Not just about straightening teeth

What is orthodontics?

Orthodontics is commonly thought to just be about teeth and the traditional metallic braces. Nowadays almost 85% of cases can also be treated with clear aligner therapies such as Invisalign or Clear Correct.

Clear aligner therapy has revolutionised dentistry. It is a conservative form of aesthetic dental treatment as it focuses on straightening the teeth to achieve correct alignment rather than using veneers or crowns to mask a misalignment

This cutting edge treatment eliminates the need for traditional metal braces and replaces this with a sequence of custom-made translucent aligners that work gently to straighten your teeth over time. Treatment typically lasts 9-18 months can this can vary depending on the degree of crowding.

Because the aligners are removable, you don’t have the nuisance of food getting stuck in between braces and wires. And because you can remove Invisalign any time, keeping up your normal oral hygiene routine at home is easy. Which means there’s less chance of suffering from damaging plaque, dental caries, and periodontal disease.

However there is much more to orthodontics! The assessment and diagnosis of the relationships between your jawbones is very important. It has impacts on facial profiles, facial aesthetics, chewing and much more.
As children the development of our jaw bones is in relation to the general growth of our body. Hence why orthodontic treatment must be timed correctly in accordance with growth periods.

You may wonder why even both straightening teeth? Is it even worth it?

Teeth and jawbone relationships still doesn't cover all there is to consider in orthodontics! Equally crucial is the correct assessment of one's airway.

If the airway is not being assessed in an orthodontic consultation then some very important findings could be missed. Blocked nasal airways commonly leads to mouth breathing. Mouth breathing is an important sign of underlying issues with either your nose, the relationship of your jaw bones, your tongue...or a combination of the three. If your child finds it hard to keep their lips closed then it's something to take notice of.

Before we get into the technical talk about all this, it's important you know a few basic terms. The maxilla is the anatomical name for the upper jaw/facial bone and the mandible is the anatomical name for the lower jaw.

Research has shown that nasal breathing stimulates correct growth of the maxilla and eating chewy foods stimulates growth of the mandible A large proportion of children have nasal obstructions.

The problem with nasal obstruction is that it forces children to then open their mouths to breathe. As the mouth opens, the tongue sinks into the floor of the mouth to allow air to flow over it and into the windpipe. The result is that the tongue is not in the position where it should be. At rest, your child's lips should be closed and the tip of the tongue should be sitting on the roof of your mouth (the palate) just behind the two front teeth. This positioning of the tongue stimulates the upper jaw (or maxilla) to expand laterally into the correct and ideal arch form. Without this correct tongue position, the palate remains narrow and high. This predisposes children to sleep breathing disorders such as obstructive sleep apnoea. Research has shown that patients with obstructive sleep apnoea will die 15 years earlier than if they didn't have it. It's essentially equivalent to smoking a packet of cigarettes a day.

Another serious drawback of the lower position of the tongue is that it stimulates the mandible to grow downwards and backwards. This positions the tongue further back onto the windpipe thereby causing a second obstruction in the airway (the first was the nasal obstruction). Now there is an obstruction in the oral cavity, so your child postures their head forward to take the tongue away from the windpipe. A forward head posture is a common sign of nasal obstruction.

Did you know that when you breathe through your nose, the lining of the nose and sinus releases nitric oxide (not nitrous oxide or happy gas). This is extremely beneficial for your body as it increases oxygen absorption into the blood by 10-25%. It also helps to kill off harmful bacteria and viruses. If your child is a mouth breather they are missing out on significant amounts of oxygen. This impacts brain development and cognitive function. Moreover, the air they are breathing is unfiltered which can result in recurrent tonsillitis.

Mouth breathing may also be due to other causes:

  • - tongue tie
  • - tongue thrusting
  • - thumb sucking
  • - muscular imbalance

The nasal obstruction means your child is not getting a good night's sleep which impacts they cognitive development. They are irritable and have difficulty learning. They frequently wet their beds because they are so tired once they do fall asleep that they sleep through the bed wetting. There are follow-on behavioural problems such as speech difficulties (e.g. lisps) because the tongue is postured too far forward due to the narrowed maxilla.

All of this needs to be considered when assessing your child for orthodontics.