Embrace Progress: Expansion Plans by Dr. Daniel Grob

Dentaltown Magazine

Orthodontic treatment should go far beyond just straightening teeth. Are you prepared to discuss the situation with patients?

by Orthotown Editorial Director Dr. Daniel Grob

How many parents have presented to your office, either in person or on the phone, inquiring about “preventive orthodontics”? What do they think that even means—eliminating the “need for orthodontics,” or orthodontics that “prevents” some disease, disorder or malocclusion?

Let me share what I consider to be one of the oldest and most effective parenting tips I can think of to assist with orthodontics, diagnosing airway issues and ensuring stability: Chew with your mouth closed.

That’s right. “Chew with your mouth closed.” Let me explain.

For years, the orthodontic community has paid lip service to the facial musculature and airway in relation to diagnosing, treating and maintaining orthodontic health. After years of personal experience, it became evident to me that one of the most important factors in our profession is the soft-tissue envelope surrounding our chosen area of expertise—namely, the arches of teeth that are positioned between the lips and facial muscles and the tongue. Patients who are unable to chew with their mouths closed may have many muscular and airway issues that go beyond just being polite.

The public searches for ways to meet its treatment needs
If you’ve been paying attention, there are many competitive solutions to treating malocclusion these days. Some claim to offer alternatives to traditional delivery of orthodontic appliances in a different setting; many others, however, utilize removable appliances to “eliminate the need for braces”—as if it’s a better alternative to have your teeth straightened without a skilled provider in control.

If you search the internet or subscribe to any groups on social media—including Orthotown forums—you may see case studies or hear anecdotal stories related to myofunctional therapy. Some of these alternative therapies involve a series of somewhat cumbersome devices designed to be worn up to full time for months—if not years.

Why in the world would one want to “eliminate braces” for the opportunity to wear these devices? Because a problem has been identified that the public and other providers have determined is not being adequately treated—or, in some instances, is being ignored or denied—by our profession. (Say “clear aligners,” anyone?)

Various philosophies of orthodontic care claim to be “the best” when arranging teeth for the most aesthetic and functional result. Most of them will deliver on their promises, especially when it comes to making teeth straight. But what if they don’t?

It is rare if, after placing or wearing orthodontic appliances for a period of time, patients aren’t elated about their new smile. Occasionally, however, extra treatment time is required, or relapse occurs rapidly. We often blame cooperation and lack of retainer wear, but many of us after the fact identify tongue-thrusting or other mouth habits. What if we had included this in our pretreatment diagnosis and discussion, so that all patients had the benefit of our knowledge, rather than using it for an excuse after the fact?

Starting orthodontic treatment early, with a discussion about the challenges
The profession is upset about alignment clinics and storefronts appearing across the country. Some may be in your backyard (as they are in mine).

We have existed as a profession to this point by being experts in arranging teeth, and by defining ourselves by this skill or task. We claim that “our technology and technique” is the answer to our patients’ concerns, but we often overlook many of the contributing factors to their actual and perceived conditions. It behooves us as practitioners and providers to begin the discussion with a diagnosis and evaluation that addresses issues that have been implicated, and in many times proven to be coincident with malocclusion.

Many of us are entertaining referral sources from school, general practitioners and physicians, hoping to gain referrals based on our ability to create the most beautiful smile in the least amount of time. Might it be beneficial to mention to these potential referral sources, as well as patients and parents, that our dedication to creating beautiful smiles begins and ends many months—and sometimes years—beyond the period of “active orthodontic care”?

In my own practice, the most obvious place to start is by identifying the presence of oral habits. What patient we see for an initial evaluation has not had some oral habit? It could be as simple as a history of pacifier or “binky” utilization, resulting in a retained infantile swallow. It could be active thumb or digit sucking, which is almost always accompanied by facial muscle imbalance. Or, a quick glance of the digits in the exam chair may reveal the signs of nail biting, which I have found usually leads to the same muscle imbalance.

Airway disturbances and skeletal expansion
Airway disturbances have many side effects that we can identify. These could include a protruding tongue that helps the patient gain access to a restricted air passage, or a lack of air for breathing and sleeping, which we are now learning influences growth and development and may affect heart health, especially in older patients.

These topics are so important that Dr. Maria Troulis, the program director and chairman of the Harvard oral surgery department, has stated: “The new goal of OMFS is the expansion of the craniofacial skeleton.”

Clenching, grinding and bruxing have been used as a justification for occlusal therapy for years. Are you familiar with abfraction and its causes and complications?

What if we were to identify oral and systemic factors that contribute to bruxism similar to how we evaluate sleep disorders?

These are just some of the topics that I as an engaged practitioner should be considering in a routine evaluation of patients seeking care.

It’s obvious that if we are to stave off the onslaught of alternative delivery systems addressing only the most basic of crooked teeth, we must make our care something that requires more than a digital representation of the crowns of the teeth.

I’ve said it before, but I repeat: The reason most patients go to the dentist is to have a great, beautiful smile. If that’s true, shouldn’t we as the deliverers of that smile be involved with almost everything that contributes to it?

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Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
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