Functional Orthodontics

Introduction

Our view at Boise Integrative Dentistry is that the majority of orthodontic problems are caused by improper placement and/or function of the tongue. Ideally, when at rest, the tongue should sit fully on the roof of the mouth, pushing up on the maxillary bones forming the hard palate. During swallowing, the tongue should also push up towards the roof of the mouth and move food down the throat. When the tongue is low during rest or swallow, or a person breathes through their mouth, the soft palate must elongate to prevent food from going into the nasal cavity. A long soft palate is a risk factor for sleep-related breathing disorders. The pressure of the tongue on the teeth in any other place than the roof of the mouth can cause crowding of the dental arches, open bite, or incorrect growth patterns in the lower jaw. Different types of tongue dysfunction or placement lead to different presentations of malocclusion or changes in facial growth.

Mouth breathing and tongue posture problems can cause changes in the overall body posture, especially moving the head forward and placing stress on the neck. In addition, the dental arches can become crowded or uneven. While dental crowding is often the chief concern of parents, it is a visible sign that the structures of the face and airway are not developing ideally.

Myofunctional orthodontics involves the use of removable and semi-removeable appliances and/or exercises that affect not only the teeth but the posture of the jaw and encourage ideal growth of the face. This is done through light expansion of the arches and improvement of tongue posture. The actual treatment plan necessary will be determined by the degree of crowding or tongue dysfunction and the age of the child. Since studies show 90% of the growth of the head is completed by age 12, it is very important to identify problems as early as possible and correct the underlying issues causing these problems.

Goals of Treatment

The goal of myofunctional orthodontics is to improve development of the face and airway through creating an ideal resting and swallowing posture of the tongue. In addition, our appliances and treatment modalities work to expand the dental arches and improve the position of the lower jaw, thus improving the airway. Consequently, the majority of patients end up with straight teeth when the tongue function is corrected. Those who need braces in the future usually find the corrections necessary are minor and take less time than those who did not have myofunctional orthodontics. In addition, ideal tongue and swallow posture reduces the risk for relapse and crowding in the future.

Treatment Times

Active treatment time can be between 12-24 months, with appliances often being worn longer during retention. Recommended treatments will depend on the degree of severity of crowding and symptoms, as well as the patient and family motivation.

Treatment Options

Tongue Habit Correction

Habit correction only with Healthy Start. This usually involves the use of 1-2 appliances and 6-9 months of treatment. This treatment is best utilized using a myofunctional therapist to aid in exercises to correct tongue posture but many kids will achieve improved tongue posture with the appliance alone. Treatment involves getting records, selecting the correct appliances, and monitoring usage for 3-6 months. Treatment modifications and referrals may be necessary to achieve success with the habit correction.

Healthy Start

ALF

Treatment with Healthy Start can commence between 3 and 12 years of age. The best time to start is before age 8 in order to capture growth, however benefits can be seen at all ages. Habit correction is the first phase of Healthy Start. Once the patient is able to wear the habit corrector 2-4 hours during the day and all night for at least 30 days we can move into the Healthy Start Occluso-guide phase. These appliances encourage proper tongue and swallowing posture while moving the teeth into proper position. Healthy Start claims have shown 90% of kids who wear these appliances for the recommended period of time do not need braces after treatment. In cases needing significant expansion, we may recommend an orthodontic expansion device prior to or while in treatment with the removable appliances. Visits are also made on a monthly basis during active treatment and then longer intervals once initial correction has been made.

Healthy Start has a strong emphasis on sleep-related breathing disorders and the signs and symptoms associated with these problems. We monitor these signs and symptoms as treatment progresses to make sure they are improving. When a child is not progressing we may need to refer them to the Ear, Nose and Throat (ENT) physician, functional medicine physician, or allergist.

Advanced Lightwire Function (ALF)

ALF

Advanced Lightwire Function treatment has the advantage of providing slow, physiologic development of the dental arches, face, and airway. The ALF was developed by Dr. Derrick Nordstrom while considering the osteopathic principles of light force to generate cranially-friendly and significant changes in growth. ALF treatment can start at any age, but younger patients see the most rapid changes. ALF treatment benefits from myofunctional therapy and cranial osteopathy after a very comprehensive medical, dental and health history. For more information on ALF please see our ALF fact sheet. Except in very mild cases, ALF is almost always the recommended treatment in our office because it provides the physiologic expansion and development, plus helps shape the growth of the jaws, face and head in 3 dimensions.

Phase 2 Treatments

After Healthy Start or ALF has been utilized to gain proper tongue and lip posture, closed mouth breathing and arch development, a variety of options are available for phase 2 finishing. Finishing means placing the teeth in an ideal esthetic and functional position. Often the teeth are close to where they need to be prior to finishing and in many cases, when the tongue and lips function correctly, no finishing is necessary. However, we cannot and do not guarantee perfectly straight teeth after phase 1.

Phase 2 can either consist of metal braces or clear aligners. With each treatment we take great care to not undo what was gained during Phase 1 treatment.

Retention and Follow-up

After the active phase of treatment, we will recommend a follow-up interval. The purpose of follow-up is to determine the stability of treatment and make adjustments or referrals as needed. Active treatment will be estimated before treatment is started. However, as each patient is very different, the final active treatment time can be affected by patient compliance and many other factors. Often, follow-up can be completed during hygiene examinations or 3-6 month intervals. In general, if an optimum swallow, tongue and breathing posture can be established then less relapse is seen. In some cases patients will need a retainer, in others they will not.

Referrals and Additional Treatment Procedures

One big advantage to our office is the network of referrals we can offer to deal with muscle and joint pain, food inferences and functional medicine, and sleep and breathing problems. Your child may be recommended to see one of our specialists in a different area to achieve maximum medical benefit.

Many children can achieve correction of myofunctional habits through use of appliances and our office myofunctional therapy. Some very difficult cases may be referred to an outside myofunctional therapist. This is outside the fee structure at our office and fees will be determined by the therapist you choose to work with.

We are very big believers in the benefits of cranial osteopathy and craniosacral treatments by qualified practitioners. We believe the body has an amazing capacity to heal when impediments are removed and optimal function is encouraged.

In addition, there are children who also have restrictive frenum attachments of the lip and/or tongue. Revision of these restrictive frenum attachments may need to be done at our office.

First Steps

Treatment can begin as early as 3 or 4 years old. We start with a one-hour appointment for a comprehensive orthodontic examination, photos and impressions. We may also advise an image of the patient, either a panoramic or 3-dimensional cone beam image. The examination is usually not covered by insurance and the imaging may or may not be covered. We will provide you with an estimate before starting treatment. Within a week you will receive a review of the findings, as well as a recommended treatment plan.

Who is a Good Candidate for Myofunctional Orthodontics?

Most children in modern society could benefit from myofunctional orthodontics. If you want to improve your child’s growth and development of the head, face and airway it is a great option. Myofunctional orthodontics also aims to treat the root cause of crowded teeth, which means there is less likelihood for relapse (the return of crowding after treatment).

Who is not a Good Candidate for Myofunctional Orthodontics?

Myofunctional orthodontics requires compliance from the patient in wearing their appliances, eating the proper food, and sometimes doing exercises to compliment treatment. If you do not think your child can do these things on a consistent and regular basis, myofunctional orthodontics may not be the right choice. There are several excellent orthodontists who can provide treatment with wires and brackets that are not able to be removed from the mouth. If there are any questions about which treatment is right for you, we encourage you to get an evaluation. Finding the right orthodontic treatment is a big decision and everyone (parents, child and the dentist) should be on board with the goals and necessary changes to lifestyle that are required for a successful outcome.

Final Thoughts

The dentists and staff at our office fully believe in the value and improvement in health that can be achieved through myofunctional orthodontics. In fact, Dr. Bruce has treated himself and all his family this way. We are constantly learning and evolving in order to make the treatments more predictable and beneficial for patients through yearly continuing education in these areas. Orthodontics is a big decision and we believe in thorough evaluation of medical history, structure and function of each individual person in order to provide personalized treatment recommendations. We are very grateful to be part of this journey to wellness for you and/or your child.