This email from a friend discusses a presentation they saw that focused on mandibular advancement for correcting malocclusions. The friend critiques the presentation for overlooking important factors like tongue position and swallowing pattern. They believe the actual problem in the cases was a low resting tongue level caused by issues like tongue tie or bottle feeding rather than mandibular position. Correcting mandibular position without addressing the underlying tongue issues risks open bite recurrence and TMJ problems later in life. The friend argues the study design did not fully consider all impactful information needed to accurately reflect what was occurring.

1. (who got the bit between his teeth and wouldn’t let go)
The GDC, that austere crew,
Bit off more than it could chew,
The day it picked on good John Mew.
They set off hard and fast and tough
Using tactics plenty rough
But John was made of sterner stuff.
He took it squarely on the chin
Had the evidence to win
Made them look again at him.
The Ballad of John Mew
by Gill Rapley
Mew by name but no soft pussy
Any opponent - John's not fussy
Now the GDC's the wussy!
What happens next? We wait to see
What the outcome here will be
But come what may, it seems to me:
In all this talk of malocclusion
There really is just one conclusion
Debate's what's needed,
not exclusion.

2. • Okay boys, it's happened... I was at a meeting this weekend with three dentists
who were at the AARD meeting. One of them mentioned Mark and Kev and also
Tom Colquitt who spoke about his own health/airway journey. Another one said he
had "heard about this Raphael guy" who was in nj and they were thinking of
having him speak to their small group. Another brought up a patient/friend who
he thinks has an airway problem. They asked about Myo and appliances and the
next step. So cool because the three of them are Kois trained dentists at the top
of their field and they were clueless about airway and risk factors, BUT they were
curious!
• I spent two days promoting the airway and the ALF programs. This is what we
have hoped will happen - that practitioners start understanding the problem and
are curious about how to solve it.
• BTW, the course I was at was a leadership conference (Kev - it was Fritz's group)
and there was a lot of talk about creating a vision. Perhaps it would be worthwhile
for us to craft a vision about what we hope for. Seems a bit hokey but it helps to
define what we envision as the successful result of our endeavors. Maybe you
already have a written vision and I'm just an interloper. But if not, perhaps as a
group (get the tribal think tank in as well) we could talk about what our vision is?
Perhaps this is the goal of of the white paper event at AAPMD?
Email from a friend…

3. Although interesting and innovative, there were numerous very important factors that were overlooked that I
felt negated the overall premise of the presentation and study. At no time was the tongue brought into the
equation or considered in any of the cases. Every one of the cases presented had a significant standing
forward head position and side plumb line denoting a low tongue level. As we know the forward head position
as seen from viewing the side plumb line is present for ease of breathing. Also a low tongue level is the
reason for the posterior crossbite, anterior open bite and downward vs. forward growth of the mandible. The
slide shown at 21 min. and 29 sec. showed a definite tongue tie which negatively impacts a normal resting
tongue level and swallow pattern. So in essence, your premise that the mandible is the problem is
completely reversed. The problem was the maxilla, created by a low resting tongue level either due to
hypotonia of the genioglossus or physical restriction from a tongue tie. If I was a betting man either all your
case subjects were either premature babies or non-breast fed. If they were breast fed it was for a short time
or their mother used expressed milk and a bottle.
Although an RPE was used, the incorrect tongue position still exists and if the swallowing pattern was
evaluated they all probably have a reverse swallowing pattern to varying degrees. Therefore these cases
have a higher risk of open bite recurrence and TMJ issues as adults. What this study was attempting to
correct is normally dealt with naturally during a child’s development with appropriate breast feeding and
hearty diet that is rarely occurring in “developed” countries. The issues in your presentation are rarely seen in
third world countries where breast feeding is predominate and less refined foods are seen in one’s diet.
Without all the impactful information taken into consideration for a study, the results will not reflect
what is really going on.
A GP talks up to a Chairman

4. Darick Nordstrom
and
Jose Camacho
The basis of light force
mechanics is that we,
the orthodontist, does as
little as possible so the
body can do as much as
possible. - D.N.
(Conventional
orthodontics does as
much as possible so the
patient has to do a little
as possible) - B.R.

5. Relationship between occlusal findings
and orofacial myofunctional status in
primary and mixed dentition
Jana Seemann, Gunther Kunst, Franka Stahl de Castrillon
Dept of Orthodontics, U of Rostock, Germany
Part I: Prevalence of malocclusions
Part II: Prevalence of orofacial dysfunctions
Part III: Interrelation between Malocclusions and orofacial dysfunctions
Part IV: Interrelation between space conditions and orofacial dysfunctions

6. Setting up Research Protocols

7. https://www.youtube.com/watch?
v=R5S5AZ50pAE
Tom’s Story

8. • The anthropologic standard
• The modern environment is a stressor
• Our compensations create the symptoms
• Symptom management hides (ignores) these causes
The Four Premises