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18 Journal of the Indiana Dental Association | VOLUME 101 · 2022 · ISSUE 2COVER STORYOrthodontics is more than straightening teeth. It also addresses modication of facial growth, referred to as dentofacial orthopedics. The holistic approach to orthodontics goes another step further: shifting the way the malocclusion is being addressed. Traditionally, the crooked teeth/bad bite/spacing/etc. are viewed as the primary problem(s) and alignment is the answer. The mindset shift that occurs with a holistic approach views the malocclusion as part of a problem needing to be addressed. The focus is on seeking solutions through collaborative care to address the overall health concerns that contribute to the symptom of crooked teeth. This is exemplied in the Surgeon General’s Report on Oral Health from 2000, “The mouth is a ‘mirror of health or disease’ and it may be an early indicator of disease in other tissues and organs in the body.” The etiology of various malocclusions continues to be studied and debated. However, as with all our practices, our patients are not simply statistics and do not want to be treated as such. Each presents with unique histories. The holistic approach connects the dots by viewing the patient as a whole and the mouth health as an indicator for one’s overall health. Although each patient is unique, there is also one thing all of our patients have in common. What is it? All are breathing. However, not all breathe the same. How can you identify this? Recognizing and diagnosing poor or improper oral rest posture is the rst step in creating and implementing strategies to improving patients’ oral health. Proper oral rest posture includes:• Tongue rests at the roof of the mouth• Teeth are lightly touching or slightly apart• Lips are together without strain• Proper balance of forces exist between the tongue and the cheeksWhen one has proper oral rest posture, they are nasal breathing. There is a connection between malocclusion(s) and improper breathing, poor sleep, attention decit disorder, poor digestion and in general, an unhappy child who may not know how to express his or her discomfort. Orthodontics: Combining Technology and a Holistic ApproachDr. Catherine MurphySigns of improper rest oral posture include:• Crusty/dry lips• Lips apart at rest• Lip strain when lips are together• Rolled out lips • Prominent “cupid’s bow” appearance of the upper lip• Top and/or bottom jaw back/recessed from preferred positionThese signs may lead to (are often related to) mouth breathing, which is detrimental to patients’ oral and overall health. Achieving proper oral rest posture can be dicult for those with tongues that are restricted. “Because the tongue plays such an important role in so many functions, restricted mobility of the tongue muscle may lead to dysfunctional compensations that may negatively aect nasal breathing and snoring due to low tongue posture or contribute to chronic stress on the other muscles of the head and neck.”1 The connections between proper rest oral posture, mouth breathing and restricted oral tissues lead me to my triad of care. My secret to creating stunning, healthy, sustainable smiles is to cooperatively address: • Breathing• Eating• Sleeping concernsABOUT THE AUTHORDr. Catherine Murphy is an orthodontist, speaker and author. Her rst book, Dear Momma…, is a picture book for moms. Her passion is supporting families seeking life enhancing treatments, rather than short term solutions. If you’re interested, please visit: DrCatherineMurphy.com.
19VOLUME 101 · 2022 · ISSUE 2 | Journal of the Indiana Dental AssociationAll three are connected. If you positively impact one, the other two will improve. Likewise, if one worsens, the other two will as well. The second step is building a team of professionals in your referral network who can best help your patients implement restorative and corrective strategies such as orofacial myofunctional therapy (OMT). OMT is a primary strategy for many practitioners wanting to address these maladaptations, especially in developing children. It is the treatment of disorders of the oral and facial muscles, consisting of behavioral modication and simple, therapeutic exercises for muscles of the tongue, lips and jaw. Stacy Lashenik, RDH of NWI Orofacial Myofunctional Therapy in Northern Indiana, is a myofunctional therapist I have referred many patients to for these strategies. She became an orofacial myofunctional therapist because she had problems with her own teeth wearing down, clenching, grinding, and facial pain. Lashenik says “my goal is to be part of the movement toward early intervention so kids today can avoid some of the lifelong problems that can be associated with myofunctional disorders.”I would like to share a case study from my practice, Jakob. Jakob rst saw an orthodontist at age 11. The approach was very traditional: Wait for treatment due to his age. There was also discussion of possibly needing to extract four teeth to correct his bite. I met Jakob a year later when he was 12 years old. I noticed he had poor tongue posture and a tethered/tied tongue. I also recognized mouth breathing and forward head posture. Through discussions with his father, I discovered Jakob suered from teeth grinding and anxiety. He also presented with behavioral and sleep concerns, often needing the aid of medication for sleep. This was all despite Jakob having his adenoids removed earlier that year. Although there was no diagnosis of sleep apnea, his sleep study revealed Jakob only entered REM sleep once during the night. REM sleep is critically essential to brain function for learning and making/retaining memories. As we discussed Jakob’s connection between orthodontics and his overall health, I put together a team of practitioners to improve his condition. No teeth were removed to correct his bite. A palatal expander was placed in addition to brackets, as well as education and accountability for improving his oral hygiene. Jakob was referred to Stacy Lashenik, the OMT practitioner formerly mentioned. She noticed that years of living with enlarged adenoids had restricted Jakob’s ability to breathe through his nose, causing his tongue to drop to the oor of his mouth in order to allow air to ow through open lips. Even though his adenoids had been removed, his muscles did not automatically begin functioning properly. While continuing his orthodontic treatment, Jakob continued to see Stacy twice per month for orofacial myofunctional therapy. He learned exercises, which he also practiced at home, to focus on strengthening and gaining control of his tongue and orofacial muscles. We were able to teach Jakob to use his tongue to suction against his palate and his lips to rest closed. We improved his nasal breathing and corrected his tongue thrust swallow pattern. There were noticeable improvements in Jakob’s health and appearance in addition to him reporting he was enjoying a better night’s sleep. Jakob is just one example of patients who can benet from a collaborative eort from multiple practitioners and a holistic approach. Although it is attering to be considered on the cutting edge due to holistic approach to dentistry and alternative functional therapies, I stand on the shoulders of incredible trailblazers. The trailblazer that had me check my own ego is a fellow IDA AIR participant, Dr. Yuliya Pinskaya. While discussing our practices at a AIR event, she challenged Above, an Instagram post from Dr. Murphy's practice.
20 Journal of the Indiana Dental Association | VOLUME 101 · 2022 · ISSUE 2COVER STORYme to rethink my approach to Phase 1 treatment. To be transparent, initially I was not open to it. My practice already included more Phase 1 than most and my results were consistently good to great. The following week, the challenge remained on my mind, so I reached out. The ood gates were opened: a myriad of new courses and research for these concepts dates back over a century. An article by Dr. E.A. Bogue from 1911 “Enlargement of Nasal Sinuses in Young Children by Orthodontia” cites several papers written on the topic of addressing stenosis of the nasal cavity. Increased development in the nasal passages and a straightening of the nasal septum was accredited to myofunctional therapies and alternative orthodontic treatments.According to an article dating back to December of 1922 from the Journal of the American Medical Association, “malocclusion always indicates abnormal functioning. Normal occlusion means the health of the teeth and their surrounding parts. Malocclusion implies a pathologic condition of the teeth and surrounding tissues.” Malocclusion is indicative of unhealth. So when is the best time to address a malocclusion? The American Association of Orthodontists (AAO) recommends that children have their rst check-up with an orthodontist as soon as an orthodontic problem is detected and no later than age 7 even if there does not seem to be any problems. However, often the process gets started at age 7, rather than when the malocclusion is rst detected. This watch and wait does not consider the overall eects on the patient. Although the access to Phase I/Interceptive treatment by an orthodontist may be challenging in some areas, more family dentists are learning to support these patients with expansion and the appropriate referrals to colleagues in myofunctional therapy, chiropractic care, speech therapy, occupational therapy, physical therapy, craniosacral therapy and others. My hope is that this article piqued your interest in the concept of Holistic Orthodontics. This approach goes beyond the often preconceived notion that with the use of essential oils while meditating I’m able to x existing malocclusions. While those can be aspects to improve the patients’ overall health, the role of the dentist is to view the patient’s oral health as part of their overall health. Collaborative care requires eort in building your team. However, once established, oers increased quality of care. Additionally, it eases the burden that is often placed on dental professions. Our area of focus, the mouth, is more complex than our patients and other professionals often appreciate. When we are able to have the underlying concerns addressed with our colleagues, all involved benet. For more information on this topic and to also learn more about why I changed my approach to orthodontics, visit my website, www.DrCatherineMurphy.com.References1. https://onlinelibrary.wiley.com/doi/10.1002/lio2.2972. https://www.sciencedirect.com/science/article/abs/ ` pii/0002941668902169?via%3Dihub3. https://drruscio.com/wp-content/uploads/2019/12/ S-jCohen-Malocclusionanditsfarreachingeects-ama2.pdf