A Future of Orthodontics

Every profession likes to justify its existence by comparing itself to another it feels inferior.  Orthodontists complain about general dentists doing incomplete orthodontics.  GP's complain about orthodontists with a narrow point of view.  Recently, an ortho colleague sent me an article about encouraging GP's to do orthodontics.  Here is my reply:

Over the past couple of years, I've met a number of dentists doing orthodontics. I've been unpleasantly surprised to find that many are very accomplished.  Even more so, some have a conception of facial growth, tooth movement, and mechanotherapy that is very different from ours.  For instance, as orthodontists, we generally see malocclusion as the problem to be solved.  However, many look at malocclusion as a symptom of a greater problem, and seek to solve THAT.   Their view takes a broader view of the face to include the formation and the function of "functional matrices" that Moss talked about: swallowing, chewing, breathing, sleeping, etc. This point of view comes closer to looking at a "medical" view of dentistry, and frankly, that is probably where dentistry is moving.  As techniques become simpler and "mid-level providers" come into play, which I believe they will, dentists will have to play more than must a mechanical role in oral health.  We see that in perio. We see that in TM problems. We see that in sleep medicine.  I believe we are going to see that in ortho, too.  Unfortunately, unless something changes, it may not be the orthodontist leading the way.  

Snoring Infants and Behavior Problems

My wife still chides me, "Is everything related to mouthbreathing?".  She is the director of a preschool program.  She sees the best and the worst of children ages 4,5 and 6.  Here is a study that relates the nighttime breathing patterns of infants to their daytime behavior.


This study, out of Einstein, where I now lecture to the ortho residents, created quite a media splash and deservedly so.   Take a look at it here.


Then take a look at my online comment to see what they are missing in their study here.


Yes, my dear, it all starts with mouthbreathing.

Untangling the Mess

Untangling the Mess

I guess you have to start out by saying, "There are no accidents" when you look at how our children are growing.  There is a reason for everything.  The reasons are a balance of genetics and the expression of the genes after exposure to the environment.  If you've read my blog, you know that I am concentrating heavily on the effects of non-genetic factors in the development of crooked teeth.

I consider crooked teeth to be a symptom, the end result of a number of interactions of various body systems that occur throughout one's young life.   I look at the difference between what the genetics is SUPPOSED to produce (straight teeth, a full healthy face and jaws)  and what has eventually come to be (underdeveloped facial bones and crooked teeth.  This is the basis of "Darwinian Dentistry" and "Evolutionary Medicine".

The interactions between our bones, our muscles, our breathing, our eating, and all of our habits within the "experience" of life makes us who we have become. It has shaped our bodies and faces. It determines our overall fitness and health. That makes common sense, no? This is true of all the various Chronic Non-Communicable Diseases of Civilization (cardiac disease, diabetes, obesity, etc.)

My challenge, as an orthodontist, is not just to look at crooked teeth and try to untangle them, but to find all those interactions that have led to the crooked teeth and try to untangle THEM.  If we untangle the REASONS the teeth get crooked first, we can help them grow straighter in the first place, and then once straight (with or  without braces) we can help them STAY straight for your lifetime.

This puts my work at the end of a list of issues to be handled: 

• the bones (chiropractor, cranio-sacral, podiatry)
• the muscles (physical therapy, body work, posture, fitness)
• breathing (Buteyko, ENT, sleep hygiene, asthma, heart rate variability), 
• eating (nutritional selection and routines, allergies)
• habits (myofunctional therapy, TMJ, parafunctions)
• and then....straightening the teeth.

So when a patient comes in, what I am looking at is the end product of 4 or 8 or 12 years of development in the presence of one or more noxious habits or exposures that have blocked normal growth.  It is over breathing? Sensitivity to milk products? A chronic stress reaction? A forward head posture?  

In order to "see" something on a medical/dental exam, you have to know it exists. That's the beginning of diagnosis.  Then we have to know where the signs and symptoms come from. And then assign the appropriate symptom to the appropriate cause.  And then treat the cause.

Well, is there any wonder why this will be an interdisciplinary effort?   We have to help each other "see" what's there.  We have to be open to allowing others to help us establish the treatment plans and protocols we use.  An that's how we are going to untangle this mess called crooked teeth.