Overjet, surgery and braces - alternatives

I’ve read a lot on blogs and forums lately about people who are about to undergo surgery for their overjet. First and foremost I wonder why they didn’t get treatment earlier (around age seven) but that’s a topic for another blog post. Something that seems very common is to wear braces for overjet for a very long time, usually with rubber bands, after which the orthodontist gives up and says, “nope, this didn’t do anything, you’re going to need surgery”.

Functional orthodontists, however, claim that an overjet can’t be corrected with braces alone (and certainly not combined with tooth extractions) so according to them that would be a waste of time. In cases when traditional orthodontists believe they have solved the problem, they have instead created an illusion and an even worse functional problem has been produced.

You could die trying to move the teeth around in order to take care of an overjet but it’s not going to help since it’s a skeletal issue. The teeth are not to blame and should be taken out of the equation.

This is why I am an advocate for functional orthodontics. Read here what my guru Tooth975, a functional orthodontist who works for Yahoo Answers, says about this matter.

ALF, Crozat and Schwarz are all examples of functional appliances that are used to broaden the upper arch in both adults and children. They are sometimes also used to expand the upper jaw forward. The lower jaw can be brought forward by using a splint. Please note that these appliances don’t move the teeth but instead they focus on the jaws which is the right way to go! You might need braces afterwards but this final touch usually doesn’t take too long.

Go on to this post.

Here, Tooth975 explains how the lower jaw has to be guided forward by stretching the muscles. This may sound strange to somebody who hasn’t dealt with these problems themselves. The best way to explain this is that the lower jaw can sometimes “hang” too far back even though there is enough bone for a non surgical approach to work.

Furthermore, Tooth975 (I know, gotta love him, right?!) says that surgery should always be avoided if possible. Sometimes it’s necessary of course but in most cases the problem could also have been prevented if it had been dealt with at an early age.

It seems relevant to discuss if too many people are recommended to have surgery. If the only alternative presented is extraction/retraction orthodontics that only camouflages the problem and doesn’t solve it, this is a very serious matter. Recovery time after surgery is several months and there is always the risk of loss of sensation in the lower lip. Some patients lose a lot of weight because they can’t eat normally for a while. Not to mention the physical and emotional suffering involved. However, here in Sweden, this is what the county council and national health insurance are willing to cover.

Researching braces treatment

Something that has been bothering me a lot all these years is the fact that almost nobody seems to fully understand their orthodontic treatment. You ask them why they had it done and they say, “It was something with my bite,” or, “There wasn’t enough room for my teeth”. However, peoples’ expectations of how the whole thing should be solved, why the problem occurred in the first place and the final outcome seem very vague. They put their entire fate and the responsibility in the hands of the orthodontist. I am no exception myself. I trusted the experts, I didn’t have to understand, or so I thought. They had been treating patients with these methods since the beginning of time, of course they knew exactly what they were doing! I have regretted having that kind of trust in them about a thousand times since then. I don’t think I will ever stop asking myself: “Why didn’t I ask more questions? How could I accept that there weren’t any alternatives?”

In this clip, Dr. Hangtalks about all of this. When he explains how the Biobloc treatment is going to turn out, he does it carefully so that the patient and the parents will understand. When the whole method makes sense to you, only then can you decide to have it done. Otherwise you shouldn’t accept treatment. I quote: “The last reason in the world to make the teeth straight is ‘because the doctor said so, we didn’t really get why but he’s the doctor. He should know!’” Dr. Hang had teeth pulled and braces himself as a kid but he never got the concept behind the treatment, he doesn’t remember and neither does his mom. Everybody wore braces! He now realizes that you have to ask yourself the big Question: “Why am I having this done?” If you are smart, you try to understand, he says and I couldn’t agree more. It doesn’t matter if you are an adult who are looking for braces treatment or if you’re researching this on the behalf of your child. Understanding is the key!

From extractions/braces to jaw expansion - the transition

I just listened to an 8 minute long radio recording with Dr. William Hang who has lately become my guru. He is one of the few orthodontists out there who try to solve the cause behind crooked teeth by fixing the jaws first. I have to say I am completely taken by this interview! This is the first time I hear Dr. Hang talk and it is almost as if he has read all the different thoughts I’ve had for 17 years (that is, ever since I had my braces removed).

Dr. Hang explains how he “converted” from extraction/retraction orthodontics to what he does today (mainly expansion of jaws and bringing them forward). Even Dr. Hang was once “on of those who recommended that you had teeth pulled”. But today he doesn’t even want to look at these people, it makes him shudder. He didn’t realize back then how bad it really was and how much damage that kind of treatment can do.

In the middle of the transition he still had a couple of patients who were undergoing traditional treatment and of course he had to finish what he started. He tells us how his pulse started to accelerate as he saw their names on the schedule. He almost had anxiety attacks and it was all very difficult for him. I am so impressed that he had the courage to break lose, that he was so far ahead of the others and that he later on had the strength to admit to himself and the public that this was wrong.

He also talks about women he met who had teeth pulled and braces and who look back at the result and say, “I don’t like this, not even a little bit!” One of them even said, “My life was over at 13. When I had my braces removed and saw myself, my life was over.”

This almost brought tears to my eyes. For 17 years I thought I was crazy! I have never liked how my mouth turned out or felt and I have hated what the orthodontic treatment did to my face. But I have never heard of anybody who feels the same way. My experience was very vague and I didn’t understand what was wrong, I couldn’t explain it. This is what it must feel like to suffer from a disease that doesn’t have a name yet and is suddenly recognized one day. An awakening, an aha moment. It is an incredible relief! 

Teeth that are shifting

I've come across many forums where people complain about shifting of teeth after braces have been removed. Either they forgot to wear their retainer or the bonded retainer wire on the back of their teeth fell off. It surprises me that almost no-one asks why this happens. Are we just supposed to accept that this is how things work? I remember questioning this before I did my major research. I used to say to myself, "What's up with this, an unstable result? What have I let them do to my mouth?" I at least wish they would've explained things before treatment. Some people still don't get this information and it's upsetting to me. In my opinion having to wear a retainer for the rest of your life involves a big risk. Let's say I go on a trip where I travel for more than 24 hours and my sleep is irregular for a week or so due to jetlag. Or if I get a kid and forget to wear the retainer for  a couple of nights because of the chaos that occurs. Or if the bonded retainer falls off while you're on a trip (I had this happen recently).

Before I did my research I asked a dentist about shifting of teeth after the wire fell off and she told me the whole thing is one big experiment. Orthodontists ask themselves if the number of years you wear the retainer is related to whether they will shift or not. After reading a lot about the topic I found a whole bunch of American websites that stated that if you don't solve the jaw problems (that almost always seem to be the culprit to begin with) the amount of time that you wear the retainer will be of no importance and that life-long retention is the safest. I would rather solve the underlying problems! Such techniques exist too, and they have been available for decades. But instead they choose to aggravate the problem. Seeing it from that perspective, I don't blame the teeth for wanting to return to their original position! ;)
 

I found a blog written by a person who lost her retainer and her teeth started shifting right away. She went back to the orthodontist to consult them and they said they made a mistake by not removing teeth because of crowding. Like that was the reason for the shifting. Where did that statement come from, was it just a wild guess? From what I've heard risk of shifting increases if you have teeth pulled. This is because the dental arches are made smaller leading to decreased tongue space among other things.
 

How about at least providing the patient with some theories. Or are they trying to evade the fact that they ignored a big problem with the mouth that still remains?

Retainer forever? We'd prefer teeth that are not kept in place by a "bandaid"! 

Adult braces and pulling teeth

I get extremely upset when I think about the fact that the government paid for something that might have damaged more parts of my health than I can imagine. (For example, my weird blood pressure and heart palpitations could be related because that's what happens when you can't breathe properly at night.) This is probably going to cost me at least 15.000 dollars (possibly more) to fix. I want treatment immediately but I realize it's not possible. I must make up my mind first about what country I want to live in.

I have surfed around on some blogs written by people who wear braces. Most of them are teenagers and adults and a lot of them were adviced to have teeth pulled. It's sure is strange that extraction orthodontics is so big in Sweden when the side effects have been discussed in the USA since the 1980's. Anyway, I have commented on blogs written by people who didn't yet go through with the decision. When commenting I always try to be humble, saying stuff like, "it never hurts to be aware of the debate".

Maybe I should stop doing this though? It doesn't seem like I can get through to them. They trust their orthodontists completely. It is just very hard when you see pictures of very mild crowding and know that extractions were suggested even for those. I know all too well that my words might not matter to them. They so desperately want to believe that this simple offer of free orthodontics will solve the matter. I think it's wishful thinking that traditional braces with extractions will take care of everything and that there are no side effects whatsoever.

I can only speak for myself but I do due diligence before I have anything done. Google is my friend. When I had my orthodontics done there was no Internet to help me (well, it did exist but nobody was aware of it). One glance at Facefocused.com would have made me turn down treatment for sure.

Traditional braces - friend's glad she never wore them

I went to dinner at a friend's place last night and we started talking about how much her crooked teeth bothered her. I started talking about what I've read lately, that you shouldn't extract and/or retract teeth in orthodontics because it can damage the profile, the bite, the position of the tongue and the position of the jaw joint (TMJ) but that this is still done in many cases. She was shocked and said, "Are you SERIOUS?" I told her about Weston A. Price and how he found the reason for crooked teeth and that traditional orthodontics don't take care of the real problem and can make everything worse.

Then I told her that you will usually need bonded retainers on the back of the teeth for the rest of your life to keep them from shifting since the result is so unstable. "Are you SERIOUS?" she said again. She couldn't let the topic go. The more I told her the happier she was that she had never worn (traditional) braces.

Later we started talking about children and that they often wait until they are fully grown here in Sweden which is the wrong thing to do. She had relatives that had to wear braces and pull out an eye tooth (a canine tooth coming in in the roof of the mouth) and when I told her that kind of scenario can often be avoided if you guide the growth of the jaws at an early age she was really surprised that more people aren't aware of this.

We then started measuring each other's intercanine width and laughed like little girls. "Ok, let's measure yours, oh my, your upper jaw is too small!" "Are you supposed to have that big of a jaw, that's huge!" (The norm is 40 mm for both men and women.) We measured the distance between the nose and the front teeth (according to Dr. Hang and Orthotropics practitioners). Her distance was too big but mine was of course bigger. We laughed again. But then we got serious once more. We discussed how I'm going to reach out to people? I don't know if most people wouldn't care about their health to get straight teeth but that they might not disregard the fact that these retraction methods cause double chin, bigger nose, damaged profile and treatment relapse? I gave her some links for further research.

Imagine if this could have been avoided at an early stage. I'm sure this person would've been thrilled.

Types of orthodontic appliances

I have read more about orthodontics than is healthy for the brain. Slowly an opinion began to take shape, an opinion that is based on something I've felt all along: "Why only consider the teeth, that they need to be straight, if they don't fit the face, if the face loses its shape, if the profile is damaged?" And: "Why defy the body, nature itself, when it's the most brilliant machine that exists? Why torture people for years with uncomfortable and sometimes horrible appliances?"

These thoughts make me very upset, especially at this age because I've started thinking, "What if I get kids, how do I deal with these things? I can't make it go through just anything." But now I know everything worth knowing about new findings and that it doesn't have to be this way. You don't need to wear the worst appliances available for it to work. The less bulky ones usually work better because they take advantage of the body. It really makes a lot of sense! The body wants to change, to correct itself, but only if it's done in the right way. Furthermore, you don't have to choose between straight teeth and face/function because the good techniques improve the facial appearance and the mouth!

ALF or RPE - which would you prefer? Do you believe me when I tell you that the thin, discreet thing to the left solves more problems?

First and foremost, to not take the entire head and the shape of the jaws into account is often pointless. That's not the way to solve a problem. For years I have been telling myself, "Wow, people who used to wear braces sure have flat faces! And narrow smiles!" and now I realize that I wasn't the only one having these thoughts even though for the longest time I thought I was.

Though bothering too much about the cosmetic part isn't necessary because it comes as a bonus along with all the other advantages with functional orthodontics (functional appliances and braces for adults) and orthotropics (facial growth guidance for kids). TMJ problems, headaches, neck pain and sleep apnea are all serious things, (in my opinion far more serious than wearing out a tooth or two which are often the argument for orthodontic treatment). They are all things you want to avoid. The aesthetic part is related to them though since we humans tend to be able to judge from the appearance of a person if they are healthy or not. Someone who has their chin very close to their neck probably has breathing difficulties. To make the mouth smaller and pushing everything backwards doesn't solve any problems, it makes everything worse.

To guide the growth of the face isn't synonymous with torturing people. In most cases there is no retraction involved. The facial profile should be convex. It improves the airway (trust me, I know all too well what it's like not to be able to breathe properly). The whole purpose is to help the body become as it would have been had it grown correctly.

If I had to make a choice on my child's behalf between crooked teeth or moving everything backwards I would pick crooked teeth any day. As far as I'm concerned, health and a beautiful face are more important than straight teeth. Luckily there are methods where you don't have to choose. Sadly, they're not very commonly used.

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