Most people think of orthodontics as a branch of dentistry that focuses on straightening teeth to improve a smile. But dentists are also concerned with the position of the specific facial bones that affect the shape and appearance of the jaws and face. In particular, dento-facial orthopaedics is the field of study that concentrates on improving the position and dimensions of the bones that house the teeth. This can have an impact on your final profile, width of your smile, airway and your midline.

Dento-facial orthopaedics (DFO) can also prevent the need for extractions as experienced dentists will focus on expanding or developing the size of your jaws first, to ensure you ultimately have room for all erupting teeth before or during straightening. This can dramatically change your lip and cheek structure – your jaws and teeth are essentially the support structure for the soft tissues of your mid-face. DFO can thus counter sunken faces or the appearance of exaggerated convex or concave facial outline, rather than a straight and balanced profile.

DFO aims to correctly position your lower jaw and upper lip in relation to your nose and cranial base, because both your upper and lower jaw can be developed to correct a skeletal imbalance. For example, if your bottom jaw is trapped back and your chin looks small and set back, at first glance, this may produce the illusion that you have protruding upper front teeth. In this case, it is often the upper jaw that requires developing, which will allow your lower jaw to move forward and into position. Although this development can take time, young children can often develop skeletally into the correct size, width and position in 12-18 months with the use of functional orthopaedic appliances that can translate the lower jaw forward into the correct position.

Skeletal imbalances, distortions and misalignment in the jaw can start to be identified as early as two years of age, when all of a child's primary teeth have erupted. A dentist will usually decide if treatment is required at this stage, as early intervention can correct an underdeveloped upper jaw and put nature back on course.

This is especially important with patients who have used dummies or thumb sucking, as that habit often leads to forward tongue-thrust swallowing. A child with this habit often presents with a gap between the upper and lower front teeth when they bite with their back teeth together. This is often accompanied by overcrowding due to the underdeveloped dental arches.

During the next dentition stage, at approximately 8 or 9 years of age your orthopaedic dentist might take impressions and three-dimensional scans of your child’s mouth to make a proper diagnosis and treatment plan. Early intervention DFO, that is, treating these issues early on in childhood, is beneficial as bone development and tissue changes will occur quickly and more effectively than in an adult.

If a child’s skeletal imbalances require intervention, an orthopaedic dentist can use a variety of appliances to change the rate, direction or amount of jaw growth. Dento-facial orthopaedic appliances can be fixed to the teeth or removable. Some of the more common appliances that dental professionals may recommend are:

Maxillary Expansion Appliance: This removable appliance slowly develops the upper jaw to widen a maxilla that is too narrow to hold the teeth.

Lower Jaw Expander: The bone that supports the teeth of the lower jaw can be developed, so this expander gradually develops the arch size.

Functional Appliances: Bionators and twin blocks corrects the skeletal imbalance of the retruded lower jaw by stimulating it to grow forward.

Reversible Headgear: Corrects a retrusive upper jaw by stimulating it’s forward growth.

Before or after an orthopaedic dentist uses one of these appliances to correct jaw position, they may also fit a patient for ordinary braces to correct the positioning of individual teeth and the way they fit together.