Thursday, August 28, 2014

Changing Facial Growth by Changing Oral Posture

The following is a guest post by Brian Hockel, DDS. After I wrote my post about Alternatives to Conventional Braces, Brian contacted me to inform me about an orthodontic method called Orthotropics®. Because Orthotropics® is so relevant to the topic of using orthodontics to encourage facial growth, I asked Brian to write a guest post about it.

When the facial growth of a child is not keeping up with the genetic potential, both jaws tend to be down and back from their ideal positions in the face. The appearance and the airway function are both affected. This isn't really caused by genetic factors so much as by environmental factors - specifically the posture of the mouth when at rest. Normal mouth posture is: lips together, teeth together in or near light contact, and the tongue firmly against the palate from front to back. When this optimal posture is present, the face will grow forward horizontally, as opposed to downward vertically. What's more, the airway will be more open, the teeth will be straight, and the teeth will have plenty of room! Historically, the problems of too much vertical growth, insufficient room for all 32 teeth (even the wisdom teeth), and the small airways which are prone to sleep apnea are ALL more recent developments. Before the Industrial Revolution, these problems were mainly limited to the aristocratic classes whose food was more refined and cooked. It is also thought that the move away from on-demand breast-feeding and the use of mushy baby food, bottles and pacifiers also contribute to the development of poor oral posture and muscle tone.

This is where Orthotropics® comes in. The goal of Orthotropics® is both to improve oral posture and function, and to convert adverse vertical growth of the face into optimal horizontal growth. This is good for appearance, good for the jaw joints, and especially good for the airway. John Remmers, MD, the sleep specialist who coined the term, "Obstructive Sleep Apnea" (OSA) said that it is a structural disease, and that if the jaws grew to their proper position in the face we would not have the disease. There's lots of other science to support this.

Appliances used for Orthotropics® (either the Biobloc or the Adapt-LRG) are very different from pre-formed or custom Functional Orthodontic Appliances. The Functional Appliances attach the lower jaw to the upper in the often misguided hopes that the lower jaw will move forward.This would include all appliances, pre-formed or custom-made, which bring the lower jaw forward by means of connecting together the upper and lower teeth/jaws, allowing a "head-gear," or pulling backward, effect on the upper teeth/jaw. This isn't to say that Functional Appliances appliances won't work to straighten teeth. They can actually do that very well. But the cost of straight teeth using these appliances is often an adverse reciprocal effect of pulling back on the upper jaw and teeth. And the result of such movement can be a risk to the airway - a risk that many doctors refuse to take. Research and experience both show that these appliances risk pulling the upper jaw even further back from its (most likely) already-too-far-back position. This only compounds the original problem, and does not address either the underlying cause of the adverse growth (rest oral posture) nor the resulting structural damage. If the lower jaw comes forward with Functional Appliances, it is a minimal amount, and the upper is sadly pulled back in a way that ultimately limits the potential for forward movement of the lower jaw - even if these appliances would bring it forward. In contrast, Orthotropics® treatment brings both jaws forward when the child fully cooperates.

Orthotropics® treatment uses the appliances as only a part of the overall treatment regimen. Remember, the goals of Orthotropics® are twofold: modify the skeletal structure AND optimize the oral posture. Accomplishing these goals encompasses much more than simply a discussion of the appliances.

Orthotropics® is among the most difficult treatment options because it requires serious cooperation on the part of the child. It's also a challenge for the parents. I know, having done it for seven of my eleven kids. For example, the child must wear an appliance that guides his jaw into a correct position, without forcing him or her to do so. It is by voluntary formation of a habit that the child learns to hold the closed-mouth posture. Except for eating, brushing, most sports, and singing, the teeth should stay in contact. Even while speaking, the habit of keeping the teeth together must be formed. So it's not going to ever catch on as the "next greatest thing," especially when the motivation of many practitioners is to minimize necessary doctor time.

Even still, thanks to the teaching efforts of Dr. Bill Hang (, Orthotropics® has not, and hopefully will not, die out. Dr. John Mew of England is the originator of the principles and the practice of Orthotropics®. He and his son Mike teach the technique in London and around the world, and Mike has put together the website Almost everyone you see in the North American map of practitioners on the website for our North American group, the NAAFO, ( was trained by Dr. Hang. The Biobloc is the name of the training appliance developed by Dr. Mew that is used most commonly, but a newer appliance called the Adapt-LGR has recently been introduced by Dr. Hang. There's no magic wire in any of the appliances, and the principles can be applied without having to use only certain appliances. Until the Adapt-LG, however, no appliance beside the Biobloc has fit the requirements.

Dentists and orthodontists might be misled into thinking that, if they only order the right appliance, they will be able to do Orthotropics®. This would be a huge mistake, as extensive training is required to avoid the many "beginner" mistakes that would follow such an approach. Many doctors have done exactly that over the past forty years that John Mew has taught Orthotropics®.

Before the ages when Orthotropics® is appropriate, and after the age when it's no longer possible, there are few alternatives to accomplish similar goals. Breathing and Myofunctional Therapy are options that can help. While the British practitioners say, "Eight is too late," most practitioners treat until later than that. By the time a child is ten, eleven or twelve, the ability to cooperate begins to diminish exponentially, and the treatment results are often not rewarding enough to justify the heroic efforts required. If sleep apnea is present beyond this point, surgical interventions may be the only way to optimally position the jaws in the face and eliminate the airway restriction. Given that alternative, the challenges and rewards of Orthotropics® are often the choice of motivated parents and their children.

Brian Hockel, DDS

1 comment:

Rebecca said...

Wow, that's great that there are other options than just pulling teeth and braces! Most dentists, sadly, have never heard of this.