Dr Ernest A. Rider, DDS

3535 Randolph Road #206R,

Charlotte, NC 28211

(704) 366-8936

orthoear@aol.com

Dr. Rider has written hundreds of articles and has also written chapters in orthodontic text books.  Enjoy Dr. Rider's weekly blog.

erorthodonticslog

Date: 2/9/2016 9:19 AM EST

A VIABLE  SOLUTION TO IDEALIZED CLEFT PALATE TREATMENT (DEVELOPING AND MAINTAINING BILATERAL NASALIZED BREATHING FROM INITIAL SURGERY ON)

Talmant** has shown that good long term Maxillofacial growth begins with the development of bilateral nasalized breathing as a result of an initial, unique cleft side intranasal surgery with follow-up designed to promote bilateral nasalized breathing from the get-go and  revised as necessary to maintain this most important breathing function throughout life. At age four orthopedic orthodontics, designed to broaden the width of the nasomaxillary complex and further improve bilateral nasalized breathing is introduced, followed by an alveolar bone graft to stabilize the correction. An active orthopedic/orthodontic device is inserted and held in place until the first molars erupt. At this age orthodontic treatment may be initiated to align the mal-posed dentition and adequate space made available to replace the congenitally missing cleft-side lateral incisor.

Why is this important?

  1. The width of the nasal cavity is determined by the width of maxilla and this dimension is most critical at the canine level. The pyriform nasal aperture is located midway between these two canine positions.  The width of the pyriform aperture is a key element determining one’s ability to breathe well through the nose. The maxillary canines measurement should be, at least, six millimeters wider than the mandibular canine distance. It may be necessary to expand the mandibular dimension if the lower arch is constricted.
  2. Canine replacement of the congenitally missing cleft-side lateral incisor is a common practice in some cleft treatment protocols (NAM being one). On the surface, this seems a very financial solution to a dental problem. However, bilateral nasalized breathing is a much more important medical problem and canine replacement, often performed as a financial rationale designed to avoid a bone graft, implant and lateral incisor crown is a bad choice. This is  a negative financial rationale when compared to the more important health issue from which the patient may suffer long term, untoward problems.
  3. Esthetically, canine replacement disturbs anterior dental balance and functionally, the canine (when in it’s proper anatomic position) is the cornerstone of a healthy functional occlusion. Absence of its critical role in functional occlusion may result in untoward dental problems in the future.

Cleft Palate Teams might consider a research program to evaluate and report on the effects of their treatment protocol long term.

  1. Document bilateral nasalized breathing beginning at an age when the child is able and willing to cooperate by closing off one  nasal opening at a time and assessing airflow through the open nasal airway. Later use of Rhinomanometry as the vehicle to measure and document early and long term breathing capacity should be the standard measuring device.
  2. Frequency of missing or damaged maxillary teeth if you are using the* Latham, NAM or other pre-surgical treatments, such as, taping and a “nasal elevator”.
  3. Frequency of impacted maxillary* cuspids and supernumerary teeth.
  4. Nasal-maxillary growth* evaluated with photographic or radiological reports, over time. 
  5. Reports of the necessary use of orthopedic face mask, LA fort osteotomy or distraction osteogenesis to manage the naso-maxillary skeletal development.* 
  6. Early surgical alveolar bone grafting with or without gingiva-periosteo-plasty and BMP*
  7. 7. Frequency of canine* replacement protocol.
  8. Routine measurement  width of maxillary canine to canine dimension relative to lower canine dimension.

What is so important about bilateral nasalized breathing in children, adults and, more specifically, cleft palate children?

It is well known that when there is a battle between muscle and bone, muscle always wins. it’s not well appreciated  that when there is a battle between the airway and muscle the AIRWAY always wins!

This is of particular importance in growing children.

Human beings were designed to breathe through their noses. Since breathing is essential for life, if you cannot breathe through you nose you must breathe through your mouth. When you can breathe well through both sides of your nose the tongue will rest in the roof of your mouth where it was designed to rest (unless you have large tonsils or adenoids blocking the posterior airway). If you have large tonsils or adenoids blocking the flow of air through the posterior nasal airway and pharyngeal pathway, the mouth must open to breathe and the tongue must protrude to open the pharyngeal airway (large tonsils, adenoids) to allow you to breathe. The tongue is a powerful muscle. When parked in the roof of your mouth (where it was designed to fit when you are breathing and  the jaws at rest). For good nasomaxillary growth this “normal” tongue position is  designed to apply a forward pressure to the maxilla stimulating  naso-maxillary growth while resisting the compression of the cheek muscles to collapse the posterior aspect of the maxilla. When not parked in the roof of the mouth  the tongue creates all sorts of dentofacial problems (crooked teeth, open bite, cross bite, abnormal jaw growth, protruding upper front teeth etc. This is ALL due to a forced adaptation to our need to breathe.

How does this apply to cleft palate children who cannot breathe through their nose?

The really big problem for these children is the upper jaw has no motivation to grow forward or wider when the tongue is out of control. The nasomaxillary complex is locked in a trap of lack of poor growth stimulation from the tongue which, if not resolved while they a very young  condemns them to a long and difficult life of jaw surgery, orthodontic treatment, speech therapy, psychotherapy and multiple other related treatment.

So why is so little attention paid to a vital bilateral nasal airway?

I do not have a clue accept to believe there has not been enough attention paid to this important aspect by the cleft palate teams.

This appears to be the situation.   Interested Cleft Palate Surgeons must commit to learn a technique designed to  successfully create a fully functional bilateral nasalized breathing protocol for all their cleft lip/cleft palate patients and their focus remain on this form of breathing throughout the life of these children. Otherwise we will continue to see mediocre to very poor long term treatment results still believing we provide the best cleft palate  treatment on the planet.

If indeed, bilateral nasalized breathing from the initial surgery through adulthood is the missing link in idealizing long term facial development in cleft lip cleft palate children it would seem wise for cleft palate teams, desiring to learn and implement a protocol that will routinely promote well developed nasomaxillary growth, consider modifying   their treatment protocol to focus on idealizing bilateral nasalized breathing as described by Tamant**. The focus must be on outstanding long term results achieved in the most precocious, thought provoking manner that every cleft palate team can provide  routinely.

**Talmant, Jean Claude

Evolution of the Functional repair concept for cleft lip cleft palate patients

Indian J. Plast Surg 2006

       Vol 39: Issue 2: Page 196-209 DVD’s Available orthoear@earthlink.net

Posted by riderorthodontics | Post a Comment

Date: 12/27/2015 1:38 PM EST

idealizing the naso-pharyngeal airway for optimum breathing capacity in children:

 

There is no way to over emphasize the health benefits of bilateral nasalized breathing.

Ideally both parents and patient must understand that mouth breathing is unhealthy for their child and will dramatically interfere with idealized orthodontic treatment. They must be willing to do everthing possible to develop and maintain a lifelong bilateral nasalized breathing pattern. This is a “health issue” not just an orthodontic issue.

 

Diagnostic protocol:

  1. patient exam:
  2. check for mouth open breathing
  3. check for inflamed gingival tissue around upper front teeth
  4. check discoloration of upper front teeth
  5. ask child if their mouth is dry when they get up in the morning
  6. ask parent if child snores or sleeps with their mouths open at night
  7. check for open bite problem
  8. check for narrow high arched palate
  9. check for posterior crossbite
  10. check tongue posture during rest and during swallowing
  11. close off one nostril and check breathing through other nostril. change sides
  12. check for dark areas below the eyes
 
  1. document physical findings:
 
  1. lateral jaw xray to evaluate posterior airway:
is the adenoid pad blocking the nasal airway?

are the tonsils large and creating a narrow pharyngeal airway?

is the hyoid bone more than 15 mm below lower border of the mandible (low hyoid indicates that the tongue is being protruded and lowered to help open the pharyngeal airway

  1. Frontonasal head film:
check patency both sides of the   nasal airway

check for enlarged NASAL TURBINATES

check for deviated septum

 

  1. nasal breathing test:
evaluate patient’s ability to breathe through both sides of their nose and compare nasal breathing capacity to known age related standards USING RHINOMANOMETRY as the measuring device.

 

  1. Dietary suggestions:
If the breathing test is negative, place the child on a lip training nasal breathing program and recommend the parent and child remove milk and gluten related products from the child’s diet. return in a month for a retest of the childs breathing capacity. If they fail their test again place the child on flonase for two weeks plus no gluten or dairy products. if they continue to fail the breathing test, refer them to a highly qualified ent physician.

If the radiographs demonstrate large tonsils and adenoids, deviated septum or enlarged turbinates associated with a poor breathing test, refer the child to A truly KNOWLEDGeABLE ear nose and troat physician. (this is vitally important). refer only to an ent physician, recognized for his/her expertise and understanding of the importance of a patent nasal airway in these young children).

Additional recommendations:

  1. Twice daily patient use of nettie pot
  2. daily sesame oil lubrication of nasal passages
  3. continued evaluation of local environmental problems, diet and compliance with instructions
  4. daily Lip, tongue and nasal breathing exercises.
  5. Regular breathing tests to validate nasal breathing pattern.
 

 

idealizing the naso-pharyngeal airway for optimum breathing capacity in children:

 

There is no way to over emphasize the health benefits of bilateral nasalized breathing.

Ideally both parents and patient must understand that mouth breathing is unhealthy for their child and will dramatically interfere with idealized orthodontic treatment. They must be willing to do everthing possible to develop and maintain a lifelong bilateral nasalized breathing pattern. This is a “health issue” not just an orthodontic issue.

 

Diagnostic protocol:

  1. patient exam:
  2. check for mouth open breathing
  3. check for inflamed gingival tissue around upper front teeth
  4. check discoloration of upper front teeth
  5. ask child if their mouth is dry when they get up in the morning
  6. ask parent if child snores or sleeps with their mouths open at night
  7. check for open bite problem
  8. check for narrow high arched palate
  9. check for posterior crossbite
  10. check tongue posture during rest and during swallowing
  11. close off one nostril and check breathing through other nostril. change sides
  12. check for dark areas below the eyes
 
  1. document physical findings:
 
  1. lateral jaw xray to evaluate posterior airway:
is the adenoid pad blocking the nasal airway?

are the tonsils large and creating a narrow pharyngeal airway?

is the hyoid bone more than 15 mm below lower border of the mandible (low hyoid indicates that the tongue is being protruded and lowered to help open the pharyngeal airway

  1. Frontonasal head film:
check patency both sides of the   nasal airway

check for enlarged NASAL TURBINATES

check for deviated septum

 

  1. nasal breathing test:
evaluate patient’s ability to breathe through both sides of their nose and compare nasal breathing capacity to known age related standards USING RHINOMANOMETRY as the measuring device.

 

  1. Dietary suggestions:
If the breathing test is negative, place the child on a lip training nasal breathing program and recommend the parent and child remove milk and gluten related products from the child’s diet. return in a month for a retest of the childs breathing capacity. If they fail their test again place the child on flonase for two weeks plus no gluten or dairy products. if they continue to fail the breathing test, refer them to a highly qualified ent physician.

If the radiographs demonstrate large tonsils and adenoids, deviated septum or enlarged turbinates associated with a poor breathing test, refer the child to A truly KNOWLEDGeABLE ear nose and troat physician. (this is vitally important). refer only to an ent physician, recognized for his/her expertise and understanding of the importance of a patent nasal airway in these young children).

Additional recommendations:

  1. Twice daily patient use of nettie pot
  2. daily sesame oil lubrication of nasal passages
  3. continued evaluation of local environmental problems, diet and compliance with instructions
  4. daily Lip, tongue and nasal breathing exercises.
  5. Regular breathing tests to validate nasal breathing pattern.
 

 

 

Posted by riderorthodontics | Post a Comment

Date: 12/23/2015 11:11 AM EST

HOW YOU BREATHE, NOT ONLY DIRECTLY AFFECTS YOUR HEALTH IT CAN ALSO AFFECT THE  SUCCESS OF YOUR ORTHODONTIC TREATMENT

HEALTHY INFANTS INSTINCTIVELY ALWAYS BREATHE THROUGH THEIR NOSES. THIS IS NATURES WAY OF ALLOWING THEM TO SUCKLE AND BREATHE AT THE SAME TIME.

UNFORTUNATELY, AS THEY MATURE, THE FOODS THEY CONSUME AND THE AIR THEY BREATHE CAN ADVERSELY AFFECT THEIR ABILITY TO BREATHE THROUGH THEIR NOSES AND THEY MAY GRADUALLY CONVERT TO A MOUTH OPEN FORM OF BREATHING.

HUMAN BEINGS WERE DESIGNED TO BREATHE THROUGH THEIR NOSES. MOUTH BREATHING CREATES A FUNCTIONAL DEVIATION FROM NORMAL THAT AFFECTS ALL BODILY SYSTEMS. YET AS ABNORMAL AND UNHEALTHY AS MOUTH BREATHING IS  MOST PARENTS AND MANY PEDIATRICIANS SEEM UNCONCERNED AND ACCEPT  THIS DEVIANT FORM OF BREATHING  AS "NORMAL". SOMETHING THE CHILD WILL GROW OUT OF. GROWTH IS THE KEY WORD!  GROWTH AND HEALTH OF ALL BODILY SYSTEMS CONTINUES FROM BIRTH TO MATURITY AND BEYOND. IF HOW YOU BREATHE DIRECTLY AFFECTS ALL SYSTEMS WHY WOULD YOU NOT WANT THOSE SYSTEMS TO DEVELOP WITHIN THE MOST IDEAL ENVIRONMENTAL  POSSIBILITY BY  GIVING THESE SYSTEMS THE OPPORTUNITY TO MAXIMIZE THEIR DEVELOPMENTAL AND HEALTH RELATED  POTENTIAL?

UNFORTUNATELY WE NOW LIVE IN  A PERIOD OF HISTORY WHERE AGRI-BUSINESS, AIR POLLUTION, FAST FOODS,TELEVISION, COMPUTERS AND COMPUTER GAMES DOMINATE MANY OF OUR LIVES. PARENTS ARE CONSTANTLY ON THE GO TAKING THEIR CHILDREN TO EVERY SEEMINGLY IMPORTANT EVENTS THAT CAN BE CRAMMED INTO THEIR LIVES. HOW THEIR CHILD BREATHES MAY NOT BE HIGH ON THEIR AGENDA OF CONCERNS BUT IT SHOULD BE.

PROFESSIONAL SINGERS (PRIMARILY OPERATIC), BRASS AND WIND INSTRUMENT MUSICIANS AND YOGA TEACHERS  AMONG OTHERS KNOW THE IMPORTANCE OF BREATH CONTROL. THE SECRET TO THEIR SUCCESS IS THEIR ABILITY TO BREATHE VERY WELL THROUGH THEIR NOSES AND TRAIN THEMSELVES BY NECESSITY WITH CONTINUOUS, CONTROLLED EFFORTS IN HOW TO INCREASE AND USE THEIR INFLATED LUNG CAPACITY TO FURTHER THEIR CAREERS IN THEIR CHOSEN FIELDS.

MOUTH BREATHING SUBSTANTIALLY REDUCES THE AMOUNT OF OXYGEN AVAILABLE TO OUR BODIES SUCH THAT WE MUST INCREASE THE RAPIDITY OF OUR BREATHING EFFORTS TO MAINTAIN A REASONABLE LEVEL OF OXYGENATION WHICH IS STILL WELL BELOW THE LEVEL MAINTAINED BY A WELL TRAINED OBLIGATE NOSE BREATHER.

UNRECOGNIZED BY MOST OF US, CONSISTENT BREATHING THROUGH THE NOSE IS VITALLY  IMPORTANT DURING OUR SLEEPING HOURS. MOUTH BREATHING WHILE ASLEEP HAS BEEN SHOWN TO BE CLINICALLY ASSOCIATED WITH INCREASED INCIDENCE OF HEART DISEASE AND SLEEP APNEA.

THERE ARE MULTIPLE FACTORS THAT CAN LEAD TO INABILITY TO BREATHE WELL THROUGH THE NOSE:

(1) NARROW ANTERIOR NASAL OPENINGS. (2)POOR NASAL  VALVE FUNCTION. (3) DEVIATED SEPTUM. (4) ENLARGED NASAL TURBINATE BONES. (5) NARROW MAXILLA. (6) ENLARGED ADENOIDS BLOCKING THE POSTERIOR NASAL PASSAGE. (7) ENLARGED TONSILS BLOCKING THE PHARYNGEAL AIRWAY. (8) VERY LARGE TONGUE ENCROACHING ON THE POSTERIOR AIRWAY. (9) ALLERGIES BOTH FOOD, DRINK AND AIRBORNE. (10) GLUTEN SENSITIVITY.  THE FIRST EIGHT MAY REQUIRE A SURGICAL SOLUTION. THE LAST TWO ARE ALLERGY RELATED AND CAN ONLY BE CONTROLLED BY CONSISTENT INDIVIDUAL DISCIPLINARY ACTION REGARDING PROPER DIET AND AVOIDING CERTAIN ENVIRONMENTAL CONDITIONS.

I HAVE LONG BEEN CONCERNED ABOUT POOR NASALIZED BREATHING IN MY ORTHODONTIC PATIENTS AND IT'S NEGATIVE EFFECT ON IDEALIZED ORTHODONTIC TREATMENT AS WELL AS IT'S NEGATIVE EFFECT ON FACIAL DEVELOPEMENT. ORAL SIGNS OF MOUTH BREATHING SHOW UP AS DRY MOUTH IN THE MORNING, INFLAMED AND SWOLLEN GUM TISSUE AROUND THE UPPER FRONT TEETH, DISCOLORED UPPER FRONT TEETH, OPEN BITE , NARROW, HIGH ARCHED PALATE, CROWDED TEETH, TONGUE THRUST AND DIFFICULTY IN SUCCESSFULLY COMPLETING TREATMENT.  SOME CHILDREN ARE BEYOND WHAT ORTHODONTICS ALONE CAN FIX AND REQUIRE JAW SURGERY TO COMPLETE THEIR TREATMENT. THE SUCCESS OF THE SURGICAL TREATMENT IS RELATED TO HOW WELL THE PATIENT BREATHES THROUGH THEIR NOSES AFTER SURGERY. POOR NASAL FUNCTION LEADS TO RELAPSE.

TO TEST OUR PATIENTS ABILITY TO BREATHE THROUGH THEIR NOSES WE PERFORM A NASAL BREATHING TEST (RHINOMANOMETRY) USING A SOPHISTICATED NASAL BREATHING MEASURING DEVICE TO ASSESS THEIR CAPACITY TO BREATHE THROUGH BOTH SIDES OF THEIR NOSE. IN ADDITION OUR LATERAL HEAD FILM REVEALS THE SIZE AND POSITION OF THEIR ADENOIDS AND TONSILS AS WELL AS TONGUE POSITION AND PHARYNGEAL AIRWAY.  IN A LIMITED NUMBER OF CASES WE TAKE NASAL TOMOGRAPHIC VIEWS TO CHECK FOR ENLARGED TURBINATES AND DEVIATED SEPTUM. IF THE PATIENT FLUNKS THEIR BREATHING TEST, HAS A HISTORY OF MOUTH BREATHING OR THEIR LATERAL HEAD FILM SHOW ENLARGED ADENIOIDS AND/OR TONSILS WE REFER THEM TO A KNOWLEDGEABLE ENT PHYSICIAN WHO UNDERSTANDS THE IMPORTANCE OF FULL TIME NASAL BREATHING AND IS WILLING AND ABLE TO PROVIDE THE  APPROPRIATE TREATMENT NECESSARY TO ELIMINATE THE PHYSICAL BARRIERS BLOCKING THE AIRWAY.

FOLLOWING UP THE ENT'S TREATMENT WE  SPEND AN INORDINATE LENGTH OF TIME TRAINING OUR PATIENTS TO FOCUS ON NASALIZED BREATHING,  PROPER TONGUE POSTURE DURING SWALLOWING AND  LIP CLOSURE EXERCISES TO EDNSURE  LIP SEAL FUNCTION.

MORE RECENTLY I HAVE BECOME MORE AWARE OF THE HEALTH RELATED ISSUES OF MOUTH BREATHING AND STRESS EVEN MORE EMPHATICALLY THE IMPORTANCE OF FULL TIME NASALIZED BREATHING AND THE TECHNIQUES NECESSARY TO ACHIEVE THAT GOAL.

THERE IS MORE TO ORTHODONTICS THAN JUST STRAIGHT TEETH. OUR JOB IS TO USE OUR KNOWLEDGE AND EXPERIENCE TO BRING OUR PATIENTS A LEVEL OF TREATMENT UNMATCHED ANYWHERE IN THE WORLD.

WE USE A NASAL BREATHING TECHNIQUE CREATED  IN THE EARLY 1960'S BY A RUSSIAN PHYSICIAN, DR KONSTANTIN BUTEYKO, (WWW.BUTEYKO.COM) WHO DESIGNED A BREATHING TEST TO EVALUATE ONE'S ABILITY TO BREATHE THROUGH THE NOSE AND INCREASE SELF-OXYGENATION FOR ASTHAMATICS.. WHEN THE RECOMMENDED EXERCISES ARE PRACTICED DILIGENTLY IN PATIENTS ABLE TO BREATHE THROUGH THEIR NOSES GREAT IMPROVEMENT IN BREATHING OCCURS. ALTHOUGH THIS TECHNIQUE WAS DESIGNED TO MANAGE THE SYMPTOMS OF ASTHMA IT IS AN EFFECTIVE METHOD OF TRAINING ONESELF TO BREATHE  PROPERLY THROUGH THE NOSE. MIKE WHITE (WWW.BREATHING.COM) HAS TAKEN THE TECHNIQUE TO A NEW LEVEL AND PROVIDES AN ONLINE AND INHOUSE IDEALIZED BREATHING PROGRAM.

MUCH LIKE OUR  EDUCATIONAL, ATHLETIC, MUSICAL AND ARTISTIC SYSTEMS, ORTHODONTICS IS A TRAINING GROUND FOR THE DEVELOPMENT OF PERSONAL GROWTH IN SELF RELIANCE, DISCIPLINE AND HIGH EXPECTATIONS EMANATING FROM DEDICATION TO EXCELLENCE. IF ONE ADDS TO THAT LIST AN INCREASED AWARENESS AND DEDICATION TO THE HEALTH ISSUES RELATED TO EXCELLENCE IN BREATHING, THE PICTURE BECOMES EVEN BRIGHTER  FOR THOSE WE SERVE.

WE NEED YOU TO WANT THE BEST, TO EXPECT THE BEST LIFE HAS TO OFFER, TO BE THE BEST YOU CAN BE YET UNDERSTAND THAT YOUR OVERALL HEALTH IS THE KEY INGREDIENT TO BEING THE BEST YOU CAN BE. OUR JOB IS TO BE THE COACH THAT POINTS THE WAY. YOUR JOB IS TO TRUST YOUR INNER GUIDE WHO KNOWS AND INTERPRETS THE TRUTH OF THE BENEFIT AND GUIDANCE OF WHAT WE HAVE TO OFFER . YOU ARE WORTH THE EFFORT. IT'S ALL ABOUT YOU!

Posted by riderorthodontics | Post a Comment

Date: 12/23/2015 10:47 AM EST

The importance of bilateral nasalized breathing for children

Orthodontists like to consider that their training, knowledge and patient care qualifies them as experts in the area of childhood dentofacial growth and clearly recognize those factors that maximize and minimize idealized short and longterm maxillo-mandibular growth, dental and facial esthetics and functional dental occlusion. The orthodontist is in a unique position to fully monitor a child’s dentofacial growth and development for at least two to three years and beyond.  One of the most important factorVs in creating  a favorable  outcome within  this developmental equation is continuous bilateral nasalized breathing beginn The importance of bilateral nasalized breathing for children

Orthodontists like to consider that their training, knowledge and patient care qualifies them as experts in the area of childhood dentofacial growth and clearly recognize those factors that maximize and minimize idealized short and longterm maxillo-mandibular growth, dental and facial esthetics and functional dental occlusion. The orthodontist is in a unique position to fully monitor a child’s dentofacial growth and development for at least two to three years and beyond.  One of the most important factorVs in creating  a favorable  outcome within  this developmental equation is continuous bilateral nasalized breathing beginning in  early childhood and  continuing throughout life. The orthodontic and ENT literature is filled with studies that conclude and  clearly substantiate having an ideally functioning upper airway is an  important  health issue as well as a factor in dental-facial development. One of the health issues, obstructive sleep apnea, is often related to poor dental-facial development and long term mouth breathing in both children and adults. During the 1980’s and 90’s several ENT physicians referred many of their (400) sleep apnea patients to me for jaw repositioning orthopedics to mask the dental-facial deformity, open the pharyngeal airway space, provide more tongue space and resolve OSA (obstructive sleep apnea) in both mild and major OSA cases. Those ENT Doctors have long since retired.

The benefit of  practicing reconstructive cleft palate orthodontics since the late 1960’s working closely with cleft palate surgeons, Dr William Berkeley, Dr. Frank  Altany and others; and  since the 1980’s, Dr. David Matthews, has helped me focus on the importance of bilateral nasalized breathing for both cleft palate children and all children. This experience, careful study and examination of the research of others has helped me focus on this  dominant health issue for all people.

Dr Matthews recognizes the importance of  nasalized breathing in cleft palate dental-facial development and is a strong advocate of bilateral nasalized breathing for his cleft palate patients beginning with the initial intranasal surgery followed by reconstructive, orthopedic orthodontics at age four to expand the maxilla  and increase the intranasal width sufficiently to further improve the cleft side nasal space, maximize bilateral nasalized breathing and nasal-maxillary growth avoiding the need for a LaFort osteotomy or  distraction osteogenesis in adolescence.

There are multiple genetic, dietary, environmental, physical and physiological aspects associated with ones ability to breathe well through their nose. Parents need to be aware of those foods that clog the nasal cavity. The medical solution, I believe, falls in the realm of the patients and their ENT physicians. I’m just the detective with a history of upper airway concerns. My  assessment and expectations may be colored by my  association with “old time” ENT physicians whose treatment philosophy agreed with mine but today seem to conflict with the corporate rationale associated  with present day ENT practitioners and their PA”s. 

Realistically the medical community considers orthodontic treatment a cosmetic service with no medically related redeeming qualities. This may weigh heavily on  the reluctance of ENT physicians when considering a request from an orthodontist regarding his/her  “medically related  concerns” regarding  orthodontics treatment, dental-facial development and general health associated with the upper airway problems worthy  of serious health related surgical treatment  considerations. Often these children are placed on Flonase and sent home. Flonase can be a diagnostic vehicle for an allergic problem but not a long term solution! Parents must be aware of this and seek a more realistic solution if their child continues to be a mouth breather during the day or night.

It’s fundamentally important the orthodontist provide  diagnostic clues as to the breathing problem (lateral head film, frontal head film, rhino-metric breathing test, mouth open breathing photo, history of dry mouth in the morning, upper anterior gingival inflammation, dark skin tissue below the eyes, poor sleep history) which one  would consider  helpful and important to ENT physicians.  Apparently bilateral nasalized breathing problems in children do not fit the diagnostic and treatment criteria determined by todays corporate ENT industry and this damaging physiological entity remains  grossly mismanaged to the detriment of these children.

“It is what it is” yet a knowledgeable and well trained orthodontist  cannot, in good conscience, stop the upper airway referral process and  continue to trust that, at some point,  PARENTS will investigate, understand and grasp the important health value of what a highly functional nasopharyngeal upper airway can have on the health of their children and take it seriously enough to insist  their ENT physician work with them to help their child develop and maintain the lifetime health giving benefit of a patent nasal-pharyngeal airway or find another  practicing  ENT physician doctor or ENT group that will!  Google “mouth breathing”.

Dr Ernest A. Rider

Posted by riderorthodontics | Post a Comment

Date: 10/12/2015 12:13 PM EDT

Attempts to align the malposed maxillary alveolar components in unilateral and bilateral cleft lip cleft palate infants has many advocates and a number of nay-sayers, particularly in Europe. The rationale for use of pre-surgical orthopedics seems sound, particularly with the addition of a nasal molding attachment (NAM) designed to pre-surgically improve the anatomical configuration of the cleft-side nasal deformity prior-to reconstructive nasal surgery. The possible developmental problems created by pre-surgical alveolar orthopedics along with the associated  initial reconstructive surgery which may include GPP ( gigivoperiostioplasty), early bone grafting and BMP (bone morphogenic protein) has yet to be truly addressed by NAM advocates or non advocates.

During the late nineteen sixties we experimented with the use of a "pin retained" pre-surgical device designed to align the lesser segments in both unilateral and bilateral cases. The rotation procedures were very successful but unfortunately,with one bilateral case, the residual palatal soft tissue inflammation generated by the acrylic device resulted in dehiscence and large oral nasal fistulae when surgery was initiated prior to  healing of the palatal tissue. Thus ended the  romance with pre surgical orthopedics.

Our experience with cases treated pre-surgically  with the  Latham device has proven to be problematic  for many patients. Although reasonable alignment of the alveolar segments is often achieved, many of these patients suffer damage to the developing tooth buds (permanent incisors and cleft side cuspids). GPP and/or early bone grafting using BMP may have added to the possibility of damaged or missing permanent anterior teeth and poor facial development.The absence of bony support surrounding the maxillary anterior teeth destroys  lip competence and becomes a restorative disaster for the prosthetic dentist and a financial burden for the child, whereas the result of poor nasomaxillary growth and development may require a LaFort osteotomy in adolescences to resolve the abnormal upper jaw growth.

It”s not clear if cleft palate surgeons and pre-surgical orthopedic clinicians factor in the sensitivity of the dental lamina to any external pressure when designing, fabricating and adjusting the intra oral  devices.  It may be assumed that forceable early  alignment of the alveolar components is a very important contribution to the surgical correction. Whereas the NAM approach using a nasal molding device may be  an important contribution to nasal surgery, the addition of the early orthopedic alignment protocol for  the maxillary alveolar components plus GPP may indeed be contraindicated and result in serious damage to the permanent maxillary anterior tooth buds. The NAM advocates have yet to publish long term radiographic results  (panorex and lateral head film) regarding the outcomes  of their technique on dentofacial growth and maxillary anterior tooth development. Without such documentation the question remains open as to the  benefit of the alveolar molding component.

If the major contribution of the NAM protocol is surgical "improvement of external nasal anatomy" the use of Dr. Luis Monesterio's nasal lift approach without  an intraoral molding device could provide an esthetic nasal improvement without damaging the fragile permanent maxillary anterior tooth buds and naso-maxillary development. The addition of a carefully planned sophisticated lip taping process may reduce or eliminate damage to the delicate dental lamina and naso-maxillary growth.

The NAM process is widely advertised and very expensive compared to the nasal lift of Montesterio. NAM is supported by surgeons  throughout the US primarily  due to the post surgical esthetically  appearing external nose and hype.

Although the anatomical improvement of the external nose is esthetically desirable, the more important  factor associated with successful cleft lip cleft palate surgery is cleft side nasal breathing function. The poorly known, unadvertised, and utilized Talmant/ Lumineau protocol (Talmant, JC “Evolution of the functional repair concept for cleft lip and palate patients” Indian Journal Plastic Surgery  2006; 39:196-209) is not only designed to create an equally esthetically pleasing external nose without nasal lift or  pre-surgical orthopedics, It focuses primarily on creating and maintaining a  fully functional, patent,  growth enhancing, cleft side nasal airway yet has  received little attention in the cleft palate literature  or surgical advocates. The  Talmant surgical technique is very complicated and precise while  Lumineau’s  reconstructive orthopedic orthodontics enhances naso-maxillary development, cleft side nasal breathing and alveolar space for replacement of the congenitally missing lateral incisor, plus NO NEED for a  LAFORT osteotomy  in adolescence.“The Full Monty” of benefits!! If you child has not had the Talmant intranasal surgery, this surgical reconstruction can still be of value beyond the infant stage. Call the number listed  for and appointment.

The Talmant/ Lumineau reconstructive surgical and reconstructive orthopedic orthodontic protocol is the basis of the early cleft lip cleft palate treatment  provided by Dr David Matthews and the orthodontic team of “The Original  Charlotte Cleft Palate Team” which has been  providing  cleft palate and congenital craniofacial  deformity care for hundreds of children since the mid 1970’s. Unrecognized  by the political arm of  ACPCA. this clinic continues to serve hundreds of cleft palate and craniofacial children in the Charlotte,Mecklenburg County NC area. If this protocol appeals to you  Call 704-375-2955 to schedule an appointment.

Posted by riderorthodontics | Post a Comment

Date: 8/6/2015 8:42 AM EDT

CHILDREN LEARN WHAT THEY LIVE

Dorothy Law Nolte

If a child lives with criticism,

he learns to condemn.

If a child lives with hostility, he learns to fight.

If a child lives with fear, he learns to be apprehensive.

If a child lives with pity, he learns to feel sorry for himself.

If a child lives with ridicule, he learns to be shy.

If a child lives with jealousy, he learns what envy is.

If a child lives with shame, he learns to feel guilty.

If a child lives with encouragement, he learns to be confident.

If a child lives with tolerance, he learns to be patient.

If a child lives with praise, he learns to be appreciative.

If a child lives with acceptance, he learns to love.

If a child lives with approval, he learns to like himself.

If a child lives with recognition, he learns that it is good to have a goal.

If a child lives with sharing, he learns about generosity.

If a child lives with honesty and fairness, he learns what truth and justice are.

If a child lives with security, he learns to have faith in himself and in those about him.

If a child lives with friendliness, he learns that the world is a nice place in which to live.

If you live with serenity, your child will live with peace of mind.

With what is your child living?

Source: Canfield, J. & Wells, H. C. (1976). 100 ways to enhance self-concept in the classroom: A handbook for teachers and patents. Boston: Allyn & Bacon.

Posted by riderorthodontics | Post a Comment

Date: 8/5/2015 9:09 AM EDT

Did you know poor tongue function and mouth breathing adversely effect ones health, upper  jaw and facial development and make  ideal orthodontic treatment impossible? One of the fundamentals built into the design of human beings is “functional balance”.  When parts of our bodies are malformed or out of balance muscular-skeletal deformities occur like cross eyes, scolosios, and knock knees  to name a few occur. However, lack of functional  balance  can easily occur in ones jaws and face yet be considered a normal genetic difference. Some of these “normal” abnormalities can be addressed and an excessive developmental dysmorphology prevented if the problem is diagnosed and treated  early enough in life to correct or minimize the outcome. Untreated over time certain  skeletal dysmorphologies  will require extensive orthodontics and  jaw surgery to restore harmony to  the face, jaws, dentition and upper airway.

One of the often unrecognized  difficulties in resolving orthodontic problems is ones ability to develop and maintain a balance between the tongue, the teeth and the muscles that support the head, neck and  alignment of the  teeth and jaws. Teeth are imbedded in maxillary and mandibular alveolar bone while the tongue  one of the strongest muscles in our body is free to function uncontrollably when it’s space is violated. When there is a battle between muscle and bone, muscle always wins! When the tongue is out of control or forced out of it’s resting position in the roof of the mouth (mouth breathing, enlarged tonsils, congenital oral facial defect) it drops into the floor of the mouth and moves forward  opening the pharyngeal airway space to allow breathing to occur.

This untoward tongue pressure against the teeth and supporting structures is more than the teeth, lips and cheek muscular can tolerate.  Normal dental alignment is eliminated and tooth moving orthodontic pressure negated.

The proper conscious and unconscious control of  your tongue  is absolutely necessary for  Successful Orthodontic Treatment. Proper control of tongue posture is vitally important in corrective  tooth alignment and harmonious jaw relationships. When there is a battle between muscle and bone, muscle always wins. Since the tongue is a big muscle and the teeth are imbedded  in bone when one thrusts the tongue forward during swallowing or unconsciously posture it forward against the front teeth, it is impossible for orthodontics to correct any related orthodontic problems. Therefore one must consciously learn to train and properly control tongue posture twenty four seven.

In order  to achieve this necessary control  the tongue must have a proper amount of  space to feel comfortable and not crowded. Normally the tongue  fits comfortably in the roof of the mouth where it can maintain the internal muscular balance  with the cheek and lip muscles while supporting the proper dental arch form. If one cannot breathe well through the nose full-time  the tongue must drop down from it’s normal position in the the roof of the mouth to the floor of the mouth (losing internal muscular control forcing  one to breathe through the mouth) resulting in lack of tongue control, inward collapse of the upper jaw, high arched palate, malposed teeth, open bite, cross bite   and multiple other untoward health issues related to mouth breathing.

Another issue affecting tongue posture and creating orthodontic problems are enlarged tonsils. Big tonsils force the tongue forward  opening the posterior airway space  allowing one to breathe through the mouth. As a result the tongue creates multiple problems for the teeth and developing jaws (skeletal open bite, dental open bite, flared teeth, speech problems, ugly smile, gingivitis, dental decay).

Bilateral nasalized breathing is the key to good health and good facial development. A deviated septum, enlarged nasal turbinates, large adenoids and tonsils create problems that  require the attention of a well trained and  knowledgable  Ear, Nose and Throat Doctor who understands the ramifications associated with a compromised upper airway and the willingness to manage the defects associated with this deformity.  Poor diet and an adverse breathing environment must also be eliminated  if a successful long term benefit is to be achieved.  Successful treatment of the cause, not the symptoms (nose spray) is the key to success. Diet and environment must be controlled if a surgical solution is to be successful longterm.

Inability to consistently  breathe well through both sides of your nose is not always recognized as  a health issue. Unfortunately mouth breathing is not only a detriment to ones present or long term health and idealized dentofacial development, it limits the probability of a reasonably stable  orthodontic treatment  result by limiting the quality and stability of the very difficult treatment protocol required to finish and retain treatment. Without a well functioning nasalized breathing pattern, idealized esthetic and functional orthodontic results can only be obtained later in life with a combination of  orthodontics, orthognathic jaw surgery plus intranasal surgery to correct and maintain correction of this preventable, health related  skeletal dentofacial deformity.

Orthodontists are highly trained in dentofacial development and aware of those developmental problems associated with chronic mouth breathing that interfere with idealized orthodontic treatment when unresolved. Aside from convincing both parents and children of the value of proper breathing habits, finding a well trained  ENT physician who understands and is willing to apply the necessary parameters of treatment required for a well functioning upper airway associated with good health and  ideal  dentofacial development provided by full-time bilateral nasalized breathing. 

Although orthodontic treatment is considered a cosmetic dental procedure unrelated to physical health by the general public and members of the medical profession, there are  multiple symbiotic health benefits associated with an understanding and  cooperative  relationship between   the ENT community and orthodontists that could be of great benefit to those children and adults with upper airway problems who, without proper care otherwise, must endure the long term consequences of their unresolved infirmity. Reminds me of the old Fram Oil Filter Add; “you pay now (oil filter) or you pay later (new engine)”!  May not seem relevant until you consider  orthognathic surgery as  a total skeletal dentofacial reconstructive procedure requiring both prolonged orthodontic preparation and highly  sophisticated jaw surgery necessary to establish a highly functional and esthetic outcome. May also require ENT Surgeon.

Very expensive procedure that could have been prevented: (Hospital fee, Surgeons fee, Orthodontic fee, Patient, if employed, misses week or more of work, Insurance may not cover the entire cost)!

Just think all this could have been prevented if the problem was properly addressed and monitored by early detection and monitoring.

Posted by riderorthodontics | Post a Comment

Date: 8/5/2015 8:47 AM EDT

Welcome to the real world. Hard to believe but It’s time to plan for your life’s work.

Although It may seem too early in your life to hear this but “YOU ARE THE FUTURE OF YOUR FAMILY IN THIS WORLD”! All your children, their children and those that  follow will be influenced by who you are and how you live your life. It’s really true!  Be careful, being a parent at an early age can destroy your chances of being prepared for this awesome task.

The difficult part of coming to grips with the reality of being parents is that “now is the time to begin preparing yourself for this important family responsibility”

The truth be told and understood, every moment of every day of your life is preparation for your future. Who will you be as an adult? What kind of job you will have? Will you go to college? Whether you go to college or not is up to you. If you plan on college, now is the time to prepare. Grades are very important! Your best bet to attend college is to be a full fledged  “A’” student. “A” students are most likely to be awarded scholarships. The tuition of some big name colleges can be as much as $70,000 per year, not including living expenses. If you want to be a doctor or lawyer you must be a straight  “A” student from middle school through high school and college. All your competition for acceptance in medical and law school are straight “A” students. If you consider yourself   an athlete, your best bet is to be selected as an “All American” high school athlete. If you are not an All American selection, select another line of work or college degree that insures you a highly satisfying, appreciative, well paying job. You may qualify for an athletic  scholarship in a small college but don’t plan on playing pro football, basketball,  baseball or other professional sports. Pick a major that insures you are properly  prepared  for a job you love that pays well “when you graduate”!

You may question “how can orthodontic treatment influence my level of preparation for life in this complicated, competitive world”?

Orthodontic treatment in this office is a special opportunity for you to engage in a process  designed to assist you in coming to terms with who you are, what the future holds for you and those who follow after you (children, grandchildren and beyond. This unique training program is designed to open your eyes and mind to how important you are to the future generations to come.

What can an orthodontic treatment experience possibly mean to you as an orthodontic patient and a parent of future generations?  Sorry folks! “Although The Truth Will Set You Free, putting that truth into action can be very difficult and  upsetting”

The great thing about orthodontic treatment is that “it’s a test of who you are, who you can be, and who you intend to be as a person of, integrity, truth, commitment and dedication for becoming the best person you can be as a standard for all your family generations that follow”. It’s about developing a can do, will do healthy attitude about life and the difference that can make in your life and the lives of your children, grandchildren into infinity.

This is “the road less traveled”. It’s a difficult road, a demanding road, but it’s the right road when you choose to set an example that can be imbedded in the lives of  future generations. You have the power to make a positive difference in the lives of the people intimately connected to your gene pool as well as a multitude of other people along your life’s way. Take a moment to visualize how important you are to those whose lives you will impact now and in the future.

How do you start the process? You start  by realizing and appreciating the reality that you are free to commit your life to being “the best person you can be in all aspects of your life”, like doing the right things for the right reasons as a vision for your future and the example to be followed by future generations. Fill your mind with good thoughts and expectations. Grading your  thoughts, actions and objectives on a scale of one to ten. Ten being ideal is a great  way of measuring your performance. For example: School grades; all “A’s” is a 10. Treating yourself and others with kindness and compassion is a 10. Doing your best in everything you do is a 10. Orthodontic treatment; a 10 is following ALL instructions to the letter of our specified requirements (keeping your appointments on time, excellent oral hygiene, proper healthy  diet, elastic wear (this is what moves the teeth, if you do not wear them as directed, 24x7, and changing them 3 times a day, you are NOT a person that can be depended upon or trusted to do what you say you will do). Not good! This kind of behavior will show up throughout  your life as well, limit your growth toward maturity, minimize your acceptance as a friend, colleague and limit job potential).   

Our main objective during your orthodontic treatment is for you to you become aware of life’s big picture and the importance for you to embrace and connect to the power within you as a role model for the future development of the human race through your gene pool. Many are called for a life of excellence. Very few heed that call. Even fewer are willing to accept the challenge and be a beacon pointing the way for becoming the best human being  they can be in all walks of life.

The ball of your life is in your hands! Understanding and planning your life now determines your future and the future of those who follow.

After you have read this preamble and believe you  have a serious  interest in becoming “the best you can be”, sign up and fully commit to our lifetime “Pursuit of Excellence” program. Although this  “road less traveled” is very demanding and difficult it will be a helpful lifetime guide for monitoring and managing the results of your commitment to yourself,

your family and those who follow.

Excellence (10)

1.  Orthodontic treatment and followup retention program.

2.  Home care. Brushing and flossing.

3.  Diet. Avoid those unhealthy foods containing sugar and GMO’s that destroy your health (candy, cookies, cake, ice cream, soft drinks).

4.  Straight A student in all subjects.

5.  No tobacco products, alcohol  or illicit drugs.

6.  No violent or abusive behavior toward anyone.

7.  Be  a good citizen. Obey the law.

8.  Honor your parents, siblings, friends and neighbors by living an honest, trusting, accepting, responsible and  supportive life.

9.  Never give-up on yourself. If you make a mistake forgive yourself and start over again. Correct the mistake, ask for forgiveness  and to do the “right thing”.

10. Since you are a precious loving child of God, accept that reality and practice  the Golden Rule. Understand, accept and truly Believe you are truly a gift of God and the entire Universe. Follow the universal rule of “Do unto others as you would have them do unto you”. Everyone on the planet is a gift to humanity. Know and believe  You are important! Your job  NOW is to accept that this is the time to begin the journey of discovery and preparation for your destiny as the special human being you were meant to be.  Know you are important to the future of this earthly planet and to your descendants  who will depend on the quality of your guiding values to develop their pathway is a great responsibility. Don’t ever lose sight of your value and the powerful potential of your existence .

If a  commitment to being  the best you can be feels right to you and you wish to continually select and follow a pathway  of excellence in your life make a written declaration of your intentions. Sign and date this document. Review the process everyday as a reminder and motivation for  mastering  your self development. Make it  a lifetime feel good process. You will be glad you did!  Every day is a new beginning and  an opportunity to commit your life to being the best you can be. Accept nothing less from yourself. To be someone who can make an important  difference to a healthy life on this planet. The “universal guide” is always with you. Just listen, follow the call of universal love and let the “force” take over and lead the way.

I hereby commit my life to being the best I can be and ask the “universal guide” to help  me find and follow the way.

Signed

______________________

Date

____________________

Posted by riderorthodontics | Post a Comment

Date: 9/19/2013 10:09 AM EDT

EVIDENCE BASED ORTHODONTICS:

Today Evidenced Based Orthodontic Treatment is the  “Gold Standard” used by the scientific community to determine the true validity of treatment outcomes claimed by the various orthodontic treatment protocols.

Claims using a particular bracket will produce superior results without the application of orthopedic forces in cases with clear evidence of a related skeletal component require “Evidence Based” evaluation to confirm or deny these claims.

It has long been known and reported in the orthodontic literature that applying a midline orthopedic force to the upper jaw in young children, using the teeth as the vehicle for correction, will separate the connecting midline suture. The correction (6-12mm) is held in place for 90 to 120 days, to allow suture healing, and a substantially wider upper jaw is created. In those cases with a sustained patent nasal-pharyngeal airway the correction remains intact. Those who fail to resolve their upper airway problems will have great difficulty maintaining the correction.

The listed benefits of this procedure substantiated by evidenced based treatment include:

1.) Improved nasal airway (The roof of the mouth is the floor of the nose. When you widen the upper jaw you also widen the nasal cavity, improving the flow of air through the nose).  Those with unresolved upper airway problems (deviated septum, enlarged nasal turbinate’s, large adenoids, and in some cases, large tonsils will be unable to maintain the correction. Nasalized breathing is the key to good health and facial development and is of primary importance for a healthy life.

 2.) Provide idealized space for the tongue. The tongue is the most powerful muscular component of the oral cavity and plays an important role in tooth and jaw alignment as well as its role in chewing and swallowing. When out of control (large tonsils forcing the tongue forward, small upper jaw preventing the tongue to fit properly in the roof of the mouth, congenital oral-facial anomalies, mouth breathing, untoward oral habits, very large tongue) poor tongue function can create multiple types of functional, dental and skeletal problems that, if not resolved early in life, may require both orthodontic treatment and jaw surgery to correct.

3.) Increase jaw space for un-erupted, crowded or blocked out permanent teeth due to an increase in jaw size minimizing the need for extraction of permanent teeth to resolve a crowded tooth problem.

4.) Harmonize the relationship between the upper and lower jaws to improve the functional stability of the teeth and TMJ

5.) Prevent, in severe cases, the need for surgically enhanced orthodontics to correct the poorly developed dental and skeletal components of the upper jaw. 

 

The most important element of evidenced based orthodontics is arriving at a proper diagnosis and treatment plan. Initially the goal is to determine if the problem is of a developmental skeletal etiology or a dento-alveolar tooth problem. This is best determined by careful evaluation of cephalometric radiographs, intraoral and facial photos, tooth models, patient observation, experience in assessing diagnostic evidence, comparison with outcome of previously treated cases and evaluation of evidenced based, competent, orthodontic literature.

One would strongly consider when the overwhelming evidence clearly indicates a developmental or congenital Skeletal deformity and not a dento-alveolar problem, the “highly trained” orthodontist would elect to treat the skeletal deformity using appropriate orthopedic/orthodontics rather than treat the deformity as a dento-alveolar (tooth) problem.

Unfortunately today a small segment of orthodontists have elected to follow the dictates of one orthodontic company and their “magic brackets” believing their “light forces” are different than the “light forces” used by non-believers and orthopedic changes can be obtained by just using their bracket formula. Apparently, “If the only weapon you have is a hammer (magic bracket), you are justified in treating all orthodontic/orthopedic problems including skeletal deformities as a nail (dento-alveolar, tooth problem)”.

All evidenced based studies published in refereed orthodontic journals have concluded there is no difference in treatment outcomes in comparing  “magic brackets” with traditional brackets when treating dento-alveolar orthodontic problems. Therefore treating dentofacial skeletal problems with “magic brackets” alone (without first addressing the skeletal deformity) is contraindicated.

In my office orthodontic treatment is an “exercise in perfection” based on years of study, multiple post graduate training and experience treating some of the most difficult congenital craniofacial (skeletal) deformities known to man.

Many orthodontic problems appear as tooth dominated malformations with only a minor skeletal deformity present. In theses cases the presence of the skeletal deformity can be masked by orthodontic treatment. Although the overall results may not be perfect, the straight teeth and beautiful smile are more than acceptable and the skeletal deformity considered within acceptable limits.

For those children with more obvious skeletal deformities, attempts to mask the skeletal problem by tooth movement alone can initially produce a nice smile and functional occlusion. However, the dominance of the underlying skeletal relationships soon become evident as the child matures. The parent and child are now confronted with two unfortunate choices: 1.) Live with the problem, or 2.) Undergo orthodontic preparation for surgical revision of the skeletal deformity. Both choices are expensive. If they choose not to resolve the skeletal deformity, the cost will be long-term physical and emotional distress. If they choose surgical revision, the cost of additional orthodontic treatment and jaw surgery must be considered.

Skeletal problems in children come in different packages. 1.) Those that can be diagnosed and the skeletal problem resolved by early intervention (age three to five) with proper follow-up care who will never require jaw surgery to correct the initial skeletal deformity; 2.) Those with more severe, inherited problems who, although properly diagnosed and treated early enough in their lives (age three or younger) with continuous follow-up to “mask the deformity during the critical growing years” yet may require surgical intervention in the late teenage years after jaw growth is complete. 3.) Children who are diagnosed with a skeletal deformity too late in their lives to fully benefit from early orthopedic treatment.

Parents trust the knowledge and judgment of their pediatrician in the diagnosis of medically related problems affecting their children; cross-eyes, knock knees, pigeon toes, scoliosis, to name just a few. Pediatricians refer these children to the respective medical specialists as soon as they diagnose the problem. Rarely do pediatricians recognize the early signs of dentofacial deformities in young children unless it’s of a recognizable congenital nature like cleft-lip cleft palate or other severe congenital deformities. They leave dentofacial diagnosis to the pediatric dentist. Not good! The pediatric dentist listens to the orthodontist to whom they refer their children.  Unfortunately most orthodontists follow the American Association of Orthodontists suggestion that the ideal time for the first visit to the orthodontist be around age eight.    Age eight for dentofacial deformities is like waiting to age eight for cross-eyes or knock knees, and other medically related problems. Too late! The window of opportunity has long passed for effective dentofacial treatment.

Pediatricians must become aware of what’s going on in the developing face and jaws of the young children they see and refer to a trained pediatric orthodontist who understands the benefit of appropriately timed dentofacial orthopedics for young children born with developmental skeletal deformities.

 

Dr Ernest A Rider

Craniofacial orthodontist

Sept 17,2013

 

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Date: 8/30/2013 1:40 PM EDT

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A simple and consise handbook providing correct breathing, dietary, sleeping, stress and exercise guidelines. Excellent self help book for asthma, snoring, hayfever, blocked nose and much more.

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