Why do our children have crooked teeth? It’s time for a real debate
250 years ago we didn’t have crooked teeth. For millions of years before that, we didn’t have crooked teeth. So why do so many children in the UK and the rest of the developed world now present with malocclusion (crooked teeth and jaws)?
Is this purely down to genetics or should we be looking more seriously at other factors?
For the last 6 years, I have campaigned for a debate within my profession about the causes of crooked teeth and how to treat malocclusion to achieve the best long-term result for the child (or indeed adult).
• What really causes crooked teeth and why are so many children affected when so few of our ancestors were?
• Why have childhood teeth extractions become the norm? Should this be necessary?
• Why do teeth that have been straightened become crooked again once orthodontic treatment is completed?
• What is the relationship between crooked teeth and the increasing incidence of ENT problems, sleep apnoea, temporomandibular disorder (TMD) and upper neck and back problems?
Why are we fixing the symptoms without understanding or treating the cause?
Most parents would be surprised to know that the orthodontic profession openly admits that it does not know why around 85% of the UK population has malocclusion. Traditional orthodontics is based on the premise of a genetic cause for malocclusion. Teeth that are not in the right place are pushed into the right place. Where space is a problem, healthy teeth are extracted to make room for the remainder. Major jaw discrepancies are corrected with surgery.
This approach is accepted worldwide by the orthodontic profession, and the lay public, yet it overlooks hard scientific evidence and key facts:
• Malocclusion was uncommon and mild in all our ancestors for millions of years until about 250 years ago
• Malocclusion is almost non-existent in the other 5,400 species of mammals – in fact nearly all vertebrates that are alive or ever have been
• Malocclusion is very rare in indigenous populations alive today
In the same way that we no longer believe that the earth is flat or at the centre of the universe, I think it is time for an uncomfortable re-examination of the truth about crooked teeth.
As a qualified orthodontist who has been practicing the orthotropic approach for (x) years (an approach that I teach around the world) I fully believe, based on hard evidence, that there is a better method that treats the underlying cause rather than simply attempting to fix the symptoms.
I also believe that parents should be given and understand the essential information they need to prevent malocclusion by making informed choices throughout their children’s development. These choices should allow children to reach their full genetic potential.
Challenging the accepted norm
The practice of traditional orthodontics has become an extremely profitable multi-million dollar industry. As such, the profession has naturally resisted any challenge. Particularly a challenge that questions the long term benefit of the approach.
In contrast to traditional orthodontics, the orthotropic approach seeks to correct the underlying causes of malocclusion and to provide the facial posture required for teeth to align naturally. While this method is far from perfect it is the only method that I am aware of that treats the underlying cause, as is good medicine. What’s more, it appears to be frequently gaining some of the best facial changes that I have seen, without the need for extraction.
Unfortunately, the orthotropic approach puts a huge onus on the patient to make changes themselves and this is hard work. Changing people and their environment is very difficult.
Orthotropics is a difficult and time-consuming (therefore expensive) approach that requires the ability to relate to and motivate young children. But it works. We have recently had particular success in the early intervention of children with class III malocclusion (protruding lower jaw) whohave been previously told that surgery is the only option. We are now even in the process of adjusting the method to gain improvements in adults.
What are we asking for?
My aim is that any interventional therapy should be provided as cost-effectively as possible, and that it should be evidence-based with feedback loops to maintain and improve quality.
I have proposed a possible pathological process (the method in how a disease or problem works) to describe how orthodontic issues develop. It also outlines a potential link between malocclusion and other problems such as snoring, sleep apnoea and TMD.