Orthodontics is a blend of engineering and art. Engineering - design and mechanics - includes
• architecture (the plan),
• physics (movement),
• chemistry (body physiology),
• ongoing changes in the smile, and
• work to stabilize the results in a dynamic (changing) human body.
How does the body change?
I tell the kids, “The toe bone is connected to the tooth bone,” like the old song. Indeed, the teeth, the bone around the teeth, the muscles and ligaments attached to the teeth, bone and joints, are connected to the muscles that hold and move our heads.
They are also connected to the muscles and bones of the neck which are connected to the muscles and bones of the back, and the shoulders and arms and the hips, and the legs, down to the toes.
Each part of the body affects the rest of the body. That's the reality of it.
When a tooth is biting or chewing, ALL those connections are in play. Really. Then, we think about moving teeth orthodontically and “fixing” them. But, the teeth are moving targets, like shooting a Nerf dart toward a slowly shifting target.
Wouldn’t it be nice if braces could put teeth into a nice smile and bite and you’d be done? It doesn’t work that way.
Even without braces, everything constantly changes under and around the teeth. Baby teeth go, permanent teeth come. Bones grow. Muscles respond.
And, then other stuff is going on in the mouth - chewing, biting, grinding, clenching, nail-biting, sucking habits, chewing on pens… These all create forces on the teeth.
The tongue, cheeks and lips should balance each other with the tongue inside and the cheeks and lips outside, so the teeth sit comfortably between. Often they don’t.
Conley breathes through his mouth - a lot. Mouth open and the tongue pushing forward and down, so the lower jaw grows down.
Agnes is a mouth-breather too - her tongue pushes forward against her front teeth and jaw which grow more forward into a Class III.
And Andre’s thumb habit keeps his tongue low and allows his cheeks to push in on the upper jaw. So, his maxilla is too narrow, and he needs expansion.
Robbie slumps forward to play on his phone or iPad. Robbie’s back neck muscles are pulled longer and as his head becomes used to that posture, the bones grow to where the muscles are pulling.
After a few brief years of this in his young life, Robbie’s head and neck now droop forward. His teeth now bite differently (not in a good bite), than they would if his posture were more ideal.
Before, during and after braces, the teeth and smile live with amazing ongoing forces, from every direction.
But, while in braces, it is up to our engineering to work with, and “on”, and in spite of, these forces, to “fix” the teeth. The engineering of orthodontics.
Tomorrow -- the art of orthodontics.