20/12/2025
Orthodontic Dogma
Let’s talk about the elephant in the room.
Lately, I have had so many parents and colleagues reach out to me in relation to an orthodontist who has been very engaged and interactive with my orthodontic posts.
People are in disbelief that he continues to discredit the work I do, in a not very professional way – using derogatory comments such as selling snake oil, rogue dentists, lazy dentists, implying airway treatments are financially driven, etc…
One of the parents of a child whose photos were shared was in shock, wishing she could share all the sleep and breathing improvements. Others have made comments in support, to be met by dismissive comments.
I want to reassure everyone that I don’t really get weighed down by dismissive behaviours in others. They only discredit themselves when they make blanket statements about general dentists, and how superior they are.
One of the key reasons they are feeling very polarised is their unshakeable belief removable appliances do not offer skeletal expansion – or distraction osteogenesis, which is new bone induced via separation of the two halves of the palate at the mid-palate suture.
I find it difficult to believe that an orthodontist with specialty training cannot see the very clear palate bone remodelling in the region of the mid-palate, that is very apparent to even parents with no dental training. This case is still in progress, and you can find the original post and thread here:
https://www.facebook.com/share/p/1Fy4szqb65/
These red lines I've marked in this case, whilst not standardized or precise, are added for parents to see what seems to be missing by some.
Yes, some of the changes are dental – there is some outward tipping of the back teeth, but I would hardly call this significant flaring. Firstly, many of these teeth are baby molars which will be lost, and secondly, if there was flaring it would be unstable the moment the plate came out. Focusing on this alone misses the bigger picture.
The failure to recognize skeletal expansion with removable devices is a result of dogmatic thinking. To see it would be contrary to what has traditionally been taught in orthodontic training programs.
What is also clear in these photos is that the change is not just about the teeth tipping outward. The entire upper jaw looks bigger and more developed, not only wider but also in its overall shape. The teeth are sitting within a larger bony framework, rather than just being pushed out of position. This reflects growth and adaptation of the underlying bone itself. Bone growth like this does not simply shrink back. What can move over time, if muscle habits are not addressed, are the tooth positions, not the jaw bone that has developed.
The Biobloc expander that I use is something most orthodontists are unfamiliar with from their training. It was developed by the late orthodontist, Dr John Mew. He published a textbook outlining his approach and showcasing his results, and he has been a major influence in the field of airway focused orthodontics.
At the same time there has been no peer reviewed research published on the efficacy of the Biobloc expander to achieve skeletal expansion. It may differ from other removable devices as it utilises highly retentive Crozat clasps and is worn 24/7. We can only go by cases documented by Dr Mew and other pioneers of this appliance, and our own clinical observations. I don’t use 3D X-ray scans, but we do have pre-treatment dental/palate digital scans which could be easily contrasted with post-treatment scans to show what I am trying to indicate with the lines marked on the photos. Do I want to do this? Not particularly to simply prove a point to others. I think the photos tell the story well. And I’m busy trying to help achieve functional improvements, and deepening my insights on how to promote stability of results, knowing that the muscles will always win in the end when it comes to final tooth positions.
We need to address the underlying muscle habits that alter jaw development for stability of results – this is where we really need more attention. Those of us in general dental practice see orthodontic relapse all the time in practice as we have long-term relationships with our patients and see many six-monthly. It seems a vocal minority of people presume they have no relapse and need to shout out their results are superior, whilst likely never having that same opportunity to follow up so many patients in the long-term. Patients accept responsibility for relapse if they don't wear their retainers after spending thousands of dollars. We all should be exploring if we can do better.
The future is greater integration and learning from each other’s perspectives and what we see – specialist title or not. I’m grateful that many orthodontists have humility to have collegial discussions with me, often seeking my insights. It's only a small minority who need to constantly make blanket statements about general dentists having poor knowledge or being financially driven. For the record, early intervention is often more individualised and time consuming with greater need for patient communication and compliance, and I am certain that I have a slower patient flow and make less income than most of my orthodontic colleagues. The airway dentistry comment being financially driven really does not add up.
I’d like to end this post with a link to research – a 5-year prospective review on maxillary expansion in a cohort of 404 children demonstrating that expansion was linked to sleep and breathing improvements, and these tended to be stable over the five years. 80% of the cases used removable expansion devices. This study whilst documenting children's sleep, breathing, and behaviour over time, did not examine bone measurements and compare differences in removable and fixed appliances.
https://www.facebook.com/share/p/17XaKkq1Es/
You don’t have to agree with me, and some robust discussion is invited – but let’s keep our emotions in check, and the discussions respectful. Anyone can critique the study, I’m not suggesting it’s perfect - but let’s keep an open mind and keep exploring these new directions of research and published results that may offer answers that can evolve our standards of care to help our children and patients better.
