Traditionally the treatment of necessity for too small a jaw would be the removal of teeth to fit them in the arch as fewer teeth would need less space.
This in our view is unacceptable, and if the teeth don’t fit in the mouth then the tongue will not fit in the mouth either. If the jaw is not big enough to fit the teeth then the jaw needs to change and we are not talking about surgical treatment either.
So why does the jaw grow too small, why is nature not looking after us? The mouth and face is genetically programmed to develop in an optimal and balanced way to give us the best form and function. If the genetic program is allowed to develop to its full potential, the jaws and teeth will usually end up in a straight and uncrowded manner.
However sometimes the environment can change how the genetic blueprint is expressed, this principle is called epigenetics. Proper signally for jaw development occurs in the nose through nasal breathing stimulus. Sensors in the nose ‘are stimulated by the vacuum pressure of the air passing through the nose. This allows the upper jaw bone arches to develop in a forward and broad way big enough to house the tongue. In turn, this creates a wide shallow roof of mouth, high cheek bones, and a balanced head and neck position. Nose breathing in other words develop the human face beautifully the way the genetic program prescribed.
The reverse is however true when mouth breathing becomes normal. The upper jaw grows narrow and vertically downward towards a longer face with crowded teeth and often asymmetry in the face. The teeth will be crowded or lean in due to the jaw being too small for the teeth. The lower jaw development is prescribed by the upper jaw development and restriction on the top will restrict the lower. Grinding, clenching due to the lower jaw being forced further back than where it is supposed to be, may over time cause damage on the jaw joint (TMJ) and can cause limited opening and or clicking with or without pain.
There is however good news as these abnormal forces on the jaws can to a large extend be reversed with exercises and even better news is that there are appliances available that can remind nature how the jaws are supposed to develop. With children when intervention is initiated at the right time we may only need fixed braces for a short period after the appliance therapy and even in some cases not need them at all. In adults, the appliance therapy will in most cases lead to the placement of fixed braces after the therapy. The treatment however is not primarily aimed at the very important aesthetics but at the balanced development of the jaws. We look at improving the position of the jaws, that will have a beneficial effect on the bite, teeth position, jaw joints and airways as well as the smile. The last procedure we want to do is the extraction of teeth as this will result in a still smaller space for the tongue to fit into and have further negative effects on all these areas we seek to improve. This improvement is achieved by reminding the genes by proper stimulation to start the remodelling process. We use the following methods to achieve this:
- Anterior Growth Guidance Appliance
- Controlled Arch Orthodontics
- Myofunctional Exercise Therapy
A clinical assessment will allow for a treatment plan and the following is just a guide as to some of the treatment that may need to be applied and is general in nature.