We need to talk about Myofunctional Orthodontics…
IIn this post I am going to revisit the concept of myofunctional orthodontics. I have decided to do this because there has been increase in advertising about this type of treatment.
This is my academic opinion on this type of care. I have previously posted about this treatment.
What is myofunctional orthodontics?
The main proponent of myofunctional orthodontics is a company called Myofunctional Research. They are based in Australia and also have branches in The Netherlands and the USA.
Myofunctional Research base their 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 put forward the concept that while orthodontic treatment effectively straightens teeth, it does not treat the soft tissue cause of the malocclusion.
Myofunctional orthodontics is different as it corrects the soft tissues and breathing when the child is young. This means that Myofunctional treatment can grow jaws, expand arches and correct skeletal discrepancies.
This treatment is very similar to orthotropics. Only a few practitioners provide this complex UK based treatment. The UK licensing authority has suspended the developer of this system (John Mew) from clinical practice. Therefore, there is likely to be a decline in the popularity of this system. As a result, I will only discuss Myofunctional Research.
What does myofunctional treatment involve?
Treatment involves a series of exercises and the use of pre-formed appliances that are similar to a loose-fitting positioner. You do not need to take impressions before you fit an appliance. I think that the appliances are the contemporary version of a Frankel appliance, again this is not new.
They 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.
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. This means that conventional orthodontics recognises that there may be shortage of space for the teeth or there are skeletal discrepancies. Orthodontics direct treatment at making space and/or correcting or compensating for a skeletal discrepancy.
Does this work?
I do not know because it is difficult to find any research or even well documented case reports. They put many pictures up on their websites and Facebook pages for comment by their admiring followers. I think that these results are similar to those obtained by standard orthodontics and functional appliances and the effects are no more than normal dental development. I have pasted some pictures in here.
Since posting I have been asked to remove the pictures because they are from a closed Facebook group (myofunctional orthodontics). I have tried to find case reports on the Myofunctional Research website and I could not find any, I am not sure why?
Two researchers have published high quality research papers. These show that the appliances may be effective. I have posted about these before. In one study, Emina Circic, showed that the effects of myofunctional treatment was similar to an Andreasen activator. However, the co-operation rates were very low for both treatments. For example, 70% of the Myobrace and 53% of the Andreasen treatments were not successful. In another paper by Rita Myrlund, the myofunctional therapy corrected mild malocclusions, but the study was small and they only reported short-term results.
How do we get trained in this treatment?
Treatment is provided by short courses for interested practitioners. They tend to direct their advertising at general practitioners using selected references to underpin their philosophy. It appears that the training programmes runs over a few days and delegates can become a Myobrace Member or Certified Provider. Again, details of how they award these qualifications are not clear. The information suggests that they base this accreditation on the number of patients that the Myofunctional practitioner treats.
What do I think?
I have done my best to evaluate this treatment and I cannot help thinking that it may have potential.
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. While they appear to encourage co-operation, when people have raised questions about the treatment the responses can be aggressive. The main spokesperson is a general dentist who is very active in writing articles that are published on websites and dental magazines. Here is an example. Their “followers” have called me pre-historic, out of touch, a “history man” and described as “me and my type do not understand”. They then delete these discussions. I cannot help thinking that 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 is Snake oil and quackery?
It is easy for us to dismiss this treatment because of the lack of quality evidence. But we must be careful and we should remember the claims that people are making about self-ligation and some of the methods that are meant to accelerate tooth movement in the absence of evidence. It is clear that 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 almost finished my research career. But someone could step up and try to work with them?
Finally, I would like to ask some questions;
- Why have Myofunctional Research not carried out a trial into their treatment methods?
- Why do dentists accept the promotion of this treatment and treat their patients in the absence of evidence on whether the treatment will work?
- Can patients consent to this treatment in the absence of evidence of its effectiveness?
These will be the subject of another blog, but it would be interesting to hear views about this in the comments section of this post.
Emeritus Professor of Orthodontics, University of Manchester, UK.