The "Tropic" Premise

“The ideal development of the jaws and teeth is dependent on correct oral posture with the tongue resting on the palate, the lips sealed and the teeth in light contact for between four and eight hours a day.”

John Mew

Advice for Parents

Be aware that in industrialised countries many if not most children’s faces will grow badly but that this can be prevented if suitable action is taken while they are young. If a child's face does not look quite like the other children’s be concerned. Watch for flattening of the cheeks or an unusual shape around the mouth because these almost always get worse.

Hanging the mouth open

This is probably the most important single factor. Open mouth postures will cause the face to grow down to such an extent that a child may have difficulty in closing their lips at all. Once this has happened, it becomes difficult to correct other than by surgery. Try to persuade your child to keep their mouth closed and do anything you can to improve the strength of their muscles. Many children are reluctant to bite hard foods, encourage them to do so from a young age. These habits often develop when the child is first weaned, but remember that too much persuasion can have the reverse affect. Note that the term “open mouth posture” applies even when the lips are together if the teeth are apart and the tongue down from the roof of the mouth.

Adverse Growth

Try this experiment yourself, open your jaw about 20 millimetres without tilting your head back, you will find that your breathing becomes slightly difficult. If you then allow your head to tilt back it becomes easier. This is a problem faced by children with excess vertical growth because the wind pipe becomes restricted as the lower jaw grows down. They respond as you did by tilting their head back to make their breathing easier. Unfortunately they then have to bend their neck in order to balance the weight of the head. This unbalances the whole spine and osteopaths, physiotherapists and chiropractors find it is commonly associated with jaw ache, headaches, neck aches, and long- term back trouble.

Sucking Habits

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

Breast Feeding

Many mothers are unsure how long they should continue breast feeding. In essence the period of time a mother breast feeds seems of less influence than the age the child commences weaning. Newly born children suckle and in my experience don’t normally learn to swallow until the age of twelve to fifteen
months. Suckling and swallowing are quite different. For the former the tongue is between the gum pads and for the latter it should suck against the palate. I feel fairly certain that early weaning on slops before a child has developed a natural swallow, can lead to the development of the tongue-between- tooth swallows that are endemic in civilised society. This is the cause of many collapsed arches and malocclusions.

Spaces

By the age of five there should be spaces between the front teeth, because the permanent teeth which should arrive about the age of six, and are considerably larger. If there are not big spaces between the baby teeth then the permanent teeth will crowd and it is easier to prevent crowding by creating space before-hand than to correct it afterwards. Remember that the new teeth are hidden in the bone for some years before they erupt and will twist while they are still buried if there is not enough room.

Crowding

If the front adult permanent teeth come through crowded at six years of age take advice and do not adopt a ‘wait and see approach’ as their face is likely to suffer if action is delayed. At the very least your child needs to improve their mouth posture.

Unattractive Eyes

If the top jaw grows vertically (down), the eyes will look protrusive and the outer corner of the eyelids will sag making them look tired with too much white-of-eye showing. The cheeks will look flat and the lower eyelid will develop a ridge underneath it rather than slope smoothly into the cheek”. Take advice.

Weak Chin

Look at your child from the side and see if you like the position of the chin. It is likely to be set back if their mouth is open a lot and they may develop a double chin. All good looking faces have a firm chin.

Prominent Chin

Children who fidget or are overactive may suffer from too much growth of the lower jaw. This is especially true if they also hold their jaw forward or work it from side to side. Excessive jaw growth can be very difficult to correct when they are older. Try to stop your child fidgeting with their jaw especially holding it forward. The old wives tale says "if you make faces and the wind changes it will stick like it".

Excessive Gum Display

You will notice that good looking people do not show much gum when they smile. The more gum that shows the less attractive the face and this can easily be measured with the ‘Indicator Line’. If a young child shows a lot of gum, their face is growing downwards and you should take early advice.

Speech

The tongue should remain within the teeth for most sounds and if it protrudes sideways or forwards between the teeth, they are likely to become irregular. The lips should come into contact between most syllables and a lisp usually indicates that the tongue is between the teeth. Ask your child to count up to six and see how far apart their lips are after the 'six'. If it is more that 3mm there is a mild problem if more than 7mm a severe problem”.

Ear, Nose and Throat problems

Ear, nose and throat problems are on the rise in young children. Blocked noses, Tonsillitis and Otitis Media ear infections are but among a few of these. We should remember that no one is certain if habitual oral respiration is the ‘result’ of enlarged tonsils and adenoids or the ‘cause’ of them. Also remember most middle ear problems arise from the blocking of the Eustachian Tube. Every time a healthy child swallows the top of the tongue should push firmly against the palate and at the same time contract a series of muscles that opens the Eustachian tubes and aerates the middle ear. In my view the non-invasive option of semi-rapid maxillary expansion should always be tried before suggesting the surgical removal of tonsils and adenoids or the insertion of grommets. If the Tropic Premise is accepted, then most of these issues can be cured purely by altering oral posture while the child is young.

Summary

There is a wealth of evidence to suggest that the facial skeleton is more adaptable in young children than in adults. Despite this most orthodontic treatment is not commenced until growth has almost ceased. There seems little doubt that many children could benefit from early treatment especially with Orthotropics.

Prof. John Mew
BDS. Lond; LDS. RCS. Eng; MFGDP.(UK);.
M.Orth. RCS. Edin
Clinical Director The London School of Facial Orthotropics