If a Bolton tooth-size discrepancy is detected, treatment options may include which of the following?

• A. Restorative changes
• B. Prolonged treatment time
• C. Selective watch and no changes
• D. Orthodontic camouflage with elastics only

Answer: (C)

Bolton tooth-size discrepancy is about a mismatch in the mesiodistal widths of upper and lower teeth, and how big that mismatch is guides what you do. If the discrepancy is mild and the bite and esthetics are acceptable, the safest and most sensible approach is to watch and not change tooth sizes or the bite. This avoids unnecessary procedures and preserves tooth structure, while still allowing treatment to proceed with orthodontic alignment.

If the discrepancy were more pronounced, you’d consider adjusting tooth sizes through selective reduction in the larger arch or restorative augmentation in the smaller arch to bring the ratios closer to normal. Relying solely on elastics to camouflage the issue wouldn’t address the size mismatch, and simply expecting a longer treatment time isn’t itself a therapeutic option.