Treatment philosophy
I believe in a straightforward approach that utilizes the body’s natural tendencies for health to minimize time in active appliances. Craniofacial growth is driven by a combination of genetics and environmental factors, but it is clear that nasal breathing provides the optimal development of the jaws and face. Mouth breathing sets up a cascade of orofacial compensations such as forward head posture, low tongue posture, and lip incompetence that adversely affect dental arch development and craniofacial growth. Helping to balance the forces from the tongue and facial muscles to guide the teeth into positions of equilibrium is, in my mind, the key to establishing facial harmony and dental stability.
In a perfect world, we would have no malocclusion and no need for the extraction of permanent teeth. Our bodies were designed for a life of hunting and gathering, much as we envision the Garden of Eden. We are not adapting well to traffic jams, smartphones, junk food, and blue screens. Our bodies respond negatively to the prolonged stresses of life in postmodern society. As civilization has advanced, humans have developed a series of disease states such as cardiovascular disease, cancer, diabetes, and yes, even dental malocclusion. It is rare to find malocclusion in ancient skull records or the small pockets of aboriginal populations found in the world today.
Unfortunately, human arch lengths are progressively decreasing (which means there is now less space on the jaws for teeth to be aligned) and rates of malocclusion are increasing. Some of this is due to genetics, as we are selecting mates from a much wider gene pool than ever before. And parents who have had orthodontic treatment are far more likely to have children who need treatment.
But a big part of the reason is environmental: We give our babies pacifiers, baby bottles, and sippy cups. We grind up their food and spoon it into their mouths. We eat diets of highly refined and processed foods. Our noses are chronically blocked, so we hold our lips apart, our tongue low, and our head forward to rescue-breathe through our mouths. The linings of our sinuses are also inflamed and can’t add nitric oxide (which is bronchodilating, vasodilating, antibacterial, and antiviral) to the air passing through our pharynx and into our lungs. Our tonsils and adenoids swell up to help fight off pathogens that are not being screened out by our nostrils. We snore and sometimes our airway gets so blocked off at night that our oxygen levels drop in our sleep. We respond to these apnea episodes by bruxing our teeth and respond to daily stress by clenching during the day. If we can’t or don’t suction our tongue to our palate, we might bite on our tongue or push it against our teeth; we might suck our lower lip or our cheeks between our teeth, or even just hold our lower jaw up to our skull all day by constantly activating our jaw muscles to touch our teeth together. If the tongue does not do its job of broadening the upper jaw and flattening the palate, the nose will be narrow and short and the dental arches narrow and crowded. It is a vicious cycle.
The net result is that there is increasingly more jaw size imbalance and less space available to align all of our teeth. The good news is that our bodies are designed in such a way that we can often avoid extractions of permanent teeth if we closely manage the transition from baby teeth to permanent teeth. The best chances for avoiding extraction of permanent teeth to achieve ideal occlusion come with early diagnosis and interception of developing problems.
This is why the American Association of Orthodontists suggests that all children be screened by an orthodontist by age 7. By this age, we can see if there are tooth size and/or jaw size imbalances developing. If an orthodontist isn’t consulted until all the permanent teeth are erupted or until growth is completed, there is a greater likelihood of longer, more involved treatments which often require extractions and/or surgery.
The good news in all of this is that we live in a remarkable time of increasing knowledge about how to treat all of these problems. Even if we haven't had the opportunity to "intercept" problems during growth and development, the techniques and treatments available today are so much more efficient and comfortable than ever before!
So what happens if you choose not to treat crooked teeth or a bad bite? Well, for one thing, we know that it only gets worse with time. The forces that caused the tooth position problems in the first place continue to exert forces on the teeth that make them get worse. The patient may not notice any bad effects from a bad bite early in life, but eventually, he or she may start to have problems. Over time, the body will respond to the dental imbalance in several ways, depending on the individual’s weakest system.
Sometimes the tooth enamel is the weakest link, and the teeth get worn unevenly or excessively or will crack and break. Sometimes the ligaments and joints are the weakest link, and the jaw joints will pop, click, or grind and the patient will often experience head, neck, and/or facial pain. Sometimes the periodontal tissues are the weakest link, and periodontal disease will cause gum recession, bone loss, loose teeth, and eventually tooth loss.
These long-term effects may not cause problems or be symptomatic for decades. But often by the fourth or fifth decade, they are becoming major issues, and patients with untreated malocclusions need significant (read: expensive and time-consuming) dental work. Considering that we are living longer and keeping our teeth longer due to advances in healthcare, it is much more important to ensure that your dentition is healthy and stable and can last as long as the rest of your body's systems!
Perhaps most importantly, we need to recognize that dental malocclusions are often a symptom of underlying health concerns. The things we find attractive in our future mates are markers of health and longevity, signs that that mate will be around for the decades that it will take to raise our children (we humans do mate for life). Flat bellies, broad shoulders, healthy skin, broad smiles; you get the picture. Crooked teeth and bad bites are often actually markers of airway issues that can have significant long-term health effects. My diagnosis and treatment plans include an analysis of how the dental malocclusion developed, how these conditions are affecting the patient now, how they might affect my ability to correct (and retain) the malocclusion, and what the long-term overall health effects might be for the patient.
-MBF
