Orthotown June 2023 - 57
When nasal breathing is obstructed, the nasal
passageways and sinuses become underused
and underdeveloped, leading to increased mouth
breathing, further restriction of transverse development
of the dental arches, and insufficient
space for the tongue. The tongue is then forced
inferiorly and posteriorly, where it can constrict
the oropharyngeal airway and worsen the mouth
breathing, especially when the patient is lying in
a supine position.16
As the mouth breathing and snoring worsen,
the transverse development of the arches
continues to restrict. The modern soft diet and
resulting weak tongue further exacerbate this
negative cycle of aberrant facial growth (often
referred to as " masticatory adaptation " ),17-23
exemplifying the interconnectivity described by
Moss and Enlow many decades ago. We see this
every day in our practices when young patients
present with narrow arches and significant
dental crowding.
The solution
Our traditional approach to the treatment of
the aforementioned patient is one where treatment
decisions are based upon the symptom
(i.e., crowded teeth). Instead, we need to shift to
a treatment approach that focuses on the etiology
(i.e., narrow arches secondary to environmental
factors). As such, our priority must be to
address the environmental factors contributing
to the malocclusion and normalize arch width,
especially in the anterior and middle thirds of
the arch.
Sample case
Let's look at this patient, 8 years and 10 months,
who presented with the mother's chief complaint
of " crowded teeth. " The patient is Class I
with a relatively normal OB/OJ and no posterior
crossbite, yet she has moderate-severe anterior
crowding and the maxillary canines are erupting
toward the roots of the lateral incisors (Figs. 1-4).
Our airway questions confirmed that she is a
mouth breather and snorer, but the adenoids
FIG. 1
FIG. 2
FIG. 3
FIG. 4
appear normal on the ceph and the palatine
tonsils are not enlarged.
The existing paradigm says to base your treatment
decisions on the management of the crowding/symptom.
As a result, a common treatment
plan would look something like this:
* Immediately send patient for extraction of
all C's.
JUNE 2023 | 57 | ORTHOTOWN.COM
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Orthotown June 2023
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