As a kid I had a severe overbite – or what looked like an overbite, with my front teeth pointed outward. It was difficult to eat and close my mouth, so my parents took me to an orthodontist when I was nine. He treated me with braces and a headgear to restrict the growth of my upper jaw, so that my lower jaw could “catch up.” I remember an aunt commenting that my older cousin had had an overbite and had grown out of it by adulthood. This was an important clue, but none of us had the context to understand it at the time. My parents took the “cautious” approach and proceeded with the treatment.
From then on, I don’t remember sleeping well. A few days a year, I would wake up feeling rested and full of energy, but otherwise I was lethargic, anxious and depressed. I also started experiencing strange headaches. I would feel enormous pressure in my head and had trouble processing information. Everything was swimmy and slow. It was often difficult to understand conversations. These headaches would last for hours and continued into my early 20s. I never knew how to explain them to anybody, so I said nothing.
Within two years of starting orthodontic treatment, my teeth were straight. But I still had an overbite. My lower front teeth rested behind my upper teeth, with my jaw sitting back in my head. My face sloped downward in a way it hadn’t before. I thought my face shape was natural, genetic. To be honest, I’m not sure I understood then that my upper jaw had been constricted in its growth.
While I always had bags under my eyes and never felt energetic, my memory was excellent in my youth. I devoured books and excelled in school through high school and into the first years of university. But as I entered my 20s I felt rougher and rougher. My ability to concentrate and remember declined. I arranged my class schedule so I only had to go in three days a week and could sleep in the other four. I’d sleep until midday, pick up a book to study, and startle awake when it dropped out of my hands. I couldn’t read more than a few paragraphs before nodding off. And I couldn’t recall much of what I read, anyway.
At the time I had no way to understand my poor sleep or what I could do about it. My grades fell off a cliff and I came within an inch of flunking out of my final year. In desperation, I went to my family doctor: I was tired, unmotivated, couldn’t concentrate. He nodded. I was depressed, he said, and scratched out a prescription for antidepressants.
In fact I really had sleep apnea, but it wouldn’t be properly diagnosed for another decade. My 20s slid by in a haze of exhaustion, anxiety and depression.
At 30 I finally began treating my sleep apnea with CPAP. It helped somewhat, but only marginally improved my sleep, memory and focus. It took a long time for me to understand that I’d been experiencing symptoms as early as high school, and likely even earlier.
It was only after discovering Right to Grow that I began to understand the contribution my headgear might have made. My jaw still sits back, and I’ve never been able to breathe comfortably through my nose. It’s impossible for me to get enough air through my nose when exercising.
It’s possible I would have developed some level of sleep apnea regardless of any misguided orthodontic intervention. But when I flip through old photos, it’s clear that my downward sloping face only appears after the headgear. Even with my buck teeth before headgear, my face and chin pointed forward. I now believe that my headgear changed my facial anatomy in a way that predisposed me to sleep apnea and breathing problems. The headgear straightened my teeth, but destroyed my sleep.
I wonder what my life could be like if my parents hadn’t tried to help me based on the best understanding they had at the time. There is no doubt that my chronic sleep deficit has shaped my life, my relationships and my career, such as they are. I’m now trying to figure out what I can do to alleviate my anatomical complications affecting my breathing and sleep in the hope that I can salvage something from the next few decades.
Showing 18 reactions
Sign in with
There is some growth after puberty is over but it is highly variable from individual to individual, and is more common in boys. ONCE in my career I saw a girl’s mandible grow a little, and coincidentally her feet grow 1/2 shoe size at age 18. If growth occurs this late, it is almost always in the mandible, and it originates from the condylar growth centers.
If it baloney that braces lock the jaw from growing anterior-posteriorly, because growth occurs posterior to the arches. For the millionth time, headgear has not been commonly used in over 20 years.
Professor John Mew writes in his article “The Aetiology of malocclusion” in the british dental journal in 1981- "That bones are responsive to environmental stimuli has never been in doubt, and the literature in full of examples from primitive native customs to modern surgical appliances, many of which produce permanent distortion. Experiments on unfortunate monkeys have distorted practically every tissue and Harvold et al. (1972) have summarized “Any common type of dental irregularity can be produced experimentally on monkeys with normal dentitions. Harvold also showed (1968) that mere changes in tongue posture could result in extensive alterations to the occlusion and Schulmacher (1977) demonstrated that a change in the head posture of rats caused remodeling at the base of the skull.”
Bones are a living tissue, and every 7 years or so will be replaced entirely by osteoclasts and osteoblasts recycling bone. Bones can be remodeled by force and their growth can also be inhibited by restraint. Footbinding is successful at inhibiting bone growth, so too is headgear successful at inhibiting the growth of the maxilla. Braces themselves prevent the jaws from widening naturally!
2012 – “Dr. Amir explained to me how orthodontia as a youngster can stunt the growth of both the upper and lower jaws. The lower jaw actually keeps growing until age 22, and the upper jaw sometime in the late teens. When an adolescent is in braces, they are in a state he calls “negative growth.” This means their jaws are not growing at all due to being locked by the braces; bone cannot grow against this resistance. The average child is in braces for 2 years. Then they wear a retainer for 2 years and are again in negative growth (the retainer holds back growth also). When you add these two together, you now have 4 years of negative growth! No wonder people are walking around with recessed lower jaws nowadays. In addition, if a child has teeth pulled BEFORE their jaws reach the mature size (this is never a good idea and I do not recommend it), as an adult they will have a “sunken in” appearance, and again, it will inhibit the full potential growth of their jaws, which has ramifications on the balance and proprioception of the entire body.” (Simonson, D. G.: The Impact of Orthodontia on the Skull, and How NCR and Dental Orthotics Can Help, Dr. Deanna Gail Simonson, 2012, Accessed on November 30, 2014, http://www.drdeannasimonson.com/ncr-for-full-body-orthodontia.html)
Because of this and because of the restrictive power of rubber bands and braces themselves, I hypothesize it was the rubber bands that moved my jaws down and back into my throat. Perhaps a narrowness of my maxilla predisposed me to nasal congestion and mouthbreathing as well. I have asked Ronald Ead or “jaw hacks” on youtube and he is sure rubber bands would restrict jaw growth. Once I get enough money from my dishwashing job, I should like to try to pay to consult with Dr Bill Hang or the Mike Mew about this. If rubber bands don’t restrict jaw growth, so be it but I can’t think of anything else that would have caused my well developed jaws to be stunted and my airways dangerously narrowed as a consequence. If there aren’t any studies done on it like headgear, I shall see to it that they are done.
You really need to study up on biomechanics before you post incorrect comments on this board. This is simply untrue. None of us use elastics to stunt the growth of the maxilla nor encourage growth of the mandible. Their light force can do neither. Elastics are used to effect DENTAL, nor skeletal movements, to align the TEETH in class I relation.
In any practice, a certain number of patients elect no treatment and the clinician gets to see what happens with growth with no ortho. I have never seen a class II child have his mandible “catch up” with his maxilla so he becomes orthognathic. One time I did a phase I treatment with Hyrax expansion and upper incisor alignment only. The mandible did grow forward enough to have a nice result, such that I never had to do a final phase treatment! My guess is her airway improves after the rapid palatal expansion.
If class II elastics caused retraction of the entire maxilla, we would see it on post-op cephs. We never do. To put the force in perspective, to treat a maxillary RETRUDED patient (most common in Asian population), we must start very young, maybe 5 or 6, and use even heavier elastics with a facemask. Even then we do not get reliable results.
If overbite decreases with age, it is through wear of the lower anteriors.
I would be very, very cautious is using scientific references from as far back as 1937 and 1953. A lot has been learned in 50+ years. To my knowledge, that was even before Rapid Maxillary Expansion techniques were developed!
Children are brought to me because they are unhappy, many times being teased in school. Conventional orthodontics by myself and others gives them a better self-image and usually stops the teasing. I don’t mutilate anyone. Neither does any orthodontist I know. We spend a very long time on diagnosis and treatment planning before placing brackets.
Just because its less of a force doesn’t mean it can’t push the maxilla back, the tongue pushing the maxilla can push the maxilla forwards and rubber bands can pull it back. This is the intended purpose of rubber bands to stunt the growth of the maxilla because its an overbite and the mandible can’t “come forwards” which is false.
1937 – From the the age 2 to 12 years old, the mandible grows at a faster pace the maxilla, both in the vertical and in the AP (front to back) direction. (Young, M.: Normal Facial Growth in Children, Journal of Anatomy, Vol 71, Pt. 4, July 1937, p. 458-470)
1953 – Generally, the overbite decreases somewhat with age. In extreme overjet cases, the mandible tends to advance to a greater degree with age, as compared to non-extreme overjet cases. (Bjork A.: Variability and age changes in overjet and overbite, American Journal of Orthodontics, Vol 39, Iss 10, October 1953, p. 800).
Note from Right to Grow: These are unique papers in that they raise the question as to which degree orthodontic intervention is necessary in overbite and overjet cases. Since the mandible grows at a faster rate than the maxilla, can you really look at an 11 year old kid who is bucked toothed, and say that this kid needs treatment? The mandible might not be done growing, and it may be growing very quickly, so perhaps there is a good reason to wait until growth is finished before concluding that there is a problem. Also, given that the mandible will advance forwards to a greater degree in non-treated patients than in treated patients, as we know from Waston’s work in 1972 and Baumrind’s work in the early 1980’s, perhaps no treatment is better than conventional orthodontic treatment.
Pulling back the maxilla predisposes one to mouth breath which pulls back the mandible even further. Also a narrow nasopharynx can collapse and be a cause of sleep disordered breathing, its not just the oropharynx.
“. I have NEVER seen a movement of the maxilla rearwards on post-op cephs after class II elastic use. "
I doubt this as mine did
" Kids are growing. In a growing child the maxilla always ends up further anteriorly than where it was. " Wouldn’t the jaws grow more as the child grows? The tongue pushes the maxilla forward, so as a child grows up their jaws grow.
" it never happens in class 3s, as protrusive mandibles have such a large inherited component"
I think you would have a hard time finding a prehistoric skull with any orthodontic issues
Also don’t lecture me on profanity as if you have some moral highground, you are the one mutilating children.
What is the difference between elastics and headgear? One is calibrated to deliver several times the force of the other, and do it to ONLY the maxilla. Elastics distributes force equally to the maxilla AND mandible.
If you throw class II elastics out, you lose any chance of inter-arch alignment canines and molars from mild class II to class I position. I have NEVER seen a movement of the maxilla rearwards on post-op cephs after class II elastic use. Kids are growing. In a growing child the maxilla always ends up further anteriorly than where it was. The best we can achieve is change the RELATIVE position of maxilla and mandible in class IIs. In my experiencer, it never happens in class 3s, as protrusive mandibles have such a large inherited component.
A long time ago when we used headgear, we always knew it was contraindicated in dolichofacial skulls, because of the vertical component of the force.
I laugh because you have to go back to 1970 to find articles about headgear. As I have been saying it is a moot point because we have not used it in such a while. You really need psychiatric help for your fixating on the harm of a therapy which hasn’t been popular for so long.
In MOST skeletal class 2s the problem is not a protrusive maxilla but a retrusive mandible. Trying to correct the maxilla via headgear was the wrong medicine anyway. The Herbst appliance acts on both maxilla and mandible, to try to align both, so it is more appropriate. But even that has been shown to have limited effectiveness. The majority of class 2s stay class 2s, and can only be corrected by orthognathic surgery. Which often corrects sleep apnea, by the way. You keep focused on the maxilla, while the REAL problem is a recursive mandible and retrusive tongue position that goes with it.
Ok so youre not denying that the headgear effect is harmful, youre straight up denying its existence. So has an entire camp of orthodontists been mass hallucinating for 50 years that headgear causes the jaws to go back and down in a clockwise direction? Also what would be different between rubber bands attached to the mandible and rubber bands attached to headgear? Nice attempt at gaslighting cocksucker. Ludicrous to claim that rubber bands cant effect the maxillas position as their literal goal is to “correct” and overbite by changing the maxillas position. I had rubber bands and had the same clockwise down and back jaw rotation as someone with headgear would have.
‘“You understand nothing of biomechanics and live in a delusional conspiracy world.”
youre the one who denies the existence of mewing, again you’re either an arrogant MORON without a braincell to rub together or an intentionally malicious monster. Either way you are worthless scum. At least regular morons drool over a tv screen, mind their own business and don’t pretend to be doctors and ruin peoples lives with their negligence.
“But again I say there are many other potential causes of OSA, like restricted nasal breathing and limited airway space.” yes this is an environmentally caused structural problem. Which I already addressed in detail in an earlier post which you didn’t refute. Your fluffy language reminds me of an israeli sposkeman who says “don’t worry about the israeli-palestinian conflict its so complicated” when its all rather cut and dry and its just child murder and occupation.
1970 – Extensive use of cervical traction has caused controversy regarding its effects on the craniofacial skeleton of a growing child; it has been shown to result in downward tipping of the palate, lack of forward chin movement, clockwise rotation and inhibited forward growth; clinical evidence points to the fact that cervical traction can be harmful to the dentofacial skeleton of a growing child. (Ringenberg Q. M., Butts W. C.: A controlled cephalometric evalauation of single-arch cervical traction therapy, American Journal of Orthodontics, Vol 57, No 2, February 1970, p.179, 180 & 184)
1970 – Cervical facebow treatment, which is similar to cervical headgear, has been shown to cause tipping of the palatial plane, backward growth of the maxilla, backward and downward rotation of the lower face in general; these are undesirable changes; the evidence of backward and downward growth of the lower face should raise concerns about the use of such retractive forces; there is little cranial growth during orthodontic treatment; forward growth is opposed; this treatment should not be used, and if so, should only be confined to short periods; these abnormal growth reactions – backward growth and tipping – are serious and disastrous; in one study, 54% of facebow-treated had downward and backward facial growth and 46% had forward growth – 88% of untreated controls showed forward growth. (Merrifield L. L., Cross J. J.: Directional forces, American Journal of Orthodontics, Vol 57, No 5, May 1970, p. 435-463)
You are half right here. OSA is more prevalent in patients with deficient mandibles. Assuming there is no pharyngeal constriction, orthognathic surgery to lengthen the lower jaw brings resting tongue posture forward as well, where it can sometimes clear the oropharynx and reduce apnea.
But again I say there are many other potential causes of OSA, like restricted nasal breathing and limited airway space. These days ENTs assess airway spaces via cone beam scan, as we do.
You are quite silly if you think that elastics of 2-6 ounces of force from rubber bands can distalize an entire bone segment of the skull.Class II elastics exert an equal and opposite forward force on the mandible at the same time. It has been pretty much established that elastics don’t accelerate lower growth or retard maxillary growth.
If reliably worn, which is a big IF, all elastics do is translational movement within the dental alveolus, as well as some unintended eruption.
As I have said before, it is pretty hard to change growth vectors in children. Sure cannot do it with tiny rubber bands hooked to teeth.
You understand nothing of biomechanics and live in a delusional conspiracy world.
Rubber bands are incredibly commonplace and have more or less replaced headgear today and more or less have the same effect, they’re designed to treat an overbite, which if you read the literature is lunacy, in most cases the lower jaw catches up. Also yes pulling your jaws into your throat believe or not can actually narrow your airways and cause sleep apnea, who would have thought!
2007 – OSA is essentially a structural problem whereby the maxilla and mandible are too far back; without realizing that the maxilla is too far back in virtually all malocclusions, treatment is frequently aimed at further retracting the allegedly protruding teeth; bicuspid extraction, headgear, and now temporary anchorage devices (TAD’s) are be used to retract the anterior teeth; the grand majority of all orthodontic care is retractive in nature and the result is a patient with a maxilla and mandible in more retruded positions in most cases following the treatment than at the beginning; children would be better off with no orthodontic care than treatment which in any way reduces the airway; is it not time to completely cease bicuspid extraction, headgear, TAD’s used for retraction, and all retractive mechanics until their effect on decreasing tongue space and possibly producing OSA has been completely resolved with research done by parties with no self interest to protect? (Hang W. M.: Obstructive Sleep Apnea: Dentistry’s Unique Role in Longevity Enhancement, Journal of the American Orthodontic Society, Spring 2007, p.28-32) “It has to do with the narrowness of the throat (NOT the dental arches), the slope of the soft palate size of tonsils, tongue, and uvula, etc.”
Pulling the maxilla back will prevent the mandible from growing fully and push the soft palate into the back of the throat, which is connected to the maxilla. Also you said you saw many patients without orthodontics having sleep apnea, I never said orthodontics was the sole cause of craniofacial dystrophy and the epidemic of small jaws and airways is also caused by soft foods, mouth breathing, bottlefeeding and poor body posture.
“Again, it is quite comical to see you guys harping on a treatment modality like headgear that has not been regularly used for at least 20 years.”
Growth restriction through rubber bands has replaced headgear. Also there is nothing comical about this epidemic, people right now are in absolute anguish, and have had their lives ruined because they can’t get rem sleep. I believe this to be a major factor in the recent rise in depression, anxiety, and ADHD. Interestingly psychologists have said that if they saw a room full of kids, half with ADHD and half sleep deprived, theyd have a damned hard time telling the difference because the symptoms are so similar. Maybe instead of giving kids a compound closely related to meth, we should take a step back and ask why they aren’t able to concentrate. Not denying that ADHD isn’t real, but clearly massive amounts of children have been misdiagnosed with ADHD. Also good job literally not addressing the points I made in the last response, really makes me attribute your malpractice to malice rather than stupidity. I truly have a hard time believing you can be this much of a moron.
I look down patients’ throats every time I do initial exams. Most all have not had orthodontics. Some patients have loads of room for air to pass in their oropharynx. Others have very little. It has to do with the narrowness of the throat (NOT the dental arches), the slope of the soft palate size of tonsils, tongue, and uvula, etc.
For fun, I look at the throats of patients and assess them. Then I try to guess if they have sleep apnea or not. Then finally I ask the patient if it is indeed a problem. I am getting pretty accurate in my predictions.
You are right, the incidence of sleep apnea is alarming. Very few of my patients who have apnea had orthodontics, much less orthodontics with extractions and/or headgear. Orthodontics has little to nothing to do with sleep apnea.
Again, it is quite comical to see you guys harping on a treatment modality like headgear that has not been regularly used for at least 20 years.
1967 – Facial growth pattern is changed by orthodontics; in untreated cases, the mandible comes one to one and a half times faster than the maxilla with significantly more forward chin movement – this is significantly more than in headgear treated cases; isolated cases show the maxilla moving backwards with headgear treatment; the mandibular plane angle is steeper for headgear treated cases and this is what brings the chin back; with headgear, the face grows significantly more in the vertical direction; the mandible comes forward significantly less; the vertical response is disastrous; the face can become dished-in; cervical headgear should not be used for high SNB angle (retrognathic) faces; PNS to lower mandible is seen to reduce with infraerupted molars. [Contrary to overerrupted molars seen in studies involving other vertically grown faces] (Creekmore T. D.: Inhibition or Stimulation of the Vertical Growth of the Facial Complex, Its Significance to Treatment, The Angle Orthodontist, Vol. 37, No. 4., October 1967, p.285-297
1970 – Extensive use of cervical traction has caused controversy regarding its effects on the craniofacial skeleton of a growing child; it has been shown to result in downward tipping of the palate, lack of forward chin movement, clockwise rotation and inhibited forward growth; clinical evidence points to the fact that cervical traction can be harmful to the dentofacial skeleton of a growing child. (Ringenberg Q. M., Butts W. C.: A controlled cephalometric evalauation of single-arch cervical traction therapy, American Journal of Orthodontics, Vol 57, No 2, February 1970, p.179, 180 & 184)
I wont paste anymore studies but it really is an indefensible position. And obviously extractions will affect the profile, you are significantly shortening the maxilla.
“We used to extract premolars, and use anchorage headgear to hold the molars in the same position while we moved crowded canines into the arch. Nothing was distalized. Now we do the same thing with transpalatal arches and sometimes Temporary anchorage devices.” you wont be for long
“You are right. Obesity was very rare in prehistoric times and is epidemic now. Obesity is a big contributor to apnea. Also our lifespan is longer. Pharyngeal muscles that keep the airway patent tend to get flabby with time.”
Sleep apnea has shown to cause obesity, Im not denying that morbidly obese people and heavy set men like Shaquille O’Neal wont have narrower airways, but the main cause of sleep apnea is set back jaws, which is caused by a variety of factors, including the increase of bottlefeeding, the softening of our diet, mouthbreathing, poor posture and retractive orthodontics. You are inflicting unimaginable anguish upon children if you are continuing this practice which I assume you are. Also prehistorical lifespans were much shorter because of the higher prevalence of infant mortality, if you carbon date the bones of many ancient human fossils, many lived into their 80’s and were in astonishingly good health. Obesity is a factor in the sleep apnea epidemic, but the main cause, craniofacial dystrophy, is preventable and if kids were taught to sit up straight and mew from a young age, you greedy bastards would be out of business and people would be more intelligent and happier. I think this epidemic may have something to do with the fact that 25 percent of young people have considered suicide in america in the past year, after using my cpap my depression and anxiety went away and I could focus for hours on end reading and listening to podcasts and working. My insatiable urge to kill myself had gone away, and now that my cpap has stopped working for about a year as I await jaw surgery, I am in immense anguish. I could have literally commited suicide because of you greedy bastards. I remember in highschool going to homedepot and looking for rope, I was completely hopeless. You have no idea the harm your profession has done, hopefully you can atone for your crimes against humanity by helping people with your skills by installing MSE, giving kids BIOBLOC so they can mew and sleep, and preparing people for MMA with braces, Im sure there will be lots of demand for these things in the future given the enormity of the epidemic of underdeveloped jaws.
No it doesn’t. I look at post-op cephalometric x-rays all the time. Of course, nobody even tries to distalize the molars anymore, so it is a moot point. We used to extract premolars, and use anchorage headgear to hold the molars in the same position while we moved crowded canines into the arch. Nothing was distalized. Now we do the same thing with transpalatal arches and sometimes Temporary anchorage devices.
Premolar extractions, as infrequently as they are done these days, do not dish in faces as some charge. A convex profile will remain a convex profile, not turn into a concave profile. The interincisal angle can be reduced somewhat.
“Also it is moronic to assume sleep apnea is anything but an environmentally caused disorder, there would be enormous selective pressure against sleep apnea in hunter gatherer times, and the incredibly high rate of 25 percent or more of the population having sleep apnea is impossible to explain through genetics alone”
You are right. Obesity was very rare in prehistoric times and is epidemic now. Obesity is a big contributor to apnea. Also our lifespan is longer. Pharyngeal muscles that keep the airway patent tend to get flabby with time.
Not sure what you mean by a “downward sloping face.” I could tell more by a profile photo of you.
In a crowded case with excessive overjet causing poor lip seal, if the maxilla was normal width, the treatment was to extract first or second premolars, use PART-TIME ANCHORAGE headgear, and retract the anteriors to a pleasing position. If the palate was constricted, perhaps the room could have been made by expansion via hyrax, but there is a limit to the amount expansion we can achieve.
You have no way of knowing if your orthodontics contributed any to your sleep apnea or not. Chances are it played a very minor role.
Like everything else in the body, face/jaw/skull morphology is primarily determined by genetics, but can be affected by enivronmental factors. Some genetic face types, like an overly long mandible, are virtually impossible to influence.