special | REPORT The history of myofunctional orthodontics Part I - The beginning and the separation By Dr Chris Farrell, BDS (Syd) and Matt Darcy, Dental Researcher yofunctional excellent health. Upon returning from his Catlin’s written work visibly influenced therapy may final voyage, Catlin expressed his confi- Angle’s perception of orthodontics. This seem like dence that breathing was the underlying was perhaps most evident in Angle’s a relatively source of his health observations. “I am 1907 book titled The Treatment of Mal- foreign con- compelled to believe, and feel authorized occlusion of the Teeth, which detailed the cept to recent to assert, that a great proportion of the dis- effects of oral habits on occlusion. Angle graduates, eases prematurely fatal to human life, as wrote “Of all the various causes of mal- but the reality well as mental and physical deformities, occlusion, mouth breathing is the most is it has been practiced for one hundred and destruction of the teeth, are caused by potent, constant and varied in its results.”4 M 1 years and has endured a largely turbulent the abuse of the lungs.” Furthermore, Angle was determined history over the last century. Therefore, any implication which sug- to discover the aetiology of all malocclu- Before delving into the history of myo- gests it is a recent realisation that oral sions and concluded that the origin was functional therapy, one should ponder the habits can act as a causative factor in myofunctional. He believed the positions process undertaken in the scientific com- substandard health and craniofacial mal- of the teeth and arches were heavily influ- munity in order to truly understand the formations should be soundly dismissed enced by “muscular pressure - the tongue beginning of the myofunctional move- with the aforementioned literature in mind. acting upon the inside, and the lips and ment. The first step in the Scientific Despite identifying the influence dys- cheeks upon the outside, of the arches.”5 Method is to make an objective obser- functional breathing could have on human Angle also spent the early decades of vation and if we apply this principle to health, Catlin believed the subsequent the 20th century mentoring aspiring ortho- the origin of myofunctional therapy, issues could be resolved. “The perni- dontists at the renowned Angle School of it produces curious results. cious (mouth breathing) habit, though Orthodontia. It was at this school that Documented recognition of distinct oral contracted in infancy or childhood, or two contrasting factions of orthodontics habits and their effect on human wellbeing manhood, may generally be corrected by developed and were later driven by three stretches into the 19th century. One of the a steady and determined perseverance, influential graduates. earliest recordings of the influence oral based upon a conviction of its baneful and One of Angle’s students was Alfred habits can have on health, occlusion and fatal results.”2 Rogers (1903), who in 1918 presented his craniofacial development is an offering One influential figure that took a strong first paper on Myofunctional Therapy of from American artist and traveller George interest in Catlin’s findings was none other Orthodontics at the annual meeting of the Catlin, who released a best-selling book than the Father of Modern Orthodontics, American Association of Orthodontists. titled Shut Your Mouth and Save Your Life Edward Angle. So strong was his interest His literature described a series of correc- in 1870. in Catlin’s discoveries, Angle considered tive exercises designed to stimulate growth The 40-page volume detailed his obser- him to be one of his heroes3 and reprinted in the maxillofacial region and influence vations of more than 150 Native American his book titled The Breath of Life or Mal- proper occlusion. Thus, myofunctional tribes and the commonality that existed Respiration and Its Effects Upon the therapy was officially established one in all primitive cultures was consistent - Enjoyments & Life of Man in 1925. hundred years ago. 74 Australasian Dental Practice May/June 2018 special | REPORT The two additional influential graduates he had mistreated his patients or unnec- The forementioned author was one that attended Angle’s school were Ray- essarily extracted teeth, Tweed famously Australian graduate who gained a com- mond Begg (1924-25) and Charles Tweed defended his views by declaring “just put prehensive knowledge of traditional (1927-28). Their views on orthodontics your plaster on the table.”7 orthodontics using the BEGG technique. directly contradicted those of Angle, As a result, the purely aesthetic approach Inspired by the correlation he observed who was strictly opposed to extractions. to orthodontics that was trumpeted by while treating patients for malocclusion and TMJ/D in the 1980s, he planted the seed for a modern adaptation of myofunctional therapy by questioning popular orthodontic views at the time. He put forward the notion that the aetiology of malocclusion and TMJ/D was myofunctional. Consequently, he established the modern practice of Myo- functional Orthodontics in the late 1980s. The history of myofunctional therapy/ orthodontics to date is perhaps best sum- marised by a metaphor put forward by internationally renowned orthodontic researcher Thomas Graber. “In our search we are not unlike the man who starts a Figure 2. Like Catlin before him, Angle trip from one city to another. He comes observed the correlation between mouth to a fork in the road and must choose breathing patients and the malocclusions one road or the other.”8 Is it possible the they presented (Figure 33 from The Treat- orthodontic community chose the wrong Figure 1. Catlin illustrated the facial dif- ment of Malocclusion of the Teeth, 1907). road to travel with Tweed and Begg? ferences he observed when comparing hu- mans who breathe naturally through their References nose and those who habitually breathe through their mouth. (Figures from Shut 1. Catlin, G, Shut Your Mouth and Save Your Life 4th Your Mouth and Save Your life, 1870). Edition, 1870, N. Truebner and Co., p. 17. 2. Catlin, G, Shut Your Mouth and Save Your Life 4th Edition, 1870, N. Truebner and Co., p. 23. 3. Peck, S, A Biographical Portrait of Edward Hartley Angle, the First Specialist in Orthodontics, Part 1, The Angle Orthodontist: November 2009, Vol 79, No. 6 pp. 1021-1027. 4. Angle, E.H, The Treatment of Malocclusion of the Teeth, 7th Edition, 1907, SS White Dental Manufac- turing, Philadelphia, p. 111. 5. Angle, E.H, The Treatment of Malocclusion of the Teeth, 7th Edition, 1907, SS White Dental Manufac- turing, Philadelphia, p. 26. 6. Proffit, W et al, Contemporary Orthodontics, 5th Edition, 2013, Mosby, St. Louis, p. 3. 7. The Charles H. Tweed International Foundation, Figure 3. Charles Tweed campaigned Figure 4. Raymond Begg pioneered the The Tweed Years, viewed 26 April 2018, http://www. for extractions to re-enter American or- reintroduction of extraction orthodontics tweedortho.com/about-us/the-tweed-years thodontics in the 1940/50s (The Charles in Australia and revolutionised the use 8. Graber, T.M, Orthodontics: Principles & Practice, 1961, W. B. Saunders Company, Philadelphia, p. 256. H. Tweed International Foundation for of brackets with his light wire technique. Orthodontic Research and Education). (History Trust of South Australia). About the authors Tweed was the loudest advocate for Tweed and Begg halted development of Dr Farrell presents courses on the the reintroduction of extraction orthodon- biologically-based treatment modalities in Myofunctional Orthodontic System and tics in the United States, while Begg was the US and Australia for multiple decades. TMJ Disorder regularly in Australia and the leading proponent in Australia. The Begg’s light wire bracket technique USA and is the founder of the Myofunc- persuasive figures achieved their shared was a driving force behind his signifi- tional Research Co. For more information objective in the 1940s and 1950s as the cant influence on Australian orthodontics. visit www.myoresearch.com. extraction philosophy became the norm His pro-extraction philosophies spread in American and Australian orthodontic throughout Australian universities as the Matt Darcy is a dental researcher at the circles6 while interest in myofunctional movement gripped orthodontic communi- Myofunctional Research Co based in therapy diminished. When questioned if ties throughout Australia and the US. Queensland, Australia. 76 Australasian Dental Practice May/June 2018.