Maxillofacial orthopaedics & orthodontics

Emotional molecules

I am currently reading a really interesting book entitled Molecules of Emotion by Candace Pert PhD, a research professor in physiology and biophysics in Washington DC. Her pioneering research has demonstrated how our internal chemicals, the neuropeptides and their receptors, are the actual biological underpinnings of our awareness and consciousness. My reason for mentioning this is that topics such as consciousness, emotions, beliefs and awareness were considered "nonthings" by scientists because, before Dr Pert came along, they could not be measured. Measurement is the very foundation of modern scientific method, so if something can't be measured, science won't concede that it exists.

A paradox

How paradoxical then that one of dentistry's most able practitioners, someone who has made an art form of measuring things and has done so for the past 30 years, is still considered to be controversial by the dental establishment. I speak of a certain Dr J Wellington (Skip) Truitt of Gainsville, Texas. He is considered controversial because although he measures he does not publish, and also because this man teaches orthodontics to general dental practitioners and encourages them to go out there and do it. The Thought Police rule OK!

Visionary pragmatist

There are those who would not recognise a skeletal malrelationship if it jumped up and did the kazatzka before them. In fact, many of Skip's critics (most of whom have never attended his courses) criticise him for seeing too much. I think this says more about them than it does about a man who is able to teach others (including myself) to see a lot more lucidly, and thus to understand the complex world of skeletal growth, dental malposition, facial aesthetics and TMJ dysfunction far more comprehensively.

Starting at the beginning

It is generally accepted that fixed orthodontic therapy is usually necessary to address malocclusion, but should this be the stating point of correction? Skip Truitt argues not. The emphasis is placed on showing the benefit of correct diagnosis followed by early inter-ceptive treatment, either in the primary dentition or mixed-dentition stage He believes that the correct point of departure is to address the underlying abnormal skeletal (postural) relationship before the dental malocclusion. By so doing, a majority of cases can be treated on a non-extraction basis, and the subsequent orthodontic therapy limited to 12 months or less.

Maxillofacial orthopaedics

Understanding maxillofacial orthopaedics has become the foundation for modern orthodontics, says Skip. A large percentage of the population have some type of maxillary deficiency, be it i) a narrow arch viewed frontally (transversely), or ii) a maxilla which is short relative to the anterior cranial base and visible in the sagittal (antero-posterior) plane, or iii) in combination. When the maxilla is underdeveloped, there is a negative effect on the patient's dentition and facial growth. A narrow arch, for example, not only creates anterior crowding but entraps the mandible, preventing normal forward and downward growth ("chinless wonders").

Mandibular entrapment

This entrapment by the maxilla can also force the mandibular condyles distally within the glenoid fossa. This distal position of the condyles relative to the meniscus is the primary cause of TMJ dysfunction. When the maxilla is narrow, the palatal vault is high, constricting the nasal passages transversely and vertically and enforcing mouth breathing to overcome the resulting oxygen deficit. The symptoms resulting from this include tonsil and adenoid inflammation and chronic middle ear infection due to reflux within the Eustachian tube.

The courses

Skip Truitt's courses run for three days apiece, and there are six in total. Topics covered during the primary course include, in no particular order: arch development in the primary and mixed dentition; arch symmetry; causes of airway obstruction; anterior and lateral tongue thrusting and their differences; anterior open and closed bites; anterior and lateral cross-bite correction; cross-arch anchorage; defining the difference between a dental and a skeletal malocclusion; dental Class II and Class III and skeletal division II and III mechanics; cephalometric evaluation: understanding Bimler and Schwarz-Korkhaus analysis (This was Greek to me until I discovered they came from Germany); TMJ dysfunction; and understanding the principles of using different treatment modalities: the selection, construction and activation of appliance such as the Schwarz, Williams, Crozat, Bionator and Twin Block.

Course 1 revisited

I decided to revisit Course 1, because there had simply been so much to grasp on the previous occasion that I felt some revision would bear fruit. It certainly did! I was not the only revisitor: many of those present had done the same, in particular a group of four Norwegians who had attended all of his courses twice before and who were now starting them for a third cycle. That's dedication, but is also a measure of the value that his disciples place on his beautifully crafted seminar presentations.

Triple O Dental Lab

The emphasis is on practical participation with the opportunity to go hands-on and to discuss your own difficult case study models. Triple O Dental Laboratory is the Birmingham-based group which sponsors the lectures with Suzi Macleod as course organiser. The managing director is the ever-genial Rob Hughes, and his general manager is Rod Lawrence. Their team understands orthodontic, orthopaedic and functional appliances better than most of the dentists on the courses. Besides being extremely knowledgeable (they've been going as a specialist lab since 1987), they are also the most helpful of technologists. They will carry out the necessary lateral cephalometric tracings for you and hold your hands until you feel confident enough to read a Bimler analysis yourself. Working with them is like jumping off the high diving board with a parachute attached: a safe landing is guaranteed.

J'regrette

I said five years ago that my only regret was that I had not met Skip 25 years before. I stand by that today. Attending his courses doesn't do much — they only change your life.

MRC trial shows Twin Block appliance improves self esteem for children as young as eight

FINDINGS from a five-year early-intervention orthodontic trial led by Professor Kevin O'Brien at the University of Manchester has shown that children as young as eight who have protruding upper incisors can benefit physically, socially and psychologically from having dental braces fitted.