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About to start treatment- thoughts on treatment plan?

8 Posts
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Posts: 8
Topic starter

Hey everyone- 

I'm new to this forum, but not totally new to this kind of space (I used to post on a similar forum about treatments and ideas etc in my late teens). 

Background: I'm 22 nearly 23, and I've been having jaw joint problems since I was 16 (jaw clicks, locks shut - I've worn a rubber night guard to bed if it gets really bad). I've had no previous dental work done, and my top teeth are pretty straight apart from a slight overlap in my front teeth. My Botton teeth are pretty crowded. Not only have I never had extractions, but in the last 2 years all my wisdom teeth have come through...So I now have a full set of teeth, and quite a narrow jaw with a long face and jaw joint problems on the right side. 

I've had X-rays done and attached them to help visualise. 

Screenshot 2020 05 06 at 21.06.47

I'm based in the UK and recently went to London for a consultation about my jaw and treatment options. 

I'd just like to post the findings here and get some feedback on the suggested treatment plan before I definitely commence with it (the consultation was actually in February, but I couldn't progress with treatment due to the pandemic). 

So here's the write up (edited down to include the most important parts): 

"Clinical examination revealed a class I malocclusion on a mild skeletal 2 pattern with a slightly reduced Frankfort Mandibular plane angle and lower anterior face height. You have competent lips. The overjet is 3mm with an average and complete overbite. The upper dental centreline is coincident to your upper midfacial axis while the lower is displaced 2mm to your right. You have class I canine and molar relationships bilaterally. The UL2 is in crossbite relationship but no mandibular displacement on closure can be detected. The maxillary dental arch is slightly constricted. You have mild crowding in both dental arches. All your teeth have good root to crown length ratio and no contraindication against treatment. 

Suggested orthodontic treatment involves removing 4 teeth (2 from top, 2 from bottom- either wisdom teeth or molars) followed by rapid maxillary expansion (RME) for the upper arch follows by dual arch fixed appliances treatment with slight interproximal reduction in the lower arch to correct your dental malocclusion. This treatment will correct your dental malocclusion."

(If anyone wants to translate that into plain English it would be greatly appreciated!). 

I know how bad extractions are, but my thoughts are that I already have 4 more teeth than most people have and having them removed will mean I'll have more room to round out my jaw (the bottom row of teeth in particular is very narrow and angular at the moment). I think my narrow jaws have occurred as a result of having a slight tongue tie, so I'd also look into having that corrected and myofunctional therapy to retain any expansion I get. 

Ideally I'd like MSE with the screws after seeing such good results for other people (I'm really after a good change in side profile), but I'm based in the UK and I don't know any practitioners who offer that here. 

Any thoughts would be welcomed- I've been waiting years for this! But I want to get it right first time. 


Posted : 06/05/2020 4:11 pm
Posts: 248

I don’t intend to sound glib, but I would keep on looking for second opinions until I found someone who doesn’t want to remove your teeth. 

You can’t exactly put them back, and if there’s a way to keep them, I would. 

Posted : 06/05/2020 11:03 pm
Posts: 8
Topic starter

Yeah I’m totally open to other options and I do have another appointment booked, I just genuinely don’t think a lot of places offer the best solution in the UK.

My ideal treatment would be keeping all my teeth and having MSE with screws, but I’m yet to find a place in the UK which offers that yet...

If anyone knows one please tell me!

Posted : 08/05/2020 5:14 am
Posts: 74

I would avoid anything that requires teeth to be extracted, including wisdom teeth extractions if you can help it. Most people I have seen seem to have weaker jaws within days of having their wisdom teeth extracted. 

Also, it seems counterintuitive to try to expand the palate whilst also prescribing extracting teeth. 

MSE is very effective for sure but I fear the results tend to look unnatural. I’m of the opinion that if you’re going to expand laterally in any significant way, then you need to simultaneously do some sagittal expansion (though not necessarily to the same degree). 

Posted : 09/05/2020 1:18 am
Posts: 8
Topic starter

Hey so just wanted to follow up on this - 

I went to see Richard Cousley in Peterborough (who I believe has trained under Dr Won Moon) who said that the treatment plan I was suggested was too aggressive and it didn't make sense to have the teeth removed but then also palate expansion, as removing the teeth would mean there was enough room for the ones remaining. 

He said if I were to get palate expansion they'd use screws in the top of the mouth... But my bone is too dense for the screws to go through so I am not eligible for palate expansion. However he showed me a scan of my mouth and said there is good width between my wisdom teeth right at the very back but then all the other teeth are collapsed in and make my arches seem narrow. Apparently I'm a borderline case and he thinks he can treat it simply by using braces to round out the top and narrow arches and then using elastic bands to straighten the bite (also he noted my bottom front teeth tilt inwards a lot, and suggested he'd flare my teeth out slightly to give my mouth an even wider appearance and more lip support). 

I'm glad I went to see him as he seems to know what he's talking about and the fact he doesn't want to take any teeth to start is promising, but I'm still a little unsure about going for the treatment he suggested as I'm not sure how much difference it will actually make if it's just using braces to round out the arches (I can't see there being much change from it). 


Posted : 13/08/2020 8:08 am
Posts: 74

I think that's a good plan that he has proposed. Self-ligating braces can offer some degree of arch expansion and may be the way to go as your case does not seem too severe. My main concern would be the constant TMJ issues you have mentioned. Did he say anything about trying to get all the teeth to align into centric relation occlusion to stop the jaw clicking? 

Posted : 15/08/2020 9:39 pm
Posts: 8
Topic starter

@eternally12 Thanks for your response! 

He was pretty honest and explained that the type of jaw joint problem I have it is likely to not be fixed from rounding out the arches alone, but also that it tends to be the worse it can be in your 20s and then seems to calm down.

But despite saying that it probably won't fix the jaw joint problem, he did mention aligning the teeth to help the bite more:

Treatment will aim to ... "resolve your dental crowding, straighten all of the teeth, modestly broaden / round out the shape of both rows of teeth, centre the front teeth, and correct the bite discrepancies between your upper and lower teeth".

So I wonder if even just that treatment he has proposed will at least alleviate some of my jaw joint issues... Perhaps if I pair what he is offering with myofunctional therapy...

Whilst I like his minimal and less invasive approach, my worry is it won't solve all my problems (seeing as the first consultation I had they said widening the jaw with a palate expander had a good chance of helping the jaw joint align correctly). Plus I don't know for certain as nobody has checked yet, but I think my airways are quite narrow as I struggle with nasal breathing clearly. 

I'm hoping to get a few more consultations in London and Bristol and review all my options, but I have a bad feeling that there isn't going to be one treatment plan that really aims to resolve all the issues (and I'll have to pick the best from a bad bunch!). 

Posted : 16/08/2020 1:51 pm
Posts: 31

Please do not extract any teeth! If you can't find an option now, then wait, you will find a way brother. Just don't extract, make space to keep them, they're yours!

Posted : 24/08/2020 1:24 pm
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