Will 2018 be the year that finally finds…Orthodontists recognizing more than the “Class of Malocclusion”? Part III

Part III A compelling physiologic reason to change 

What if we recognized that all malocclusions have one thing in common? The very first clue to a developing malocclusion/poor facial balance is that the upper anterior teeth fall down and back in the face. What if we recognized that virtually all malocclusions (Class I, II, III) have maxillas (upper jaws) that are recessed? What if everyone realized this is caused by lack of proper rest oral posture (teeth together lightly, tongue firmly to the palate, lips together without strain). What if we treated that poor rest oral posture and focused on correcting that problem? What if we recognized that there is already a growing group of people called myofunctional therapists whose goal is helping others achieve proper rest oral posture? What if dental professionals, ENT’s, and pediatricians either had a myofunctional therapist working in their practice or had a close referral relationship?    

What if we used known and tested techniques of developing the upper and lower jaws forward in growing children and worked with myofunctional therapists to achieve proper rest oral posture to maintain that jaw position? Would our patients have better looking faces? Might their airways be bigger as their jaws developed further forward (something which the literature confirms can occur)?    

What if every orthodontist began treating Obstructive Sleep Apnea? What if everyone realized that OSA wouldn’t exist if, as a very famous sleep doctor stated, the jaws were placed properly forward in the face? How might the orthodontic profession change? Would it still be afraid to move the teeth forward for fear of causing recession as most have been told? Would the profession finally begin to believe its own refereed literature with at least 8 articles confirming that recession is not a problem with advancing teeth in the face? Would the profession still cling to the idea that any amount of retraction is fine and say the tongue (innervated by 4 cranial nerves) will accommodate? Would the argument about extraction / non-extraction finally go away and be replaced by a question about how any proposed treatment might affect the airway positively or negatively? Would the profession finally adopt a resolution stating that the airway is never to be compromised even minutely and ideally would be enhanced with orthodontic treatment? Would the profession then find ways to measure and document these changes? 

What if the goal was optimizing facial balance and optimizing airways? What if doing sleep tests on children and adults became a routine part of dental care and guided decision making with the idea of optimizing sleep and breathing for every patient? Would we finally be considered part of the health care profession? Would Smile Direct have a chance of competing with someone who is literally “saving lives”? Would orthodontists have to be continually thinking of a way to compete with other orthodontists by being “all digital” or “up to date on the current research”, or “caring more than another office”? Could we finally hold our heads high and feel like we were truly professionals? Would orthodontists feel better about themselves being mouth doctors rather than excellent marketers? Will 2018 be that time of transition? 

What if we recognized that treating malocclusions in adolescence is rearranging the deck chairs on the Titanic? What if we realized that there by then there was so little growth left to optimize that we have long missed the boat? What if we quit telling the public that the right time for an orthodontic examination is age 7 when problems are easily recognizable and treatable in 3 and 4 year old children? What if all orthodontists learned to recognize warning signs of problems with one simple measurement long before the first permanent tooth erupted into the mouth? What if the goal of orthodontic treatment was never having a child wear braces and having the tongue, lips, and cheeks be the “retainers”? Will we start to recognize this is possible in 2018…..or will we continue to straighten teeth as we always have?