KIDS APNEA.COM   The website of Allen J.Moses, DDS


Orthodontics as a specialty in dentistry has a strange dichotomy.  There are two distinct philosophies – cephalometrists and the functionalists.  Cephalometrists believe the facial skeleton is immutable, in that its size is genetically determined.  They have arbitrarily defined certain bony landmarks in skull x-rays and established certain angles, distances and relationships that exist in beautiful people.  Based on x-ray analyses their treatment is designed to move teeth in less than beautiful people into more favorable positions predetermined by the measurements.  Thus, the cephalometrists rarely initiate treatment before the adult determinative landmarks can be established in cephalometric x-rays.  This is about the time 95% growth has been completed – approximately age 13 in girls and 14-15 in boys.  The cephalometrists believe that if the mouth and bones in which the teeth must fit is too small, then teeth must be extracted to make the teeth fit into the jawbones.

The functionalists believe that both improper tooth position and crowding are based on improper muscle function inhibiting proper growth.  Changing the orientation of muscle function changes the direction of the forces they direct on the growth and development of the face and jaws.  In extraction cases the tongue is forced backward and downward into a shrunken space, narrowing the airway and making it more collapsible.  Rather than extract four bicuspid teeth, retracting the anteriors, collapsing the anterior face, and making the mouth smaller, functionalists stretch the dental arches to make room for all the teeth.  This makes more room for the tongue.

In the unfolding development of an organism, as cells differentiate and organs form, it had been thought for a long time that the genetic code of the DNA was the sole determiner of phenotype.  Now scientists are discovering that non-genetic factors such as environmental influences cause variations in the expression of genes without changing the DNA sequence.  The "epigenetic theory" of development accounts for the differences in identical twins.

Many genes require environmental factors in order to be expressed.  Environmental signals such as intermittent hypoxia (apnea episodes) influence development of a child’s face.  Early in a child’s development, when the cells are less differentiated and the growth potential is at its optimal, is when the environmental influences are the maximal.  The best time for environmental forces to exert the most positive effect on the genes for breathing, swallowing and facial growth is when the child is young.




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