Popular posts 5: We need to talk about myofunctional orthodontics…
I have discussed myofunctional orthodontics several times over the past few years. In this original post, published in 2017, I summarized current knowledge about this treatment method. It is still regularly accessed several hundred times a month. I have made some changes to its content to update it and reflect some of the comments made about the post.
This is my academic opinion on this type of care. I have previously posted about this treatment.
What is myofunctional orthodontics?
Currently, the main proponent of myofunctional orthodontics is a company called Myofunctional Research. They are based in Australia and have branches in The Netherlands and the USA.
Myofunctional Research bases its treatment philosophy around the hypothesis that soft tissue dysfunction is the major cause of malocclusion and aberrant craniofacial growth. This is nothing new, as this concept is one of the central tenets of Moss’s Functional Matrix theory. They extrapolate this theory to suggest that while orthodontic treatment effectively straightens teeth, it does not treat the cause of the malocclusion. This can be the soft tissues, the airway, or the functional matrix.
As a result, myofunctional orthodontics is different from “conventional” orthodontics as it corrects the soft tissues and breathing when the child is young. Myofunctional treatment can grow jaws, expand arches, correct skeletal discrepancies and solve breathing problems.
In many ways, this treatment is very similar to orthotropics. Only a few practitioners provide this complex UK-based treatment. The UK licensing authority has removed the licence to practice from John Mew the developer of this system. However, this treatment is still practiced by a few dentists in the UK on a private contract basis. Recently, there has been a reduction in the publicity of this system. As a result, I will only discuss Myofunctional Research.
What does myofunctional treatment involve?
Treatment involves a series of exercises and using pre-formed appliances similar to a loose-fitting positioner. You do not need to take impressions before you fit an appliance. I feel that the appliances are a contemporary version of a Frankel appliance. As a result, this concept is not new.
I have recently looked at social media and web-based information on myofunctional treatment. The proponents ask us to take a massive quantum leap and accept that this treatment will correct most developing orthodontic problems to provide a more natural solution than conventional orthodontic treatment. The underlying premise is that by altering the environment of the teeth, malocclusion can be corrected naturally. Importantly, this leads to the correction of any skeletal discrepancy and solves airway problems. Any treatment results do not need retaining because the etiology of the problem has been corrected.
In some ways, this theory is compelling. However, it ignores the genetic component of malocclusion, which is central to conventional orthodontic treatment. The “conventional” theory is that there is a genetic and environmental component to the aetiology of malocclusion. As a result, conventional orthodontics recognises that genetics has some influence on aetiology. The genetic component leads to a shortage of space for the teeth or skeletal discrepancies. Treatment is, therefore, directed at making space and/or correcting or compensating for a skeletal discrepancy, in addition to any environmental influences, for example, digit sucking.
Does Myofunctional orthodontics work?
We do not know. This is because it is difficult to find research or well-documented case reports. The proponents put many pictures up on their websites and Facebook pages for comments from their admiring followers. These results are similar to those obtained by standard orthodontics and functional appliances, and sometimes the “effects of treatment” are simple normal dental development.
I have tried to find case reports on the Myofunctional Research website, and I could only find simple cartoons of moving faces and teeth. I thought that this was not a high level of evidence and perhaps revealed a lot about the treatment. I wish that I could just treat cartoons.
In general, there is a lack of engagement by the proponents of myofunctional treatment with researchers. Nevertheless, several researchers have published papers. These show that the appliances may be slightly effective. I have posted about these before. One study, by Emina Circic, showed that the effects of myofunctional treatment were similar to an Andreasen activator. However, the cooperation rates were very low for both treatments. For example, 70% of the Myobrace and 53% of the Andreasen treatments were unsuccessful.
In another paper by Rita Myrlund, the myofunctional therapy corrected mild malocclusions, but the study was small, and they only reported short-term results. A study that is often quoted in support of this treatment was by Keski-Nisula. Again, this study revealed small changes in the region of 1.1mm over three years of treatment. Similarly, Janson found a 2mm reduction in overjet with 3 years of treatment. These are not great treatment effects.
How do we get trained in this treatment?
Treatment is provided by short courses for interested practitioners. They tend to direct their advertising to general practitioners using selected references to underpin their philosophy. It appears that the training programmes run over a few days.
What do I think?
Over the years, I have been interested in this treatment. I cannot help thinking that it may have potential. However, I cannot recommend or support it because no evidence supports the claims.
It would be good to see some high-quality research because it would be great if this simple treatment was effective. I have tried to engage with Myofunctional research and orthotropic promoters. While they appear to encourage cooperation, the responses can be aggressive when people have raised questions about the treatment. Their “followers” have called me pre-historic, out of touch, a “history man” and described me as “me and my type do not understand.” They then delete these discussions. I cannot help thinking they would get a long way if they became more open about their treatment and provided more information on its cost, burden of care, and treatment duration. All this is missing in their information.
Is this Snake oil and quackery?
We can easily dismiss this treatment because of the lack of quality evidence. But we must be careful and remember the claims people make about self-ligation and some methods meant to accelerate tooth movement in the absence of evidence. Someone needs to do some research. Surely, it is time for academic researchers to work with Myofunctional research and carry out a trial. I cannot do this because I have finished my research career. But could someone step up and try to work with them? I made this plea in 2017 and as far as I know, limited progress has been made.
Finally, I would like to ask some questions again;
- Why have Myofunctional Research/orthotropics not carried out a trial into their treatment methods?
- Why do dentists accept the promotion of myofunctional orthodontics and treat their patients without evidence on whether the treatment will work?
- Can patients consent to this treatment without evidence of its effectiveness?
Look at the many comments from the original post and add more to have a good chat about this.
Emeritus Professor of Orthodontics, University of Manchester, UK.