Orthodontics/Dentofacial Orthopedics

Woman with BracesAt DC Smiles, orthodontic treatment (including braces) is a critical component of Dr. Singer’s work. Dentofacial Orthopedics Orthodontics (DOO) is a more advanced orthodontic approach than traditional orthodontics. DOO focuses on the diagnosis, treatment, and prevention of oral and/or facial irregularities.

These irregularities can cause malocclusion: a misalignment of the teeth that is also known as a bad bite. But more importantly, a dentist can survey the cause and effects of a bite disorder, which often impairs the airway and breathing, and correct the disorder in developing faces. Properly timed and executed DOO can greatly enhance the aesthetics of a patients face for life.

Malocclusion is a common problem. Genetics (epigenetics read more), injuries, lifestyle, and environmental factors can all contribute. Usually, it is actually a combination of these factors. Dental academics debate the causes, but increasingly, scientific evidence points to epigenetic expression and nutritional factors as the cause of the worldwide epidemic of malocclusion and poor facial development.

Weston Price, DDS, a Cleveland dentist, is properly credited with discovering and proving this phenomenon over a century ago in his classic book, Nutrition and Physical Degeneration. However, intervention can positively affect teeth, jaw growth/development, aesthetics of the smile, and even overall health.

Many contemporary studies have validated the groundbreaking research conducted by Dr. Price in the 1930s, suggesting that environmental influences, such as nutrition, have more dramatic influence on our bodies. Now, we are just beginning to understand how this manifests in what scientists now term epigenetic predisposition.

Corrective appliances fitted by a dentist, such as braces (Damon System) or Advanced Lightware Functionals (ALFs) are used to treat malocclusion. Beloware examples of functional appliances customized by a dentist to widen the palate. Note how constant forces are preferable to rapid expansion (screw type) devices or techniques.


Side view

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Bite Correctors
Side view

Types and Symptoms of Malocclusion

Click the video above to learn more

Dentists treat three classes of malocclusion based on the alignment and spacing of the upper and lower teeth.

  • Malocclusion Class I: The upper and lower molars are aligned properly, but the teeth are either crowded or have gaps, rotations, overlapping, or crossbites.
  • Malocclusion Class II: The upper teeth stick out past the lower teeth in what is commonly referred to as an overbite.
  • Malocclusion Class III: The lower teeth stick out past the upper teeth in what is commonly referred to as an underbite.

Dentists sometimes see malocclusions that are concurrent with skeletal asymmetry. These asymmetries can originate in the body below the neck and work their way upward; they can cause asymmetries in the facial bones or vice versa. Skeletal asymmetry is analyzed using 3D imaging of both the hard and soft tissues of the jaws and mouth, as well as looking at the overall structure of the individual. For example, problems in the foot and hip on one side can work their way up the spine and into the neck and facial bones. (See example below DO)

Dr. Singer has seen how malocclusion, whether inherited or acquired, can cause problems that distort the function and appearance of the mouth, face, and airway, while impacting the ability to properly chew, speak, swallow, and breathe. Some of the physical abnormalities that may result from malocclusion include:

  • Long and narrow faces
  • Pinched noses
  • Small-looking lips
  • A bird chin, or narrow protruding chin
  • An underbite or protruding lower jaw
  • An overbite- prominent and forward positioning of upper teeth and jaw

Malocclusion also causes physical symptoms that can be painful. Orthodontic treatment may be required if you or your child experience any of the following symptoms:

  • Pain in the jaw or face
  • Difficulty swallowing
  • Tongue thrust, in which the tongue is incorrectly positioned at rest, as well as while swallowing and speaking
  • Difficulty speaking clearly (including a lisp)
  • Difficulty breathing, or abnormal breathing patterns
  • Difficulty chewing due to pain in the teeth or poor teeth alignment
  • Crowded or crooked teeth
  • Abnormal positioning of permanent teeth
  • Frequently biting the cheeks, tongue, or lip, causing irritation in the mouth

Correcting Airway Blockages

Many people do not realize that difficulty with breathing can often be treated by advanced orthodontics. Airway-driven dentofacial orthotics customized by a dentist can treat the underlying cause of malocclusion. The presence of a bad bite is heavily influenced by the existence of a problem with the airway.

Moderate airway obstruction before treatment with orthodontics.

Moderate airway obstruction before treatment with orthodontics.

Improved airway post treatment with orthodontics.

Improved airway post treatment with orthodontics.

Practitioners of airway-driven orthodontics know that the jaws alignment can be corrected with orthopedic appliances and braces that move the jaw, open the nasal and oral airway, correct the position of the teeth and skeletal symmetry, and often dramatically improve the appearance of the face. Treating the teeth without treating the airway, which is standard practice in traditional orthodontics, is a superficial fix that usually results in long-term failure, TMJ problems, orthodontic relapse, and the missed opportunity to enhance smile and facial appearance.

Since specific postures and movements of the tongue and its associated musculature facilitate the development of the face, the tongue is also essential for proper facial and airway development. Deviation in the development of this muscle function can seriously impact other systems of the body, including abnormal development of the jaw, inflammation of the airway, and malocclusion. Airway problems can even be successfully cured in children whose bones are still forming.

We teach face muscle exercises to our patients as well. These are an important adjunct to braces and orthopedic development. Called myofunctional therapy, this treatment can begin as early as 2 or 3 years of age, followed by appliance therapy when the child is mature enough to cooperate and participate in his or her treatment. When used together, myofunctional therapy and appliance therapy, such as braces, are able to enlarge the facial skeleton, alter the position of the jaw, and correct the airway.

State-of-the-Art Braces

Dr. Singer most commonly uses the Damon Braces System and Invisalign clear aligners. The Damon System typically shortens the length of time that patients have to wear braces. They are also more comfortable, as they have a slide mechanism that allows the dentist to adjust them without having to resort to the uncomfortable tightening that is necessary with traditional braces.

With the state-of-the-art design of Damon Braces, headgear and expanders are almost never necessary, and natural teeth do not have to be pulled in 99% of growing patients. Damon Clear Invisible Braces are also considered to be the best clear braces on the market. Patients who are not candidates for Invisalign clear aligners may be candidates for Damon Clear Braces.

Dr. Singer is Certified to use the Damon System, which consists of passive self-ligating braces that do not need the elastic or metal ties associated with traditional braces. They are lighter, more discreet, more comfortable, and easy to clean.

Invisalign braces consist of invisible, customized aligner trays that are worn over the teeth. No wires or metal brackets are required. Each set of aligners lasts for two weeks, after which you insert a new set, and they gradually shift the teeth into proper placement. Invisalign isn’t appropriate in all cases, but it can correct a wide variety of issues, including gapped teeth, overbite, underbite, crossbite, open bite, and crowded teeth.

Whether you are fitted with Damon Braces, or Invisalign clear aligners, the amount of time you must wear them will be specific to your circumstances. Dr. Singer will provide you with all the information you need, as well as ongoing care to make sure your braces are performing properly and comfortably.