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Are Braces Necessary?

by John Utama

Welcome to my first blog post!


This is one of the most common questions I am asked at my practiceand
unfortunatelythe answer is not a straight forward one,infactorthodontic
problems that you see are outward signs of deeper underlying problems
and some can be very serious. Before I delve further, let me first explain
my orthodontic background so that you have a better understanding of
this most important topic.
My interest in orthodontics started about 15 years ago. Before then I have
been doing numerous cases of cosmetic dentistry, namely veneers. The
veneers would improve peoplessmile,when previously the front teeth
had been either discoloured and/or extensively broken down.
In the meantime, an increasing number of adults also presented to me with
crooked teeth and wanted to improve their smile. There were two main
options then, either to shave off the enamel and place veneers to give an
illusion of straight teeth, or to see an orthodontist and wear braces. As
braces are now increasingly more acceptable in adults, more and more
adult patients are quite prepared to endure the procedure for 4 to 18
months. I was frequently asked if I could place the braces myself, but due
to inadequate orthodontic training at dental school, I exclusively referred
orthodontic treatment to the specialists. With a lot of prompting from my
own patients, I decided to do a 24 month course in
Orthodonticswww.posortho.com. Since then my interest in orthodontics
heightened, attending courses such as LVI neuromuscular orthodontics in
Las Vegashttp://www.lviglobal.com/, and later on functional orthodontics
http://orthotropics.com/andhttps://dnaappliance.com.
Having now fitted numerous braces, mainly to straighten teeth, the one
thing I found orthodontic patients have in common is restricted airway,
virtually all have a certain degree of mouth breathing. And when you look
at the literature (1), there is a correlation between mouth breathing and the

size and shape of the upper jaw. There are numerous theories to this
phenomenon (2) (3). The wider the mouth is open at rest, the narrower the
upper jaw becomes, ie, the more people breathe through the mouth, the
smaller the jaw gets. It makes sense, in the ideal nose breathing, the tongue
rests against the roof of the mouth. The tongue exerts pressure against the
roof of the mouth and therefore shapes the upper jaw. In mouth breathers,
the tongue drops down, thus, the external forces of the lips and the cheeks
become dominant, disturbing the equilibrium, consequently constricting
the upper arch.
The nose is designed for breathing, the mouth is not designed for
breathing, it is mainly designed for eating and talking. The mouth is
designed as a secondary breathing apparatus, if there is an obstruction in
the nose such as allergic rhinitis (4) or enlarged tonsils (5) the mouth is
available as a reserve to breathe in Oxygen. Mouth breathing is only
designed as a temporary measure until the optimal conditions of nasal
breathing are reinstated.
From here there is a potential domino effect, the upper teeth become
crowded, the lower teeth also become crowded to fit against the narrow
upper jaw. Consequently, the upper and lower teeth dont fit together,
causing stresses in the muscles and the TMJ joints. When the TMJ joints
are stressed, the surrounding structures such as nerves, blood vessels and
ligaments are also stretched and compressed. There are a number chronic
illnesses such as vertigo, migraines and headaches, Menieres (6) that are
associated with TMJ dysfunction.
A more serious consequence of an orthodontic problem is the receded
mandible. Here the lower jaw is pushed back in order for it to meet up
against the upper jaw during the normal functional activities such as eating
and swallowing. When the lower jaw is forced back in the toxic bite
position, the tongue is carried with it backwards reducing further the
already constricted oral cavity and ultimately airway, directly behind the
tongue at the back of the throat. This can occur at any age leading to the
serious condition of OSA (Obstructive Sleep Apnoea). This topic will be
covered later on another blog.


The left pictureaboveshows a narrow airway, the right picture shows a
normal airway. The main difference is the size of the upper jaw length
(antero-posteriorly) (7), as shown on the picturebelow.Needless to saythe
patient on the left has been diagnosed with OSA confirmed with a sleep
study.


Conclusion
When you see someone with crowded teeth and/or a toxic bite, there is
more to the bad appearance than meets the eye. Crowded teeth is usually
a sign that there could be something more serious lurking underneath and
it pays to investigate. We humans are meant to have jaws that are big
enough to accommodate all our 32 teeth! Extracting teeth to create
(instant) spaces will definitely facilitate straightening teeth, but not
necessarily the best option.
The answer to the original question of Are braces necessary? is usually
yes, as thorough diagnosis and treatment planning will not only resolve
the important aesthetic consideration but will also lead to a measured
management of the TMJ joints and most important of all the airway.
References
1 Wong ML, Sandham A, Ang PK, Wong DC, Tan WC, Huggare J.
Craniofacial morphology, head posture, and nasal respiratory
resistance in obstructive sleep apnoea: An inter-ethnic
comparison.Eur J Orthod2005;27:91-97.

2
3

5
6

Moss-Salentijn L. Melvin l. Moss and the functional matrix.J Dent


Res1997;76:1814-1817.
Kilic N, Oktay H. Effects of rapid maxillary expansion on nasal
breathing and somenaso-respiratory and breathing problems in
growing children: A literature review.Int J Pediatr
Otorhinolaryngol2008;72:1595-1601.
Schlenker WL, Jennings BD, Jeiroudi MT, Caruso JM. The effects
ofchronicabsence of active nasal respiration on the growth of the
skull: A pilot study.Am J Orthod Dentofacial
Orthop2000;117:706-713.
LopatieneK, Babarskas A. [malocclusion and upper airway
obstruction].Medicina (Kaunas)2002;38:277-283.
6.Wright EF1,Syms CA 3rd,Bifano SL. Tinnitus, dizziness,
andnonotologicotalgia improvement through temporomandibular
disorder therapy.Mil Med.2000 Oct;165(10):733-6.
Lowe AA, Ono T, Ferguson KA, Pae EK, Ryan CF, Fleetham JA.
Cephalometric comparisons of craniofacial and upper airway
structure by skeletal subtype and gender in patients with obstructive
sleep apnea.Am J Orthod Dentofacial Orthop1996;110:653-664.

John Utama BDS MBA


Robina Town Dental
Dentists @Capri
Gold Coast Australia
www.thewholedentist.com



johnutama@me.com

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