Dental News - The nose knows: A big-picture look at myofunctional orthodontics

Barry Raphael, USA

Sun. 24 November 2013

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After three decades practicing orthodontics, including experience with the “muscle-centric” philosophy of orofacial development, I was recently asked to provide a summary of the "big picture" for a group of Buteyko practitioners who were not familiar with myofunctional orthodontics. Here is my response:

At issue is the head-on collision of the human face with the modern environment. Anthropology demonstrates how the human face has changed in the past several hundred years, presumably as a result of the many stressors that have created the over-breathing that Buteyko addresses. The ensuing open mouth posture prevents the tongue from fulfilling its role as scaffolding for the developing maxilla (just as the eyes are the scaffold for the orbits and the brain for the cranium) and allows this bone to collapse downward and back into the face, severely restricting space for erupting teeth. As a result, the mandible is forced to cope with a distorted upper partner. It compensates in a variety of ways, all of which result in facial deviations from ideal.

The biggest concern is that this damage starts very early in life. So by the time a child’s teeth have crowded — and are considered ready for braces — it is too late to prevent it. Consequently, traditional orthodontics operates as a compensation for misshapen jaws (80 percent of the time to my estimation) and, in the case of using extractions to relieve the crowding, is actually locking in the problem permanently by collapsing the dental arches in order to match the collapsed skeletal arches.

In addition to the esthetic problems associated with profile and smile, a misshapen face can cause a variety of health issues. An elongated face is a risk factor for sleep breathing disorders because the airway is often more narrow in the throat. Stresses are placed on the jaw joints, often creating dysfunction or causing pain. A lowered tongue posture leads to muscular dysfunctions that place additional stress on the teeth, jaws, cranial bones, joints and airway. It is a messy situation, and it seems increasing in frequency and severity with each generation.

In my opinion, the best treatment approach is preventive. Even when orthodontists try to intercept the issues leading to open mouth posture (a dissertation in itself), the longer the delay in starting treatment the more damage that must be dealt with. By adulthood, not only is the original facial damage present, but so are all of the secondary effects these stresses have created, including wear and tear on the teeth and joints, long-standing muscle and breathing dysfunction, musculoskeletal issues and chronic inflammation in all parts of the body.

There are several treatment techniques designed to help the jaws grow to their full genetic potential. These, of course, work best in young, growing children, but can be beneficial at any age, albeit with varying degrees of success, since even a 5 percent positive change can have a large impact on an out-of-balance system. At the base of these efforts has to be the restoration of nasal breathing and correct breathing dynamics, without which all issues remain refractory.

Note: This article was published in Dental Tribune U.S. Edition, Vol. 8, No. 11, November 2013 issue.

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