hey it's dr amanda with straight smile solutions straight smile solutions.com and today we're
going to talk a little bit more about cance and asymmetries and how this affects your orthodontic
treatment this is going to be talked about from a doctor's perspective but if you're a consumer
you're welcome to listen it might be a little bit high level for you but in any case a lot of people
are not ace are not symmetrical to get started so not a big deal you know if it's something that
really bothers you often it can be fixed with surgery if a child is still growing
before they've reached peak puberty it's possible if there's an asymmetry that it could be
something that is corrected especially if it's an asymmetry in the lower half of the face it could
be something that is corrected by orthodontics or growth modification if you're done growing
most likely the asymmetry would have to either be camouflaged by some type of fillers or something
like that at the plastic surgeon's office or you can have a jaw surgery to go ahead and correct it
if the asymmetry is something very serious where you're having issues with function
with chewing with eating things like that with airway it might be fully covered by your insurance
so never rule it out so for example the way i like to kind of look at it um is i really like to take
that's why you have to take your photos for your patients with their hair out of their face behind
their ears can't have their face mask on can have hats on um headphones on anything like that i see
a lot of patient photos that doctors submit to me and i'm like okay you know if you have all this
stuff on their face and neck and head we can't really look for asymmetry so all the hair needs
to be out of the face hair needs to be tucked behind the ears earrings jewelry needs to be off
so we can really take a good look at the patient head should be vertical not tipped not tilted
and we really want to visually and i'm not saying i do this on all patients i don't draw these lines
you know but i visually look at it i look at the patient in the office i look at the photos
and if i see an asymmetry i might double check you know just to make sure um in that case you
can have an asymmetry and still have a good bite but your bite might be canted like this so this
is i see the word can't being thrown around a lot so most you can have a skeletal cant which is like
this i mean clearly you can see in the skeleton that it's canted right if we drew a line against
you know that was parallel to the occlusal plane like this and a perpendicular one um you know
you'd see that it's canted theoretically if you draw this line down and draw this line like this
it should look like this not like this right well this is a flip-flop version but you get the idea
so just things you know i think a lot of doctors are hesitating to bring up this topic with their
patients when they see a cat because it might be very subtle and maybe you as a doctor have better
eyes than the patient and they maybe have never noticed it even i have an asymmetry in my face
definitely my nose is a little asymmetric my occlusal plane is a little asymmetric my
face is a little asymmetric hey we all want to be symmetrical but we're not we aren't all so it is
what it is but it's very subtle you know and it's not something that i'm looking to get fixed so but
i just want to make sure before you jump in doing orthodontic treatment with the patient that you
do identify those asymmetries or can't and see if it's something that the patient wants to get fixed
you never want to assume or make assumptions that the patient doesn't want to get it fixed because
the patient might be assuming you are going to fix this and that this orthodontic treatment will fix
it and very likely if the patient is done growing and it's a skeletal asymmetry it will not fix
so i have personally gotten myself in trouble before it's one of those rookie mistakes that
you make you know newbie mistakes where you're like oh i don't want to cause trouble um
i do remember being a patient in the orthodontic chair and my orthodontist was um he was the head
of the aao so he's a very very very well-known orthodontist in the 80s you know very educated
and of course you know he taught ortho at an orthodontic residency he was very thorough right
you remember him going over the asymmetry with my parents and mentioning it and at that time i was
done growing i was 17. um and i remember oh man he didn't do it right because i remember having a
huge complex of it from there on out from there on out you know about my profile about my asymmetry
i remember never feeling quite right about myself and the way i looked for a long time after that
because i was like oh man i'm asymmetric i'm abnormal you know so you have to be really careful
in how you present it and how you talk about it and make sure especially if it's a child i just
want to put that out to you be really careful i'm not saying don't have them in the room um
but there's a way to say it and there's a way not to say it so i'm going to give you some
scripting right now that i would use to say it so um goodness i mean you can use the same scripting
you know for a child that maybe has a slightly larger chin or slightly larger jaw you know and
you just have to be really really really gentle with your explanation and not say it's wrong
just say you know sometimes i'll look at something like my fingers or my toes and and i'll start with
something really easy like that and i'll say you know um all different types of faces right um so
or there's all different types of toes you know so sometimes some of us have this toe longer than
another some of us have the this toe longer than another same thing with fingers we're all a little
bit different right same thing with faces some of us have bigger jaws smaller jaws bigger chin
smaller chins it's not wrong or right it just is you know and i just want to point out to you that
we're not all quite symmetrical you know and you can even say one hand is often a little smaller
or a little bigger than other i know for example ring fingers is an easy one to discuss i i've used
that i'll say my ring fits on the left finger but doesn't fit on the same finger on the right
just a little asymmetrical that's okay same thing with faces sometimes you know we will have one
side of our face a little more down than the other side of our face who knows why you know um if
you know they're a religious person and you feel comfortable talking like that you can bring that
in that can be very comforting in certain parts of the country if not i wouldn't go that direction
but you say we're all made different ways and that that's what makes us unique just like fingerprints
you know so i just wanted to point out that there's a little asymmetry you know on your face
that's okay um because so and so is growing isn't growing there might be an opportunity to improve
it or there might not i just wanted to point it out because it's part of my diagnostics to make
sure that you knew about this and i just wanted to address it to see if that was something that
you guys were thinking about fixing or if it was something that was even a concern and just bring
it up and then if they're like oh no it doesn't matter okay great you talked you brought it up
documented that you had that discussion boom done because i've had it happen where i didn't bring
it up i think i mentioned that and then later at the end they're like well what about this
and i said oh we can't fix that with braces and they're like what that was the whole reason i had
braces and i know you all are thinking well why didn't they mention that in the chief complaint
well people don't always mention that in the chief complaint they'll just say straight teeth you know
but they're thinking that jaw correction is part of straight teeth in that case honestly if that
happened you might be giving a full refund um there's definitely grounds for it and there's
definitely grounds for complaint and i'm not saying most patients would take it to that
level but there are patients that will escalate it to insurance to a dental board and be like dude
this person ripped me off you know i went to get this fixed and if it's something pretty obvious
you know they're gonna say well did you did you document it did you notice it and if it was
something you know as severe as this for example i know you're seeing the the skull they're gonna
say how come you didn't take a pa x-ray how come you didn't offer the patient the option
of jaw surgery to refer them out and this just literally goes into the whole conversation about
compromise treatment you know be really really careful with your compromised treatment unless
you're giving the patient perfect which a lot of cases might include jaw surgery and 99 of the
patients probably won't do it they'll probably say bryce this is fine straight teeth is fine
okay that's totally fine i just wanted to make sure you knew about it you knew
that was an option it's not something that i do but i can refer you to a doctor who does do it
you know i know you might think it's expensive but it's not always expensive and sometimes it's fully
covered by insurance it's not something that i know that much about but i can send you to people
who can i just want to make sure you have all your options again i can't for those of you who work
with me in my consultancy practice you've probably had a few lectures from me because it's really
something i feel very strongly about because i've seen people get in trouble and i'm not saying i've
gotten in trouble before but there's plenty of times when i work for other orthodontists or work
for other corporations would they be like don't even mention it well no i can't do that because
that's below standard of care i have to mention it and you know what if the patient wants to get that
jaw surgery or wants to get that referral to learn more about it i'm all for it even if it's not
something i'm doing because that's part of them getting educated and making an informed decision
99 times out of 100 they still come back to you for the treatment you know maybe occasionally they
don't and they stay within the other doctor that's all right because you know what this patient was
educated and got to make an informed decision and that keeps you out of hot water with your cases
all right anyway so that's my little diatribe today hopefully you learned something about
canting and you know what it's okay to be a little bit canted and again even if it's
something not that serious a lot of patients will point out later you caused this well unless you
pointed it out at the beginning well you might be given a refund so all right thanks so much