My formal orthodontic training taught me that long faces and narrow maxillas were predominantly genetically determined. My CE journey has led me to believe otherwise.
Narrow maxillas and long faces are not primarily genetic. They result from poor rest oral posture. When the tongue rests low in the mouth, the cheeks push inward and the tongue fails to push laterally. The result is a narrow maxilla.
Correcting posterior crossbites and decreasing resistance to airflow through the nasal passages have historically been the goals of orthodontic expansion. That is a good start.
The late Dr. Christian Guilleminault, Stanford University Sleep Clinic Director, was correct in making the true goal of treatment the establishment of 100 percent nasal breathing at rest.
Only when the tongue can comfortably fit in the palate at rest, supported by a broad maxilla, can we achieve this outcome.
My orthodontic training never considered expansion of the mandible since it has no midline suture. We were told that expanding cuspid width would push teeth off the bone.
In the mid 1980s I met an orthodontic department head who was expanding the mandible dramatically. I followed his lead for my own children and have since expanded adult mandibles—including my own and my wife’s—successfully and significantly.
Even today, orthodontists and dentists often avoid mandibular expansion. By not expanding the mandible, they limit the potential of maxillary expansion.
If we truly want to help our patients, both children and adults, we must expand the maxilla and the mandible. Only then can we create sufficient room for the tongue to rest in the roof of the mouth, which facilitates proper oral posture and nasal breathing.
