Understanding Bolton Discrepancies in Orthodontics (A Guide)

A Bolton discrepancy, a term coined in the dental world, pertains to a marked size variance between the upper and lower teeth. This discrepancy, if left unaddressed, can contribute to discomfort, aesthetic concerns, and dental health problems. The concept of Bolton discrepancy was unearthed by Wayne A. Bolton, who devised a related analysis.

This piece provides an overview of Bolton discrepancy, its impact on dental health, and the available treatment options.

Bolton discrepancies can be caused by a variety of factors, including genetics, tooth wear, and previous dental work. It’s important for orthodontists to identify and address these discrepancies early on in treatment.
– Dr. Vincent G. Kokich

Defining Bolton Discrepancy

Dr. Wayne A. Bolton is credited with the development of the Bolton Analysis, a technique for assessing teeth sizes to prevent misalignment during instances of overcrowding. This analysis employs a Boley Gauge to measure each anterior and posterior tooth, thereby creating a calculation to determine the extent of the overbite and guide the treatment options. 

The Bolton method strives to address overcrowding and misalignment by taking into account the teeth’s dimensions and the space available for realignment. The analysis begins with an assessment of the mouth’s space, followed by measurements of individual teeth to identify overcrowding.

As per Dr. Bolton, the upper teeth should be 23% wider than the lower teeth to maintain a healthy overbite; any deviation from this ratio indicates misalignment and overcrowding, termed a Bolton discrepancy. Bolton’s analysis aims to quantify this tooth misalignment ratio.

A Bolton discrepancy can be attributed to various factors, including genetic variations, developmental factors, missing teeth, dental attrition, dental extractions, and dental treatments such as crowns and veneers. There are, however, treatments available to rectify these discrepancies.

What Causes Bolton Discrepancy?

Bolton discrepancies, which can lead to misalignments and overbites, are inherent to the natural positioning of adult teeth. However, a more technical perspective reveals that narrow upper laterals (upper incisors) creating space for tooth movement often induce Bolton discrepancies.

A Bolton discrepancy can also result from missing teeth. The absence of a tooth in the anterior region can generate an overbite, disrupting the Bolton ratio of 23%. Such a situation can be managed by either narrowing the upper teeth or adding a lower tooth. 

Interestingly, tooth extraction for dental purposes can inadvertently cause a Bolton discrepancy and misalignment. Fortunately, dental professionals can address this issue during routine check-ups, using implants or braces to enhance alignment.

While Bolton discrepancies occur naturally and cannot be prevented, an orthodontist can diagnose and treat them. Rectifying a Bolton discrepancy is crucial for oral comfort and health, as an overbite can lead to dental issues like decay and gum disease.

Types of Bolton Discrepancies

Bolton Discrepancies can be categorized into two types: Anterior and Overall Bolton Discrepancies. Let’s delve into each of these:

Bolton discrepancies occur in about 10-15% of orthodontic cases

Orthodontic treatment is a journey, not a destination. It requires patience, dedication, and commitment from both the patient and the orthodontist.
– Dr. David M. Sarver

Treatments for Bolton Discrepancies 

Treating a Bolton discrepancy usually depends on the overcrowding or alignment issues in the mouth. Every patient is different, and treatment approaches differ accordingly. In most cases, a dental professional will narrow the anterior teeth by slenderizing or air-rotor stripping the teeth to create more space for movement in the mouth: aligners or braces can then be fitted to the teeth.  

Interproximal Reduction (IPR): If the Bolton discrepancy is slight, interproximal reduction can be used to improve the bite and condition of the mouth. Dental professionals can remove a small amount of enamel from the target teeth improving their alignment and preventing issues. 

Traditional Braces: Another common treatment option for Bolton discrepancies is traditional braces that create better alignment over time. First, the Bolton discrepancy needs to be established by an orthodontist; then, teeth must be removed or narrowed before fitting.  

Orthodontic Surgery: If the Bolton discrepancy is severe enough, surgical intervention might be required to improve alignment and resolve an overbite. Dental surgery might involve repositioning the upper and lower jaw to achieve better dental harmony before the treatment. 

Bolton discrepancies are very common, and treatment options vary significantly. Still, they tend to involve reducing the width of the teeth, creating more space in the mouth, or repositioning the jaw in severe cases. An orthodontist can measure the ratio of Bolton discrepancy in the mouth and recommend a suitable treatment option. Treatment combinations might be needed.    

Bolton discrepancies occur in about 10-15% of orthodontic cases.    

Correcting Bolton discrepancies is essential for achieving a stable, functional, and aesthetically pleasing result in orthodontic treatment.
– Dr. Ravindra Nanda

Embrace Your Journey to a Perfect Smile

Orthodontic treatment is a journey, and like any journey, it’s filled with unique challenges and rewards. Becoming familiar with Bolton discrepancies is just one part of that journey. It’s about understanding the ‘why’ behind the treatment plan and participating in your dental health journey actively. So here’s to embracing the process and looking forward to the radiant smile at the end of the journey!

Remember, every smile tells a story, and we’re here to make sure yours is a masterpiece. Happy braces journey!

Perry Stevens

Perry heads up a dynamic marketing team that has help the leading orthodontic practices in the USA 10X their business for over a decade. He’s a tea connoisseur, avid reader, traveling and grower of exotic fruits in his permaculture food forest.