OUR ORTHODONTIC PHILOSPHY at the DENTAL SPA
“FACES BEFORE BRACES”
When considering early orthodontic treatment for children, our primary concern is to First of all, think of the face. In doing so, we employ a dental philosophy known as Functional Jaw Orthopedics. Starting with a myofunctional evaluation, we look for signs nd symptoms of airway problems, mouth breathing, abnormal tongue and lip habits tongue thrusting and thumb sucking), and reverse swallowing with an overactive rnentalis (chin) muscle. All of these conditions can lead to narrow jaw arches, open bites. receding jaws, and crowded teeth. Myofunctional therapy, training the tongue muscle, can begin to eliminate these problems from the very beginning, often as early as age six, with the correction of thumb sucking starting by age two or three.
Using myofunctional therapy and functional orthopedic appliances, we work with the child in developing the individual jaws to their proper size, shape, and position, while simultaneously aligning them to each other in their correct relationships. We also consider the conditions and interactions of the TMJs (jaw joints), the airway (tonsils,adenoids and turbinates), and any breathing or swallowing difficulties. We look for crossbites, open bites, deep bites (overbites) and underbites. Teeth will not come in straight or function together if there is inadequate space or discrepancies among the jaws the TMJs, or other associated structures. It is only after addressing these concerns, and developing harmony among them, that we straighten the teeth.
The analyses of a cephalometric (lateral skull) x-ray, a panoramic x-ray, diagnostic photographs and dental casts help us determine the correct positions of the teeth and facial bones as we begin treatment. Teeth extractions are considered only as the last resort if space discrepancies cannot be alleviated by other means, such as myofunctional therapy, arch expansion and/or tooth slenderizing.
For the face to grow properly - downward and forward - the TMJ’s must be in healthy working condition, with the condyles of the mandible (lower jaw) on the meniscus’(discs of cartilage) between them and the temporal (side skull) bones, and they should always exhibit the seven signs of TMJ health. Thus, we get the facial supporting structures in place before we brace. That is why we say our philosophy is “Faces before Braces”
Next, we use Straight Wire Orthodontics (braces) - which gently and gradually, with minimal effect on the roots, move the teeth into their correct positions by leveling, aligning and rotating them into place.
Treatment is usually divided into three phases: Removeable (functional appliances), Fixed (braces), and Retentive (retainers). * Phase I-removeable, is usually six to nine months, *j) Il-fixed, is twelve to eighteen months, and the retentive phase for some should be a lifelong commitment. Dr. Michael Florman, an orthodontist, states that retention should be indefinite because post-treatment relapse is so common. But, with myofunctional therapy and functional jaw orthopedics started at the proper ages, most relapses can be prevented, eliminating the need for lifelong retention, other than in some adult-treated situations. If teeth are severely rotated before treatment, a procedure known as a fiberotomy should be done at retention to prevent them from rotating back into their original positions. Some retainers can be removeable, while others, especially for lower
anterior teeth, should be fixed. * For insurance Purnoses

EDWARD E. BOWLING, D.M.D., PLC
4YOFUNCTIONAL THERAPY
FUNCTIONAL JAW ORTHOPEDICS
STRAIGHT WIRE ORTHODONTICS
ONE-PHASE VERSUS TWO-PHASE ORTHODONTICS
in two-phase orthodontics, which I practice, both the treatment and the total fee are livided into two segments: fifty (50) percent for Phase I, and fifty (50) percent for Phase [I. Parents and patients should understand this at the beginning of treatment. as well as lie fact that there are essentially two philosophies regarding orthodontic treatment.
The two-phase treatment is centered on the belief and scientific evidence that by age 6 the jawbones and skull bones normally grow 80-90% of their adult size. So, orthodontics but not orthopedics) at age 8 can be too late to influence proper balanced jaw growth:
Facial Growth and Facial Orthopedics-I 986.
Treatment can start as early as age 2 to correct thumb and fmger-sucking, pacifier use, mouth breathing, reverse swallow, anterior open bite, and other myofunctional disorders. For most orthodontic treatment of the teeth, and orthopedic correction of thejaws, myofunctional training is the foundation, and usually the missing link, that determines whether an orthodontic/orthopedic condition will treat out successfully or succumb to inadequate treatment results and eventual orthodontic relapse following treatment. Myofunctional treatment is followed by functional orthopedic appliances that widen the dental arches, take teeth out of crossbite, or move the jaws either forward or backward orthopedically. In most cases, these appliances help to prevent surgical intervention at a Later age.
One-phase treatment does not address craniofacial development until it is too late or not at all, and attempts at affecting it by age 12 at “brace time” are non-existent, or futile at best. It usually involves the use of dental arch maintenance via fixed lingual arch retainers until all the baby teeth have been lost by age 12 or 13, and then placing braces to straighten the teeth over a two (2) year period. Sometimes, in a very crowded arch, a treatment method known as “serial extractions” of baby teeth is used which does relieve the crowding, but also can result in smaller, more narrow jaw arches and the subsequent extractions of bicuspid teeth. This also can lead to smaller, more narrow faces and smiles possible TMJ complications, a mid-face collapse, shortened facial height, thin lips from reduced facial bone support, and a dished-in, concave profile which leaves a person looking much older than he/she should, as they age. On the other hand, some patients’ faces and profiles can be improved by bicuspid extractions if they have a bimaxillary protrusion , where both upper and lower front teeth protrude (flare out). This is sometimes found in the African-American and Asian-American populations.
One-phase treatment is most successful with children who have no myofunctional, orthopedic, or arch development problems, with mild or moderate crowding. It is also a eompromise approach in situations with behavioral problems, compliance and ooDeration oroblems. or nhvsical. emotional, or mental nrohlems.

Many one-phase practitioners either ignore or fail to recognize myofunctional or Punctional jaw orthopedic conditions during the early stages of a child’s development. They adopt a “wait and see” attitude, or tell the parents that there’s no need to treat until ill the baby teeth have come out before starting braces at age 11 or 12. By then most of the underlying causes of malocclusion will have been firmly established and entrenched, making treatment at the end-stage of development more difficult, more prone to relapse, and more difficult to get compliance from, and cooperation with the children.
Children want early treatment! They know how their faces look and what other children say about their appearances. They don’t have to be convinced that something can be done NOW!, instead of waiting 6 or 7 more years, meanwhile suffering through years cf teasing and taunting about their teeth and jaws from their peers. Read the copies of the Personal Orthodontic Evaluation, in which the children themselves tell you what they think about their appearances.
Please read David C. Page,D.D.S.’s book, YOUR JAWS — YOUR LIFE and the brochures, FUNCTIONAL JAW ORTHOPEDICS and VERTICAL DIMENSION PRIMARY MOLAR BUILDUP CROWNS. They are great eye-opening introductions to early orthodontic treatment.
In situations where children have small, underdeveloped lower jaws (Class II skeletal malocclusion), recent research has shown that correcting this type of malocclusion with functional jaw orthopedics is more effective than Class 11 elastics in stimulating the jaw to grow downward and forward, as it should, naturally. Since it is a more natural growth mechanism, this type of treatment produces results that are more stable in the long term.
Regardless of philosophy, positive and negative effects can and do result with either method, and patients must usually rely on the faith and confidence they have in the treating doctor’s skill to achieve the best results possible for his or her individual condition.
Edward E. Bowling, D.M.D.
Member, American Association
for Functional Orthodontics
Postscript- These statements are not to be construed as a criticism of orthodontic specialists, since many specialists also practice two phases: orthodontics and craniofacial orthonedics.

Biography and dental practice:
Bdward E. Bowling,D.M.D.
“Faces Before Braces”
Dr. Bowling, a native of Louisville, Kentucky, has been a resident of Vienna, Virginia since 1970. He and his wife, Myra, have a son, Steve, in Lovettsville, Virginia and a daughter, Lisa, in San Diego, California.. His activities include tennis, hiking, sailing arid skiing.
As a general practitioner, he has been practicing orthodontics since 1986. with a strong emphasis on early treatment. He has taken numerous courses in Orthodontics, Functional Jaw Orthopedics, TMJ and Occlusion. He is a member of the American Association for Functional Orthodontics and the Academy for Sports Dentistry.
With young children in this practice, one of our primary aims is to look for signs and symptoms of developmental problems. These are usually obstructed airways (enlarged tonsils), thumb and finger-sucking habits, overuse of pacifiers, reverse swallowing, mouth-breathing and tongue- thrusting, and are the primary causes of crooked teeth and unattractive faces.
We believe in correcting these conditions as soon as possible, using myofunctional therapy for the tongue, lips, and breathing problems, and functional jaw orthopedics to treat the skeletal conditions. Both methods, while not totally eliminating the need for braces, make orthodontic treatment less complicated, can shorten treatment time, and make relapses less probable.
No future orthodontic treatment can be successful or have long-term stability unless myofunctional habits and orthopedic conditions are corrected early!
In this way, by first treating the facial supporting structures, the tongue, lips, airway, face bones, and jaw bones, we help guide the development ofjaws and faces before placing the braces. That is why we say our orthodontic philosophy is “Faces Before Braces’.