Dr. Couser’s goal is to provide you with the most advanced orthodontic treatment to create a beautiful and healthy smile to last your lifetime.  Another goal is to treat the dynamic nature of the changing face over time, instead of the static view treated by traditional orthodontists.  Using this approach he can predict future soft tissue changes and plan your treatment accordingly.

Diagnostic records are taken at the initial examination, and are an invaluable part of the evaluation process.  These digital x-rays and photographs are not only used in the evaluation process, but also serve to document time points in a patient’s growth and development.  However, these records fall short in a full evaluation because they are viewed on a two-dimensional computer screen.  Therefore, our emphasis is placed on the clinical exam, rather than just the diagnostic record evaluation.

It is only during the clinical examination that we can observe how the smile animates the face.  Care must be taken because treatment solutions may affect a desired attribute of the face or smile.  Therefore, Dr. Couser strives to protect all of the positive attributes of your smile, eliminating the bad things and keeping the good.

The face is commonly only viewed in three physical dimensions.  However, a critical fourth dimension – time – is often overlooked.  As a child becomes an adult and then a mature adult, many facial changes occur.  The best treatment solution anticipates these types of changes.

Dr. Couser’s focus of the final treatment plan goals revolve around the appearance and esthetics of the face and smile. This requires careful evaluation of the macro-, mini- and microesthetics of both.

Macroesthetics looks at the outside of the face and smile, including:

  • the profile

  • vertical proportions of the teeth

  • lip fullness

  • chin projection

  • and other such factors.

Miniesthetics looks at the smile as a whole, including:

  • tooth display

  • smile symmetry

  • crowding

  • smile arc

  • and other such factors.

Microesthetics looks at the smile at the individual tooth level, including:

  • gingival (gum) heights

  • black triangular holes between teeth

  • emergence profiles

  • spacing

  • tooth shade

  • tooth shape

  • tooth angulations

  • and other such factors.

What causes orthodontic problems, and how will early prevention benefit my child?

Orthodontic problems such as crowding of the teeth, too much space between the teeth, jaw growth problems, and protruding teeth are usually inherited or caused by injury to the mouth, early or late loss of baby teeth, or thumb-sucking habits.

Dr Couser recommends that you bring your child in between the ages of seven and nine. Only a small minority have problems where early orthodontics will truly benefit. By bringing your child in at this age Dr Couser can help you prepare for future orthodontic treatment when they are between eleven and thirteen and have all or close to all of their adult teeth.

Please contact our practice and schedule an appointment. Our team will provide your child with an initial exam, and discuss with you the best steps to take toward caring for your child’s smile.

Different Types of Bites

Class I – A Class I bite is the desired bite where the jaws and teeth line up in a straight line.

Class II – A Class II bite is familiar to most as an overbite in which the upper teeth extend out over the bottom teeth. Today, the majority of Class II bites are a result of underdevelopment of the lower jaw.

Class III – A Class III bite, also known as an underbite, is treatable in some cases without extracting teeth. An underbite used to be seen as the overgrowth of the lower jaw. In today’s world, research shows that most underbites are due to insufficient growth of the upper jaw.

Additional Information

Class II Overbite

Overbite occurs when the upper front teeth protrude over the lower front teeth. Generally there is no contact between the upper and lower front teeth. Often you cannot see the lower incisors. Overbite is due to a disproportionate amount of eruption of front teeth or over development of the bone that supports the teeth and a front to back discrepancy in the growth of the upper or lower jaw (Class II Relationship). Overbite is also known as a deep bite.

Overbite should be corrected because it can:

  • result in the lower front teeth biting into the gum tissue of the upper palate leading to tissue problems

  • unusual wear of the lower front teeth

  • make your smile less attractive





Class II Overjet


Overjet is also known as protrusion. In this case, the lower teeth are too far behind the upper front teeth. This can be caused by an improper alignment of the molars(Class II Relationship), a skeletal imbalance of the upper and lower jaw; flared upper incisors, missing lower teeth or a combination of all the above. In addition, oral habits such as thumb sucking, finger sucking or tongue thrusting can exacerbate the condition.

Overjet should be corrected because it can:

  • lead to premature wear

  • make your smile less attractive





Class III Underbite


The lower teeth protrude past the front teeth. An underbite is usually caused by undergrowth of the upper jaw, overgrowth of the lower jaw, or a combination of the two (Class III Relationship). Underbite can also be caused by flared upper incisors, missing lower teeth or a combination of all the above. Early correction of underbite is recommended.

Underbite should be corrected because it can:

  • prevent proper functioning of the front teeth or molars which can lead to premature wear of the teeth

  • make your smile less attractive






Crossbite can occur in the front and/or the sides of the mouth: One or more upper teeth bite on the inside of the lower teeth. This can occur with a single tooth or multiple teeth. Early correction of crossbite is recommended.


Crossbite should be corrected because it can:

  • cause premature wear of the teeth

  • cause gum disease including bone loss

  • cause asymmetrical development of the jaws

  • make your smile less attractive






Openbite is an insufficient vertical overlap of the teeth. It is caused by oral habits such as tongue thrust, digit sucking or when the jaws don’t grow evenly. Timing of treatment is critical to the overall success of the therapy.




Impacted and Missing Teeth

Impactions can be caused by improper positioning of the developing tooth bud. This can cause the tooth to fail to erupt into the mouth. Impactions can also be caused by early loss of primary teeth or crowding of teeth. Wisdom teeth are the most commonly impacted teeth. Canines and premolars can also be impacted.

This problem should be corrected because it can:

  • cause damage to the root structure of adjacent teeth

  • leave unwanted spaces

  • lead to improper functioning of the teeth

  • cause premature wear of the teeth

  • case asymmetric alignment of the teeth



Missing Teeth

Missing teeth is the absence of a tooth or teeth that should normally be present. This can be caused by trauma or lack of development.

  • cause improper functioning of teeth

  • cause premature wear of teeth

  • cause asymmetric alignment of the teeth

  • make your smile less attractive



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