Don’t just straighten your teeth; give more value to your face. The team at Lake View Dental are straightening, strengthening and preserving your family’s teeth for life.
We as humans have become masters over our environment. We have subjugated nature and colonised every corner. We have invented intensive farming and use pesticides to keep all those nasties at bay, increasing our food supply. We have domesticated wolfs and have crossbred them to a mere resemblance of their former great selves to little dogs with even some breeds struggling to breath properly and unable to survive in the wild.
We are becoming an increasingly sedentary species reaping the rewards of scientific advances but inadvertently also becoming more and progressively sicker with new diseases that have not been around before. We are keeping ourselves healthy with antibiotics, yet this has increased the incidence of other slower, but more dangerous diseases. Epidemics have become so commonplace that we have grown to accept these as being normal.
Modern human face structure has also changed from wide forward dental arches, allowing for proper breathing for hunting and gathering, to longer narrower faces and further back jaws. This is leading to a new and very dangerous epidemic of breathing problems. Especially in our children with sleep disordered breathing becoming very common. You could be excused for thinking that this is because of our genetic structure changing, and a lot of dentists and orthodontists still believe this myth. However, the evidence is increasingly pointing to epigenetics (or the environment having an effect on the expression of our genes) as being the cause.
Marketing is playing an immense role in our perceptions and the things that we think we know are further removed from the actual than ever before, as we listen to these big companies with big budgets selling us their product and images.
Conflicting advice is everywhere, from diets to inoculations and it has become so much harder to cut through to the truth. As clinicians, we try to balance the wants and needs of our patients on a daily bases. What the patient usually wants is not what they actually need from a health point of view. Even more important is the need to stay on top of the evolving nature of the evidence of what is actually the best for our patients.
Parents have the unenviable task of sifting through all this and find the best path for our children not yet able to make these decisions for themselves. We at Lake View Dental understand this as we ourselves have this task for our own children and for this reason we would like to help on this path.
The traditional role of a dentist is to look after teeth and this is what many patients expect us to do. However we believe that our role is so much more and that we are the guardians of the airways and normal facial growth and development. Our aim is to treat towards a beautiful full smile with a genetically normal functional bite, without TMJ problems or sleep disordered breathing and a long-term stable result that improves your general health.
If genes are not the major cause of oral-facial development problems then what environmental factors play a role? There are many ranging from lack of breast-feeding to development of habits that place inappropriate forces on the bone and teeth and change the shape of the face and the strength of the muscles. However, the overwhelming cause can be attributed to mouth breathing and the long list of side-effects that mouth breathing causes.
Most patients attending for straightening of teeth just want them straight. The difficulty in the want-need balance for us is to keep the patients primary concern in mind but to also educate them that crooked teeth are only a symptom of something more. We have to allow the patient the autonomy and final say over their bodies but only if they have all the information at hand.
So, what are the treatment options for improper oral-facial development?
The first instinct for a parent or patient is seeking the consultation of an orthodontist. Orthodontists mostly believe in the genetic model of malocclusion and therefore don’t delve deeper for the real cause. They tend to focus on teeth only and not so much on the whole face and more importantly the airways and the negative effects the proposed treatment could have on the other structures surrounding the teeth. Orthodontists also, as a general rule, wait until most of the facial growth is complete before intervention is recommended and could even be of the opinion that early intervention on facial growth anomalies is a waste of time and even consider it fraudulent. We can not stress enough this myth to be a contributing factor to the new epidemic of poor facial development and all it’s associated problems. Waiting for the growth to go completely wrong before treating is like detecting high blood sugar but not treating the patient until they are fully diabetic.
Orthodontists overwhelmingly believe if teeth don’t fit in the mouth, they need to be extracted and that is the right way to “create” space or the only other alternative is extensive and painful surgery to reposition the jaws. Late treatment makes sense to them as growth slows down by puberty and then don’t need to be considered in their treatment. They believe in the myth that growth can not be influenced at all. Accepting as normal the lower jaw in a receded position does not take in account the resulting lower and back tongue position, and the resulting closure of the airway. The teeth are then forced into what they believe to be the right position, however this may not be a balanced position between the muscle forces applied on the teeth and the evidence points to this being the reason most orthodontic results being of a non permanent nature. To overcome this permanent retention is employed and works very well if they don’t break or get misplaced or eaten by the dog.
As hard as it is for the profession to admit there is actually very little hard science behind orthodontic treatment options and at best the results may not be stable and at worst can lead to collapsed airways and TMJ problems.
We would like to stress that a dominant role played by genes on malocclusions can be disregarded in almost all cases and there is a lot of good strong evidence supporting this. Nearly all cases of oral-facial positional disturbance could be traced to an environmental cause that will need to be altered to have stable result.
Orthodontics is a field of dentistry that treats malocclusion, a condition in which the teeth are not correctly positioned when the mouth is closed. This results in an improper bite. Orthodontics deals with the diagnosis, prevention and correction of these mal-positioned teeth. Orthodontic treatment can be cosmetic; to improve a person’s appearance, but it often aims to improve oral function too. This treatment does not aim at positioning the jaw in the right position nor does it consider the airway as influenced by the jaw position.
Orthopaedics (or orthopedics as our American cousins spell it) is a term indicating movement of bone, but this does not qualify the direction of that movement.
A very selective group of orthodontists and dentists choose to look more holistically at the problem of crooked teeth and believe that environment has an influence on the way we grow and function. They believe in early intervention to illuminate the causing factors and seek to look at patients at an earlier age as they believe with justification that growth can be influenced and changed.
These practitioners look at factors like lisping, mouth breathing, incorrect swallowing and other habits like thumb sucking as the cause for the abnormal growth of the jaw and teeth. They start looking at these patients around four years of age and prescribe exercises and bulky appliances to restrict the habit. The exercises are difficult and need to be adhered to strictly. In our day-to-day lives, our experience is that a vast majority of the patients only say they do the exercises.
This is however a very attractive route as treatment is started early and changing some of the habits will have a beneficial effect and parents will notice the change in their child’s face and development.
The promise of not taking out any teeth and expanding the jaws are also very attractive to the parents. However expansion does not position either the top or lower jaw further forward and has very little beneficial effect on the airway or posture of the head and spine.
An even more alarming orthopaedic technique done by some practitioners is the backwards pull of the top jaw to meet the lower jaw with headgear. This will result in the proper fit of the teeth together but inadvertently also create pressure on the TMJ and the airway and have significant deleterious effects for the patient in the future.
This treatment option often promises no further treatment in the future as they seek to identify the cause and remove the case of the crooked teeth. However, the vast majority may need further treatment in their teens after the permanent teeth have erupted. This is part of why the traditional orthodontic colleagues think this practice to be unethical even though the patient is better off than where they started. Looking at airway and lower jaw position, the results are promising but not good enough.
Forward Dental Orthopaedics
This is a treatment of malocclusion that seeks to address even more problems than just misalignment of teeth. This treatment is aimed at aligning the jaws forward towards the genetic potential and do not just look at aligning teeth aesthetically. This option is called Orthotropic or Forwardontics by some clinicians in an attempt at branding. We believe that branding limits the treatment options much like franchising would limit a business and would not be in the best interest of patients and that we should seek the best out of all options.
This is the new kid on the block for treatment and is also the most promising option available. Even though the treatment fundamentally differs from what we were taught at university it is profound and very effective and caries a lot of evidence behind it. However, because it has created a fundamental paradigm shift in dentistry there is a lot of resistance to this option among our professional colleagues. Mostly, general dentists have picked up on this treatment option due to our dissatisfaction with the results of standard orthodontics. We have noticed and started asking questions with the damaged faces, restricted airways, TMJ pain and permanent retention we see on a regular bases.
Forward dental orthopaedics, unlike orthodontics focus on the whole face and also on the neck and head posture and airway. It seeks to improve all these modalities and, in most cases, can get this as close to perfect as possible.
Like traditional orthodontics, we too are concerned with how the teeth are arranged. But, we look deeper at the relative positioning of the teeth and spine and primarily the airways. This sometimes puts us at odds with our patients wishes (just straighten my teeth) on the needs-wants spectrum as we know the effect of what we do long term and wish to first do no harm.
In some cases the aesthetic needs of our patients is difficult to manage as some patients with a protruding upper jaw struggle to see the relative relationship is only forward due to the lower jaw being significantly further back. To create the ideal situation, we need to adjust this upper jaw even more forward still to its genetic normal position and then let the lower jaw come forward and join the upper jaw. In other words, sometimes it needs to get worse before it gets better. However, it does get better and wonderfully so. Almost all patients we see need their faces developed like this as mouth breathing is a major issue and the top jaw has not developed properly even though it appears relatively forward.
Some of the techniques of forwardontics are the application of external headgear pulling the jaw forward. This wonderfull idea however, is not very practical due to social pressures and risks of being bullied. We do not use these headgear appliances and employ only in-the -mouth appliances that puts pressure on a very specific physiological spot to initiate dental arch and jaw growth.
Forward dental orthopaedics do believe in early growth guidance and we do also teach exercises to help with the correction of habits. However, we hope, but never promise that the patient will not need some form of intervention in the permanent dentition development.
We are able to intervene with deficient jaw growth and therefore deficient posture and airway development at any age and not just in your growing years. The reason for this is that we have come to understand that we retain the ability to grow bone beyond our growing years much like when you break a bone it heals through growing. It just needs the right motivation and this motivation is just faster and easier when you are still in your growing years. In other words, bone is not static nor cast in concrete and moves throughout our whole lives.
Our biggest aim with treatment is the cure of the problem not just suppressing it. This is why we put so much emphasis on rectifying the cause and can say that as long as you follow 3 rules your treatment should be completely stable. There is a genetic predisposition of the lower teeth to crowd slightly so we permanently retain the lower front teeth and the uppers in one specific rare malocclusion that is also genetic of nature.
Other treatment options
We hope that you have now come to understand the value and importance of Forward Dental Orthopaedics. We do value your autonomy and decision process as unique just as much as your situation is unique.
If your unique situation leads you to a purely aesthetic or cosmetic treatment option only, the options available range from clear braces to ceramic brackets. We are happy to discuss these treatment options with you and happy for you to make your choice for the treatment that you wish.
Splints, or jaw repositioning appliances
The conditions that cause malocclusions are to a large extend the same conditions that cause jaw joint (TMJ) problems. The TMJ has to suffer a lot of damage before any symptoms become apparent and we believe that every patient that needs braces to some degree have TMJ damage and in some cases the damage is so extensive that an additional appliance is needed. This appliance removes the backward pressure and decompress the joint and stabilise the joint where it heals by remodeling for about six months.
We do understand this information will differ from what you have been told before and do wish for you to consider all options as presented and would be more than happy to give further proof of what we say if you so wish.
One of the key philosophies that drives our practice is “prevention is always better than a cure.” We strive to preserve your teeth for life, utilising state-of-the-art technology for exceptional quality care and long-lasting solutions. Contact our friendly team to talk more about your smile!