Orthodontics has traditionally focused on straightening teeth. I mean, who doesn’t love a beautiful smile? But at what cost? Pulling teeth to “make space” or using appliances to push and pull teeth into a “perfect” position and bite without first addressing the reason WHY the teeth are crooked to begin with is a perfect recipe for relapse and undesired side effects. In many of my adult patients, that “beautiful smile” is a contributing factor to their current TMJ pain, snoring/sleep apnea, and chronic head and neck pain. It makes sense when you think about it. If we treat any symptom without treating the underlying cause, the symptom is likely to recur and we often end up with unwanted side effects.
So, what is the reason for crooked teeth? With the exception of children born with certain syndromes affecting cranial structure, none of us are born destined to have crooked teeth. There is no “crooked teeth” gene. That means that epigenetics must be responsible for the new generation of flat faces, limited airways, and malocclusions. Epigenetics are the things in our life that affect the way our genes express themselves rather than an actual change in the genetic code itself. Our bodies are born to stay alive and reproduce. If something threatens our ability to stay alive, we adapt.
If a child cannot breathe through his nose, he will adapt by mouth breathing. The new open-mouth posture now leads to a vertical growth pattern, a long face, narrow arches, and crooked teeth. If a child has a tongue tie and cannot hold her tongue flat up against the palate, her arch does not form properly, leading to a V-shaped arch, a high vaulted palate, and crooked teeth. If a child is transitioned from breast or bottle to solids without learning a proper swallow, the tongue pushes against the teeth instead of the top of the mouth and pushes teeth into a crooked position.
It stands to reason then that orthodontics should be started much sooner than the 12- to 14-year-old with permanent dentition. Sooner even than the 7- to 8-year-old that would typically start in phase one orthodontics. If we can identify the underlying cause of the crooked teeth before they erupt, we can correct the problem and begin to guide the child’s growth in the right direction. The best way that we can start treatment this early is through mastering “The Big 3.”
I talk a lot about “The Big 3” with my patients—both children and adults. In order to get the most out of our Growth Guidance Orthodontics, it is important that “The Big 3” are mastered:
1. Nasal Breathing
2. Good Lip Seal
3. Absence of Tongue Habits
To be clear, “The Big 3” isn’t just a list of things to check off. By developing these three aspects of orofacial posture, the patient is equalizing the complex forces of craniofacial biology. They are using a natural rest position to allow the soft tissues to shape the arch and guide the teeth into an esthetic and functional position. The elimination of these three causative epigenetic factors will allow ideal treatment to be accomplished and stable. We start working with children as early as five to correct habits and encourage proper growth. Early intervention with the use of myofunctional therapy, elimination of tethered oral tissues, and proper sleep and nutrition can often prevent the need for braces at all!