Posts filed under ‘TMJ’

Smile Direct Club – the New Kid on the Block

The launch of this new supplier of “invisible” braces is yet another reminder of how technical advances are rapidly changing the world around us. This international tele-dentistry company was founded in the US five years ago and has rapidly become the largest provider of orthodontic treatment in the US.  Last year, revenue nearly tripled to $423m from about $146m in 2017. According to their website Smile Shops have already opened in twelve locations in the England & Scotland and will be launching in Canada and Australia next year.  So, how does it differ from mainstream orthodontics and what does this mean for the future of orthodontics as we know it?

Smile Direct Club uses 3D scanning and computer technology to create a programme of treatment using clear braces that are posted to the customer.  Only one appointment is required and the treatment is 60% cheaper than the market average.  In the US some orthodontists are so fearful of the threat that Smile Direct Club pose that they have sought unsuccessfully to have tele-dentistry banned.  It is easy to be scathing of treatment that involves less contact with a qualified clinician, but Smile Direct Club appear to have the winning combination of competitive pricing, good results and reliable standards of customer service.

Until now, orthodontics in the UK has been dominated by small clinical practices owned and run by qualified orthodontists who treat a mix of private and NHS patients.  Small clinics already face onerous costs to ensure they meet statutory legislation on employment, care quality and so forth.  Can they survive the downward pressure on prices presented by this direct-to-consumer business model?

Strange as it may seem, this threat may actually be what will spur the speciality, at last, to change tack! Orthodontics at its best is so much more than mere tooth straightening. Early diagnosis and intervention can reduce and even prevent the presentation of crooked teeth.  By treating the face and not just the teeth, orthodontists can offer something that mail order clear braces never can.

The orthodontic profession has the knowledge and practical skills to impact on the health and wellbeing of young children and their future lives.  There are progressive orthodontists like William Clark and John Mew who spent decades pushing the boundaries to develop appliances like the twin block and the biobloc, that have been shown to encourage jaw growth to make room for the adult teeth.  Yet, despite international recognition, they have never been properly recognised for their achievements at home.  Neither one of these men has been invited to speak at a British Orthodontic Society conference.  It is time for the arguments between different factions of the orthodontic profession to end and for collaboration to begin.  If the orthodontic profession wants to survive, it needs to properly understand the causes of malocclusion, its relationship with other conditions like sleep apnoea and TMD and the best ways to prevent and treat it.

In the long run, Smile Direct Club’s quantum leap approach could bring about the changes which so many of the non-establishment practitioners have been calling for decades! Good news for us and better health for patients.


September 30, 2019 at 5:02 pm Leave a comment

Movement Disorders, Dystonia and Tourettes

I was recently contacted by a lady who had suffered from Dystonia for several years which had severely limited her everyday life. Fortunately she has now made a complete recovery. Her treatment was carried out by Dr André Hedger ( and involved the recognition of Temporo-Mandibular Joint Dysfunction and the misalignment of associated cranial bones. An integrated team approach is required to diagnose and treat these complex cases. Members of the British Society for the Study of Cranio-Mandibular Disorders acknowledge this and a list of other practitioners can be found on the website:

See the Dystonia,TMJ and the connection on Facebook.

October 3, 2016 at 1:26 pm 1 comment

The TMJ / Chiropractic Connection

19 November, RAC Country Club, Epsom.

Dr André Hedge arranged this study day on behalf of the British Society for the Study of Cranio-Mandibular Disorders (BSSCMD).

Dr Skip Truitt gave a presentation demonstrating that most malocclusions were orthopaedic problems and most involved some derangement of the Temporo-Mandibular Joint. He began by classifying a range of presenting symptoms and followed this by explaining the protocols he has for each category.

He drew our attention to the relationship between the optic plane, the otic plane and the maxillary plane. A major reason for these planes being off kilter is an under-developed maxilla. This directly involves not only the optic plane and the maxillary plane through the maxillary bone but also the otic plane through the association of the temporal bone with the TMJ.

Angela Winter (Chiropractor) gave a thorough explanation of her work regarding posture and body alignment. Tom Robinson (Sports Massage Therapist) demonstrated his techniques to relax muscles and improve circulation. Both these practitioners work closely with André and this is particularly helpful for patients with temporomandibular joint dysfunction. His protocol is: podiatrist, massage, chiropractics, cranial osteopathy and then orthopaedics/orthodontics.

Skip ended the programme with an excellent presentation on airways. Problems can arise from constriction of the nasal, naso-pharyngeal or the pharyngeal airway. Many of these are caused by a less than ideal position or shape of the maxilla. ie; a narrow palate, a maxilla that is short or positioned distally, or a mandible that is trapped back by any of these factors.

Nasal breathing is far superior to mouth breathing due to the following:

1. Air is moistened and filtered.

2. A vortex is formed which delivers the air to the lungs at the correct speed.

3. Air is warmed.

4. Anti-bacterial Lysosomes are present.

5. Nitric oxide is added which increases the uptake of O2 at the alveolar membrane.

6. Mouth breathing flushes out more CO2 which reduces respiratory rate/sleep apnoea.

It is his belief that insufficient oxygen uptake in child night time mouth breathers is often the cause of ADHD.   

This meeting was sponsored by Triple “O” Dental Laboratory which  makes most of the orthopaedic appliances in the UK and has now introduced their new product called “Smile-Tru”. This is an aligner system but has the added benefit of expert diagnostic support. See and

November 20, 2013 at 1:45 pm Leave a comment

The British School of Osteopathy

10 November.  17 qualified osteopaths attended this weekend Refresher Course. The presentation which I gave, entitled “The Effects of Jaw Problems on the Rest of the Body”, seemed to be well received. I started by showng a 10 minute video clip of Dr Brendan Stack’s video on movement disorders. The rest of the presentation was divided into two sections. The frst outlined the Orthodontic/Osteopathy Connection and this was followed by the Temporo-Mandibular Joint(TMJ)/Osteopathy Connection.

The aim of this presentation was to equip the delegates with sufficient knowledge so as to be able to advise  their patients with regard to orthodontic/dental orthopaedics problems and Temporo-Mandibular Joint Dysfunction (TMD). The video dramatically demonstrates the far reaching effect that jaw problems can have on the rest of the body. The links on my blogroll lists functional orthodontists ( & and further information about participating practitioners can be obtained by contacting Triple “O” (

November 11, 2013 at 10:34 am Leave a comment

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