Orthodontics & Corrective Jaw Surgery

Orthodontics & Corrective Jaw Surgery

A DxD Session with National Dental Centre


Ended on Sun Mar 31 2019
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Top Answers


Thank you for your question. I must admit that I was initially unfamiliar with the term "mewing" and had to do a bit of research into what this meant.

Mewing is a concept developed by Drs Mike Mew and John Mew that encourages a proper way of positioning the tongue and jaw muscles so as to influence the way the face grows and also purports to have a positive impact on an adult's facial structure.

Although this termed "Mewing" is a new term, the concept behind form follows function is definitely not new. 

Melvin Moss in 1962 introduced the concept of functional matrix hypothesis which is a theory that suggests that the growth of the face occurs as a response to functional needs and mediated by the soft tissues in which it is embedded. 

Some of the possible functional influence on facial growth include the resting tongue posture and chronic mouth breathing as a result of nasal obstruction.

A good example of the result of chronic mouth breathing due to nasal obstruction is the "Adenoid facies" or long face syndrome, a termed coined by C.V. Tomes in 1872.

When one has a chronic nasal obstruction, the neck extends upwards to improve the airway, there is downward and backward rotation of the lower jaw and the tongue assumes a more forward position, all of which contributes to a longer face growth.

Though there is an association between facial growth and functional influence (e.g tongue posture, mouth breathing and muscles), the relationship is an association.

A closer look at the evidence suggest that the relationship between nasal obstruction and a long face syndrome is not causal. This means that not all children with nasal obstruction grow to have a long face while a large proportion of children with chronic nasal obstruction are observed to have a long face.

This I believe is because growth of the face is also influenced  by other factors including genes , growth pattern and the severity of the disordered breathing.

There is currently no published evidence on the effect of mewing, though there are certain ideas in mewing (e.g proper tongue posture is important in the stability of anterior open bite correction) that are well accepted by the orthodontic community.

However, there is little in the concept that is supported by proper research and data. 

11 Feb 2019

In general, most orthodontic treatment for crowding is considered elective and cosmetic. An instance in which orthodontic treatment could be deemed medically necessary include crossbites causing trauma to other teeth, such that non-treatment can potentially lead to early tooth loss.  

Crowded teeth do not usually push against one another to create forces high enough to cause pain. The discomfort you have been experiencing might be due to inadequate oral hygiene leading to gum disease. Hence, it may be helpful to go for regular teeth cleaning and to upkeep good brushing and flossing practices.  

Malocclusions are, however, evaluated on a case-by-case basis. Thus, to determine if your malocclusion is considered medically necessary, it would be best evaluated with a proper clinical consultation by an orthodontist 

14 Mar 2019

Thanks for your question, the rotation of your upper left back molar can be corrected with the braces wire or with repositioning of the bracket on the tooth. It isn't a cause for concern as it can be corrected while you still have your braces bonded. Do let your orthodontist know about your concerns and he/she will be able to address it. 

NDCS is hosting a public forum on making your dental visit worthwhile, for more information please check out: 

https://www.facebook.com/events/81578365441187/

12 Mar 2019

Thank you for your question. Orthotropics is a term coined by Dr John Mew a dentist from the UK, who has been suspended by the General Dental council from clinical practice. Details can be found in this link: https://gdcolrlive.blob.core.windows.net/annotationspublic/857ab0e5-0481-e711-8107-5065f38bd502

Orthotropic dentistry is not a recognised branch of dentistry. It purports to treat malocclusion by guiding the growth of the facial bones and correcting the oral environment. This treatment supposedly creates more space for the teeth and tongue with its main focus being to correct a patients oral and head posture.

However, due to lack of scientific evidence, the information presented on their website about this treatment can be misleading to the general public. 

The basis of orthotropics treatment is that the cause of improper bites and facial form is mostly environmental and hence modifiable. They do this with removable appliances and muscle exercises.Hence orthotropic treatment is supposedly most effective in young patients experiencing growth as this is the period whereby correcting the soft tissue behaviour and oral environment will then influence the way the jaw bones and teeth grow. 

However, the cause of improper bites and jaw problems can be multifactorial, both genetic and environmental factors are important considerations. This also explains why parents who are of tall stature have also bestowed this gift of height upon their progeny. Likewise it is not uncommon to see families who have similar facial structure, long lower jaws are often found in siblings and relatives. A famous example would be the Hapsburg monarchy.

The concept that form follows function is nothing new, orthodontists have been trying to modify growth by changing the environment for centuries using a myriad of appliances. Just to name a few they are: the Frankl appliance, the Twinblock and tongue spurs. All of these appliances aim to influence the environment so as to improve one's teeth and jaw growth. However to answer your question on the effectiveness of orthotropic dentistry and the recommended age range, it would be important to understand the type of malocclusion (bad bite) that one is wanting to correct. It would be best to consult an orthodontist who may be better able to assist your concerns. 

NDCS is conducting a public forum on tips to make your dental visit worthwhile, to find out more, do join us!

https://www.facebook.com/events/81578365441187/

12 Mar 2019

Thank you for your question. From the profile photos that you have sent, it does appear to me that the upper lip position is ideal, while the lower lip is set back due to the retruded position of the lower jaw. I use the Zero Meridian line as a reference, which is a vertical line from the nose bridge perpendicular to a true horizontal line. The most convex point of the lower chin should lie 0 to 2mm away from this line. As you can see in the line drawings, the lower chin does lie more posterior compare to the upper lip. 

I do agree with your doctor that the issue does lie with the lower jaw position as opposed to the upper lip position. To correct the lower jaw position, a lower jaw advancement surgery will be required. However this is still considered an elective procedure and the decision on whether you require the orthognathic surgery (lower jaw advancement) still lies ultimately a personal choice. 

There are other alternatives such as a chin advancement (genioplasty advancement) or chin fillers/implants to mask the underlying lower jaw deficiency. However, these may not correct the underlying malocclusion that you may have. 

zero meridian

NDCS is conducting a public forum on tips to making your dental visit worthwhile. For more information, do join us at our upcoming NDCS public forum: https://www.facebook.com/events/81578365441187/

12 Mar 2019

Top Questions


I had my braces removed a few years ago. I noticed that there was glue residue where the braces once were. Is this normal, and how can it be removed?

I noticed a dark mark on my tooth where my braces used to be after removing them. What could be possible causes?

I had 4 premolars extracted for my braces treatment. Since then, my facial profile has changed so much that people thought I looked different when they saw me during Chinese New Year.  Why is this so? Will it be the same after braces? Thanks in advance! (: 

I did not use to sleep with my mouth open. Ever since braces, I've started sleeping with my mouth open. This causes my mouth to feel very dry ever since I've gotten braces on. 

I have a teenager turning 14. He is very much in need of braces, but his molars are still baby teeth. Should he wait until all the baby teeth are fallen out and replaced by baby teeth before getting braces?

I've noted the large difference in prices between various clear aligner brands in Singapore. 

I have overcrowding and overbite/overjet. With traditional metal braces treatment, I was informed that 4 premolars must be extracted as expanding to create more space will not work well for an adult patient. Will Invisalign treatment require the same?

My problem are spaces in my upper teeth due to small teeth and big jaws. How do I close the gaps in between my teeth? Will braces help to close the gaps or can I do teeth bonding?

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Disclaimer: Any answers provided are for general informational purposes only and is not a substitute for professional medical advice. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

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Disclaimer: Any answers provided are for general informational purposes only and is not a substitute for professional medical advice. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

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