Myobrace

What is Myobrace (myofunctional training, MRC) and what does it aim to do?

'Myo' means muscle. Myobraces are special appliances to help guide craniofacial growth and development. The appliances are just one part of it though, and are combined with myofunctional training, which gets the muscles functioning properly to guide the child into normal, ideal growth. This means treating more than just the teeth -- we have to look at posture (head and body position), airway, tongue, swallowing pattern, facial and chewing muscles and any swellings (adenoids/tonsils) or inflammation (allergies, asthma). By picking up on the subtle signs of developing issues, early intervention allows us to correct their habits, get them functioning correctly and then guide the child's growth to optimise jaw and facial development.

The aim is to address the question 'why do children develop crooked teeth and incorrect jaw relationships?'. Research is showing that crowded teeth and other issues aren't because the 'teeth are too big', it is largely environmental factors that have created the huge surge in orthodontic issues. Genetics does play a role, however, the size of the teeth are designed to fit perfectly within the growth potential of the child's jaw. So, often the issue is that the jaws did not develop correctly, or did not develop to their potential. Why? The muscles guide growth. If your child has incorrect functional habits, such as mouth breathing, tongue thrusting, reverse swallowing, thumb sucking, open mouth posture (asthma and allergies often contribute to this), then this hampers facial development. It has been estimated that 3 in 4 people have some degree of facial development problem.

We focus on getting function and the underlying structures correct. If you get the framework right, the teeth tend to guide themselves into the correct place, and thus we find the need for braces in the future is minimised or completely avoided. In this, we assess breathing, oral habits, posture, and more. The best thing about this is it has lifelong benefits. This therapy goes far beyond getting straight teeth. The issues that cause crooked teeth also cause other more severe issues. For example, if your child is mouth breathing, this affects their entire posture. Forward neck posture created by mouth breathing causes chronic neck pain later in life, as well as many other compensations within the body. Read more about mouth breathing

What is the difference between myobrace and conventional braces?

It is a different approach and often referred to as 'pre-orthodontics'. We are not against braces, and in our clinic we use conventional braces, invisalign and other orthodontic tools to achieve great results. However, braces do not address the underlying cause of the issue. Braces only put your teeth in the right place within the jaw but do not change your muscle relationships. Braces alone cannot change the jaw relationship or jaw development, therefore you have to work within what you have, which is often not ideal facial relationships. To get more room, sometimes you need to extract teeth.

As the muscles have not changed and often there are contributing functional issues, these are constantly working to push the teeth back to where they used to be. This is called orthodontic relapse and is why patients often have to wear retainers for the rest of their life to keep their teeth straight.

There is also a difference in when these are done - braces are generally placed once the child has all of their permanent teeth, whereas myobrace is much earlier as it uses the child's own growth, therefore is started anytime from 5-6 years of age.

If your child undergoes myofunctional therapy and still wants braces in the future, we have a package deal for this.

Mouth Breathing and Airway issues

If children are mouth breathing as their normal method of breathing, this can cause many problems. Humans are obligate breathers meaning we can breathe through our mouth or nose, however, it is undisputed that nasal breathing is the best functional breathing. Mouth breathing should only be as a backup if our nose is blocked or we are doing strenuous exercise.

Long term mouth breathing has many consequences:

Incorrect neck posture (forward neck posture) as to open the airway the neck must come forward a little. This increases the weight of the head considerably and causes neck pain in the future. Also the body has to balance this shift and therefore compensates through many other posture adjustments, causing the entire body to become unbalanced.
Their tongue is not in the correct position. The tongue at rest is designed to sit at the roof of the mouth, which puts forces on the roof of the mouth which is also the floor of the nose. This gentle force actually stimulates growth and develops the top jaw as well as the nasal airway. If a child grows up mouth breathing, they sit their tongue on the bottom of their mouth, which often means that their top jaw is underdeveloped, leading to both narrow upper airway as well as crowded top teeth. Growth direction can change as the forces are different, leading to vertical growth (downwards) rather than forwards growth, changing their facial profile.
Do not get the benefits of nasal breathing. When you breathe through your nose, you filter the air of dust, pollens and bacteria, your sinuses also moisten the air and add nitrous oxide which is an anti-inflammatory and also helps kill bacteria. If you breathe through your mouth, the dry air that is full of dust and bacteria goes straight to your lungs and causes irritation. This makes asthma and allergies worse.
Not utilising your lungs and diaphragm correctly. Your tongue is connected to muscles which connect to your diaphragm. When your tongue is in the right position and you breathe through your nose, you activate your diaphragm and use the lower parts of your lungs, which have more blood supply and therefore oxygenates your blood better. Your diaphragm is the only thing that pumps your lymphatic system. If you breathe through your mouth, you use the top part of your lungs and have shallower breaths.
Many people have heard the term "if you don't use it you lose it". This applies here too. If we don't use our nose, our airway and sinuses don't develop properly, and we will find our nose gets blocked a lot more often, if not constantly, making it more difficult to start breathing through our nose.

Snoring

What is snoring? Snoring is the noise created when you are breathing during your sleep because of the vibration of tissues in your airway. More than 70% of people who snore have some sort of restriction or blockage along their airway which causes functional sleep disorders. Obstructive sleep apnoea (OSA) or hypopnea is just one of these sleep disorders. OSA is where you stop breathing for more than 10 seconds during your sleep. It is a disorder that is commonly thought of as an adult or 'late life' issue, however studies have shown that children suffer from OSA too. Research is now also showing that children who have parents with OSA have a much higher incidence of having it too.

OSA is linked to:

Poor sleep quality. In children this can lead to them being hyperactive as children as self-stimulating when they are tired. Children are deprived of critical time for brain and body development. Only in certain phases of sleep does your body produce the right hormones needed for proper growth. A chronic deprivation of good quality sleep has many flow on effects
hypoxia (lack of oxygen) which as you can imagine, has extremely negative impacts on any person, but more-so in a growing child
bruxism (tooth grinding)
Increases risk of future chronic disorders such as high blood pressure and dementia

What can you do? OSA in adults is often treated with CPAP machines however these are not suitable for children except as a last resort as they interfere with the child's growth and development and cause future issues. We recommend having a check up with us so that we can assess symptoms as well as physical signs to screen them for the issue. If necessary, we may refer for a sleep study or to a specialist (ENT or paediatric sleep physician).

Thumb Sucking

Sucking on their thumb, finder or a pacifier is quite normal in the first years of life. It is believed a baby's natural suckling instinct makes them feel secure and safe. This is why some children make a habit of it when they're anxious, tired or about to sleep. Usually, children stop on their own between 2-4 years of age. However, continued thumb sucking after their permanent teeth come out can change the way that the child's mouth develops and can push the teeth into the wrong place. This is why dentists generally recommend that we begin to try to ease them out of the habit if they are still thumb-sucking after they have turned 5 (their permanent teeth start to come through at 6 years old).

The effects that the habit has depends on how long, how often and most importantly, how intense the thumb sucking habit is. Is your child actively sucking their thumb, or is it more resting there? A child that is actively sucking creates very strong forces with their tongue muscles, thumb and chewing muscles which can even affect the baby teeth. This may warrant earlier intervention as it can quickly cause severe issues. The signs we see are that the roof of the mouth forms very narrow, the front teeth get pushed out and they may develop what we call an open bite (when the child bites down, their top front teeth don't touch the bottom front teeth - see photo for a severe example).

What do we recommend?

First, monitor them. They may stop on their own. Also note patterns - when do they tend to suck their thumb/finger/pacifier? We want to get an idea of why they do it.

Common times for children to suck their thumb are: when they're nervous or upset about something, when they're tired or going to go to sleep, when they are hungry or when they are watching TV.

If the habit continues and their permanent teeth are close to/have erupted, then you can try these few gentle tips to help break the habit. Please bear in mind that it is critical that the child develops a positive view towards oral health, therefore we do not recommend punishing them or scolding them for their habit or using deterrants. The best way to get a child to stop is if they themselves want to stop. The tips depend on why your child sucks their thumb.

If your child absentmindedly does it, rather than in response to something or for attention, talk to them about not sucking their thumb and why its important. Use positive reinforcement. Rather than getting upset when they do suck their thumb, praise them when they aren't. Gently remind them when they are doing it and try to avoid pointing it out in public (maybe you could have a special hand signal to let them know they are doing it). You can come up with little rewards that are suited to your child, for example, a small reward if they have gone all day without doing it, or stickers on a calendar for every day they manage to avoid thumb-sucking.
Identify when they do it and try and find replacements. For example, if they do it when they are watching tv, you may give them something to hold or play with instead. If they do it when they're nervous then try to find other ways to comfort them like giving them a hug or have a toy to hold. Encourage them to express how they're feeling. It is important to work together to help your child find alternatives to sucking her thumb. Find replacements and solutions.
If you feel like they are doing it for attention, the best thing to do is to completely ignore it.
Once children start school, we find the habit often disappears due to peer pressure.
If the child is older, then it is important to involve them. Make sure to explain properly and then give them the opportunity to suggest ways to kick the habit, and have more control in this process.

When should my child be assessed.

The American association of orthodontics recommends no later than 7-8 years old for a screening.

Benefits

Minimise or avoid future braces
lifetime benefits and improved long-term stability of treatment
better facial devleopment and facial profile, meaning ebtter overall appearance
Improve breathing and airway issues due to improved airway development through correct breathing
Proper development means better overall function and health for their lifetime
natural way

For further information there are great resources at:

http://myoresearch.com/orthodontics/#patient_education

http://orthotropics.com/

http://www.buteyko.info/

https://articles.mercola.com/sites/articles/archive/2013/04/07/orofacial-myofunctional-therapy.aspx

When should you see us?

We do recommend seeing the child around the age of 6 to have a check-up regardless of this habit. We can gauge the severity of the habit and be able to plan for this, and give you more personalised recommendations. This gives you, and us, more peace of mind. If there are changes to the development in the mouth, then the sooner we can correct this, the better and less intense the treatment. We also want to check for any other issues that are starting to form around this age (see myobrace)

Sources:

https://www.babycenter.com/0_thumb-sucking-why-it-happens-and-what-to-do-about-it_63687.bc

https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/thumb-sucking/art-20047038?pg=2

http://www.mouthhealthy.org/en/az-topics/t/thumbsucking

https://www.aap.org/en-us/about-the-aap/aap-press-room/aap-press-room-media-center/Pages/Thumbsucking.aspx

Tooth grinding in children

Tooth grinding (bruxism) is quite common in children. Why this happens is not known. Possible reasons are that it is a natural reaction to growth and development, due to stress, due to medications or it could be due to breathing issues. Often children are completely unaware that this is happening. Children also may grow out of grinding once they get their permanent teeth. However, it is definitely worthwhile mentioning it during your child's dental checks.

If your child is snoring, breathes through their mouth or sleeps with their mouth open then it is important to have an assessment to screen for underlying airway or developing issues (please read myobrace and related sections for more information.