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Have you ever wondered why some people develop crooked teeth? Have you been told that it is dad’s sized teeth in mum’s sized mouth or that we are just born this way, even by professional people? Among the professionals, there is not even agreement and two deferring schools of thought exist. The two distinct ways of thinking are the cephalometrists and the functionalists. Cephalometrists believe the facial skeleton is predetermined and set in its size and growth pattern, in other words, you are just born this way.
Cephalometrists use hard to find and define bony landmarks in skull x-rays for analyses. These landmarks are only of use when most (95%) of the growth has been achieved (13 years old in girls and 14-15 years old in boys). This school of thought believes that if the teeth don’t fit in the jaw, then teeth must be extracted. In these extraction treatments, the tongue is forced back and down into a smaller space. This, in turn, makes the airway smaller and as there is no allowance for muscle forces on the teeth the results are seldom stable, allowing for the bite to collapse even more. With the delayed treatment at age 13-15 intervention in the growth, patterns are more difficult and time-consuming. With these conventional orthodontics, the long-term negative effects can not be disregarded and have lead to a shift away from extraction orthodontics.
Another option of fast results is extensive surgery to reposition the jaws in the right position, however, the level of healing and long term side effects are extreme. Even this kind of surgery does not address the deficient jaw growth and does not allow for the correction of the original cause of the problem. If there was a way to reactivate the growth of the deficient jaw the need for such an extreme solution could largely be sidestepped.
Now scientists are discovering factors such as environmental influences, are causing changes in the way we grow without changing the genetic blueprint. This “epigenetic theory” of growth explains how identical twins can sometimes differ in appearance. Epigenetics has lead to the second school of thought of the functionalists. We believe that improper tooth position and crowding are the result of improper muscle function, inhibiting proper growth of the jaw. These myofunctional causes include intermittent hypoxia (apnea episodes), mouth breathing, thumb sucking, aberrant tongue habits and lips not being strong enough to keep the mouth sealed with chewing function. With these changes in muscle function and the direction of the forces on the bone there is also a change in growth and development of the face and jaws. Another way of explaining this is the house builder deviating from the architect’s plan due to environmental factors inhibiting the full development of the building as intended.
Cephalometrists often opt to extract teeth accepting the smaller mouth and even making it smaller. Functionalists endeavour to develop the jaws to make room for all the teeth, thus working with nature and not against it. This also makes more room for the tongue and allow for better breathing. The lower jaw move up because the tongue is now able to be placed in the roof of the mouth.
The good news is that armed with this information, we can detect and intervene at a very early stage to counteract these environmental factors to allow the genetic blueprint to express its self to its full potential. When we are successful in changing the environmental factors we should be able to achieve long lasting and stable results. The best time for the change in environmental forces to exert the most positive effect on the genes for breathing, swallowing and facial growth is when the child is in active facial growth.
Also with the elimination of the causing factors at an early age and reactivating the growth with pre-orthodontic treatments the natural genetic growth could be unlocked again. Some patients may not even need any braces as the natural forces could create the ideal shape of the teeth and jaws. Even if braces are needed the time in braces are shortened due to the process being complementary to natural growth and not against where the jaws want to be. The teeth just go along for the ride when the bone grows to where it needs to go.
Common Causes Of Crooked Teeth
Mouth breathing caused by habit, blocked nose, large tonsils and or adenoids result in the tongue positioned lower in the mouth at the level of the lower jaw and not fully into the roof of the mouth. This in turn forces the lower jaw down and could result in further problems like snoring, grinding of teeth and sleep disturbances (sleep apnoea and sleep hypoxia). Think of this like the need for the lower jaw to be lifted when mouth-to-mouth breathing is initiated in order to get the air past the neck and into the lungs.
The tongue is quite a strong muscle that could cause the teeth to be positioned in the wrong place if it is not functioning as it should. When if the tongue does not place the right force in the right place in the top jaw the result is the underdevelopment of this jaw and in turn will keep the lower jaw from coming forward as much as it should.
The lips are meant to function as a counterforce to the tongue with normal tongue function. If the lips are not strong enough to push the front teeth back, the tongue will win and push the teeth forward.
There is only one genetic type of malocclusion out of many and even this can be overridden with the right treatment but will have to be permanently fixed into place with retainers after treatment.