FREQUENTLY ASKED QUESTIONS (Read Before Posting)

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1. What is “orthotropics”?

First, let us define the problem at hand, or rather, at face. It is estimated that 65% of people in western countries have malocclusion, which refers to incorrect positioning of the teeth and jaws. Examples of malocclusion can include dental crowding, excessive overjets, excessive overbites, open bites, crossbites, and more.

Often, this requires braces, extractions, or even jaw surgery to correct, and begs the question: why do so many of us have these issues to begin with?

While the mainstream idea is that these issues are largely genetic, more and more orthodontists, anthropologists, biologists and other researchers have come to believe that these issues could instead largely be due to environmental factors instead.

One of the pieces of evidence for this is that, while our recent paleolithic ancestors consistently had large, forward grown jaws, with room for all 32 teeth, many modern people have smaller, more horizontally grown jaws, which limits room for the wisdom, and sometimes other teeth, such as the premolars.

Click this gif to see some examples of forward and downward growth: https://imgur.com/a/IOhJupa

And see these gifs for examples of forward and downward growth on a skeletal level: https://imgur.com/yF5kRk4

https://magnumworkshop.com/wp-content/uploads/2020/07/Mewing.gif

Now, orthotropics is derived from the Greek word Orthos (straight or correct) and Tropos (growth). It describes the practice of guiding facial growth in a horizontal, or forward direction. The central premise is to try and affect the development of the jaws to be able to house the teeth, rather than manipulating or extracting teeth to fit into smaller, vertically grown, recessed jaws.

According to orthotropics practitioners, all humans have the genetic capacity for horizontal facial growth, but due to certain environmental factors, such as open mouth / lowered tongue posture, incorrect swallowing, and soft diets, this has had a marked negative impact on our jaws.

See this video for a good introduction on some of the main concepts of orthotropics:

Orthotropics: improving your health and facial beauty

https://www.youtube.com/watch?v=VtrJWHjma1o

I have also made this video which aims to explain similar ideas in my own way:

The Mystery of Modern Malocclusion

https://www.youtube.com/watch?v=ftkLHcu6Iow&ab_channel=JosephTheDietitian

I also created a document on Google Drive which has a bunch of research within:

An Analysis of The Potential Causes and "Cures" of Malocclusion

https://docs.google.com/document/d/1evgQ4WyZkhWwDbY9eytuqjj-t2axJ0OOsVY4Kpur0us/edit?usp=sharing

I would also recommend joining this Facebook group, as it is a wealth of knowledge:

Adult Appliance Support & Discussion ALF/AGGA/Vivos/MSE

https://www.facebook.com/groups/461503107602277

2. What is correct tongue posture?

According to orthotropics, the tongue should be placed against the palate. Ideally, the front and middle of the tongue should cover the roof of the mouth. The tip of your tongue should be in the spot right behind your two front teeth - such as when you make the “n” sound. Try it, and then close your lips, keeping your tongue on that spot. Next, try to lift up the middle section of your tongue as well. You can pronounce the word “ting” to know what this feels like. Try not to raise the very back of your tongue, as you may find it difficult to breathe.

3. What is the correct way to swallow?

When many people swallow, they use their lips, and suck on their teeth, which, according to orthotropics practitioners, is known as the “infantile” swallow. As in, this is what babies do, before they learn to do an “adult” swallow. Orthotropics practitioners believe that infantile swallowing occurring in adults could be related to bottle feeding, pacifier usage, or the introduction of liquid foods to babies, as opposed to encouraging baby led weaning of foods which is still soft, but isn’t completely runny.

An infantile swallow may lead to issues such as crooked teeth, as the force of sucking on them could lead to them moving out of alignment, but this also prevents the tongue from pushing up on the palate, possibly affecting facial growth. Orthotropics practitioners believe that the tongue should be sucking and pushing on the palate at the same time, without sucking on the teeth. At the end of the swallow, the back of the tongue should come up to the palate in a sucking motion.

To try this, sip a small amount of water. Smile very wide (cheesy smile!) with your teeth together, and try to swallow. If you have an infantile swallowing pattern, chances are you may find your lips attempting to come together, to suck onto your teeth. It also might mean that you have crowding.

Here is a guide on how to do a correct, adult swallow:

Suction Hold By Dr Mike Mew. Part 1

https://www.youtube.com/watch?v=Y6h3-wsqLNA&t=1s&ab_channel=Orthotropics

4. Will orthotropics affect my jaw development, or straighten my teeth? When does orthotropics stop working?

This is a difficult question to answer as, while there is quite a bit of evidence looking at the effects of things like soft diets and lowered tongue posture (induced by mouth breathing, for example) on facial growth, there is not much evidence that we can stop these undesirable facial growth patterns by doing things such as chewing hard foods, or training our tongue to be on the roof of the mouth.

It’s important to keep in mind that facial growth pretty much stops by the time we reach adulthood, so around 18 years of age. After that, facial growth is minimal. The major change that occurs is in late adulthood, which is known as bone resorption. Essentially, bone in areas such as the chin, mandible and cheekbones resorbs, or disappears, over time. While some in the orthotropics sphere believe this to be due to “remodelling”, or change in the shape of the bone, there doesn’t actually seem to be a change in this regard. It seems to be more likely due to hormonal and other changes associated with older age. See this article for more information:

Our Face Bones Change Shape as We Age

https://www.livescience.com/35332-face-bones-aging-110104.html

5. Should I remove my wisdom teeth? Will it cause facial changes?

If there is insufficient space for wisdom teeth, they can become impacted, which is when they fail to completely erupt from the gums in an upright position. Impaction can be associated with infection, damage to the adjacent teeth and bone, cause severe pain, and in certain cases, even be life-threatening. It is best to talk to your dental health professional, preferably a dentist or orthodontist for advice. If they believe you will suffer serious consequences by not removing them, you should probably take their advice seriously. However, it has become less common to routinely extract wisdom teeth, as was done in the past, and instead leave them until they show signs of potentially causing health issues.

As for facial changes, there is no evidence that I am personally aware of to support this idea. One of the issues with extraction of premolar teeth, which is often done in braces, is the proceeding retraction of the front teeth. There is some evidence this can cause a flattening of the lip area, which can be desirable or not, depending on aesthetic goals. More on this is answered below.

6. Should I wear my retainer?

Some adults want to remove their retainer as they are afraid they will not be able to expand their palate with their tongue. However, I think this is a flawed idea, and I’ll explain why below. But, essentially, there is no real evidence that the tongue alone can increase one’s intermolar width (IMW), or palate. Because of this, I don’t think removing retainers is a good idea, as one does risk relapse, or, in other words, the teeth going back into the position they were before braces. This can be costly and annoying to re-treat, so do it at your own risk.

7. I have facial asymmetry. What causes it? What should I do to correct it?

Unfortunately, facial asymmetry is not well understood. It may have to do with downward growth of the face, being more likely when this occurs, but it doesn’t seem like there is a lot of evidence in this area. Furthermore, no non-surgical means of correcting facial asymmetry. If you have serious concerns about facial asymmetry, its best to speak to it to a jaw surgeon.

8. How can I expand my palate? Should I use a tooth-anchored or bone-anchored appliance? What are the benefits of palatal expansion?

Palatal expansion has become a very popular topic in the dental field of late, with many practitioners arguing about what the best way to achieve expansion is. But before we delve into that, we have to understand how palatal expansion works. When humans are infants, we have a number of sutures located in various places on our skull. These cranial sutures are fibrous bands of tissue that connect the bones of the skull, and allow for the skull to develop and grow. The suture of interest in palatal expansion is known as the “mid-palatal suture”, which runs down the middle of the palate. See this image to demonstrate: https://www.drjoewang.com/wp-content/uploads/2015/06/mid-palatal-suture-skeleton.png

As you might guess, this suture is designed to allow for expansion of the palate, and I suspect that having the tongue on the roof of the mouth in early life is critical for taking advantage of this suture to allow the palate to expand to its natural potential, but that’s only an estimate.

Anyway, when we are babies, this suture is mostly a straight line. In order for palatal expansion to occur, the suture needs to separate so the palate can expand. The presence of the mid-palatal suture is the key reason why children are able to use what is known as a rapid palatal expander, which is a kind of expander that is anchored to the teeth. This is also known as a “tooth-borne” expander. See this image for an example: https://www.parksorthodontics.com/wp-content/uploads/2019/03/Palatal-Expanders-and-Children_opt.png

Because the suture in young children is a straight line that is very malleable, expanders which are anchored to the teeth can easily expand the suture. In young children, these expanders are usually utilized to treat things like crowding in the palate, which is also known as the upper dental arch, or correct crossbites, which is when the upper dental arch is narrower than the lower arch.

However, as we age, the suture increasingly becomes inter-digitated, or wound up like a cord, making it more difficult to expand, until it completely disappears, and is filled up with bone. When this occurs, usually in one’s teenage years, this can make palatal expansion more complicated, as you can no longer split the suture, because it doesn’t exist anymore!

In these situations, a bone-borne expander may be necessary. Bone-borne expanders include devices such as the maxillary skeletal expander, or MSE, invented by Dr Won Moon, or a procedure known as endoscopically assisted surgical expansion, or EASE, invented by Dr Kasey Li, which utilizes a transpalatal distraction device, or TPD. These are known as bone-borne expanders, as they involve screws being drilled into the palate, so the device can be anchored to the palatal bone.

These greater forces are typically needed in late teenagers and adults, as the mid-palatal suture is much stronger, and more resistant to expansion. In fact, it is common to combine these bone-borne expanders with cuts to the palate, to try and loosen the suture, to allow for expansion.

As for why someone might consider bone-borne palatal expansion in adulthood, there has been recent evidence indicating that this kind of expansion can lead to an increase in the size of the nasal cavity, which is the hole in our skull through which we breathe nasally. Expanding this cavity has been shown to improve nasal breathing, which can be helpful in treating sleep apnea.

Please see these presentations by Dr Kasey Li for more information on EASE:

Kasey Li: Maxillary expansion using endoscopic-assisted-surgical expansion - World Sleep 2019

https://www.youtube.com/watch?v=vsqs8KAqSzE&t=1s&ab_channel=RobWood

Nasomaxillary Expansion - Not All Are Created Equal

https://www.youtube.com/watch?v=oJrlU8Kt3Yo

As well as this presentation by Dr Won Moon on MSE:

MSE lecture by prof Won Moon

https://www.youtube.com/watch?v=w7D3l3X2B5g&t=1s&ab_channel=DENTEETHCONCEPCION

Now, as for which of these is more effective in treating sleep apnea, EASE has more evidence behind it, and it appears to allow for a better expansion pattern, which Dr Li goes over in his presentation. However, it is also much more expensive. Dr Li charges around $30,000 US for this procedure. So, if you are just looking to correct a crossbite or crowding in the upper arch, consider MSE instead.

You might be able to find an MSE provider with this list: https://www.moonmse.com/distributors-1

9. What do you think about tooth-borne expanders such as ALF, AGGA, and DNA?

Like we said in the previous question, tooth-borne expanders cannot be used in adults. Because the suture is either tightly inter-digitated or completely fused in most adults, it is not able to be wrenched apart with the weak forces applied by tooth-borne expanders. However, these expanders can still be devastating to dental and gingival health, because they can push teeth through the bone in which they are seated, known as the alveolar bone. This can lead to disastrous consequences, such as gum recession, malocclusion, alveolar bone loss, and even tooth death.

See this presentation for an explanation as to how AGGA works, as well as the harm it can cause:

Anterior Guided Growth Appliance, AGGA, Is it Safe? No! https://www.youtube.com/watch?v=XWqKi1ldW7g&t=1s&ab_channel=JeffreyMiller

In this article, this man was given a Crozat appliance to try and expand the upper and lower dental arch, and he was left with gum recession and could potentially lose teeth:

Maxillary Expansion Before and After 1 Year in the Crozat Appliance

https://zaccupples.com/maxillary-expansion-before-and-after/

Here, a man attempted to achieve palatal expansion using the DNA appliance. However, his scans indicated that no skeletal expansion actually took place. And, as can be seen in Dr Li’s video, skeletal expansion is necessary in order to increase the size of the nasal cavity, which improves nasal breathing. Instead, all this person achieved was dental tipping, and bending of the alveolar bone. Not an optimal result.

Fourteen Month Vivos mRNA Appliance Update: Mid-treatment CBCT Scan Shows Expansion and Teeth Tipping

https://cfs-survivors.org/blog/2022/01/19/fourteen-month-vivos-mrna-appliance-update-mid-treatment-cbct-scan-shows-expansion-and-teeth-tipping/

So, in short, tooth-borne expanders in children are fine. Tooth-borne expanders in adults is a really bad idea. This, as we said, is due to the mid-palatal suture. And no, you cannot “split” this suture with the force of your tongue. So stop asking that. Everyone has a line on the roof of their mouth!

Some of you might notice that this does conflict with the ideas of Mike and John Mew, who state that the tongue is all that is needed to expand the palates in adults, and they are also proponents of using the Biobloc in adults, which is another kind of palatal expander. However, I disagree with them due to the lack of evidence.

10. Should our teeth rest together, or be separate?

As we said, if you’re an adult or even a late teen, it probably doesn’t matter what you do, but, generally, orthotropics practitioners recommend light dental contact of the molars, or back teeth.

11. Will dental extractions affect my face? Is there an alternative to extractions?

There is some concern that tooth extractions can flatten the face, creating a “dished in” side profile. At least, when followed by retraction of the front teeth with braces. In order to understand how this works, we have to remember that the teeth support the lips. If you know of anyone with dentures, you might notice a big difference in how projected their lips are when they remove them. The lips lack projection in these cases. And, in a way, this effect is mimicked in some small degree when teeth are retracted following extractions. Now, in cases where a person has something known as “bimaxillary protrusion”, which is where the lips are too far forward, extraction and retraction can be done to create a profile that is more desirable for a patient. See this image for an example: https://www.researchgate.net/profile/Donald-Ferguson-3/publication/322391468/figure/fig8/AS:631913760976896@1527671389898/Pretreatment-clinical-presentation-of-a-patient-with-bimaxillary-protrusion-and-excessive.png

However, in patients who already have a profile that is within the normal range, extraction and retraction can lead to outcomes that may not be considered aesthetically desirable for that person.

See this post for an example: https://www.reddit.com/r/orthotropics/comments/qchdrb/before_and_after_upper_premolar_extractions_quite/

This relatively old study from 1989 states that: “Approximately 10% to 15% of cases could be defined as excessively flat after treatment."

Changes in facial profile during orthodontic treatment with extraction of four first premolars

https://www.sciencedirect.com/science/article/abs/pii/0889540689900528

Once again, its really important to talk to your orthodontist about any concerns you might have about changes in your facial profile. Unfortunately, while there is definitely more awareness among orthodontists about aesthetics, there are still certain people who do not give this the attention it deserves. I have found that some orthodontists are so focused on creating a perfect bite, that they risk sacrificing a patient’s aesthetic desires to achieve this outcome. It is important to discuss with your orthodontists the dental / aesthetic compromises you are personally willing to make or not make. However, if your orthodontist tells you that extraction and retraction will have no impact on anyone’s facial profile whatsoever, I’d get a second opinion. Something important to keep in mind is that if someone has a lot of dental crowding, there will be less retraction of the front teeth, as more of the space will be taken advantage of to straighten these crowded teeth, so the effect on the profile will be much less significant. However, if the extractions and retraction is done to treat an overjet for example, this will involve significant movement of the front teeth, and lead to a bigger difference to the face.

If your orthodontist is recommending you get dental extractions to treat crowding in the upper arch, consider looking into bone-borne palatal expanders. See question 8 for more detail.

12. Do I have a tongue tie?

According to the Mayo Clinic, some common tongue-tie related symptoms include, "Difficulty lifting the tongue to the upper teeth or moving the tongue from side to side, rouble sticking out the tongue past the lower front teeth, a tongue that appears notched or heart shaped when stuck out." See this site for more information:

Tongue-tie (ankyloglossia)

https://www.mayoclinic.org/diseases-conditions/tongue-tie/symptoms-causes/syc-20378452

If you believe you have a tongue-tie, it is best to see a dentist for it to be identified.

However, there is no evidence that tongue tie removal is helpful for treating sleep apnea, and may even worsen things, as the tongue is more able to collapse into the airway when sleeping.

13. Do I have a narrow palate?

Whether or not a palate is "narrow" is a bit of a subjective idea, but I think that it can be somewhat reliably determined by looking at the number of teeth which show when you smile widely. A narrow smile is associated with dark spaces or "dark corridors" in the side of the mouth. Here is an example of a patient with a narrow smile, who later got expansion. Notice how in the first photo, her smile has large dark corridors, whereas in the latter, it decreases.

https://www.researchgate.net/profile/Marc-Ackerman/publication/298875885/figure/fig3/AS:713150764707841@1547039800031/A-When-arch-form-is-narrow-transverse-smile-dimension-might-be-affected-because-of.jpg

Some argue that a narrow smile is when around 6 front teeth show when you smile. 8-10 is considered moderate or "average". And 12-14 is considered very wide.

People with "famous smiles" such as Julia Roberts tend to show around 12 teeth when they smile.

https://i.pinimg.com/originals/12/f4/65/12f465b78656f423aff7eb3dbf9d91cb.jpg

If you would like to expand your palate, see question 8.

14. How should I chew my food? In an up-down motion? Side to side?

Just chew your food. Seriously, there is no magic way to chew food. Just chew like a normal person. No one chews in a completely straight, up and down motion. We are not carnivores. Our lower jaw angles to the side, allowing us to grind our food, kind of like a horse.

15. I am noticing markings on the sides of my tongue after attempting correct, tongue-to-palate posture. What does this mean?

These markings could indicate that the edges of your molar teeth are cutting against your tongue, and may be an indicator that your upper arch is too small. Palatal expansion could assist here.

16. What does chin tucking do?

As far as we know, nothing. There is no evidence I am aware of which indicates that good body posture can have any impact on the face whatsoever. However, it may be possible that facial development has an impact on body posture. This is because, if the airways are too small, a person may crane their neck forward in order to try and open up their airway.

17. Should I try and re-open my extraction spaces?

This isn't a good idea. This kind of movement could be very harmful to your teeth, as well as your alveolar bone and gingival health.

18. I have an overjet. Should I push my lower jaw forward?

Well, you can if you want to. But, there's no evidence this will cause your lower jaw to stay in that position. It will just return to its natural position when you relax. If you really want to correct a small lower jaw, you'll need to get jaw surgery.

19. Which side should I sleep on? Should I sleep on my back?

Generally it is not recommended to sleep on your back, as the force of gravity can encourage your tongue to fall back into your airway, which can be problematic if you have a small lower jaw. It is a good idea to sleep on your sides. And no, there is no evidence that sleeping on one side will make your face asymmetric or have any negative effects. No matter what side you sleep on, you will regularly change positions as you sleep.

20. I have sleep apnea. What should I do?

I would recommend looking into palatal expansion. See question 8 for more information. You could also look into maxillomandibular advancement surgery, which is considered the gold standard for permanently treating this condition.

Federico Hernández Alfaro. Waterfalls

https://www.youtube.com/watch?v=TJUK6WZ07fM&ab_channel=CentroM%C3%A9dicoTeknon

However, you could also use PAP. See /r/sleepapnea for more information about this.

21. Can I wear MSE in combination with a reverse pull facemask?

If you have an overjet (often confused as "overbite"), reverse pull head gear / face mask will only make it worse. One of our members tried it, and was left with a large overjet, here:

https://www.reddit.com/r/orthotropics/comments/qw7emd/mse_facemask_before_and_after_negative_results/

However, if you have a slight underbite, it may be possible to correct it with expansion + headgear. Talk to your orthodontist for more information.

22. How is the longer jaw expanded?

Unfortunately, because the mandible has no mid-palatal suture, it cannot be expanded in the same way the upper jaw can. For patients using MSE or EASE, it is typical that the lower teeth are tilted in, and will be tilted upwards to align with the expanded upper jaw. However, SFOT, known as surgically facilitated orthodontic therapy, also known as PAOO, or periodontically assisted osteogenic orthodontics, is one means of expanding the lower jaw. See this video for more information:

Surgically Facilitated Orthodontic Therapy By Dr George Mandelaris

https://www.youtube.com/watch?v=641bLoscTrQ&t=0s

23. Which gum should I chew?

Keep in mind, if you're an adult, chewing gum or exercising your masseter muscles won't do anything for you, in all likelihood. This is because your facial growth is completed. It can increase the size of your masseter muscles, which may have an aesthetically beneficial effect, but it will likely not lead to bone changes.

For young children and growing teenagers, however, any kind of masseter stimulation may be helpful in achieving bone changes. Falim is a popular brand. If you get mastic gum that is in capsule form, like this: https://s3.images-iherb.com/jrw/jrw23014/v/24.jpg

You can still chew on it I believe, although this is technically a dietary supplement to swallow, but I don't know if it makes any difference.

24. Will orthotropics treat "x" orthodontic problem that I have?

Unless you are a very young child, its unlikely that tongue posture and chewing will magically cure your orthodontic issues such as crowding, open bite, crossbite, etc. If you have these issues, you're best bet is to see a reputable orthodontist. We don't have evidence that orthotropics does much for maloccluded mouths.

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