Most dentists agree that the curriculum in the majority of dental schools does not adequately cover the subjects of orthopedics and orthodontics. I believe that the knowledge and understanding of orthopedics (functional orthodontics) is the missing link in the education of general dentists.
Ideally, children with developing malocclusions should be treated with functional appliances in order to guide their growth and to prevent more serious problems later on. Functional orthodontics has, as its foundation, balanced function of all components of the stomatognathic system. Properly developed arches, patent airways, the mandible properly related to the maxilla, and correct vertical dimension all contribute to balanced function of the head, neck and facial muscles. Children treated with the functional philosophy can be done non-surgically and without the extraction of permanent teeth in most cases.
Since the roof of the mouth is the floor of the nose, a properly developed maxillary arch encourages nasal breathing and can assist with improving such symptoms as nasal allergies, asthma, and sinus problems. One of the most common causes of constriction of the maxillary arch is an airway obstruction, which causes mouth breathing. Another cause of constriction would be enlarged tonsils, which prevent the tongue from posturing on the roof of the mouth upon swallowing. It is the ability of the tongue to position itself on the palate that allows for proper lateral development of the alveolar processes, which helps to develop the maxillary arch to its normal size.
This narrowing of the maxillary arch, in turn, causes the mandible to be held in a retruded position. This retrusion of the mandible is implicated in jaw joint disorders as well as snoring and sleep apnea. The nerves and blood vessels are located at the back of the socket of the TMJ (jaw joint); therefore, a posterior position of the mandible and condyle can cause head, neck and facial pain as well as a host of other symptoms including dizziness, ringing in the ears, numbness in arms and hands, stuffiness in ears, back and shoulder pain, and difficulty swallowing..
A retruded mandible can cause the tongue to fall back and encroach upon the airway. Snoring and obstructive sleep apnea and the whole spectrum of breathing disorders can also be caused by a mandible that is positioned too far posteriorly (Class II skeletal cases).
CORRECT VERTICAL DIMENSION
Patients with deep overbites often are overclosed vertically (lack of adequate posterior vertical dimension) and this causes the condyle to be posteriorly displaced, resulting in TM dysfunction. The mandible is trapped in a retruded position, which leads to chronic clenching and bruxing at night as the body attempts to reduce the muscle spasms that occur due to the shortening of those muscles. Bruxing is also caused by the patient moving the lower jaw and tongue forward in an effort to open up the airway.
Orthodontic education should be aimed at understanding and correcting the following:
· Constricted maxillary arch · Posterior crossbite · Constricted mandibular arch · Anterior crossbite · Thumb sucking habit · Mouth breathing · Airway problems · Retrognathic mandible · Deep overbite · Bruxism
We need to utilize functional jaw orthopedic appliances at ages 4 – 12 years to correct the problem before the eruption of all the permanent teeth.
Learning to correct all of these problems at an early age can prevent TMJ problems, snoring and obstructive sleep apnea in adulthood. Orthodontics (age 12 – 14) involving fixed braces then becomes a finishing technique to improve esthetics by straightening the teeth.
If you want to give your patient more than straight teeth, I recommend treating children earlier with functional appliances. Our objective should be to improve the overall health of the patients. To create a broad smile, we must develop the maxillary arch with functional appliances and avoid the extraction of permanent teeth. To create a straight profile In Class II skeletal cases with retruded mandibles, we must utilize a functional appliance to reposition the mandible to its correct forward position. One of the keys to achieving overall health for the patient is to have the mandible properly related to the maxilla in order to prevent TM dysfunction and snoring and sleep apnea. The use of functional appliances in children can consistently accomplish these goals.