Specific conditions require early intervention to prevent a negative impact on growth, function, and habits.

Medical practitioners of any specialty should recognize the role of an orthodontist in the diagnosis and treatment of complex dentofacial or craniofacial conditions. Certain abnormal stomatognathic functions influence the growth and development of the face and jaws. While the ‘wait and watch’ approach is non-intrusive and many irregular habits resolve with time - they can also leave lasting negative consequences. An orthodontist is uniquely trained to identify and correct such conditions.

Breathing

The medical fraternity recognizes the importance of nasal breathing in promoting balanced facial growth. any condition that leads to oral or naso-oral breathing should be identified and resolved at the earliest. The goal is to establish and maintain nasal breathing.

Pediatric concerns: It is commonly observed, especially in growing children, that repeated inflammation in the adenoid glands or tonsils, plus allergies, and constricted airway, among other factors, facilitate abnormal breathing patterns. It is important to identify if this breathing pattern is obstructive, habitual, or a combination. Once an abnormal breathing pattern is noted, a clinician should inspect further, and look beyond the respiratory structures. An orthodontist’s perspective can enable a more informed treatment approach because oral and/or naso-oral breathing could be due to:

  • Jaw disproportions with a retro positioned and/or small mandible

  • Narrow maxillary palatal arches

  • Improper hyoid bone and muscle relation

  • Habitual

  • Obstruction: The vertical growth of the maxilla is exaggerated beyond normal limits if oral breathing continues. In case the obstruction is not managed in a timely manner through invasive or non-invasive methods, it could further complicate and even worsen the situation.

An orthodontist is trained to identify, treat, and maintain the correction of such conditions to improve breathing and promote normal oro-facial growth.

Adult concerns: If a physician finds that an adult patient shows abnormal breathing, they should consider referring the patient to an orthodontist to appropriately identify the underlying problems in the stomatognathic system. A treatment plan should be decided after mutual discussion amongst the physician, orthodontist, and patient. 

Sleep apnea / obstructive sleep apnea in adults and children: It is common to find sleep apnoea in both children and adults and may be also called ‘sleep-disordered breathing’. This complex situation requires a collaborative approach for proper diagnosis, treatment planning, and execution. An orthodontist plays a crucial role in certain cases of sleep apnoea disorders which are caused by maxillo-facial abnormalities.

Jaw disproportions

It is important to have a normal relationship between the maxilla, mandible, skull bones, and associated structures. Disharmony in jaw relation may lead to compensation in optimal functions and morphological adaptations. If a clinician finds signs and symptoms of jaw disproportions, they must refer the patient to an orthodontist for further investigations. Some of the important indicators are:

  • Improper speech

  • Flaccid or hyperactive lip and chin musculature

  • Impaired breathing

  • Abnormal swallowing patterns

  • Faulty dental relations and bite

  • Excessively convex or concave facial profile

  • Bruxism

Timely resolution of jaw disharmony promotes normal growth and function. It also reduces the need for complex, and often, invasive treatment in the future. However, if early management was not performed due to unavoidable reasons - adult patients with jaw disproportions can be managed successfully by an orthodontist.

TMD (Temporomandibular Disorders)

TMJ disorders are complex in nature, with a multifactorial etiology. In recent years, especially during and after the pandemic-related lockdown, the occurrence of such disorders and pain syndrome has significantly increased. Owing to its complexity, the diagnosis and treatment plan must be precise, organized, and collaborative. 

It is pertinent to note here that not all TMJ disorders are stress induced. The bite (occlusion), musculoskeletal structures of the head, neck, and face, along with other environmental factors require careful assessment by trained clinicians. Dentists, and orthodontists in particular, can examine the relationship between the upper and lower teeth of the patient at rest and during function - to help achieve a pain-free outcome.

Further, once the patient achieves a comfortable jaw position, an orthodontist can change the bite in harmony with the joint’s function. This is a conservative approach to promote a long-lasting, healthy stomatognathic environment for the jaw joints, dentition, and musculature.

NOTE: Often, even an orthodontic treatment will require support from dentists of other disciplines to ensure a well-rounded treatment.

Speech

Doctors, especially pediatricians, have a golden opportunity to identify speech abnormalities at an early stage. Speech sounds are a result of harmonious functioning between multiple anatomical structures -- the tongue, dentition, palate, musculature, and skeletal attachments such as the hyoid bone and laryngeal cartilages. Any aberration in the stomatognathic system can result in speech abnormalities.

Once an aberration is identified, an orthodontist can further assess the involved elements in an organized manner to rectify the cause and prevent the situation from worsening. The treatment may also involve physicians in other fields (speech therapy, oral and maxillofacial surgery, physiotherapy, and more)