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.