8 August 2019

Entertaining Conversations with an Orthodontist

Has the idea of a beautiful smile always looked the way it does now?

The notion of a beautiful smile is quite debatable. For example, ancient Maya tribes made special grooves in the teeth using a straw and ground quartz, and inlaid them with precious stones, shaped teeth into bizarre forms, and dyed them in bright colors. In excavations of ancient Egyptian mummies, researchers also found teeth with signs of mechanical intervention, and even gold wire used to fix fallen or artificial teeth. The Etruscans and ancient Romans made dental crowns and even bridge-like structures that replaced defects or corrected tooth positions. One could say this already was a prototype of modern orthodontic procedures!

And in some countries, for example in Japan, girls before getting married would stain their teeth with black pigment, which signified eternal devotion to their future husband.

And despite the current cult of the so-called Hollywood bright-white with perfectly aligned teeth, some world fashion leaders are not afraid to experiment with beauty canons — recently Gucci’s advertising campaign surprised the online community by choosing for the campaign a owner of, to put it mildly, non-standard smile with missing teeth. And while it’s not entirely clear whether this is shock content or a move from the Hollywood smile to personalization. Or perhaps an attempt to establish new canons of the perfect smile?

When did orthodontists actually appear?

In any case, a straight row of teeth has been associated with beauty for a long time! It is believed that the founder of modern orthodontics is Pierre Fauchard — the personal dentist of Louis XV (the 18th century). Thanks to this inventive Frenchman, teeth that are outside the dental arch began to be aligned using silk threads or silver plates, rather than mercilessly removing them as was sometimes practiced before. Pierre Fauchard also gave us the emergence of modern dental prosthetics. It is known that jewelers worked in his dental prosthetics workshop, who studied medical books and anatomical atlases. For fixation, springs made of gold were used, and the color and shape of the teeth were expertly chosen using coatings of fired porcelain enamel in various shades.

The first true bracket system was created in 1886 by Edward Hartley Angle. It is on this basis that modern metal braces were developed, which were the main method of correcting bite throughout the 20th century and remain popular to this day.

And by what parameters do dentists determine the ideal smile?

The ideal smile from the perspective of modern aesthetic dentistry is based on three pillars — three kinds of aesthetics: macro, micro, and mini aesthetic concerns:

The arc of the smile — the edges of the upper teeth should follow the curve of the lower lip, and the upper lip should cover the gingival line of the teeth;

Leaving aside aesthetics — does an uneven dental row threaten anything besides reluctance to smile in photos?

Of course, the main request people bring to a dentist-orthodontist today is to improve the aesthetics of the smile.

It is important to consider the body as a whole, a complex of interrelated functions. If the teeth do not close properly, we have not only an aesthetic problem but also a changed function. Over time, a so-called pathological muscle pattern forms, which can lead to structural deformations.

For example, imagine this situation: you’re driving straight on a level road, and suddenly an obstacle appears. A sharp maneuver, turn the wheel to the side and you bypass the obstacle, stabilize the car and continue. The same thing happens when even one tooth in the mouth is not in its place. Our central nervous system sends signals to the muscles to “go around the obstacle,” and what if there isn’t just one tooth?

Thus the visual graph of the movements of the lower jaw changes, muscular tension appears, the temporomandibular joint begins to adapt. There can also be deformation of the musculoskeletal apparatus, development of scoliosis, and even changes in the position of internal organs! Patients also often complain of migraine-like pains or hypertonicity in the cervical region.

Why and when does a bite problem arise, and can it be avoided in any way?

Most often, an incorrect bite forms in childhood during growth and development.

A significant role is played by sucking. In infants, from birth, the tongue, lips, and cheeks’ muscular activity begins to be established. By 1.5 years old, a child mainly uses an infantile type of swallowing (tongue between the gums), and from 1.5 years the swallowing method changes to somatic (tongue on the palate) to consume solid foods. The transitional shift from one swallowing type to another begins at 6 months (first complementary feeding) and ends by 18 months. If certain factors are present — tongue position at the bottom of the oral cavity (as in breastfed or bottle-fed infants), buccinator muscle activity (active during sucking) — a full transition to the somatic (adult) swallowing type may not occur. This can later cause bite problems.

Therefore, from an orthodontic point of view, this is exactly the period when it is worth reducing the use of pacifiers and bottles.

Breastfeeding involves the same muscle processes and swallowing reflexes. Official recommendations acknowledge the possibility and even usefulness of prolonged breastfeeding, but one should still consider the physiological changes of this age and weigh the benefits and risks.

If you use a pacifier, it should be chosen carefully: for the correct tongue placement, it should be flat on both sides.

Problems with the bite can be triggered by some harmful habits: sucking a finger, placing the tongue between the teeth, gnawing on pencils. Any foreign object, with prolonged exposure, can alter the development of the facial skeleton because it disrupts the proper coordination of the jaws and affects how they close.

Diet plays an important role. Repeated thermal processing, lack of meat, hard vegetables and fruits rich in fiber, and preference for puree-like foods over hard forms create a short chewing pattern, which in turn does not promote the development of the lower jaw in length.

Adenoids, polyps, vasomotor rhinitis, sinusitis, congenital or acquired deviations of the nasal septum — these factors usually cause difficulties with nasal breathing. And this is compensated by mouth breathing. But mouth breathing is possible only if the tongue is placed at the bottom of the oral cavity, and in such a way that the tongue root does not block the airways, i.e., by jutting the neck forward. Since physiologically correct is the position of the tongue on the hard palate, which ensures its adequate growth and development, such a situation leads to narrowing of the palate. And this subsequently threatens misalignment of tooth positions. If the tone of the muscles supporting the mandible is weak, we also get a vertical growth pattern.

Sometimes bite problems appear in adults. More often this is associated with tooth loss or trauma.

Can we consider an incorrect bite to be an inherited problem?

Of course, in the development of any pathology, genetics plays some role. However, in the case of bite problems, the main role is still played by the exogenous factors mentioned above. And this is interestingly described in a book that appeared quite recently — Sandra Kan and Paula Ehrlich "Jaws: The Story of a Hidden Epidemic."

And here is one of its quotes: "Right under our noses an epidemic is taking place: our jaws are shrinking, and teeth are becoming misaligned, which creates not only aesthetic problems but also increases health risks due to narrowing of the middle airways."

There is a common belief that teeth straightening should be done in childhood. Can it be done in adulthood?

You can straighten teeth as long as there are teeth.

Of course, in childhood and adolescence all processes are faster and more predictable. The remodeling of bone tissue occurs through the so-called processes of resorption (bone resorption) and apposition (bone formation). At the very beginning of our existence, the resorption process slightly predominates over resorption (note: likely a redundancy; should be remodeling). Over time they balance, and after thirty the resorption process tends to prevail, which in the elderly may manifest as osteoporosis. Of course, this imposes certain limitations on orthodontic treatment and its duration. In addition, in adulthood there are often already some interventions in the anatomy of teeth and dental arches, missing teeth, periodontal problems, etc.

Therefore, in childhood and adolescence, the main goal of treatment is to create favorable conditions for normal growth and development of the dentoalveolar system, elimination of harmful habits, and an interdisciplinary approach (involvement of an otolaryngologist and a speech therapist if necessary). In adulthood, most often, this is about creating an attractive aesthetic and maximum possible correction of an already formed pathological bite for proper system functioning and prevention or transition to remission of joint or soft tissue problems, preparation for adequate prosthetics or implantation.

Orthodontics, like all branches of medicine, is developing and adopting new progressive treatment methods. What, in your opinion, do modern technologies offer orthodontics? Which directions would you like to develop?

We live in an era of modern digital technologies, and the technologies for treating teeth translate perfectly into a digital protocol, perfectly combined with three-dimensional scanning, virtual planning, and 3D printing.

I would say that we are already living in the future!

I would like to emphasize the importance of popularizing preventive practices, because preventing is always simpler (and cheaper) than fighting with outdated pathology. It is important to undergo assessments on time, monitor the diet — this depends on both health and the quality of our life.