Teeth may become crowded due to a discrepancy in the tooth size to jaw size relationship. The traditional viewpoint is that we have inherited large teeth and small jaws. However, the work of Dr Donald Enlow Author of “Essentials of facial growth” shows that there are distinctive growth patterns for the bones of the skull as there are for every part of the body. If these growth patterns are disturbed, through bad habits like thumb sucking or mouth breathing etc then a resultant discrepancy will appear. This may manifest as crowded teeth.

The anterior cranial fossa will determine the shape and proportions of the facial airway. The palate is a projection of the anterior cranial fossa. The apical base of the maxilla (upper jaw) and the arch itself is programmed by the configuration of the anterior cranial fossa.

All of the organs and parts of the body are bound together and interconnected by a web of collagenous fibres. As the separate parts grow they exert forces on the other parts. This has a separating effect drawing them away from each other “displacement” which then opens up new spaces for growth enlargement to progress.

If the maxilla (upper jaw) is narrow due to underdevelopment then the mandible (lower jaw) will be held in a backward position restricting the airway space available for breathing. This may result in the child developing a forward head posture.
If the child has recurrent tonsillitis or oral infections this may impinge on the developmental patterns of facial growth.

If the patterns of growth have been disturbed resulting in crowding of the teeth then it is sometimes possible to attempt to re-establish the growth patterns through the use of orthopaedic functional appliances. These help to attempt to rebalance the muscular forces present and redevelop the jaw size and shape. This would then be followed by the traditional orthodontic pathway to straighten the teeth. This may be achieved through fixed wire (train tracks) in metal or porcelain or even using Invisalign (see cosmetic dentistry section for more information).

Functional orthopaedic appliances are removable appliances but must be worn twenty four hours a day to have a beneficial effect. They are only to be removed for eating and to ensure good oral hygiene through regular cleaning of the teeth gums and the appliances themselves.

It also possible to place designs and colours on the different appliances to make them more fun to wear and to encourage the child to wear them.