Facial Form and Symmetry

What are the early signs?

The most important thing is for parents to be aware that the growth of their child’s face may go wrong just after birth! Birth for both mother and baby is an extremely traumatic and stressful event. After  delivery, the skull bones need to recoil and adjust back to normal proportions. This does not always occur, however, and any distortions undetected and not treated early on by a qualified practitioner within a week of delivery would lead to intra-cranial stresses. These strains begin to gradually affect the growth pattern of the skull, face and jaw. Indeed, the skull is positioned over the spine, thus the entire postural skeleton of the individual may be adversely affected for life.   This can be avoided if early action is taken. Watch for flattening of the cheeks, size discrepancies between the eyes and position, or an unusual shape around the mouth because these will almost certainly get worse.

Hanging the mouth open.

This is probably the most important single factor. Open mouth postures will cause the face to grow vertically down to an extent that a child may have difficulty in closing their lips completely ( lip incompetence). Once this has happened, it can be very difficult to correct. Try to persuade your child to keep their mouth closed from a young age. Also monitor their breathing “tool” used – that’s what their nose is for!

Adverse Growth.

The downward (vertical) growth of the face tends to set the jaw back and restrict the size of the throat. In order to breathe more easily, their head is tilted incorrectly backward. Try dropping your jaw an inch and you will see why this is. To restore the balance of the spine the neck is tilted forward. This unbalances the whole vertebral column and osteopaths, physiotherapists and chiropractors find this to be a common cause of headaches, neck aches, and long term back trouble.

A horizontally growing face and a vertically growing face, note how the head is tilted back to enable them to breathe and how their lips are usually apart.

Sucking Habits

If your child’s face does not look quite like the other Childrens’ do seek advice. Strange sucking habits, or swallowing with the tongue showing, can also distort the teeth and jaws, and may precipitate a speech impediment. Remember that the only thing that guides the teeth into position are the lips, the cheeks, the tongue and the other teeth and any faults in any of these these will be reflected by irregularity of the teeth, followed later by facial disfigurement.

Spaces.

At the age of five there should be spaces between the front teeth. Their permanent successors which should arrive around the age of six, are a lot larger, and if there is no space they erupt crowded and rotated. It is easier to prevent crowding by creating space than to correct it afterwards.

Crowding.

If the lower front teeth are crowded at six years of age take advice and do not accept a ‘wait and see approach’. At the very least your child needs to improve their mouth dimensions early on.

Unattractive Eyes.

If the top jaw grows down, the eyes look prominent and the outer corner of the eyelids will sag making them look tired with too much white-of-eye showing. The lower eyelid will develop a ridge rather than slope smoothly into the cheek.

Weak Chin.

Look at your child sideways and see if you like the position of their chin. It is likely to be set back if their mouth is open and they will probably have a double chin.

Prominent Chin.

Children who fidget or are overactive, may suffer from too much growth of the lower jaw, even more so if they stick their jaw forward and work it from side to side. Excessive jaw growth can be very difficult to correct when they are older. The old wives tale says “if you make faces and the wind changes it will stick like it”.

Excessive Gum.

You will notice that good looking people do not show a lot of gum when they smile. Simply put “gummy smiles” are NOT attractive. If a young child shows a lot of gum their face is growing downwards!

Speech.

The tongue should be in the palate for most sounds and if it protrudes sideways or forwards between the teeth, teeth are likely to become malaligned. A lisp usually indicates that the tongue is frequently positioned between the teeth. The lips should come into contact between most syllables. Ask your child to count up to five and see how far apart their lips are after the ‘five’. If it is more that 3mm there is a mild problem if more than 7mm a severe problem.

Eating Habits.

Many children avoid hard foods, this will allow their muscles to become weak and can be a principal cause of vertical growth. Bad habits often develop when the child is first weaned. Babies suck with their tongue and do not naturally swallow until they are about fifteen months old. If they are weaned by spoon feeding before that, they are likely to develop a tongue-between-tooth swallow (also known as a tongue-thrust motion). A mother can recognise this because she has to scrape the baby-food from around the mouth with a spoon and reinsert it. Try to encourage babies to chew hard things and not give them soft food until they have learnt to swallow naturally but remember that too much persuasion can have the reverse affect.

Where should the teeth be?

To measure the correct position of the upper front teeth simply put a pencil mark on the forward most point of the nose, and measure from there to the edge of the upper front teeth. Ideally it should be 28mm at the age of five and increase 1mm each year until puberty, when it should be 36mm for a girl and 38mm for a boy. Average children in industrial countries are 3 or 4mm more than this. If it is more than five millimetres over this there will be some irregularity of the teeth and disfigurement of the face, and if more than eight millimetres the child is certain to grow up with an unattractive face.

Thumb sucking

Together with other finger, dummy and blanket sucking habits will, if severe enough distort the growth of the face and teeth. It is very important that babies and young children are discouraged at every opportunity as it can cause severe damage to both the face and teeth. Don’t accept it as a passing phase, be gentle but firm.

Facts and Figures

What conventional orthodontists do and where they differ from orthopaedic orthodontics?

Although research is constantly taking place, most orthodontic treatment is still ‘empirical’, or in other words it is based on trial and error. As a result methods of treatment have alternated each decade with everybody extracting teeth for a period and then when the results are criticised no one extracts for a period. In each of these periods, as now, they were convinced they were right but unfortunately no type of treatment has proved very successful in the long term and the teeth usually re-crowd afterwards.

Some orthodontists avoid extractions during treatment by pulling back the side teeth with a strap aground the back of the head or neck. This ‘Head Gear’ makes room to straighten the front teeth, but unfortunately increases the unattractive vertical growth, and increases the need for extractions later on. Head Gear is condemned as unethical by others who point out that people with good looking faces and naturally straight teeth have forward growth.

Because of these failures an increasing number of orthodontists are turning to surgery to correct jaw discrepancies. The upper and lower jaws are cut and moved to better positions. The facial improvement is sometimes dramatic, but between 20% and 30% are subsequently rated as unsatisfactory. About 3,000 children and young adults have facial surgery in this country each year, but probably twice this number refuse surgery and accept their facial deformity. Many of this latter group are very distressed.

In conclusion, few orthodontists are sure why teeth are crooked. They can be straightened with orthodontic appliances but the crowding is likely to return, unless they are held straight for ever. In addition, there is a risk that the face can be damaged but no one is sure how often this occurs or how severe the damage might be.

Does Facial Appearance Matter?

Babies. Babies as young as three months strongly prefer attractive mums to unattractive mums. Attractive babies receive more affection and attention from there parents and other adults, and are more likely to grow up to be well balanced adults themselves.

Children. Children grow up to believe that heroes are good looking, heroines are beautiful, and bad people are ugly. These stereotypes remain with us all our lives.

Teenagers. Although they may not admit it, young teenagers are more concerned about their appearance than their relationships with their parents, their siblings, their friends, their work, or their pastimes. Handsome cadets achieve higher rank by the time they graduate.

Criminals. A judge is more likely to give an attractive criminal a shorter sentence. Unattractive people are more likely to become criminals, four out of five females committed for aggressive offenses were rated as unattractive. Criminals who have their appearance improved by facial surgery are less likely to return to prison.

Intelligence. Good looking people are likely to be perceived as more intelligent. Surprisingly good looking people are actually found to be more intelligent, possibly because they receive more attention at school. They are also likely to get better jobs, rise to higher positions, and earn more money.

Can orthodontic treatment change faces? While it is certainly possible to damage a face, most orthodontists do not believe it is possible improve the shape of the face with appliances. This may be true with traditional treatment but it does seem that Orthopaedic Orthodontics can achieve changes in facial appearance, as well as oral posture.