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Common Myths About Orthodontics and Airway Health Debunked

There are many orthodontic myths just as there are dental myths.  Probably the most common orthodontic myth is that malocclusion is largely a genetically determined thing. There are books I’ll cover in another blog for readers interested in learning about how the environment is a much more plausible cause of malocclusion. I think an orthodontic truth should be established that malocclusion is largely environmental.  

Perhaps one of the most common dental myths is that wisdom teeth, also known as third molars, cause lower anterior teeth to crowd when they erupt. I’m unaware of even one article in the refereed literature which would support this contention even though many lay people on the street would agree that this is an “orthodontic truth”.   

Very few people seem interested in seeing myths debunked, and I’m suspecting this is why articles have not been written to do that.

Airway health is now a very important topic but there are still many airway misconceptions.    One of the misconceptions that I hear too frequently in the profession is that the orthodontic profession cannot cause airway problems and nor can they do anything to treat airway problems.  I’ve re-opened previous orthodontic extraction sites and have seen OSA (Obstructive Sleep Apnea) resolved as shown with a polysomnogram (sleep test) signed by a board certified sleep physician. I also have treated a 5 year old boy for his sleep apnea with his sleep physician confirming with a sleep test that the problem was eliminated. It is interesting to note that orthodontists were treating children in the primary dentition to essentially prevent “mental retardation” more than 100 years ago. For those interested please look up articles from Dr. Bogue. I look forward to the day when airway health facts would include information about this very issue.

In my practice people sought treatment to improve airway health for their kids all the time.   I’ve never once promised one patient that anything we might do would increase their airway.   I do believe that there are a number of things which can do this and the public would benefit from being given a list of airway health facts.  

If one were truly wanting to have orthodontics explained, they might want to know what is scientific and evidence-based in the profession. Several years ago the German government did an exhaustive literature review to see if there are long term health benefits to traditional orthodontic care. I read that the government was unsuccessful in finding any long term health benefits documented in the literature. They stopped funding orthodontic care.

There is growing concern in the profession regarding the inadequacy of polysomnography (traditional sleep test) and many people are discussing how home sleep tests can be an alternative in some cases. Having said that, there are many in the industry who question the entire efficacy of sleep tests. I believe tools which may become more useful in the future will include autonomic testing which specifically focuses on heart-rate variability and DISE (drug induced sleep endoscopy).   

I’ve said for years that we are truly in our infancy understanding sleep disordered breathing, quantifying it, and having easy to do and highly successful, predictable treatments.

FAQs About Common Myths About Orthodontics and Airway Health Debunked

What are the most common myths about orthodontics?
Probably the most common myth about orthodontics is that there is a broad base of science documenting that malocclusion is genetically determined. I have not seen one article confirming this “truth”. I believe that the Angle Classification of malocclusion (Class I,II, III) is viewed as being scientific and a reality. I’m unaware that anyone has ever scientifically validated it. Another very common myth is that Class II patients (those with so-called “buck teeth”) frequently have upper teeth protruding. An article in the refereed literature in 1981 casts severe doubt on that. Books by two PhD anthropologists would find that the teeth in such patients not only don’t protrude but are actually not far enough forward. I believe that most orthodontic residents leave their residency essentially feeling that malocclusion is isolated and not related to any other body problem. I think there are things in the literature going back to the 1800’s (at least) which would suggest an intimate connection of the teeth and jaws to the rest of the body. Indeed, I believe that dentistry/orthodontics should be the center of health care. The way things currently are, it is not.
One of the saddest misconceptions is that orthodontics can’t affect the airway to damage it and also cannot do anything to help it. Orthodontists more than 100 years ago were treating children in the primary dentition to help improve the airway to avoid brain damage in kids. I’ve personally seen cases where I believe treatment has made an airway worse and also has made it better. I have worked closely with sleep physicians and cite their sleep studies and personal comments as evidence to support this. For those who want to learn about airway health look for books by Patrick McKeown and James Nestor.

I believe we live in a very dangerous age when false information is everywhere. Just as dangerous as that information might be, I firmly believe that many who are concerned about false information wish to either silence anyone who disagrees with their position or have others pass laws to do that very thing. False information is a hot item in the popular press and orthodontics isn’t immune from it.    

As the son of an engineering professor who was a skeptic about many things in life and sought scientific proof for pretty much anything important, I pretty much grew up as a skeptic. In my lectures I openly announce and encourage everyone to be a skeptic of what I say and what every other lecturer says.  As many others have said in the past, “If it sounds too good to be true it probably is.” I invite you to be skeptical of everything I am writing that you are currently reading. I also invite you to do the same for everything you read. At the end of the day you have only yourself to trust that you’ve done all the proper research for yourself to draw your own conclusions.

Braces are not only for teenagers. I believe that they have use in children who are in the primary dentition (prior to age 6) and adults, as well.
Most orthodontic treatments do not require surgery. Surgery is a necessary treatment for patients who have NOT had the advantage of earlier treatment to improve their rest oral posture and have lived a life with their teeth not together, their tongues not to the palate, and their lips not together at rest. George Catlin wrote a book about this in the mid 1800’s and described how faces fell back from their ideal forward position when people hung their mouths open. Patients whose faces have fallen back due to a lifetime of poor rest oral posture may have no other option than surgery to move both jaws forward. I treated hundreds of such patients in my career. I also treated children as young as age 3 in an attempt to prevent the need for surgery. I never promised results. I believe it is possible with early orthodontic treatment to save many patients from needing surgery if the proper treatment is done to optimize their rest oral posture. Many would disagree with me. I invite skepticism and would love to see open debate on this issue.

Some airway issues actually can resolve without treatment, however, that doesn’t mean there may not be consequences. As an example, if a child has very large tonsils and/or adenoids they may shrink as the child gets older. But there are 2 problems! The first is that the child may have sleep apnea which causes irreversible brain damage. The second is that the child becomes a habitual mouth breather which changes the facial growth to down and back. This direction of growth tends to make the airway smaller which may contribute to sleep and breathing issues in the future.

To me these are 2 excellent reasons to treat airway issues as soon as they are recognized.

Orthotics are actually not for cosmetic reasons. In dentistry they are generally part of a protocol to treat TMJ/pain/dysfunction problems. I believe the consumer needs to know that there are many differing opinions on this very subject. There are strong voices in the profession who would say that an orthotic is not needed and TMJ problems are “bio-psycho-social” or terms to that effect. There are others in the profession who have decades of success in treating such patients with orthotics. I am not an expert in orthotics but have seen very successful treatments when others have used them in treatment. I believe every consumer should do their homework in finding answers that make sense for them.

Misinformation can lead someone to seek treatment that won’t resolve a given problem. Misinformation can also cause someone to NOT undergo treatment which has a good chance of helping. I’ve seen too many examples of both in my career.    

Be skeptical of everything. Educate yourself. Make your own decisions about your own health. One of my mentors, the late Avrom King, stated, “Everyone has a built-in crap detector. Trust yours when it goes off.” I’ve tried to heed this advice and advise everyone to do the same.