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Dental Tribune U.S. Edition

Ortho Tribune U.S. Edition Special Section | November 2013 A21 Ad created the over-breathing that Buteyko addresses. The ensuing open mouth posture prevents the tongue from ful- filling its role as scaffolding for the de- veloping maxilla (just as the eyes are the scaffold for the orbits and the brain for the cranium) and allows this bone to collapse downward and back into the face, severely restricting space for erupting teeth. As a result, the mandible is forced to cope with a distorted upper partner. It compensates in a variety of ways, all of which result in facial devia- tions from ideal. The biggest concern is that this dam- age starts very early in life. So by the time a child’s teeth have crowded — and are considered ready for braces — it is too late to prevent it. Consequently, traditional orthodontics operates as a compensation for misshapen jaws (80 Dr. BArrY rAPHAEL has practiced orthodontics for close to three decades. During this time he has benefit- ed from all the advances modern orthodontic treatment has to offer, including functional orthodontics and low-force, low-friction techniques. Although Raphael has been practicing orthodontics for nearly 30 years, he has only recently begun to recognize the benefits of myofunctional therapy in his practice. He also has first-hand experience with moving from a “tooth-centric” philosophy of orthodontic mechanotherapy to a “muscle-centric” philosophy of orofacial development. Raphael can offer clinical insights into the changes he has made in his own practice and where he thinks orthodontic practice and education are heading. He may be contacted at percent of the time to my estimation) and, in the case of using extractions to relieve the crowding, is actually locking in the problem permanently by collaps- ing the dental arches in order to match the collapsed skeletal arches. In addition to the esthetic problems associated with profile and smile, a misshapen face can cause a variety of health issues. An elongated face is a risk factor for sleep breathing disorders be- cause the airway is often more narrow in the throat. Stresses are placed on the jaw joints, often creating dysfunc- tion or causing pain. A lowered tongue posture leads to muscular dysfunctions that place additional stress on the teeth, jaws, cranial bones, joints and airway. It is a messy situation, and it seems in- creasing in frequency and severity with each generation. In my opinion, the best treatment approach is preventive. Even when or- “ KNOWS, page A20 OrtHOdONtICS NEWS thodontists try to intercept the issues leading to open mouth posture (a dis- sertation in itself), the longer the delay in starting treatment the more damage that must be dealt with. By adulthood, not only is the original facial damage present, but so are all of the second- ary effects these stresses have created, including wear and tear on the teeth and joints, long-standing muscle and breathing dysfunction, musculoskeletal issues and chronic inflammation in all parts of the body. There are several treat- ment techniques designed to help the jaws grow to their full genetic potential. These, of course, work best in young, growing children, but can be beneficial at any age, albeit with varying degrees of success, since even a 5 percent positive change can have a large impact on an out-of-balance system. At the base of these efforts has to be the restoration of nasal breathing and correct breathing dynamics, with- out which all issues remain refractory. ortho triBuNE SECtioN members was the James L. Vaden Edu- cational Leadership Conference, held on May 3. This conference emphasized excellence in orthodontic education, concentrating on graduate program standards. These programs will hope- fully change the decline of “educated” orthodontic faculty members and the increased attrition of full-time post- graduate faculty positions. However, at the present time, alea iacta est — the die has been cast. Why would a graduating resident forgo the incentives of private practice and a de- cent starting salary to accept a low pay- ing academic position with little hope of advancement and a mounting finan- cial struggle, especially when the major focus of his or her education has been to treat patients? As noted 10 years ago by Johnston (2002), sadly there is still no market for a career in academe as there was prior to the 21st century. If experience has taught us anything, it is that money talks. Most new graduates make deci- sions that are personal matters, i.e., supporting a family, paying back edu- cational loans and living a decent life- style. One measure of an individual is how well he or she can overcome adversity; the future of orthodontic education is also at the crossroad of adversity — the trying times associated with academic careers in education. Until profitable career options in edu- cation become a reality, the supply of orthodontic educators and research- ers will be limited. American-educated residents are blinded by future pros- pects of earning a living and may never regain their sight toward considering a career in academics. Until academe becomes a profitable career option, orthodontic education may experience a diminished or daunt- ing outlook. For the new orthodontic graduates, regardless of whether their path leads to academics or private prac- tice, aspirations should be concentrated on practicing to the best of his or her ability. References are available from the pub- lisher upon request. “ CAREER, page A20