"Orthodontic" and "Orthognathic" are descriptive words derived from the Greek "Orthos" meaning straight, and "odontos" and "gnathos", meaning teeth and jaws. Applied clinically, the terms are associated with the processes of improving the alignment of teeth, and placing the jaws in proper alignment to each other and the rest of the skull. Since the jaws make up such a large proportion of the face it is easy to understand why they have a great deal of influence on facial form. The jaws form the basic foundation of the face, and like any natural process or endeavor, foundations can have errors built in from the beginning that compromise the facial outcome.
Your face is basically a product of your inheritance, but it's final form is also highly influenced by a host of environmental and functional factors. Structurally, it is made up of skin, the underlying muscles and soft tissues, the bones that make up the skull and jaws, and the teeth that are part of those bones. All of these tissues are influenced by numerous internal growth processes and regulatory mechanisms from conception, throughout development, and even after maturation. External factors, such as harmful habits, disease processes, and the effects of significant, or even apparently minor injuries, complicate things even more. Harmful habits may include seemingly innocuous things such as sleeping with an arm under the face, or they may even be somewhat less obvious, such as the chronic mouth breathing that occurs as a harmful side-effects of enlarged tonsils and adenoid tissues. Minor injuries can include such seemingly innocuous things as falls in early childhood, especially those where a child's chin sustains a bump and maybe a small laceration as a result. Relatively minor discrepancies in any of the growth processes and regulatory mechanisms may produce a final result that may be unpleasant to the owner. The face changes constantly throughout life. Sometimes it improves in appearance, sometimes it gets worse.
A small proportion of patients seeking orthodontic treatment present a treatment dilemma to the orthodontist. The problem comes down to the fact that they really cannot be helped by traditional braces. The astute orthodontist recognizes the limitations of his appliances, and knows that any attempt to treat these problems by conventional orthodontics may actually end up doing the patient more harm than good in the esthetic sense. Patients must realize that a pleasant smile, and a properly functioning dentition are highly interrelated with their existing facial features and especially with their underlying bone structure. A pleasing face and a pleasant smile are multidimensional affairs requiring some coordination of all the parts to be a success. If teeth are placed in alignment while effectively destroying other facial features in the process, the orthodontist has not done the patient any real service. If teeth are placed in unstable positions in what may appear to be an improved face, who is going to suffer as a result?
Throughout history facial esthetics have remained fairly consistent. For example, most people have seen photos of the burial masks of the ancient Egyptian, King Tutankamen, or King Tut. Tut would be considered a reasonably good looking person today, over three thousand years beyond his prime. Retrospectively, most of us would not cause any raised eyebrows if we were suddenly transported back to ancient Egypt. Severely crowded teeth, a cleft lip, an obvious underbite or overbite would have been considered esthetic problems in Tut's day just as they are considered esthetic problems today. Archeological examination of human remains from that time has revealed the existence of just about every dental and skeletal problem we see today, so not much has changed except the fact that we now have ways of correcting these problems that didn't exist before the advent of modern surgery.
In actuality, very few people meet what could be termed ideal standards when it comes to facial features, and most of us vary around a range of features that are considered generally acceptable, or what most people refer to as being "normal". Those individual's who have features ranging toward the outer fringes of facial acceptability are in the minority, and are usually the ones who can gain the most benefit from some form of intervention, either through orthodontic treatment alone, or in conjunction with surgical treatment.
Most of the people in the "normal" group are quite aware of their facial features and, if not totally happy with what they see, are at least resigned to facing life with what Mother Nature gave them. Other "normals" are, for the lack of any other term, quite unhappy with what they see reflected in the mirror every day for a variety of reasons. Many millions of dollars are spent on facial cosmetic surgery around the world, and an entire medical industry exists to satisfy the human desire for having normal, or better than normal facial features. Faces are not the only body parts that some people are dissatisfied with, and many additional millions are spent on improving many other perceived anatomic deficiencies as well.
Quite another group of people face life with facial features that are definitely not "normal" and are distorted, even grossly deformed, by developmental disorders and as the result of injuries and destructive disease processes. In spite of all of this, the line between what we call normal and what we call abnormal is not sharp and distinct. Perceived abnormality on the part of the patient is an individual factor that is as variable as the number of patients. Documentable abnormality is often as variable as the clinicians doing the diagnoses and treatments. Some patients have high personal awareness of their appearance, have fervent desires to make changes whenever possible, demand cosmetic services, and are easily convinced to have treatment if it is physically possible to accomplish. Others are less demanding and seemingly tolerate varying degrees of physical deformity without great distress. As with most things, somewhere in the middle ground is a group of patients who probably would seek cosmetic change if they were fully aware of the treatment services available and had the financial resources available for the service.
So far, this discussion hasn't even touched on what is arguably, the most important aspect of human existence, probably the be all and end all - Function! Nature designed every system of the body to perform a specific function in harmony with the rest of it's parts. Nature is no stickler for detail and occasionally fails to achieve her own design specifications. Nature also has a warped sense of humor and has designed various things to work to some degree, even when that function is an inefficient compromise. Finally, Nature is unforgiving, and rarely allows her more serious errors even the option of survival. That means you should cheer up. At least you are here today and able to move around.
What are faces for and why do we have them? In the scheme of things, the face allows the performance of several biologically necessary functions. Obviously, the most essential functions are respiration and eating, and the face is the first link in the process of breathing, digestion and nourishment. Next it performs as part of a sensory platform for vision, hearing, smelling, and tasting, . Finally, it functions as a complex communication device that identifies us to ourselves and others, allows us to perform the activities of both speech and facial expression, and conversely, allows us to interpret of those same activities in others. Nature expends a large percentage of biologic resources on the face. Compared to the rest of the body, the face has enormous nerve and vascular supplies, so it is safe to assume that it is a very important anatomic structure.
Eating seems like a relatively simple process, especially if you happen to be fortunate enough to have an approximately "normal" set of lips, jaws, and teeth. Most of us can function quite adequately in the eating department even with a bit of variation, or "abnormality" in these structures. However, there is a subtle, but important distinction to be made between the raw basic process of eating, and the associated functional process of chewing. There are also important psychological considerations in this department, but these are being purposely ignored right now so that we can stick to the basics. Tasting foods is important. But taste is also a product of individual and cultural factors and is going to be passed over beyond saying that few animals will eat anything that does not "taste" good. The function of chewing encompasses several relatively important processes to the human organism. First, it allows large chunks of various nutrient materials to be reduced to a size and texture that the digestive system can process with some efficiency. It would be hard for any modern creature, human or otherwise, to consume a whole buffalo hock without some intermediate process. Second, it initiates the digestive process through the incorporation of saliva, and salivary enzymes directly into the food materials during the act of chewing. Finally, chewing produces an altered end-product that can be successfully introduced to the second most important link in the digestive process, the process of swallowing. Swallowing is historically the only dependable process that can act on and deliver prepared nutrient materials to the stomach. And we can all appreciate how the stomach, which may be as much as 12 to 18 inches away from the mouth parts of the face, really depends on those parts above it for its activities and existence. So do all the other parts.
Respiration is intimately associated with the face. Air is constantly being exchanged through the nostrils and the mouth with little thought. Breathing through the nostrils is considered to be the normal physiologic pathway. Breathing through the mouth is not. Mouth breathing can be considered an auxiliary function, or one that can be brought into play if circumstances demand extra airflow. Gasping for breath after running up a hill to escape from getting run down by a herd of water buffaloes is nature's way of allowing physiologic recovery from unusual exertions. Usually, the need for high volume air exchange diminishes in a minute or two and the normal pattern of nasal breathing returns. Inadequate nasal airflow can complicate matters for the individual, and can be temporary, seasonal, or chronic in nature.
Nasal respiration has important physiologic functions that may not be fully appreciated at first glance. Olfaction, or the process of smelling anything in the environment only occurs during nasal respiration. While this function may not be absolutely critical to existence anymore, it could still come in handy as a warning device in numerous ways. When not actively sniffing the air for signs of predators or fires, the first things that happen to the air coming in the nostrils is that it is warmed (when outside temperatures are low) and humidified by the tissues lining the nasal passages before being delivered via the larynx, trachea and bronchial tree to the lungs. Blood flow through the nasal mucosa is fairly high and it can easily give up the moisture needed to moisten the air flowing through the area. Small hairs inside the nostrils are there to act as filtration for the incoming air, and while they are not very efficient at screening out very tiny particulates like smoke and dust, they do manage to keep us from inhaling small insects and feathers.
Chronic mouth breathing, while it still allows air delivery to the lungs, nevertheless fails to properly prepare the new air for processing in the bronchial tree and lungs. The incoming air is flowing through and across the lining tissues of the mouth and tongue and these tissues do not readily give up moisture from underlying blood flow. The most common side effects of mouth breathing are therefore, a dry tongue, a dry mouth, and a dry throat. Under these conditions, some of the normal microscopic level protective housekeeping mechanisms of tissues lining the airway are reduced in efficiency, or completely thwarted. Germs can lounge around the mucosal surfaces of the trachea and bronchi and enjoy themselves instead of being swept along to areas where they can be eliminated by swallowing. Mouth breathers often have sore throats that are less the product of bacterial infection than tissues that are simply dried out. Chronic inflammatory conditions are produced that are compensated for by increased lymphatic activity. Tonsils and adenoid tissues in the pharyngeal area are in a state of high activity, often enlarged, and complicate the whole process. Once started, chronic mouth breathing encourages a whole stable full of other nasty processes that are harmful to the individual. Chronic mouth breathers have pulmonary blood pressures that are increased beyond normal ranges. Chronic mouth breathers have less restful sleep than those who breathe normally. Chronic mouth breathers have more problems with ear infections. And when involved from an early age, chronic mouth breathers can have significant growth deficiencies that can have effects beyond the immediate area of the facial skeleton.
The uses of the face in matters of vision and communication are much too large to incorporate in this discussion.
So far, you should begin to recognize that the form of the face is greatly influenced by the basic structure of the upper and lower jaws. You also found out that the form and function of the face is highly influenced by your genetic make-up, but it is also greatly affected by many other factors you might never have considered: your environment, habits, trauma, and disease processes. You have some understanding of the basic purpose of having a face, and you know that it is an important structure for a lot of reasons you may never have thought about before. And finally, you know that it is not really unusual to be a bit dissatisfied with your face, and that it is probably entirely possible to make the changes you would like to see happen - if you really, really, desire those changes.
Consult your local orthodontist about your problems. It is much better to know what
your particular problem is and how you can go about resolving it than to remain
dissatisfied with your appearance. Only a small percentage of patient's need surgical help
to achieve a pleasing end result.
You can reach Dr. B by e-mail at: rebross@orthoman.com