Research suggests that the public prefer forward growing faces with good cheek bones, but surprisingly Orthodontists appear to prefer flatter faces and retruded cheek bones. Peck and Peck (1970) studded the X-rays of good looking film stars and found that “The general public admires a fuller, more protrusive dento-facial pattern than customary standards” (of Orthodontics).
This finding was later supported by others (Tedesco 1983) who found that “Lay judges seem to be more sensitive, than judges with orthodontic training, to dental-facial esthetic impairment”. This is not just a Western concept because Soh (2005) using a sample of Chinese subjects concluded that “Orthodontists considered a flatter male profile to be most attractive, but Oral Surgeons (who aim to improve the face) preferred a fuller normal Chinese profile”.
Why should Orthodontists think so differently from the rest of us? Part of the reason might be that most of them are taught that it is not possible to increase the forward growth of the face by more than 2 millimetres which hardly shows (Looi and Mills 1986). However Zettergren-Wijk et al (2006) found that if children learnt to close their mouths, their face grew forward by about 10mm, but if the mouth was left open, the jaws became flatter and less attractive.
This finding was later supported by Trotman et al in 1997, who also found the reason why Orthodontic X-rays failed to show this”. Other research (Mew 2015) showed that patients who were trained to keep their mouths closed became very much better looking than patients who had not, but this still does not explain why Orthodontists think flat faces look better. I can only assume that they learn to like the flat faces they create.
Orthodontists placed this case 12th most successful out of a series of 32 cases but members of the public placed it last.
This case was considered most successful by both the lay public and the orthodontists.
see You Tube video here
Most orthodontists take lateral skull X-rays about the age of 12 to 14 to establish the position of the maxilla and mandible in relation to the cranium as a whole. X-rays have been used for this ever since Brodie showed (1938) that the skeletal form was more or less set by that age. Treatment was not recommended before then because experienced showed it tended to relapse.
Orthotropics suggests that most skeletal malformations are due to adverse oral posture; mainly leaving the mouth open and tongue-between-tooth habits and the emphasis of diagnosis is moving to studying oral posture. This is difficult to recognise using X-rays until after the damage has occurred although photographs can be used to forecast facial growth from the age of three or four (see illustration).
With experience anyone can be taught to read the muscle posture of the tongue and lips from the face itself and their effect on developing facial form. A photograph will demonstrate this but not an X-ray. Changing oral posture can create large changes in a growing face provided the child is under the age of seven or eight, but of course the postural changes must be maintained afterwards if a permanent correction is desired (see illustration).
see YouTube video here
Many clinicians from different disciplines offer explanations and cures for TMJ and it is widely assumed that there is no ‘One Size Fits All Treatment Guarantee’. However when part of the body goes wrong there is usually only one direct cause, although by coincidence two or possibly three causes could occur simultaneously. Most of the other factors are either, resultant, coincident, predisposing, or unrelated, but not causative. It is wise therefor to consider each one separately and then try to select the real culprit.
My research in anthropology convinced me that the jaw joints of our ancient ancestors rarely showed any signs of damage, so why does this joint cause so much trouble now? Things have changed since then and many jaw bones are now set back as much as 20 to 30mm from where they were back then. Most TMD clinicians agree that this distalization, causes pressure on the joint but there are few suggestions about how to improve it and surgery has not so far proved a reliable cure.
There are many recommended treatments but about 20% of patients continue to suffer whatever is done. Good cures usually surface quickly and the single most effective treatment appears to be a dental splint (orthotic) which separates the teeth somewhere between 1 to 8 millimetres. While the relief can be dramatic, and permanent the problems often return after a few weeks or months. This suggests to me that the splint may rest the joint in the short-term but the underlying cause remains. This explanation fits the fact that thickening the splint often provides a further period of relief but again the problem returns. Splints can also have side effects such as intruding teeth and despite what is done 20% or so of patients continue to suffer.
Other cures exist such as physiotherapy which can be almost as effective as splints, but again they seem ineffective for about 20% of patients. A number of clinicians and patients consider changes in the content and consistency of our diet is important, but ‘cures’ on this basis are rather unspecific and it not appear to have a high ratio of success.
With orthotropics we try to reverse the life-style changes because we believe that modern living has encouraged many children to leave their mouths open and also to swallow with their tongue between their teeth. Research shows that this is a major reason for both jaws failing to grow forward which in turn disrupts the way the teeth and jaws meet and effects the position and form of the TMJ. Orthotropic treatment is based on the ‘Tropic Premise’ which says “correct oral posture is with the tongue resting against the palate, the lips sealed and the teeth in light contact for about six hours a day”. Orthotropic treatment aims to train children to keep their mouths closed which increases forward growth improving the teeth and face. This seems to reduce their susceptibility to TMJ problems later but is only fully effective with growing children. However adopting the Tropic Premise can often cure TMD pain in young adults possibly reaching that last 20%. see the picture below.
see YouTube video here
The Tongue: What Part does it Play?
It is hard to comprehend the full difference between the correct and incorrect action/posture of the tongue. The teeth are resistant to short-term force during biting or swallowing but they are very sensitive to light long-term force/posture, including the touch of the tongue. If you place a blob of resin on the lingual side of an unopposed molar it will move away from the light contact of the tongue because it is continuous while the strong push from the tongue during swallowing lasts barely a second and so has little influence.
The shape of the dental arch is determined primarily by the tongue but also by the cheeks and lips, all of which have far more influence than the genes. That is why the arch shape of all animals and our primitive ancestors reflects the shape of the tongue. That does not apply to people who have any malocclusion because all of them have displaced tongues. Usually children from industrialised countries rest their tongue to a greater or lesser extent between the teeth. In fact about 95% of civilised children do this, leaving the teeth and lips apart for varying periods which of course is why malocclusion is endemic.
William Profit’s research at South Carolina, showed very clearly that teeth erupt when out of contact and intrude when in contact (Proffit et al 1993). From this research it is obvious that teeth need to be in contact 4 to 8 hours a day for them all to meet evenly with the face the correct height. But if the tongue rests between the teeth this balance is distorted.
The problem has been that few clinicians who work in the mouth have realised how influential the tongue is for the growth and development of the jaws and face. This includes many Dentists, Ear Nose and Throat Specialists, Orthodontists, Speech Therapists, Orthognathic Surgeons, Oral Myologists and to some extent Beauty Specialists and Plastic Surgeons all of whom are involved in the shape and function of the facial skeleton. We could also include Anthropologists who study the historical shape of the face as well as the Cranial Osteopaths, and Chiropractors who treat internal deformation of the skull. Many of them visualise the tongue as a soft structure which adapts to the form of the tissues around it, rather than seeing it as the large powerful muscle it is.
Orthotropists believe that the natural growth and appearance of the face is largely guided by the position of the tongue, but no one has yet found an accurate way of measuring tongue posture and so this suggestion is as yet hypothetical. It is theorised that the forward growth of the maxilla (the mid face) depends to a large extent on support from the tongue but although there is incidental evidence to support this concept it is not widely accepted by orthodontists. Sadly because it can’t be measured, university researchers have shown little interest in tongue posture so we have little idea whether it is crucial or unimportant.
The illustration below shows the effect of enlarging the maxilla and taking it forward.
YouTube video here
The big majority of orthodontics in Britain is carried out with fixed appliances this achieves excellent alignment of the teeth but is often followed by relapse. I think orthodontists are embarrassed about relapse but believe that by retaining the result afterwards they remove the problem.
To prevent re-crowding, the teeth must be held in position by one of the many types of retention available, and the British Orthodontic Society has recently recommended that every orthodontic patient should be advised that they will need to wear a retention appliance for the rest of their life. This can require more work than the treatment itself. There are also concerns about food retention and gum damage with fixed wires, especially if subsequent restorative work is required. Experience suggests that removable retainers are usually dis-guarded within a decade or two. There are clearly problems ahead and who will pay for this?
Concern has recently been expressed recently by periodontists (ref if poss) about the consequences of long-term retention of expanded dental arches. Many orthodontists do this to avoid extractions. The teeth are held in position but the soft tissue forces of the tongue, lips and cheeks remain unchanged resulting in progressive clefting and fenestration of the teeth and bone. Because this type of expansion is now widespread, it is likely to become a major problem, not only for the patients but also of course for the dental insurance companies, which may be why it is rarely discussed.
Orthotropics does not need any retention hence there is little risk of gum damage.
see YouTube video here
The big majority of orthodontics in Britain is carried out with fixed appliances which achieve excellent alignment of the teeth but several scientific papers have suggested the possibility of adverse facial changes (Battagel 1996). I think orthodontists are embarrassed about this but believe that by avoiding discussing the subject, the public will not be worried.
The father of the girl shown below was a medical doctor and asked for non-extraction treatment for his daughter hoping this would avoid damage. After a year of retractive Headgear there was little change and she then had 4 teeth extracted. After another year the orthodontist said she would need jaw surgery. The picture below shows the change to her face at that point.
The next patient (below) received a nice improvement from Biobloc Orthotropic treatment but then decided to have the alignment improved with fixed appliance. See the vertical growth that followed.