Aren’t airway problems just a function of people today being more obese? I might have concluded this when listening to a number of major university sleep department heads lecture in the past. If this were the only reason, why would tiny 85-pound women suffer from OSA?
Doesn’t lateral expansion resolve airway problems? I might conclude this if I listened to most lecturers on the subject today.
Aren’t MARPE, SARPE, DOME, SFOT, and other similar approaches all necessary—even essential—for success in treating airway issues? I might conclude this from surveying meetings and programs for various lectures. If this were the case, why have I and others been successful for more than 30 years without employing these treatments?
Isn’t it true that the adult maxilla cannot be expanded without surgery and/or TADs? I might conclude this if I listened to a number of lecturers and read specific articles from the refereed literature. If the adult maxilla couldn’t be expanded non-surgically, how was I able to expand my own maxilla 7 mm and my wife’s about 10 mm without doing surgery or using TADs?
Doesn’t traditional orthodontics just require some “tweaks” to get it leading the airway revolution? I might conclude this by looking at statements made by a number of well-meaning folks in the profession.
All the above questions open the door on topics which must be thoroughly understood and explored if a person is to be successful in helping people breathe better and prosper. Traditional orthodontics focuses on “treating malocclusions” as if they are separate from the body. The idea is to align teeth, often retracting them in one way or another, to make the teeth fit like gears. Facial balance is actually often ignored. Airway is rarely discussed in most articles even today, over 20 years after airway issues made it into the current discussion in the profession.
In 2017, I co-authored an article with my friend, Dr. Michael Gelb, on “Airway Centric Dentistry.” We called for a new non-retractive orthodontic approach and outlined how much of orthodontics is retractive. Our article proposed changing the entire orientation of the profession from a mechanistic approach of straightening teeth to a health-centered approach of optimizing the airway. Unfortunately, little has changed in the journals in the past 8 years.
If we truly understand that sleep/breathing problems are a function of lack of FORWARD growth of the entire face compared to our ancestors (as Harvard anthropologist Dr. Daniel Lieberman has noted in his book The Evolution of the Human Head), we would be making changes in the way we raise our children to prevent their faces from falling back. We would be promoting anything and everything which helped grow children’s faces forward. Orthodontics would have to change. What we feed our kids would have to change. Orthodontics would have to change from being a technique to address a problem (malocclusion) widely assumed to be genetically determined. Orthodontics could become the center of health care—optimizing forward facial growth and airway—to help our kids be healthier than they are today. There is plenty of evidence to support this change.
Making such a change would cause an emotional reckoning in the profession. What we have done in the past usually has not helped people be healthier—and probably caused more problems from retraction than most would imagine. Unlearning supposed “truths” would be required. Guilt for past treatment would need to be confronted. New treatment modalities would need to be learned and practiced. In reality, the profession would merely be returning to its roots of more than 100 years ago when orthodontists were treating children in the primary dentition to prevent brain damage! Check the old literature if you doubt what I’m saying. Start by Googling Dr. Edward Augustus Bogue from New York. Don’t blame me for making you upset if you wonder how we got so far away from being more of a healthcare profession to a “make the teeth fit like gears at all costs” profession.
