Another Ortho asks me about "Trainers"

I am completely new to the technique and am very open minded but as you might understand think it is a bit too good to be true. You will not hear me say it is as easy as it sounds.  It's more than just the trainers. But the approach covers aspects of treatment and health that classic ortho just ignores. Once you learn what that is, it will be hard to stay ignorant of these issues.  

I am not sure what the situation is in the US but as a UK ortho specialist something like this would not be considered mainstream and many orthos would frown on this.  If mainstream means what everybody else does, then I agree, it will not be readily accepted since it requires intellectual retooling and some new protocols.  However, it will not replace tooth alignment techniques. It will only broaden our capabilities to guide the child to not only a beautiful smile but to better all around health as well.  Many of these concepts are well accepted if not totally well documented.  It will be the public that will demand this from us eventually.For instance, one issue you must learn about is how teeth get crooked and how that affects the airway.  With the increasing incidence of chronic diseases, like malocclusion and sleep disordered breathing, there will be a huge demand for our service soon.

I have a couple of questions please:

1. How long have you been treating cases with this and what has been your experience of long term stability and are there any side effects of the treatment documented?  Like any treatment, there are limitations, both short term and long term. There is no magic bullet.  In the past 4 years of involvement, I've had my successes and failures.  Most failures stem from my inability to garner understanding and cooperation from the family and patients.  Yes, that damnable "C" word. Ortho has been drifting toward non-compliance techniques for good reason.  And here I am trying to get people to take responsibility for their own health.  Sometimes I think myself the fool.  But what would you want for yourself (as an analogy): to prevent a heart attack or to have open-heart surgery?  What would you want for your child (as a fact): to grow with a balance between the teeth, face, spine, airway and heart, or to have one problem fixed to the detriment of others?  Were are health care practitioners, or so we say.  We have a bigger game to play than just straightening teeth.

2. In terms of getting it out there I am looking at mainly the general dental market in the UK. I think UK orthos will be late adopters to this if it works. Any thoughts on this? Go to the parents.  they will know what is better for their child.  Once they understand it, that is.  And yes, many of the GP's already understand the link between the mouth and the body.  And many wonder why it's taking ortho so long to find out.  You'll see once you start talking about this subject with conviction, your circle of influence will expand rapidly.

3. Do you have any tips on getting started as the number of appliances is a bit confusing and the types of cases I should start with? It's not the trainer so much as it is the training.  Buying a piece of exercise equipment alone will not make you fit.  You have to learn to use it properly. Soon, you can exercise without the crutch. Same with the trainers.  They teach certain specific principles of health: 1) Breathe through the nose, 2) Keep the lips together without strain, 3) keep the tongue on the palate when at rest, and 4) learn to swallow without using your facial muscles.  The trainer is just an aid to that.  The MRC concept is there to make it easier to implement this teaching.

Enjoy the journey,

Barry 

The Challenges Ahead

The Challenges Ahead for Orthodontics and the 

American Academy of Physical Medicine and Dentistry

by Barry Raphael, DMD

The First Challenge: To see malocclusion as a symptom of a greater imbalance.
The Second Challenge: To understand these imbalances as being involved in the overall health of the child.
The Third Challenge: To recognize the condition of “Bimaxillary Retrusion” as an endemic condition of modern life and learn how to treat it.
The Fourth Challenge: To understand the relevance of orthodontics to the formation and maintenance of the oronasopharyngeal airway and proper breathing, both day and night.

Background
Most people understand that there are two approaches to health. One - described as “Western” or “allopathic” medicine - focuses on the elimination of symptoms, whether chronic or acute. The other, described as “Eastern” or “holistic”, focuses on the elimination of etiologies on a broader scale and attempts to promote health as opposed to eliminating disease. Currently, we’re seeing a trend toward Integrative Medicine which takes the relevant aspects of both approaches.

In orthodontics, we call the allopathic approach “Corrective”, that is, the straightening of crooked teeth.  We call the holistic approach “Preventive” and “Interceptive”, where we ameliorate a problem by intercepting the cause.

Throughout its one-hundred-plus years of organized effort, the practice of orthodontics has also seen attempts at integrating both approaches.  Leading figures in the profession such as Edward Angle, Alfred Rogers, Thomas Graber, Robert Ricketts, and Donald Woodside, among many, many others, promoted the idea that the face takes its shape from developmental influences that are identifiable and reversible.

Yet, efforts made in clinical practice to take advantage of this knowledge have waxed and waned.  For economic, political, practical, and intellectual reasons, there is pressure on practicing orthodontists to forgo efforts at preventing malocclusion and to favor mechanical solutions for alignment of teeth.  When crooked teeth are considered “the problem” to be solved, there is validity to the idea that “braces” (or any form of tooth moving mechanics) has become the simplest, quickest, most predictable, and most economical(?) method of solving the problem - much like taking an ibuprofen is a solution for a headache.

Yet just as pain pills do not guarantee a headache won’t return, orthodontics has struggled with the long term instability of its results, resorting to methods of permanently holding teeth in place despite what the body’s attempts at equilibrium might be dictating.  Furthermore, there is some evidence that certain orthodontic techniques either ignore or aggravate preexisting conditions requiring additional treatments, orthodontic or otherwise,  later on.  Especially relevant to this discussion is the provision of adequate space for the tongue to be housed within the “fence” of the teeth without being forced back into the pharynx where it may block the airway, especially at night.

An ounce of...
There is also some pressure for orthodontists to start looking at integrative solutions, too.  The overall movement toward health and wellness in our society has increased awareness that prevention is far better for health than waiting to treat symptoms.  

There is growing evidence, especially from the field of anthropology, that malocclusion is not genetically predetermined, but is rather a modern phenomenon created by the dramatic mismatch of our genome with our rapidly changing environment.  The study of epigenetics is attempting to pinpoint some of the triggers that send development awry.  Many of these triggers have already been identified and are in fact, "intercept-able".

The alarming rise of chronic non-communicable diseases of lifestyle (CNCD) is pushing us toward integrative approaches as well, since Western medicine, despite all its new techniques and pharmacology has failed to stem the tide.   Malocclusion can easily be grouped in this category.  More significant is the rise in sleep disordered breathing (SDB) - very much related to the shape of the face - which is now being shown to be extremely deleterious in its effect on body systems.  To the extent that orthodontics can contribute to, or alleviate, conditions leading to SDB, there is an imperative to pay attention and act where we can.

Meeting the Challenge
There are many who think that orthodontics as a specialty is unable or unwilling to face the challenges ahead.  Many thought leaders and professional societies are seen as entrenched and bent on protecting turf.  Evidence-based Dentistry is being seen as being used to protect the status quo.

However, there is no “one” way of thinking within the profession, which has been seen to polarize frequently over many issues over the years.  There will always be a portion of the profession that is forward thinking enough to incorporate change when it seems warranted for the benefit of our patients.

One purpose of the AAPMD will be to give a forum and a voice to those in the profession that see that there is a real opportunity now, in our time, for a positive change to the kind of care we provide and the way we deliver it.  Membership will give you a personal stake in our mission.  Presence at meetings and on forums will give us the benefit of your knowledge and experience.  Differences of opinion will help us iron out the details and give direction to future research.  Most importantly, your voice will help spread the word of our mission.

In subsequent articles, I will address the specific challenges outlined at the beginning of the article.