How do we do orthodontics?

The perfect man breathes as if he does not breathe

Lao Tze

It’s important to understand that crowded teeth are a symptom of underdeveloped jaws. Straightening them is does not actually fix the problem. And the problem is underdeveloped jaws, which if not corrected, may adversely affect the airways, cervical spine and entire body posture.

The philosophy behind the orthodontic treatment we provide for you or your child has a strong focus on airways. There is plenty of evidence and our own case experience to support the premise that good airway function support ideal craniofacial growth and optimal facial aesthetics.

Indeed, Dr Christian Guilleminault, the father of sleep medicine asserts that “The establishment of nasal breathing should be the ultimate goal to secure adequate craniofacial and airway development in children”.

The first thing we assess is whether the individual is a nasal or mouth breather. Nasal breathing is ideal, however, for a mouthbreather the flow-on effects can be significant if left untreated.

A referral to an ENT is provided if we note some sort of blockage in the nasal airways (such as enlarged turbinates, adenoids and tonsils).

If the nasal obstruction is not corrected, then the tongue is forced to adopt a low posture in order to facilitate mouth breathing. This commonly causes a ‘long face’ appearance (also known as adenoid facies). To make matters worse, the tongue can’t be up and forward against the roof of the mouth to guide upper jaw development. The cheek muscles (buccinators) overpower the tongue’s low position and the dental arch caves in. The upper jaw becomes underdeveloped which affects:

  • Facial appearance – significant asymmetries
  • Dental crowding
  • Poor breathing during the daytime and sleep
  • Poor Sleep quality and sleep apnoea
  • Risk of several signs and symptoms

Whilst the nose is addressed, we can begin to develop the jaws…and timing is everything.

By age 5, 70% of craniofacial development is complete. By age 8, 90% is complete. So why wait any longer?

Treatment for children is divided into separate phases.

Phase 0 is the orthotropic phase where muscular dysfunction is corrected to guide ideal jaw and facial development.

Phase 1 is the dentofacial orthopaedic phase and is best started in children aged between 7-9 years old. During this time we are able to intercept and modify growth to ideal proportions. The bones are developed to ideal proportions and the teeth drop into place. There are multiple effective ways of achieving this and we select the most appropriate option after taking records and carrying out our analysis. One method is the use of palatal expanders. Research, even as recent as 2021, shows that reduced width of the upper jaw is a predictor of multiple site obstruction in patients.

Phase 2 is full arch braces. Many children (up to 90%)  do not require Phase 2 if Phase 1 is begun early and performed well. Perhaps a short course of clear aligners is all that may be needed to tidy things up.

In adults, the options are functional appliances that effect changes via epigenetics or other surgical options that can be performed by a specialist.

Eliminating habits in children such as thumb sucking or pacifier use is also paramount. We offer excellent alternatives to pacifiers that can help to settle your child as well as stimulate jaw development.

Good orthodontics is not just about moving teeth but also about understanding muscle activity. In the mouth there is a war between bone, muscle and teeth. And the muscle always wins. The tongue, lips and other oral muscles need to work in synchrony during function and whilst at rest.

Our in-house orofacial myologist is on hand to help correct any muscular imbalances. It’s an important part of treatment. No orthodontic treatment is stable without balanced muscular function. How many people do you know that had braces and the end result relapsed?

We are trying to develop the correct myofunctional patterns to naturally establish and maintain good jaw development, good facial development, a quality airway and breathing function as well as stable TMJ.

Think of our philosophy as Airway Orthodontics or Myofunctional Orthodontics.