Q: I was hoping you could help me respond appropriately to a client of ours. Her son came in for an eval and has an overjet measuring at 9mm. We explained to mom that therapy could not begin until this was addressed. Additionally, he will be getting his palate expanded around summer time. Mom is adamant that we begin therapy prior to his expansion. Can you help me explain as to why we do not recommend this. Thank you!
A: Can he achieve a decent palatal seal without excessive overlap? If you let her know that the goal is to get correct tongue and lip rest posture I would assume with a 9 mm over jet he has difficulty getting his lips closed comfortably. For him to be able to be successful the structures have to be in place for treatment to be effective. He would have improper tongue positioning with a 9 mm over jet and it seems highly unlikely that you’ll be able to get a good lip closure without the mentalis being overused so I would go from the perspective of explaining the impossibility of correction without structural integrity. No doubt, you can show her the impossibility of a tongue posture position where it should be with a 9 mm overjet since his lower teeth will be biting on his tongue if he had it in the correct position! Also if you show her lip closure and the mentalis activity that’s occurring, that is not the goal. You would be wasting both your time, their time and money. Hope this helps:)