Anterior openbites are frustrating in every patient. Too often, I see doctors just jumping-in and trusting the treatment planners into a plan that isn’t predictable or retainable long-term.

I always say, doctors should never take an openbite case until they’ve been a detective first. They need to find all the etiologies and treat those FIRST and then do the ortho.

Here are the tools I recommend using in order to learn more:

1. Adult or kids sleep and habits / OSA questionnaire
2. Mallampati Scoring
3. Look for adenoids in the ceph xray
4. Look for mouth breathing clinically
5. Look for tongue thrust clinically
6. Check patency of the nasal airway

Treatment may mean putting in a fixed or removable tongue or habit appliance first for 6-9 months before braces or aligner begins or working with a myofunctional therapist.

If Malimpotti, adenoids or nasal patency is an issue or if the sleep questionnaire gave red flags, I would refer out to the ENT before starting treatment.

Although this delay may be frustrating for patients, this would be standard of care and you’ll be likely increasing the health of the patient and the quality of their life long-term. You’ll also be likely to have a better orthodontic outcome.