Amaya started coming to my office when she was almost 8 years old. She had undergone part of a phase I treatment before I started seeing her. This first photo was taken six years ago. One thing I know for sure is that I did not see then, what I see now!
Now, I see that her lips are apart, tongue likely rests down and between her teeth, not up at the roof of her mouth, and her lower jaw is recessed or set further back than the upper jaw. She has a V shaped upper arch because she mouth breathes, so her tongue rests in the down position which has the effect of widening her lower jaw instead of her upper jaw.
At the time, the treatment that was done moved her upper jaw back to correct her overbite, instead of bringing her lower jaw forward. Unfortunately, with a lot of orthodontic appliances today, the upper jaw still is still pushed back.
So, in the second photo, when Amaya finished her first phase of treatment, her overbite was in fact corrected. It was also likely easier for her to bring her lips together, although I now notice that she is straining her chin in order to achieve this. Did her upper jaw grow forward? No. Did her lower jaw grow forward? It looks like it did a little bit.
Through photos like these, I’m hoping that you begin to understand why I talk to all of my patients about mouth breathing, lip posture, tongue posture, and straining in the chin muscles. Each of these elements impact a child’s growth pattern. It can cause downward and backwards growth, leading to an overbite, or the lower jaw can grow forward excessively, leading to an underbite.
A year after her braces were removed, I saw her to monitor her growth and to see how her teeth and jaws were developing. My notes from this visit say Amaya was still tongue thrusting (despite using an appliance to keep her tongue back during the first phase). We tried to remind her to keep her lips together when swallowing and the tongue to the roof of her mouth. I see now, her head posture is forward to help her breathe better. She still had mentalis strain, indicating that she was still mouth breathing. Now, both her upper and lower jaws were growing backwards. We took additional photos and I saw mom and Amaya back a month later.
What was my treatment plan at that time? I discussed with Amaya and her mom, the only way to correct her profile and bite at that time was orthognathic surgery. I was going to send her to the oral surgeons and have her undergo surgery to bring both her upper and lower jaws forward. Luckily, at this appointment, Amaya’s mom also shared with me Amaya was having trouble sleeping. She was very restless at night. This improved once her tonsils and adenoids were removed, but since then had gotten worse. She was also having some TMJ pain.
Around this same time, I luckily started taking courses and learning about airway health and reasons kids grow the way they do, instead of just looking at trying to get their teeth to fit together without taking into consideration their profile. I also referred Amaya to Dr. Dan Klauer to address her TMJ issues. After one year of working with Dr. Klauer and doing myofunctional therapy, her lip and tongue posture was better. Mom reported she was doing much better, with less pain. She denied the orthognathic surgery option, which we are both thankful now, she decided not to move forward with that route.
Almost 3 years after her braces were taken off for Phase I, she was ready for the next phase. This was just the amount of time I needed to take several courses focused on airway health alternatives to traditional orthodontics that can help patients grow in a more forward direction.
The two photos below were taken 6 months into Amaya’s treatment. WOW! Amaya, her mom, and our entire office was thrilled with the amazing changes. Amaya had to put in a lot of effort with myofunctional therapy as well as becoming mindful about nasal breathing, keeping her lips together, and her tongue in the roof of her mouth. At this point, she still had a little strain to her chin and we discussed this.
Amaya continued her hard work. The photos demonstrate a more relaxed profile. Mom reported that Amaya was more relaxed, sleeping better, breathing better, and more confident!
Amaya and Denise, thank you both for your trust and allowing me to be a part of Amaya’s orthodontic journey. I will be forever grateful to have a part in Amaya’s beautiful smile and profile. She is one of the many reasons I love what I get to do each day.
“Do the best you can until you know better. Then when you know better, do better.”
– Maya Angelou