FORWARDONTICS? By Sandra Kahn DDS, MSD, José de Jesús Rangel Chávez, MD & Paul Ehrlich, PhD, Bing Professor of Population Studies, Emeritus and President, Center for Conservation Biology, Stanford University injury or death in hospitals where interns may be sleep-deprived. The human jaw is shrinking in industrialized societies, and as a consequence of an obstructed nose and mouth breathing. 19,20,21 Jaws can no longer comfortably house the tongue, which then slops back and tends to block the airway, causing snoring and OSA. And the cause of that shrinkage is crystal clear. Human cultural evolution has caused a gigan-tic environmental change as Homo sapiens transitioned from being gath-erers and hunters through the agri-cultural revolution and into the industrial age. 22 The leading cause of dental prob-lems, from malocclusion, tooth enamel disease, gum disease to breathing and sleeping disorders; we concluded again and again: was in the current lifestyle of people. 23 Of aspects of that lifestyle, the most obvious are the diet, the way of breathing and the posture of the mouth during rest. 24 (Fig. 1) Today, most people eat a soft diet, requiring little chewing and rich in processed foods, which are high in refined sugar. That diet not only has an effect on our blood sugar levels, diabetes, our weight, our muscle tension and our bone growth, but it also seems to have a psychological and mental impact (Lustig 2017). 25 WHAT IS Transdisciplinary Approach: Fig.1: Less than 100 years ago, a person with normal features and full unadulterated occlusion. Dental standards appear different than what we follow in orthodontics. Photos by Gidré Kobs I n our clinical and teaching prac-tices, we have focused on presenting a technique that is applicable, both for patients and for orthodontists, dentists and pedi-atric dentists. This led to creating a new term to describe clinical proto-cols that gather, under one umbrella, all the techniques that foster forward growth of the upper and lower jaws and reject retraction. Ehrlich and Kahn coined the term Forwardontics, which is based on the basic principles of postural orthodontics, with recommenda-tions based on our clinical experi-ence. Forwardontics uses Stage 1 1 (semi-rapid expansion devices) 2,3 modified by Dr Wong, the Bow for bimaxillary traction, the vacuum activator, 4 and the GOPex/GOFex 5 postural and functional program. The Problem We have written about the hidden jaw-shrinkage epidemic for almost 10 years and we have tried to shine a light on the environmen-tal origins of the problem. The symptoms of the epidemic are everywhere in industrialized soci-eties. 6,7,8,910,11 Children are walking around with their mouths open, unable to close them, and snoring like adults. Teenagers are having their misnamed “wisdom” teeth extracted, sometimes with trau-matic results. 12,13,14,15,16 And so many people now have obstructive sleep apnea (OSA) 17 that sterilizers for continuous positive airway pres-sure machines 18 are being advertised on television. But the cost, bother, injury, and physical unattractiveness that accompany these symptoms are only the tip of the iceberg. There also is the stress caused by repeated awakenings at night that, in turn, make people more likely to suffer serious insults such as cardiovascu-lar disease, cancer, attention deficit hyperactivity disorder, and perhaps even Alzheimer's disease. Plus, sleep disturbances result in daytime fatigue that causes poor perfor-mance in school and on the job, highway accidents, and possibly Open Mouth/Closed Mouth The resting position of the tongue and the tissues of the naso-orofacial complex are of vital importance for maintaining health. Kahn went from using orthotropic appliances to comple-menting and implementing the GOPex program (Good Oral Posture Exercise program) to coin the term 20 Winter 2021 JAOS
Journal of the American Orthodontic Society Winter 2021: Page 20
