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Orthotropics – Improving Facial Form and Guiding Growth

Orthotropics and its History

Etymology – Orthos, straight/correct and troph meaning growth. It is a study that focuses on influencing craniofacial structure, development, and function with postural and therapeutic exercises. The main criteria are improving and adapting growth in children from the ages six to eight but it can be applied to adults up to the age of twenty-five.

Dr. John Mew is a 91-year-old orthodontist from the United Kingdom. For the past 50 years, he has championed an unorthodox cure, based on a theory about the cause and treatment of crooked teeth. If correct, Mew’s theory would upend many of the fundamental beliefs of mainstream orthodontic practice. Since the late 1970s, Dr. Mew was later joined by his son and fellow orthodontist, Dr. Mike Mew who has treated patients in his practice in London.

According to them, the genetic control of the face’s development is not precise and can be shepherded into an ideal form with postural and therapeutic exercises of lips, cheeks, and tongue. They believe that the environmental influence on the way that our face and teeth are formed i.e., the Environmentalist perspective is to be given more credit than it normally gets.

“Sheepdog shepherding sheep with just the tongue, lips, and cheeks alone.“

Mewing

A series of facial exercises and specific ways to hold one’s posture to influence the structure of the face. The most popular example of mewing is resting the tongue on the hard palate with the lips sealed.

Orthodontics vs. Orthotropics

Orthodontics includes the study of growth and development of jaws and face particularly, and the body generally as influencing the position of the teeth; it is the study of action and reaction of internal and external influences on the development, prevention, and correction of arrested and perverted development.

Repositioning of teeth by functional and mechanical means to establish normal occlusion and pleasing facial contours is the main goal. Traditionally, orthodontic braces and aligners can be used for ages from mixed dentition to adulthood and the treatment period varies from six months to two and a half to three years in most cases. This is followed up by a short-term or long-term retention phase depending on the severity of the individual case.

Orthodontic treatment is possible by the fact that teeth can be moved through the alveolar bone by applying appropriate forces. Orthodontic tooth movement is a unique process where a solid object (tooth) is made to move through a solid medium (bone). The presence of a periodontal ligament which is unique for mammals enabled independent tooth movement.

Biology of Tooth Movement

Orthodontic treatment is possible due to the fact that whenever a prolonged force is applied to a tooth, bone remodelling occurs around the tooth resulting in its movement. As a general rule of thumb, it can be said that bone is subject to pressure as a result of compression of the periodontal ligament resorbs while bone forms under tensile force as a result of stretching of the periodontal ligament.

The mechanism of movement of a tooth by an orthodontic force has been a subject of ongoing research for decades. The theories that are accepted and have stood the test of time are: ‘Pressure Tension theory’ by Schwarz, ‘Blood Flow theory’ by Bein, and ‘Bone Bending and Piezoelectric theory.’

According to the studies of Oppenheim and Schwarz, optimum orthodontic force is equal to the capillary pulse pressure which is 20 – 26 gms/ sq.cm of root surface area. This translates to 20 to 150 gms of force per tooth. Orthopedic force on the other hand to modify the craniofacial bones is delivered at higher magnitudes of more than 300gms.

The idea of mewing/orthotropics is centered around the concept that low, consistent and continual forces of the lips, tongue, and cheeks for prolonged periods of time will naturally move the teeth into the desired position and retain the movement.

Dr. Weston Price, Dr. William Proffit, and Dr. Egil Harvold’s studies and application.

In the early 1930s, a Cleveland dentist named Weston A. Price began a series of unique investigations with the goal to discover the factors responsible for good dental health. His studies revealed that dental caries and deformed dental arches resulting in crowded, crooked teeth are the results of nutritional deficiencies, not inherited genetic defects. These studies are almost a hundred years old but the ideas have been partly accepted by the dental community.

The photographs Dr. Weston Price took illustrate the difference in facial structure between those on native diets and those whose parents had adopted the “civilized” diets of devitalized processed foods. The “primitive” Seminoles pictured on the left has wide, attractive faces with plenty of room for dental arches. The “modernized” Seminole girl on the right, born to parents who had abandoned their traditional diets, has a narrowed face, crowded teeth, and reduced immunity to disease.

Dr. Proffit proposed equilibrium theory as he discussed the importance of the tongue and lips as sources of intrinsic forces, in contrast to extrinsic forces from habits or orthodontic appliances. He believed that the primary factors for the equilibrium are still the resting pressures from the intra and extraoral muscles and possibly the forces created by the periodontal ligament. Most authors however agree that the normal soft tissue functions (functional forces) are of only short duration and therefore of little importance to tooth movement. [Thuer, U (1999). Cheek and tongue pressures in the molar areas and the atmospheric pressure in the palatal vault in young adults. The European Journal of Orthodontics]

Dr. Harvold’s paper on ‘Primate experiments on oral respiration’ stated that the frequently observed association between oral respiration and dental malocclusion has been reported by many investigators. In 1956, for example, Brash’ reviewed earlier experimental and clinical studies. Linder-Aronson in 1979, discussed the subject and presented his own extensive studies on nasal obstruction and its influences on human cranial growth. The clinical observations suggest that a rather close association exists between nasal obstruction, oral respiration, and dental malocclusion, but a direct cause-and-effect relationship in the human being had not been established. Animal experiments in his laboratory have shown that induced nasal obstruction in healthy rhesus monkeys leads to oral respiration and subsequently to changes in both the facial skeleton and the dentition. However, even though their noses were blocked by the same method and at the same age, the animals did not develop the same type of dental malocclusions. It was evident that the response to nasal obstruction differed considerably among the animals. It appeared that, under the pressure of the respiratory drive, each animal would find its own most convenient way to secure the oral airflow and then develop a dental malocclusion in accordance with this new function.

In conclusion, the primates in these experiments developed an oral airway in response to nasal obstruction. The response was not uniform among the animals. However, some traits were common: increased face height, steeper mandibular plane, and larger gonial angle. Various animals recruit different muscle combinations for rhythmic movements or for changing the position of the lips, tongue, and mandible. The morphologic changes in the orofacial region, facial skeleton, and dental occlusion did vary accordingly. It is unlikely that a correlation can be established between oral respiration and a particular type of dental malocclusion. On the other hand, it can be postulated that increased tonic activity in certain muscles and a specific change in jaw positioning may cause corresponding bone remodeling, which should be predictable. This hypothesis is the cornerstone of Dr. Mew’s work.

Is Mewing a Replacement for traditional braces and jaw surgeries?

No. Mewing is effective for a very particular age group for very specific problems. There are several downsides to a method that is solely dependent on patient compliance. It has very little data on its long-term effectiveness. The components of growth and development as agreed by several distinguished authors and researchers are multi-faceted. The argument that “prolonged bad habits such as mouth breathing, tongue thrusting, and thumb-sucking produce significant negative orofacial changes” and hence proper postural and functional as well as therapeutic exercises without mechanical support from external appliances would produce significant positive results have no scientific backing. Effectively practicing pre-determined postural exercises for prolonged periods of time, years in fact is quite hard to stick to and in Dr. Mew’s own words uncomfortable.

Dr. G. V. R. Meghana

Bachelor of Dental Surgeon (BDS) Panineeya Mahavidyalaya Institute of Dental Sciences and Research Centre