A letter to a collegue

I just wrote this letter to a collegue and thought your might want to evesdrop (unedited)....

December 24, 2010

Dear T.,

We met in Chicago at the first MRC meeting, and recently, I met your staff at the MRC center near LA. (They glow when they speak about you BTW - even when you're driving them crazy...)  I've become quite involved with this preventive orthodontic concept, and all along I've been meaning to contact you.

Through German Ramirez, I've been asked to develop a curriculum for the pedo residents at Mt. Sinai medical in NYC.  After a pilot run last Spring, I'm in the middle of a 14 lecture series. The more I learn, the more there is to add.  What's amazing to me is that the knowledge has been around for 130 years and has emerged and receded many times over.

 Our focus on malocclusion as "the problem" and not as "a symptom" is a narrow perspective and has limited our profession from Angle on.  I'm thinking that it's been much easier for us to concentrate on mechanics and mechanisms than it is on behaviors and training. Otherwise, we'd have become psychologists.    My vision, however, is for us to become the physicians of the face and not just the mechanics of the teeth.  Especially as mechanotherapy becomes more systematized and delegatable, it should be obvious that a transition like this is advisable, if not inevitable.

The other issue is the assumption that malocclusion is an unsolvable tangle of genetic factors that will never be able to be engineered enough to put us out of business.  However, Chris and John Flutter, and my reading of Mew, and Price, and Tomes and all the people in Functional schools, have opened my eyes to a new way of thinking: the MAJORITY of malocclusions (aside from tooth size and number anomalies, and more severe syndromes) have a developmental component that is only given lip service by conventional orthodontic thinking.  Our real business should be about controlling those factors so that malocclusions are eliminated or minimized in the first place.  Would we want it any other way for our own children with any other disease?  Of course, that means intercepting the harmful factors when they are of influence, i.e. from birth on.  Again, with our current trend of bad-mouthing early treatment, we are headed in the wrong direction.

Terry, that puts me swimming upstream.  And when it comes to my private ortho practice - well, even Chris knows that this paradigm shift  has to be profitable enough from the get-go to make a transition smooth enough to attract interest. 

I was uninitiated in Chicago. But what I remember of our conversation, you've probably considered all this before.  While I've met many people that see things in this new light, only a very few are orthodontists, as you can imagine.  I want to think that I'm not alone - frankly, I don't want to be alone.  My mission is to bring a bunch of people along with me.  In the meantime, I'd like to have a "friend" (do we ever grow up?).  I'm thinking you are far enough ahead of me to be a good companion.  Interested in (or have time for) a conversation?  Who else do you know that is going on this ride?

Sincerely,

Barry

Breathe your way to straight teeth AND better health

People don't expect to hear me talk about breathing when they come to hear about crooked teeth.  But did you know that many children who breathe through their mouths have crooked teeth. Why?  


For air to pass through the mouth, the tongue must lie low in the mouth.  That means it's not on the roof of the mouth where it should be to stimulate the growth of the upper jaw and guide the erupting teeth.  Low tongue : narrow jaw : crowded teeth. Simple.


Here's the health part: air breathed through the nose is healthier than air breathed through the mouth.  Same air, you say? Not nearly.  Through the nose air is filtered, warmed, moistened, and ionized.  Through the mouth it is raw, filled with dust, pollen, allergens, and all the same gunk you pull off your air-conditioning filters at home.  All that stuff lodges on the back of your throat where it triggers allergies, asthma, swollen tonsils and adenoids, and more.


What's more is that the concentration of oxygen and carbon dioxide in the lungs and in the blood  is different for nose breathers and mouth breathers.  Oxygen in not as easily transfered from the blood to the tissues in mouth breathers.  Poor circulation and nutrition to the cells can lead to all kinds of problems (a topic for another day).


So, close your mouth, put your tongue on the palate and breathe through your nose and you'll be on your way to better health AND straighter teeth.  (P.S. The younger your are, the better this works...)

Nature versus Nurture in orthodontics.

 "Nature" is what comes from our genes, and "Nurture" is what happens to us after we're conceived.  This dichotomy is not quite so clear cut since what happens to us can, and does, affect the way genes are expressed, so the two are closely related.  But still, we look at issues as being predominantly affected by nature or nurture.  The color of our eyes is more Nature than Nurture.   Being overweight is probably less Nature and more Nurture, but both play a role. It might be 20:80 for some people.  Maybe 40:60 for others.

For many years, when people asked me why they have crooked teeth, I would give them a general answer that favored  Nature. I'd say "Well you get your teeth from your mother and your jaws from you father, and they don't match", or "You get one jaw from Mom and the other from Dad", etc.  I thought that malocclusion was 70:30 Nature vs Nurture.

I think I was mistaken.

I now believe, as have many throughout the history of dentistry, that most of the common forms of malocclusion (crooked teeth) are not inherited at all.  In fact, malocclusion is a relatively modern disease.  Findings of skulls from as little as 30,000 years ago show NO signs of crooked teeth and it is believed that our genes cannot have changed since that period of time.  Studies of populations that eat natural foods (not processed or sugary) show much less malocclusion.  This has been know since at least 1904, and was made clearly know by Weston Price in the 1940's.

Now I'm thinking 30:70 or even 20:80 in favor of Nurture.

So if crooked teeth is not in our genes, what causes it?  The answer will surprise you.  Have any ideas?

What's this blog about?

What do you do if you want to straighten your crooked teeth? You get braces, isn't that correct?  For the first 25 years of my career, that's how I looked at orthodontics.  Even when I proscribed "Early Treatment" to try and intercept budding problems, the assumption was that, most of the time, treatment would be finished with braces (and by "braces", I mean anything we use to straighten teeth, like aligners, clear brackets, inside braces, removables, etc.).  Most orthodontists practice this way, and most patients look at orthodontics the same way.  You have crooked teeth, you get braces.

There is an underlying assumption in this way of thinking that defines the context of braces: Crooked teeth are a PROBLEM.  Crooked teeth don't look so nice, they're hard to clean, they wear down faster, they stress the jaw joints, etc.  And orthodontics is the SOLUTION to the PROBLEM.  Again, orthodontists and patients agree on this point of view.

But I've come to see a new way of looking at this, and it gives the problem an entirely new context :  Crooked teeth are a SYMPTOM of an underlying problem.  As such, braces are a SYMPTOMATIC solution, but they don't really treat the problem at all.  Just like pain killers are used to dull the discomfort of a headache, a toothache, a stomach cramp, a sore back, or any of a thousand other symptoms, they NEVER really treat the problem: the high blood pressure, the cavity, the infection, or the muscle strain, etc.  Likewise, braces do not directlly treat the underlying cause of the crooked teeth either.

In this blog, I will explore what I have learned about the real cause of crooked teeth and what can be done about it. I'll talk about the controversy surrounding it. I'll talk about how I am shaping my career around it.  And I want to say, right off the bat, NONE of this comes from me, but from what I have learned from people far smarter than I who have been working on this problem for the past 130 year history of modern orthodontics. 

I hope you find this blog helpful. I hope, like the rest of my work, it helps to make the world a little better place.