Osteopathic physicians appreciate ihe importance of orthodontic correction as a means to improve jaw and tooth alignment and are an important factor in fostering the best health of the individual. Many dentists recognize the importance of osteopathic treatment as an integral part of assisting the body in making an orthodontic correction and in maintaining good health thoughout the process.

The proper alignment of teeth is dependent on a correct anatomic relationship of the upper jaw (maxilla) to the lower jaw (mandible). To make changes in tooth alignment requires changes not only in the relationship of the maxilla to the mandible but also in complex relationships of these bones to several other bones of the face and skull. Osteopathic physicians have known and demonstrated that all places where bones come together in the skull have significant capability of motion in infancy and childhood and many maintain motion throughout life. Although very little motion is permitted at any one of these joints, that motion is essential to allowing a successful orthodontic correction. Osteopathic cranial treatment assists orthodontic correction by helping all the bones of lhe skull adjust to accommodate the orthodontic changes.

Osteopathic physicians seek to work hand in hand with orthodontists and dentists who recognize the importance of normal cranial mobility as a factor in the success of orthodontic correction. Through osteopathic manipulative treatment the physician can help the individual to better tolerate the orthodontic changes and can alert the dentist to the possible need to adjust the orthodontic plan. It is not uncommon to find that when osteopathic treatment accompanies orthodontis, the desired results are obtained in half to two-thirds the time estimated by the dentist, and the corretion is more likely to hold well over time.

It is typical for the normal mobility of the cranium to be compromised somewhat during orthodontic correction. The degree to which this happens depends on the types of appliances used and on the ability of the patient to tolerate the changes brought about by the appliance. Because the teeth are imbedded in bone, this rigid relationship of teeth to each other results in rigidity in the motion of the maxilla and mandible and through them, limits the normal motion of other bones of the skull. Functional appliances, such as adjustable palate expanders, permit the cranial bones to retain more of their motion pattern during orthodontic correction. They are, therefore, preferable whenever they are capable of making the needed correction.

The topic of tooth extractions is a controversial one. While there are times when avoiding extractions makes the orthodontic plan unreasonably lengthy and complex, it is best to keep all the teeth whenever possible. Removing the canine teeth, which serve as stabilizers to the jaw can have profound negative consequences to the cranial mechanism and to the general health of the individual.

The tongue is a powerful force in forming the shape of the developing oral cavity. When the tongue is not functioning properly within the mouth, speech and breathing are also affected. Conditions such as respiratory allergies or asthma which prompt mouth breathing, foster an oral cavity more likely to need orthodontic correction. Children who continue to suck their thumbs or to use a pacifier after the age of about 30 months are more likely to have orthodontic problems requiring correction. Sometimes the osteopathic physician or the dentist will recommend myofunctional therapy devoted to correcting the position and action of the tongue, before attempting orthodontia.

A person's overall health can suffer both when jaw alignment is poor and when jaw and teeth are undergoing orthodontic correction. It is ideal when the only complication of correction is the experience of pain in the teeth for one or two days after obtaining or adjusting an appliance. Unfortunately some people suffer persistent headaches as a direct result of the compromise in bone and membrane mobility of the cranium.

Some individuals experience sinus and ear infections because of the compromised ability of the sinus cavities and middle ear to drain. Orthodontia impairs the rhythmic motion of several cranial bones which assist this drainage, and is, therefore, a factor in both infections and headaches. The temporal bones which form the upper portion of the jaw joint also house the eustachian tubes which drain the middle ear to the back of the throat. When motion is compromised here, fluid is retained in the middle ear, and ear infections or hearing loss may result.

Nausea and loss of appetite are complications, which may be annoying to an adult, but can be a serious problem in a school-age child with poor nutritional status. And in some individuals the compromised cranial mobility manifests in behavioral problems, distractibility and low tolerance to frustration. This can make life very difficult both at home and at school. Perhaps the most serious complication is persistent lethargy and fatigue. They are often accompanied by an immune system less able to fight off illness. Although some people sail through orthodontic correction with no apparent complications, many do not. Osteopathic treatment can help maintain good cranial motion during orthodontia thereby fostering better overall health.

It is ideal to begin orthodontic correction with a fullv mobile cranial mechanism. An evaluation before beginning orthodontic correction is advised and may reveal the need for osteopathic manipulative treatment prior to orthodontia. This restores mobility which was compromised by birth trauma or childhood injuries. It is advisable to schedule osteopathic treatment within the first few days after obtaining an appliance or getting it adjusted. If the individual is not suffering any complications and the cranial mobility maintains good symmetry and vitality, further treatment is not needed. However, if health problems such as headache, respiratory or gastrointestinal illness, fatigue or behavioral complications ensue, osteopathic treatment is indicated.

A Doctor of Osteopathy (DO) is a fully licensed physician whose training includes, beyond the normal medical curriculum, extensive training in manual manipulation as a treatment to improve body function through addressing body structure. Although many osteopathic physicians are in family practice or providing specialty care, some have chosen to focus their practices on the hands-on approach which makes osteopathy unique. Of these, some have pursued additional training in cranial osteopathy, which is essential in the osteopathic treatment of children.