STRAIGHT TALK about CROOKED TEETH (part 3)

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Published: Saturday, 26 October 2013 12:16 Written by 

Third in a series of articles by Derek Mahony, BDS, MDSc and S. Kent Lauson, DDS, MS (Orthodontists)

This is the third in a series of articles, which highlights information taken from the new book “STRAIGHT TALK about CROOKED TEETH” by Dr. S. Kent Lauson, Orthodontist, Aurora, Colorado, USA, with a Forward by Dr. Derek Mahony, Orthodontist, Sydney, Australia. 

The book was written with the orthodontic consumer in mind. This is a parent of a child with a developing malocclusion, and the family dentist they see.  Dental experts have heaped praise on the book, as a must read.  Note the following endorsement: “The book Straight Talk about Crooked Teeth should be mandatory reading for every orthodontic provider. This book should also be read by every parent contemplating making an orthodontic investment, in his or her child’s future health, and well-being. Its principles embody the fundamentals of what is necessary for long-lasting, highly cosmetic, and highly functioning results, which if not followed, will result in a compromised solution to the presenting orthodontic problems. I can only pray that Dr. Lauson’s treatment principles will seep deeply into the conscience of the world’s orthodontic profession.”

Brendan C. Stack, DDS, MS, Orthodontist, noted author, and lecturer Vienna, VA, USA

The first two articles dealt with the reasons for writing the book  and talked about the first two, of the Nine Keys, to Lower Facial Harmony.  Those first two keys were as follows:  Key # 1: Fully Developed Upper Jaw and Key # 2 Unobstructed Nasal Breathing.  We presented the rationale as to why each of these keys are the most important keys to having not only a great orthodontic result, but a much healthier life for the patient, post orthodontics.  Once the first two keys have been accomplished, the next keys can be much more easily achieved.  This article will present Key #3: Proper Forward Positioning of the Lower Jaw.

Key #3: Proper Forward Positioning of Lower Jaw

A key factor to lower facial harmony is for the lower jaw to be in balance with the fully developed upper jaw (Key #1). When this occurs, the facial balance, that results, gives a person the most attractive and healthy relationship. This allows the adult woman to enjoy a confident and attractive profile that gives proper support to her lips, and creates a natural fullness. A properly placed lower jaw, complementing this fully developed upper jaw, creates the gentleman’s ideal profile and gives him an air of strength. 

As stated in the first article, the upper jaw must be expanded to a full arch form, which can allow the lower jaw to develop to its normal size, shape, and position. It stands to reason that if the upper jaw is constricted, the lower jaw will also be restricted, in its development and placement, hence the book discusses the principle of the “trapping of the lower jaw” to restrict it’s normal development. The trapping of the lower jaw doesn’t cause a lack of growth of the lower jaw so much as an actual posterior displacement of the entire jaw. This has huge health  implications, and is a primary factor in the resulting TMJ dysfunctions so common among people with retruded lower jaws.  This aspect will receive more explanation in the next article.

These photos illustrate an example of a narrow upper jaw promoting an entrapment of the lower teeth, and jaw.

Another less common condition is when the upper jaw becomes trapped behind the lower jaw, creating an underbite.  Although this condition really relates more to the development of the upper jaw, the condition sometimes fools dental practitioners into thinking the problem is overdevelopment of the lower jaw.  This happens when the lower jaw develops ahead of the upper jaw and can cause entrapment of the upper jaw.  Therefore to help eliminate confusion, we have included this condition in this key.

Many times a frustrated parent is told by his or her dentist that the child will have to wait until he or she is at least eighteen years of age to have orthognathic surgery to set back the prominent lower jaw.  This has been the traditional approach for many years. The good news is that with the use of Functional Facial Orthopedics (FFO), these facial bone structures can be corrected because, as explained in Article #1, the human skull has viable sutures that allow for the expansion of the bone.  The next pictures show the progression of treatment of a young patient with an underdeveloped upper jaw using slow orthopedic expansion, with a removable appliance, and then braces to achieve the final result, without surgery or extractions.

The next case is a good example of how a lower jaw can commonly become entrapped during development.  This patient had an extreme overbite (skeletal Class II relationship) and a narrow upper jaw. He also had a chronic mouth-breathing habit.  The treatment plan called for orthopedic widening of both jaws, and dental arches, which would not only create the needed room for all the teeth, but also provide a better airflow through the nasal passageway. Additionally, the wider upper dental arch would release the lower jaw, that was trapped by the narrow upper jaw.  This allows it to come forward, in a very natural way, to correct the overbite and give a much-improved profile.

Pretreatment photos showing excessive overbite and narrow dental arches.  Also note the facial retrusion of the lower jaw, before treatment began. The treatment commenced with an upper Schwarz expander, an anterior bite plate, and a lower lip bumper. The expansion took about eight months, and we waited for six months for the eruption of permanent teeth before placing braces. During this time the mouth breathing stopped and normal nasal breathing was established. With the upper arch widening completed, and the mouth-breathing habit no longer present, the lower jaw began to move forward, naturally, as predicted. Once the remaining permanent teeth came in, we placed braces. The braces segment of his treatment was completed in eight months, with the beautiful result, seen below.  This illustrates the profound improvement, in the position of the lower jaw, as well as the other nine keys being achieved.

In the next article we will discuss the very important topic concerning the function of the Temporomandibular Joint (TMJ), which is Key # 4: Healthy TMJ Function.  Stay tuned.

Copies of this new orthodontic book are available from EODO by ringing (02) 83389420.

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