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Editorial: Dr. John Wellington (Skip) Truitt
Contemporary Orthodontics vs. Maxillofacial Orthopedics
“ Where is the general dentist? “
Contemporary Orthodontics is predicated on the concept that a child’s malocclusion, (crooked teeth and
the manner in which the upper and lower jaws grow and relate to each other), is a genetic predetermined
situation. And, that the doctor has no direct control over this relationship. Therefore the only accepted
treatment option is minor tooth guidance as the patient is growing until the child has lost all of the “baby
teeth”, followed by fixed appliance therapy (full braces) when all of the permanent teeth have erupted.
This type of treatment frequently involves the extraction of at least four healthy permanent teeth with the
overall objective being to camouflage any pre-existing skeletal problems.
This form of conventional therapy can lead to very unaesthetic changes in the patient’s face and profile
as well as possible damage to the temporal-mandibular joints (the joints that connect the lower jaw to the
skull). In addition conventional orthodontic therapy does not address growth problems such as an under
developed maxilla (an upper jaw that is to narrow). A narrow upper jaw can not only cause the teeth to be
crooked, but it can also obstruct the patient’s airway forcing the child to breath through their mouth. This
in turn can cause the lower jaw to grow improperly as well. In addition the obstructed air way can create
severe problems within the child’s ears which include chronic ear aches, infections and loss of hearing.
The concept of maxillofacial orthopedics understands that the growth of most of the bones of the face
and jaws is directed by function and not just by genes. For example the size of the upper jaw is directly
related to the child swallowing correctly and breathing properly from birth. If the upper jaw does not grow
to its proper size then the upper teeth will be crowded, not because the teeth are large, but because the jaw
is to under developed to accommodate the teeth.
Removing healthy teeth is therefore not the appropriate solution for this type of problem. The correct
treatment is to place an orthopedic appliance in the child’s upper jaw. This type of appliance will easily
correct the growth problem and in turn create the necessary space to properly align all of the permanent
teeth with out the need for extractions. In addition, developing the upper jaw opens the patient’s nasal
airway allowing the child to breathe correctly through the nose. Figures #1, #2, #3, &#4 are examples of
properly developing the upper jaw.
This begs the obvious question as to why most doctors do not at lease offer the parent and patient the
option of maxillofacial orthopedics as part of their over all therapy. The primary reason for this failure is
lack of knowledge on the part of the doctor. One has only to evaluate the American contemporary
orthodontic literature to understand this situation.
For example, one of the most widely read American journals is the “Journal of Clinical Orthodontics”.
Until recently their editorial review board would not even consider accepting a paper on maxillofacial
orthopedics for review, much less for publication. The few they now do publish are always from doctors
and universities out side the United States. Why is this so?
The reason for this is very straight forward. ” Contemporary Orthodontics” has become a religion within
the American and international university and specialty setting. To question the people in charge of
orthodontic education about treatment techniques and diagnostic concepts that they have been using for
decades is to question the very authority of organized dentistry. Everyone knows the world is flat and that
the sun revolves around the earth. These things are obvious to those who propose to possess true
knowledge, and they can be easily proven true by flawed research!
One has only to speak with those doctors who have been open to change, and have incorporated the
concepts of maxillofacial orthopedics into their treatment regime, to appreciate the tremendous impact it
has had on the over all health and well being of their patients. When you do encounter a specialist
orthodontist who understands these concepts, he or she has almost always had the practical experience of
practicing as a general dentist for a period of time prior to becoming a “Specialist”.
We as general dentists are faced with a serious professional dilemma. We have the common sense to
diagnose children with cross bites, underdeveloped arches, trapped mandibles, crowded teeth, Class III
mandibles, TMJ problems, and airway obstructions. We in good faith send these children to our specialist
colleagues in the sincere desire to obtain the very best treatment for our patients. What recommendations
do we usually receive from these knowledgeable colleagues? Does this sound familiar??
Dear Dr. Smith,
Thank you for referring Susie Jones to our practice. She is such a lovely child. We saw Susie on
March 32nd and conducted a thorough orthodontic examination. As a result of this extensive study
I have concluded it would be wise to see Susie in twelve months to re-evaluate her situation.
We have informed Susie’s parents that we are placing her into our recall system, and that we will see her
on a regular basis to monitor her malocclusion until she is in her permanent dentition.
Once again our office appreciates your confidence in us, and we stand ready to assist you with any future
referrals.
Sincerely Yours For Better Dentistry,
Dr. Bill
Translation: I do not have a clue as to how to address your concerns for this patient.
Or
Dear Dr. Smith,
Thank you for referring Susie Jones to our practice. She is such a lovely child. We saw Susie on March
32nd and conducted a thorough orthodontic examination. As a result of this extensive study I have
concluded the following:

You must immediately remove all four of the deciduous cuspids in order to create room for the
developing permanent teeth.

I will place appliances to maintain the arch length during the transition dentition as well as
utility arches to align the permanent incisors.

Full and comprehensive orthodontic therapy will be initiated when Susie is in her permanent
dentition.
We will continue to monitor Susie on a regular basis, and we have informed Susie’s parents
accordingly. Thank you again for referring Susie to our practice and we stand ready to assist you with any
future cases or questions you may have regarding your orthodontic patients.
Sincerely Yours For Better Dentistry,
Dr. Bill
Translation
The teeth are crowded and my only solution is to wait until the child is in the permanent dentition and
extract enough teeth to correct the anterior alignment. However, I have placed fixed appliances so the
patient is now economically committed to me for all future treatment.
Where is the parent in all of this confusion and miss diagnosis? They are most likely on the Internet!!
They find examples of other children suffering from the same problems they see in their own child. They
see logical solutions to these problems. And they find a doctor with the knowledge and skill to treat their
child.
Conclusion:
When will the “powers at be” take their collective heads out of the sand and put the health of the child,
and all of their orthodontic patients ahead of their autocratic and economic self interest? When will
committed dentists decide it is not enough to be just a good dental mechanic, “as you were taught in
school”, but also a good dental physician, “as you learn when you truly try to heal the patient”? One thing
is certain. This change will occur for various reasons, but it will occur. It will be a change that results is
superior treatment for our patients, and a change that totally eliminates many of the unsolved problems of
modern dentistry.