay so then what you're gonna do is you're going to tell them to
put their tongue back there okay so you can say hold it for 10 seconds but I find that when you
do that a lot of times it slides so if you use the myospot then it won't slide because it's
glued so and then you're gonna tell them to close their jaws and not their teeth together so you're
going to kind of explain that your teeth may not touch but I want your jaws to close down until you
feel something touch it doesn't have to be all the way down and once you feel something touch I feel
like you can't close anymore stop and stay there and I'm going to check your bite and take some
pictures okay and let them know I want your tongue to keep staying where it is this whole process
until I say you're done then you can go ahead and let this and by the way these comes in tons of
flavors these are my spots and I want you to wait till it melts you know until you can comfortably
release it don't try to yank it off or you're gonna rip the skin either off the roof of your
mouth or off your tongue it might I mean these are meant to last like 30 minutes but you can you'll
usually release it pretty easily in five to ten minutes so they're gonna be like this for a while
um they come in lots of flavors last I checked you cannot order them from Amazon or any other Dental
distributor they have to be ordered directly from this company and I don't even know who makes my
spots um they're vegan by the way too that's awesome literally I believe this was something
Mayo spots Australia I think I had to ship them from Australia and I think it was cheaper to ship
them to the mainland than it was to where I am in Hawaii if I remember correctly it was like I swear
this was like 50 bucks and I was like I know this cost like five cents to make this is annoying um
but there's a lot in here so you can use them for a lot of cool things and also for Maya training
okay so I'm gonna go ahead and do the demo now I don't have a crco shift so my bite's gonna look
exactly the same but it's somebody that is class three sometimes you're surprised woo it's totally
different someone that is class two sometimes it's totally different right and the less you
tell the patient sometimes the better so um okay let's go ahead and do the demo let's get started