Orthodontic clinicians in the past have been severely criticised by scientists for ignoring the scientific evidence. Here are some of the comments about orthodontics from world scientific heavyweights they are:
“behind homeopathy and on a par with scientology” (Sackett 1985), their work is “based on trial and error” (Johnston 1990), the schools “teach technical skills rather than scientific thinking” (Richards 2000), “Sadly it is hard to see this situation change unless the inadequacy of current knowledge is acknowledged” (Shaw 2000), their treatment of crowding “treats a symptom, not the cause”. (Frankel 2001).
Orthodontists are taught that the size and shape of the jaws is inherited and most of their treatment is based on this belief. Clearly if the teeth were too large for the jaws some teeth would have to be extracted but there is almost no evidence to show that this is true.
Many orthodontists consider crowded teeth are caused by interbreeding between humans with different sized jaws. Biologists do not support this view, and even if a 100 kg Great Dane were crossed with a 1kg Chihuahua the offspring would be unlikely to have a malocclusion. There is evidence to suggest that the size of the teeth and jaws is inherited, but little to suggest that disproportionate growth is.
Some orthodontists believe that evolution has caused jaws to become smaller over the last few thousand years (Walpoff 1975). Certainly crowding has got worse, but this has been mostly within the last 400 years (More 1968), which is far too short a period for an evolutionary change. Also an evolutionary change would have to start in one area and spread, but irregular teeth are found all over the world, wherever people take their standard of living above a certain level.
Despite this overwhelming evidence, most orthodontic treatment is still carried out on the basis that disproportionate jaws are inherited and that little can be done to change them. Based on this belief and in contradiction to the evidence the teeth are moved into line mechanically usually coupled with the extraction of either four or eight permanent teeth. If the jaws are in the wrong position orthodontists may recommend that they are cut and corrected surgically. Many thousands of children and young adults have this surgery each year although a substantial proportion of those who have been told that surgery is the “only answer” have subsequently been corrected with Orthotropics. Despite this surgeons are refusing to tell there patients that there might be an alternative.
Iatrogenic Damage caused by ‘Train Tracks’.
Scientists have clearly shown that ‘train tracks’ can damage both the roots and the enamel. “Over 90% of the roots of the teeth show signs of damage following treatment with fixed appliances”. (Kurol, et al 1996). “40% of patients show shortening of more than 2.5mm”. (Mirabella and Artun 1995). This is a substantial proportion of the root length and must shorten the life of the teeth. Enamel damage, with fixed appliances, is rapid, widespread and long-term. (Ogaard et al 1988) (Ogaard 1989) (Alexander 1993).
All orthodontists accept that faces can be damaged by inappropriate treatment but they disagree about which approach will cause least damage. “The maxillary retraction associated with ‘train tracks’ (Edgewise) contributes to the poorer aesthetic result.” (Battagel 1996) and may be “accompanied by exaggerated vertical facial growth”.
It is known that ‘Train Tracks’ tend to lengthen the face (Lundstrom,A. &Woodside,D.G. 1980) and that longer faces look less attractive’ (Lundstrom et al 1987). However there is little sound research to establish how often or how severe the damage may be.
Twins who are genetically identical still show more contrast in the shape of their jaws than any other part of their skeleton (Krause 1959) showing that much of the variation is due to non-genetic environmental factors such as open mouth postures and unusual swallowing habits that distort the growth of the jaws. Orthodontists in the past have found it difficult to explain why modern children have so much malocclusion but the following new hypothesis appears to fit the known facts better than those put forward previously: –
“Environmental factors disrupt resting oral posture, increasing vertical skeletal growth and creating a dental malocclusion, the occlusal characteristics of which are determined by inherited muscle patterns, primarily of the tongue” (Mew 2004).
Most children with sticking out front teeth are treated by pulling them back. However, if you look at the side of such a child’s face, you can see that the fault is often their lower jaw which is too far back (see Antonia below). Almost all orthodontists pull back the top teeth in this situation risking an increase in downward growth with subsequent damage to the face. It is important that prospective patients are warned of this risk, because little research is being done to establish how often it occurs. However Antonia had Orthotropics to take both her upper and lower jaws forward.
In conclusion, space to align the teeth can be provided by extractions and ‘train tracks’ but the crowding is likely to return, especially of the lower front teeth (Little 1988). There is also a risk of damage to the teeth and face. Orthotropics aims to avoid extractions by early correction of the cause rather than later treatment of the result, but is highly dependent on the ability of the child to learn to keep their mouth closed.