Orthodontic Evaluation

The orthodontic evaluation really begins with the parent or patient recognizing that there is an orthodontic problem which leads you to this website or our office.  Our job as orthodontic professionals then is to listen and define that problem.  Listening is the most important first step for any doctor as what concerns you most may not be the most obvious problem to us.  The evaluation is such an important part of orthodontics that Dr. Bentele did his research and thesis at Ohio State on this subject.

Bentele MJ, Vig KW, Shanker S, Beck FM. “Efficacy of training dental students in the Index of Orthodontic Treatment Need.
American Journal of Orthodontics and Dentofacial Orthopedics.  2002 Nov: 122(5): 456-62.

You should never feel rushed into orthodontic treatment.  These problems do not develop overnight and will not change appreciably in the near future.  An evaluation should consist of more than the recognition of crooked teeth and a prescription of braces. During the growing years there are windows of opportunity when certain orthodontic issues are more easily addressed and that is part of the evaluation. At Bentele Orthodontics a systemized approach is used.

  1. Missing teeth: You may not think of this as a part of orthodontics but it is very important to evaluate.  Are the teeth so crowded that some permanent teeth are unable to erupt?  Did the canines get lost on their eruption path and become impacted in the palate? Were baby molars lost early and now the permanent teeth are shifting unfavourably?  Did all the permanent teeth develop or are some congenitally missing and will need a replacement plan?  Is this an adult patient with missing teeth who needs the adjacent teeth realigned prior to implants?

  2. Overjet: (Commonly called “overbite”)  How far the top teeth extend beyond the bottom teeth is an indicator of several problems. 

    1. If the top teeth are in an underbite relationship the maxillary (upper) incisors fit behind the mandibular (lower) incisors.  This is particularly damaging because the teeth wear excessively. The lower incisors may be driven forward and strip off gum tissue causing recession.  An underbite may be an indication that the lower jaw is growing excessively or the upper jaw is deficient.  Earlier treatment may be indicated to modify jaw growth.

    2. If the upper teeth extend excessively beyond the bottom teeth then usually either the top teeth are angled outwards or the bottom jaw has not grown sufficiently to catch up with the upper jaw.  Children with this arrangement are more prone to damaging the upper teeth in an accident.  We will review the many modalities for correcting excess overjet from orthopedic modification of jaw growth to repositioning teeth.

  3. Crossbite:  If the maxilla (upper jaw) is too narrow for the mandibular (lower) jaw and teeth, then the posterior teeth will be in crossbite.  Teeth in crossbite will not fit properly, will cause excessive tooth wear and may redirect lower jaw growth in an asymmetric direction.  A narrow upper jaw restricts the amount of space for the teeth to erupt and may cause impactions.  A posterior crossbite is best treated early before growth is complete to prevent these problems.  After growth is complete a surgical procedure is part of the treatment.

  4. Crowding: This is the most obvious orthodontic problem and the most common chief complaint.  An assessment will be made on the severity of the orthodontic crowding.

    1. Minor crowding is normally resolved with simple orthodontic alignment and is a candidate for Invisalign treatment.

    2. Moderate crowding may require more complex measures such as maxillary expansion in an adolescent or interproximal reduction to create the space needed for alignment.

    3. Severe crowding indicates that extraction of teeth is likely.  Avoiding extractions at all costs is not conservative treatment.  Overexpanding the jaws and pushing the teeth outwards can be damaging to the gum tissue, push the lips outwards in an unesthetic profile and lead to instability of the teeth.

  5. Bite depth: How much the teeth overlap vertically is an often overlooked but important facet of orthodontic health.  A deep bite is when the incisors overlap excessively and the lower incisors almost disappear.  In this arrangement the teeth will wear excessively over time and may even strip gum tissue off the upper incisors.  In an open bite the teeth do not come together which means excessive wear on the other teeth and functional problems biting into food.

In addition to these 5 areas, other factors to consider are the patient’s: facial profile, stage in growth and development, medical history, cleft lip/palate and timing issues such as a desire to finish before high school graduation.

If a younger child is not quite ready for comprehensive orthodontics and there is no valid reason to start them in early orthodontic treatment then they will be placed in our no cost Growth & Development program.  An orthodontist receives extensive training in growth and development during residency training.  Proper timing of orthodontic treatment is very important to our overall goal to accomplish the best orthodontic outcomes at the most reasonable cost and least impact on your busy schedule.  A recall every 6 months assures that any potential problems are caught early and that orthodontic treatment is timed most efficiently right as the last baby teeth fall out.


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