THE SIMPLE TRUTH ABOUT CROOKED TEETH — Excerpts
http://www.fasttraxortho.com/when_to_be ... atment.htm
Teeth become crooked if the jaws grow incorrectly. The most common causes are simple things like thumb sucking, bad swallowing habits, or hanging the mouth open (airway problems). Bad growth of the jaws will also spoil the look of the face. This can be avoided if the jaws can be encouraged to grow correctly from a young age.
Scientists have known this for ages (evidence provided later) but most orthodontists are currently taught that it is too difficult to alter the growth of the jaws, or not worth the effort, and prefer the more reliable option of fixed braces, often accompanied with extractions and sometimes jaw surgery. This form of traditional treatment has been used for about 100 years and orthodontists are fully aware that it can damage the teeth and face and also the crowding tends to return later. Despite this, braces and extractions are still widely used all over the world because that is how they were trained. In America, currently over 60% of the cases in “traditional treatment” involve extraction of usually four to eight teeth. In England, over eighty percent of the orthodontic cases involve extraction. Austin Powers pokes fun at the English smile in his movies. Treatment in my office involves extraction less than 1% of the time and typically only adult patients.
Treatment. Occasionally a simple appliance to widen the upper jaw will have the same effect as removing tonsils. This is because the nose is attached to the top jaw and widens with it, making it easier to breath. In more severe cases treatment should begin by the age of six. In mild cases, an excellent result can be achieved in the teens or later. Unfortunately, unless the child learns to keep their mouth closed, treatment will not last a long time, and the problem will tend to return afterwards. If correct growth and oral posture can be achieved there can be a dramatic improvement in the appearance of the face and no extractions should be necessary.
When to Bring in Your Child
We like to see children as young as 4 years old if they are mouthbreathers or their upper teeth are inside the lower teeth when your child bites down. Actual treatment often begins in the 6-10 year age group if there is crowding or less than ideal facial balance. If the child is not a mouthbreather and has proper dentofacial development, we will wait for all 28 teeth (all teeth but the wisdom teeth) to be in the mouth before orthodontics. This minimizes the time children are in braces.
We would much prefer seeing a child early before it is the appropriate time for treatment than having to tell a parent it is too late for ideal treatment.
Reasons to treat early:
If space is made for the permanent teeth to erupt into relatively good positions they will tend to be more stable in those positions.
Improper skeletal relationships, poor facial balance and gummy smiles can be corrected at an early age with orthopedic appliances. By the time a child is over 10 the window of opportunity is starting to close on females, and a year later for males.
A narrow airway can be expanded 4-5 times in area with the use of orthopedic appliances at a young age. Establishing a good airway contributes to good facial development, stability of the orthodontic result, and a healthier child. An ideal airway can become of critical importance in later years since obstructive sleep apnea (a life threatening problem) is a direct result of a reduced airway! Posture also improves with the proper development of a restricted airway.
Does Airway Matter?
An adequate airway is THE most important factor in a child's facial development. Genetics determines factors such as hair color, eye color, and height. In contrast, it is altered oral posture usually caused by an altered nasal airway which determines whether or not the face will be well balanced.
Can orthodontic treatment change faces?
While it is certainly possible to damage a face, most orthodontists do not believe it is possible to improve the shape of the face with appliances. This may be true with traditional treatment but it does seem that Orthotropics can achieve changes in facial appearance, as well as oral posture.
Can Orthodontics Damage Your Face?
The attractiveness of a child's face depends largely on two things:
• The shape of their parents faces
• Whether their face grows forwards or downwards.
While the first is fixed at conception, the second displays a range between 'horizontal' which orthodontists label favorable and 'vertical' which is considered unfavorable. Horizontal growth is associated with good looks, square jaws and straight teeth, while vertical growth produces the reverse, and the effects of this may range from the barely perceptible to the markedly unattractive. The direction of growth can be affected by a range of simple things like thumb sucking or hanging the mouth open, both of which encourage 'vertical' growth and the degree of damage will depend on the severity of the habit.
Facial Damage.
The public have a strong preference for 'horizontally' growing faces. Unfortunately there is clear evidence that almost any kind of orthodontic treatment encourages an increase in the unattractive 'vertical' growth (Battagel 1996).
It is interesting to note that orthodontists seem to prefer the flatter profiles seen with 'vertically' growing faces. (Peck and Peck)
Recent evidence (Clark et al 1998) would suggest that the large majority of orthodontists in Britain are not interested in the relationship between oral habits and the direction of facial growth. Furthermore that 91% are prepared to extract teeth, even if there is no crowding and 63% to pull teeth back despite strong evidence to show that this encourages 'vertical' growth. Not only is this approach likely to damage facial appearance but the teeth often re-crowd after treatment despite the extractions. This approach plays right into the hands of Austin Powers who mocks the bad teeth found in Great Britain.
Extraction versus Non-extraction
The treatment of irregular teeth has evolved over the last century, largely by trial and error. Many types of treatment have been tried during this period, most of which have been superseded. Most treatment has been based on two underlying alternatives.
• Accept that the jaws are too small and extract teeth to provide the space.
• Enlarge the jaws to accommodate the teeth.
Over the last 100 years, treatment has alternated between these two concepts and there have been decades when no orthodontists extracted teeth and decades when they all extracted teeth. At the moment most countries are leaving a period of extraction but some are moving towards it. This might suggest a degree of discontent with both methods.
Both methods work well in the short term but unfortunately tend to fail in the long term with re-crowding of the teeth. In Europe teeth are extracted in around 75% of cases while at the moment in the USA it may be closer to 60%. Most orthodontists will say they extract teeth only when absolutely necessary, but clearly there is considerable disagreement about when this might be so. Whatever the treatment, very few patients treated by these methods finish with all their teeth and a large proportion loose eight teeth as there is not room for the wisdoms.
Some orthodontists avoid extractions by pulling the side teeth back with a strap aground the back of the head or neck, so making room to straighten the front teeth. However this tends to reduce the room for the wisdom teeth. It also encourages downward growth of the face and there is no doubt that this can damage the face, sometimes severely.
Are Extractions Necessary?
Orthodontic clinicians in the past have been severely criticized by scientists for ignoring the scientific evidence. Here are some of the comments about orthodontics from world scientific heavyweights they are “behind homeopathy and on a par with scientology” (Sackett 1985), their work is “based on trial and error” (Johnston 1990), the schools “teach technical skills rather than scientific thinking” (Richards 2000), “Sadly it is hard to see this situation change unless the inadequacy of current knowledge is acknowledged” (Shaw 2000), their treatment of crowding “treats a symptom, not the cause”. (Frankel 2001).
Traditional Orthodontists are taught that the size and shape of the jaws is inherited and most of their treatment is based on this belief. Clearly if the teeth were too large for the jaws some teeth would have to be extracted but there is almost no evidence to show that this is true.
Many orthodontists consider crowded teeth are caused by interbreeding between humans with different sized jaws. Biologists do not support this view, and even if a 100 kg Great Dane were crossed with a 1kg Chihuahua the offspring would be unlikely to have a malocclusion. There is evidence to suggest that the size of the teeth and jaws is inherited, but little to suggest that disproportionate growth is.
Some orthodontists believe that evolution has caused jaws to become smaller over the last few thousand years (Walpoff 1975). Certainly crowding has become worse, but this has been mostly within the last 400 years (More 1968), which is far too short a period for an evolutionary change. Also an evolutionary change would have to start in one area and spread, but irregular teeth are found all over the world, wherever people take their standard of living above a certain level.
Despite this overwhelming evidence, most orthodontic treatment is still carried out on the basis that disproportionate jaws are inherited and that little can be done to change them. Based on this belief and in contradiction to the evidence the teeth are moved into line mechanically usually coupled with the extraction of either four or eight permanent teeth. If the jaws are in the wrong position orthodontists may recommend that they are cut and corrected surgically. Many thousands of children and young adults have this surgery each year although a substantial proportion of those who have been told that surgery is the "only answer" have subsequently been corrected with Orthotropics and dento-facial orthopedics. Despite this, the dental profession are not informing their patients that there might be an alternative, or they are not aware of alternative treatment.
Iatrogenic Damage caused by Braces.
Scientists have clearly shown that braces can damage both the roots and the enamel. "Over 90% of the roots of the teeth show signs of damage following treatment with fixed appliances". (Kurol, et al 1996). "40% of patients show shortening of more than 2.5mm". (Mirabella and Artun 1995). This is a substantial proportion of the root length and must shorten the life of the teeth. Enamel damage, with fixed appliances, is rapid, widespread and long-term. (Ogaard et al 1988) (Ogaard 1989) (Alexander 1993). According to the AAO Orthodontist’s Journal, the type of bioeffecient non-friction bracket system used at Fast Trax Orthodontics is the safest on the market.
All orthodontists accept that faces can be damaged by inappropriate treatment but they disagree about which approach will cause least damage. "The maxillary retraction associated with braces (Edgewise) contributes to the poorer aesthetic result." (Battagel 1996) and may be "accompanied by exaggerated vertical facial growth".
It is known that Braces tend to lengthen the face (Lundstrom,A. &Woodside,D.G. 1980) and that longer faces look less attractive’ (Lundstrom et al 1987). However there is little sound research to establish how often or how severe the damage may be.
Twins, who are genetically identical, still show more contrast in the shape of their jaws than any other part of their skeleton (Krause 1959) proving that much of the variation is due to non-genetic environmental factors such as open mouth postures and unusual swallowing habits that distort the growth of the jaws. Orthodontists in the past have found it difficult to explain why modern children have so much malocclusion, but the following new hypothesis appears to fit the known facts better than those put forward previously: -
"Environmental factors disrupt resting oral posture, increasing vertical skeletal growth and creating a dental malocclusion, the occlusal characteristics of which are determined by inherited muscle patterns, primarily of the tongue" (Mew 2004).
Most children with upper front teeth sticking out are treated by pulling them back. However, if you look at the side of such a child's face, you can see that the fault is often their lower jaw which is too far back (see Antonia below). Almost all orthodontists pull back the top teeth in this situation risking an increase in downward growth with subsequent damage to the face. It is important that prospective patients are warned of this risk, because little research is being done to establish how often it occurs. However Antonia had Orthotropics to take both her upper and lower jaws forward.
In conclusion, space to align the teeth can be provided by extractions and braces but the crowding is likely to return, especially of the lower front teeth (Little 1988). There is also a risk of damage to the teeth and face. Orthotropics aims to avoid extractions by early correction of the cause rather than later treatment of the result, but is highly dependent on the ability of the child to comply with wearing appliances and learning to keep their mouth closed.