FUNCTIONAL ORTHODONTICS

Orthodontic Treatment for Every Age

Though many people think of orthodontics as "straight teeth", Functional Orthodontics, or Functional Jaw Orthopedics (FJO), addresses the function of the whole dental system, including the jaw joints, bite, teeth, and related musculature. Approaching treatment from a whole body perspective provides a vastly enhanced experience of orthodontic treatment.

Babies: Measures toward orthodontic health can begin at birth for the child. Through the early years, there are many important factors that impact the health and future of a child's orthodontic state.

Young Children: An early phase of treatment is aimed at establishing proper muscle function and aligning the jaw bones so that optimal development can occur. Enivronmental factors (diet, habits, posture, etc.) should be addressed with this phase as they play an equally important role in healthy development. The goal of this early treatment is to reduce future orthodontic needs.

Teenagers: Teenagers have most of their permanent teeth in and more mature jaw bones and structure allowing more specific orthodontic needs to be addressed. The use of functional appliances is the usual method of treatment with minimal use of braces.

Adults: With fully mature jaws, orthodontic treatment for an adult may take longer than for a teenager, but the treatment is rather similar. As the adult jaws are no longer developing, changes do not occur as rapidly, but the result of a beautiful, healthy smile is well within reach.



Orthodontic Analysis- Why we measure what we do. Orthodontics For Your Child
Considerations in a Whole Body Approach Adult Orthodontic Treatment



ORTHODONTICS FOR YOUR CHILD
What every parent should know before treatment begins.


The Purpose of Treatment

There are many reasons for seeking orthodontic treatment for your child. It is either recommended by their dentist, or initiated by a concern you may have. Recommendations generated by their Dentist are usually more health related (The concern is a "bad bite"). Parent or Child concerns are usually more esthetics oriented ("My daughter's front teeth are crooked"). Be sure that you understand and agree with the purpose of the treatment. In the case where complete care is desired, both health related concerns and esthetics related concerns should be addressed. If any compromises to ideal results must be made, they should be stated and agreed upon before treatment starts.

 

Treatment Timing

When to start treatment is dependent on both the type of problem, and the orientation of the Orthodontist. As a general guideline, I find the following useful. From ages one to eight, the emphasis should be on identifying and correcting causative factors like thumb sucking or mouth breathing. Some orthodontic treatment may be done at these earlier ages, but it rarely involves braces. From ages nine to twelve, treatment focused on correcting the dental foundation should be started. This is usually done with retainer-like appliances that focus on correcting the overbite, or relieving crowding. Any treatment that begins after the age of twelve, when all the permanent teeth are in, must deal first with correcting causes, then with the foundation. Only after these are done is one ready for "braces", which are the most effective at "straightening" the teeth. Keep in mind that excellent results are achievable regardless of age, it is just that you want to combine the best techniques with optimal timing to get that "picture perfect" smile.

 

Types of Treatment

The type of treatment will vary as no two children have the same orthodontic problem. There are some fundamentals that apply regardless of the type of problem. First, the approach to solving your child's orthodontic problems should be based on "Functional Orthodontics". This approach organizes treatment in what I feel as a Dentist, Parent, and Orthodontist is the very best. The steps in treatment involve identifying and resolving the cause of the problem, developing arch form and correcting skeletal relationships, and finally, straightening the teeth. This order to evaluation and treatment consistently produces the best facial esthetics and the most beautiful smiles. The treatment modalities to be avoided are bicuspid extractions and headgear. These types of treatment adversely effect the face or smile and have no place in Functional Orthodontics, let alone your child's face. I feel so strongly about this that I recommend that even if you have already started treatment and find that the Orthodontist wants to add headgear, or suddenly pull teeth, seek another opinion before you go on.


Causative Factors

As "Crooked Teeth" and "Bad Bites" are the visual effects of improper development, their causes usually begin very early. Most children had the same type of orthodontic problems in their baby teeth as they have in their permanent teeth. With the baby teeth being much smaller, there is less evident crowding, so it doesn't get noticed. This is why it was mentioned above that early treatment should focus on resolving the causes. The things that you as a parent can watch for are mouth breathing, snoring, lip biting, thumb or finger sucking, headaches and allergy problems. With any of these present, a consultation with the Orthodontist should start the process of resolving them. Needless to say, if your child were to suck his/her thumb after orthodontic treatment, the crooked teeth would return. Therefore, it is very important that the cause be identified and resolved before or during treatment. This should be discussed in detail due to the importance of eliminating causes to prevent relapse after treatment.


About "TMJ"

"TMJ" stands for Temporomandibular Joint. Everyone has one in front of each ear from which the lower jaw hinges. Improper jaw relationship causes "TMJ" problems and all of the related health issues. Therefore, establishing proper jaw relationship during treatment is extremely important. Since orthodontic treatment can both cause, as well as cure, TMJ problems by changing the bite, it is very important that this issue be discussed. If you are not completely sure of the Orthodontist's position on this issue, it's time to find someone else. In my experience, less than one in ten Orthodontists are knowledgeable about TMJ. The symptoms of "TMJ" problems include clicking or popping of the jaw joints, pain in or around the ears, ringing in the ears, headaches (including migraines), sinus conditions, neck and back pains, and many others. Many of these symptoms do not show up until one is older, so measuring now is extremely important. The Functional Orthodontics approach is to include evaluating the jaw joints as part of the diagnostic regimen and making sure that the orthodontic treatment creates the healthiest possible joint relationships.


What Is Involved In Treatment

All treatment methods involve a partnership between the Orthodontist and the Patient. Each has certain responsibilities throughout the treatment. Be sure that you understand what you and your child's part consists of relative to treatment. Functional Orthodontic Treatment usually involves several different appliances to correct your child's problems. Removable appliances (retainer-like devices) to relieve crowding and correct the bite are usually the first step. Braces are usually the last step of active treatment. The important part is picking the proper tool to best deal with each problem, then have everyone work together to assure the ideal result.


Our Goals
Beautiful Face
Straight Teeth
Radiant Smile
Healthy Teeth, Gums & Jaw Joints

 


ADULT ORTHODONTIC TREATMENT
What to know Before Treatment Begins


The Purpose of Treatment

Be sure that you understand and agree with the purpose of the treatment. Orthodontic treatment is either recommended by your dentist or initiated by a concern of your own. Dentist generated recommendations are usually more health related (The concern is a "bad bite"). Personal concerns are usually more esthetics oriented ("My front teeth are crooked"). Regardless of the reason, both health related concerns and esthetics related concerns should be addressed.


Types of Treatment

The type of treatment will vary depending on the nature of the problem, however there are some fundamentals that apply regardless of the kind of problem. First, the approach to solving your orthodontic problems should be based on "Functional Orthodontics". This approach organizes treatment in what I feel as a Dentist and Orthodontist is the very best. The steps in treatment involve identifying and resolving the cause of the problem, then treating the crooked teeth and bad bite into a "functional" relationship. Treatment always involves treating the face first, then the teeth. This produces the best facial esthetics and the most beautiful smiles.


Causative Factors

The most common cause of Crooked teeth and Bad Bites are breathing problems and habits like thumbsucking. Only breathing problems seem to continue to be a problem in adults. If this proves to be the case, referral to a Ear, Nose, and Throat specialist may be appropriate. In most adult cases, the causes are long past and the focus will be on treatment of the existing condition.


About "TMJ"

"TMJ" stands for "Temporomandibular Joint". Everyone has one in front of each ear from which the lower jaw hinges. Improper jaw relationship causes "TMJ" problems. Due to the fact that Orthodontic treatment can both cause, as well as cure, TMJ problems, it is very important that this issue be discussed. The Orthodontist should be able to identify the status of the jaw joints (X-rays or Sonography should be included in the records), and inform you what influence the treatment will have on their condition. The symptoms of "TMJ" problems include clicking or popping of the jaw joints, pain in or around the ears, ringing in the ears, headaches (including migraines), sinus conditions, neck and back pains, and many others. Functional Orthodontics is the only approach to include evaluating the jaw joints as part of the diagnostic regimen and making sure that the orthodontic treatment creates the healthiest possible joint relationships.


What is involved in Treatment

All treatment methods involve a partnership between the Orthodontist and the Patient. Each has certain responsibilities throughout the treatment. Be sure that you understand what your responsibilities are relative to treatment. In most cases, treatment involves removable appliances (retainer-like devices) to relieve crowding and correct the bite, followed by braces. This system consistently produces the nicest faces with the most beautiful smiles in the shortest possible time. Retainers to support the result of treatment are usually a requirement with adults. One last but important feature of adult orthodontics, is the need for some restorative changes after the orthodontic treatment. Often the size or shape of teeth were altered with crowns or fillings. After proper alignment, these teeth may need new restorations to return them to the proper shape. This is relatively predictable, so it should be discussed prior to treatment.


Review

Goals of Treatment: Beautiful Face Straight Teeth Beautiful Smile
Healthy Teeth, Gums and Jaw Joints
Treatment Methods: "Retainers" followed by "Braces" (usually)
Treatment Time: As short as possible without compromising the result.
Retention: Usually needed. Some restorative treatment as well.

J. Bruce Johnson, D.D.S.

 

 

 


ORTHODONTIC ANALYSIS
Why We Measure What We Do

A Guide for the Orthodontic Consumer

 

All of the following are carefully considered in analyzing someone's orthodontic concerns.

1. Facial Analysis

You see the face before you see the teeth and smile. Who cares if you have straight teeth if you have a big nose or no lips, or a receding chin?

The facial proportions are an indicator of proper growth patterns. Orthodontic dilemmas are manifestations of growth pattern abnormalities, so it makes sense to analyze the whole face, not just the teeth.

Distortions in facial symmetry can be indicators of problems elsewhere.

 

2. Airway Analysis

Rarely considered, but the nasal passages (above the mouth) and the throat (behind the mouth) are dramatically influenced by the development of the mouth.

Full time nasal breathing is optimal for health, as well as dental stability.

The manner in which the mouth and teeth are treated dictates enhanced breathing or restricted breathing.

 

3. TMJ Analysis

Rarely considered, but the jaw joints are an integral part of the dental system.

Everything that happens to the teeth affects the jaw joints.

Proper analysis guides us to treat the teeth in a jaw joint friendly way.

 

4. Posture Analysis

As we are becoming increasingly aware, everything is connected.

Jaw posture (your bite) affects head posture.

Head posture affects neck posture.

Neck posture affects shoulder and back posture.

Guess where many back problems start?

 

5. Dental Analysis

Arch width, tooth size, overbite, underbite, overjet, open bite, over-closed bite, missing teeth, extra teeth, and so on.

Many things to measure, but all a reflection of the previous four.

The previous four tell us what to do about the problems we see here.

 

 

 


Considerations in a Whole Body Approach

Mandibular (lower jaw) posture relative to:

  • Head posture
  • Cervical posture
  • Thoracic Vertebrae posture
  • Hip Posture
  • Breathing problems - snoring, sleep apnea, post nasal drip, bed wetting, ADS, SIDS,
  • Ear Problems
  • Eye problems

 

Oro-Facial Development shortcomings in modern times

  • Weston Price research
  • Lack of downward and forward growth of the maxilla
  • Lack of downward and forward growth of the mandible
  • Lack of adequate lateral development of the maxilla
  • Narrow maxillary development produces high palate resulting in reduced nasal cavity volume and deviated septum.

The concern expressed by many orthodontists is about the importance of early treatment to correct a unilateral (functional) crossbite. This concern is the basis for early treatment, and is predicated on the assumption that the mandible will grow asymmetrically if allowed to continue growth with the mandible displaced to one side. The fact is, I have yet seen a patient with a midline deviation that is not corrected when the bite is. My experience is based on hundreds of patients mounted on an articulator that takes into account the temporomandibular joints. When the TMJ's are properly aligned, the midline comes into alignment as well, in almost every case.

 

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