Orthodontics / Dentofacial Orthopedics
Alexandria VA | DC

A critical component of dentistry is orthodontics. Orthodontics specializes in the diagnosis, treatment and prevention of oral and/or facial irregularities. These irregularities can cause malocclusion, a misalignment of the teeth also known as a “bad bite.” But more important is the effect it can have on the actual shape and size of the bones, airway and facial appearance. Long and narrow faces, pinched noses, small-looking lips, and a bird chin are all examples of the physical abnormalities that may present as a result of malocclusion.

Malocclusion is a common problem that may be contributed to by genetic factors, environmental factors or a combination of the two. Academics debate the cause but we at TMJ & Sleep Therapy Centre know that intervention now can affect growth and development. Many studies, including groundbreaking anthropological research that was conducted by Weston Price in the 1930s, suggest that environmental influences such as nutrition have a more dramatic influence on our bodies than genetic predisposition. Whether inherited or acquired, malocclusion can cause problems that distort the function and appearance of the mouth, face, and airway and affect one’s ability to chew, speak, swallow, and breathe properly. Corrective appliances such as functional appliances, braces, and Advanced Lightwire Functionals (ALFs) are used to treat malocclusions of the teeth as well as those caused by skeletal discrepancies.

Palate Expander
Arch Expander Appliance
Arch Expander Appliance

Example of functional appliances to widen palate. Note how constant forces are preferable to rapid expansion (screw type) devices or techniques.

Bite Correctors
mara side view


Fill out our Contact Form or call us at Alexandria Office Phone Number 703-239-6475 if you have any questions or to schedule an appointment with Dr. Singer today!

There are 3 classes of malocclusion based on occlusion, or the alignment and spacing of the upper and lower teeth.

  • Class I- the bite is aligned so that the top teeth are properly aligned with the bottom teeth where the upper canine tip coincides with the back edge of the lower canine (see video).
  • Class II- the upper teeth stick out past the lower teeth in what is commonly referred to as an “overbite”
  • Class III- the lower teeth stick out past the upper teeth in what is commonly referred to as an “underbite”

A. Normal bite – B. Class I – C. Class II – D. Class III

Malocclusion may also be caused by skeletal asymmetry. Skeletal asymmetry is determined using 3-dimensional records and images (i-CAT) of both hard and soft tissue.

A bad bite can cause pain and other uncomfortable symptoms.

Orthodontic treatment may be required if you or your child experience any of the following symptoms:

  • Pain in the jaw or face
  • Difficulty swallowing
  • Tongue thrust, in which the tongue is incorrectly positioned at rest as well as while swallowing and speaking
  • Difficulty speaking clearly
  • Difficulty breathing, or abnormal breathing patterns
  • Difficulty chewing due to pain in teeth or poor teeth alignment
  • Crowded or crooked teeth
  • Abnormal positioning of permanent teeth
  • Frequently biting the cheeks, tongue, or lip, causing irritation to the mouth

Airway-driven dentofacial orthotics treats the underlying cause of malocclusion.

The presence of a bad bite is heavily influenced by the existence of a problem with the airway. Practitioners of airway-driven orthodontics know that the jaw can be encouraged to grow and be corrected with orthopedic appliances and braces that move the jaw, open the nasal and oral airway, correct the position of the teeth and skeletal symmetry, and improve the appearance of the face. Treating the teeth without treating the airway, which is standard practice in traditional orthodontics, is a superficial fix that often results in future TMJ problems, orthodontic relapse and missed opportunity at enhancing optimal facial development.


At our Centre, airway-driven orthodontics emphasizes treatment plans that correct skeletal abnormalities and create the healthiest possible airway. The entire airway – including the nose, mouth and pharynx (throat) – is examined and considered, since blockages in any of these places lead to sub-optimal breathing ability, as well as poor facial development and compensating postures in the head, neck, and lower spine. Typically, the first phase of treatment is always correcting the airway and establishing the optimal position of the jaw. Once this has been accomplished, teeth are then straightened.  Airways first!

Airway problems may start from birth and can significantly impact normal development and quality of life.

Child with Buck Teeth Before Treatment
After Orthodontic TreatmentAfter a period of treatment with dentofacial orthodontics

The tongue and its associated musculature are essential for proper facial and airway development. Specific postures and movements of the tongue also facilitate the development of the face. Deviation in the development of this muscle function can seriously impact other systems of the body, including abnormal development of the jaw, inflammation of the airway, and malocclusion.


Myofunctional Therapy

Myofunctional therapy may begin as early as 2 to 3 years of age, followed by appliance therapy when the child is mature enough to cooperate and participate in his or her own treatment. When used together, myofunctional therapy and appliance therapy are able to enlarge the facial skeleton, altering the position of the jaw that in turn corrects the airway. Airway problems can be cured in children (whose bones are still forming) and successfully treated in adults.

Mouth Breathing and Facial Structure:  What We Learned from
Dr. Harvold and His Experiments with Monkeys

The causal relationship between mouth breathing and dental malocclusion (bad bites) has been widely known and established for many years. What many people do not know, however, is that much of our today’s knowledge regarding oral respiration actually derives from primate experiments. In 1981, Egil P. Harvold, D.D.S., Ph.D, L.L.D; Britta S. Tomer, D.D.S.; Karin Vagervik, D.D.S.; and George Chierci, D.D.S. set out to examine the relationship between mouth breathing and dental malocclusions (bad bites).

Harvold began by selecting 42 monkeys, ranging in age from two to six years. The monkeys were divided into pairs on the basis of sex and maximum similarity. One of each pair was designated the experimental animal (with obstructed nasal passages), and the second was the control, in which breathing remained unaltered. (Note: Animals, on whole, are nasal breathers. As such, Harvold and his team induced mouth breathing in the experimental group by obstructing their nasal passages with silicon nose plugs. )

Records were taken at repeated three-month intervals during the experiment, and then again every six months after the nasal passages had been re-opened.

After a year of oral respiration, researchers noticed a number of differences, including:
Lips: Primates in the experimental group kept their mouths open after the nasal passages were blocked. All mouth breathers showed a tendency to develop a notch in the upper lip. The notch in the upper lip typically disappeared once nasal respiration resumed. (Animals in the control group kept t heir lips together most of the time.)

Harvold experiment with monkeysScreen Shot 2015-01-01 at 12.43.25 PM

Tongue: While only the expected growth changes were observed in the control group, in ALL animals in the experimental group, the dorsal section of the tongue became thinner. The morphology and elevation of the soft palate and uvula were also changed.

Dentition: In the experimental group, the changes in dentition resulted in a narrowing of the mandibular dental arch and a decrease in maxillary arch length, resulting in an incisor cross-bite. (Dentition developed normally in the control group.)

Mandibular movements: The experimental primates responded to nasal obstruction by placing the mandible downward and forward, with the tongue between the maxillary teeth. At the conclusion of the experiment, when nasal respiration was resumed, lip and tongue changes (noted above) returned to normal. The dental malocclusions found in the experimental group, however, were retained.

Harvold’s experiment demonstrated that breathing through one’s mouth physically alters the structure and positioning of one’s face. Primates in the experimental group of Harvold’s study demonstrated craniofacial alterations (increased face height, steeper mandibular plane, larger gonial angle, etc.) as well as occlusions. Significant changes were also noted in the jaw as well as in the inclination of the incisors. If you or your child suffers from oral respiration, HYPERLINK “https://www.capitaltmjcenter.com/request-appointment/” contact us to learn more and discuss possible treatment options. 703 299 4614. Serving the Washington, DC metropolitan area, Alexandria, Springfield, Burke, Arlington, McLean.

Fill out our Contact Form or call us at Alexandria Office Phone Number 703-239-6475 if you have any questions or to schedule an appointment with Dr. Singer today!