Orthodontic techniques fall broadly into two groups that reflect the differing views about the cause of the irregularity of the teeth.
Practitioners of Traditional Treatment hold the view that the dimensions of the jaws are largely predetermined at birth. As a result they extract teeth in crowded arches and use ‘traditional’ fixed appliances to align the teeth within the existing dimensions of the jaws, resorting to orthognathic surgery if the disproportion is severe. A second group of practitioners believe that over the last two hundred years industrial pollution, SOFT diet, use of pacifiers/baby bottles and lack of breastfeeding has caused narrowing of the upper jaw. In people living in remote areas, where industrialisation and modern life have not yet reached them yet, wide jaws and no crowding are the common finding.
This second group uses a combination of ‘Expansion’ appliances to widen narrow jaws, and ‘Functional’ appliances to reduce inter-arch differences. This approach is called ‘Dentofacial Orthopedics’ meaning ‘moving bone’ or ‘Orthotropics’ meaning ‘growth guidance’.
Dentofacial Orthopedics and Orthotropics may have greater potential for a long-term correction but are very dependent on the cooperation of the patient, which makes them unpopular with traditional orthodontists/dentists. It takes a special dentist-patient relationship to produce good patient compliance. Both groups accept that the teeth and their supporting bone are in a position of balance between the soft tissues (lips, cheeks, tongue) and are aware that adverse oral posture is likely to be associated with disruption of growth. Unfortunately, oral posture is difficult to measure, diagnose or treat.
Orthotropists go to great efforts to correct the effects of the environmental problems by means of appliances that strengthen the jaw muscles and train the patients to keep their mouths closed in the expectation that this will encourage natural forward growth of the face instead of the more subsequent downward or vertical growth. They claim that if this is achieved while the child is young, they will grow up with a good-looking face and at least 28 teeth in good alignment. Many clinicians use a mix of the two systems but there is concern that the treatment objectives may sometimes conflict.
The balance of the face and the airway are respected at Lake View Dental with straight teeth being a third part of the overall treatment goal. Primary (baby) teeth are not extracted to alleviate crowding and jaws are developed to accommodate the teeth. Permanent teeth are not extracted to alleviate crowding for children and adolescents and only in very rare cases for adults. Instead, space is made for the teeth. (Wisdom teeth are a separate, unrelated issue.) We believe a broad smile is more attractive, and jaw development treatment to accommodate the teeth helps keep the airway from being compromised. Traditional Headgears are NEVER used to push the upper teeth back and upper teeth are almost never too far forward relative to the rest of the face! It’s the lower jaw that is too far back making the upper teeth appear to be too far forward! Treatment for children and adolescents is done as early as possible to achieve the best result in the shortest amount of time.
Malocclusions (crooked teeth) and unfavourable facial development are caused by altered oral posture (the way the tongue, teeth, and lips are held at rest and in action). Because breathing through the mouth rather than the nose is frequently the cause of altered oral posture, we try to find the reason someone is a mouth breather and change the pattern to nose breathing. In turn, this supports proper dental and facial development and stability of the orthodontic result. Deviant swallowing is the stamp of malocclusion, and the adversary of the functional dentist, therefore there is need of Myofunctional Therapy in conjunction with the treatment as well as breathing retraining.