Editorial: Dr. John Wellington (Skip) Truitt
Contemporary Orthodontics vs. Maxillofacial Orthopedics
“Where is the general dentist? “
Contemporary Orthodontics is predicated on the concept that a child’s malocclusion, (crooked teeth and the manner in which the upper and lower jaws grow and relate to each other), is a genetically predetermined situation. And, that the doctor has no direct control over this relationship. Therefore the only accepted treatment option is minor tooth guidance as the patient is growing until the child has lost all of the “baby teeth”, followed by fixed appliance therapy (full braces) when all of the permanent teeth have erupted. This type of treatment frequently involves the extraction of at least four healthy permanent teeth with the overall objective being to camouflage any pre-existing skeletal problems.
This form of conventional therapy can lead to very unaesthetic changes in the patient’s face and profile as well as possible damage to the temporal mandibular joints (the joints that connect the lower jaw to the skull). In addition, conventional orthodontic therapy does not address growth problems such as an underdeveloped maxilla (an upper jaw that is too narrow). A narrow upper jaw can not only cause the teeth to be crooked, but it can also obstruct the patient’s airway forcing the child to breathe through their mouth. This, in turn, can cause the lower jaw to grow improperly as well. In addition, the obstructed airway can create severe problems within the child’s ears which include chronic ear aches, infections, and loss of hearing.
The concept of maxillofacial orthopedics understands that the growth of most of the bones of the face and jaws is directed by function and not just by genes. For example, the size of the upper jaw is directly related to the child swallowing correctly and breathing properly from birth. If the upper jaw does not grow to its proper size then the upper teeth will be crowded, not because the teeth are large, but because the jaw is too underdeveloped to accommodate the teeth.
Removing healthy teeth is therefore not the appropriate solution for this type of problem. The correct treatment is to place an orthopedic appliance in the child’s upper jaw. This type of appliance will easily correct the growth problem and in turn, create the necessary space to properly align all of the permanent teeth without the need for extractions. In addition, developing the upper jaw opens the patient’s nasal airway allowing the child to breathe correctly through the nose. Figures #1, #2, #3,  are examples of properly developing the upper jaw.
This begs the obvious question as to why most doctors do not at lease offer the parent and patient the option of maxillofacial orthopedics as part of their overall therapy. The primary reason for this failure is a lack of knowledge on the part of the doctor. One has only to evaluate the American contemporary orthodontic literature to understand this situation.
For example, one of the most widely read American journals is the “Journal of Clinical Orthodontics”. Until recently their editorial review board would not even consider accepting a paper on maxillofacial orthopedics for review, much less for publication. The few they now do publish are always from doctors and universities outside the United States. Why is this so?