ALF: Alternative Lightwire Functionals

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When it comes to orthodontic treatment, there are more options than braces.

Fixed braces are a mechanical approach to straightening teeth. Much importance is given to a predetermined cosmetic outcome: no irregularities accepted! Little attention goes to creating harmony between the teeth and the occlusion (bite), and the whole person.

Rather than keeping a narrow focus on the teeth, alternative orthodontic approaches recognize the mouth as part of a whole functional system. Treatment aims not only at looks but at function, stability, and natural beauty.

1. Fixed braces and rigid appliances do not address the underlying causes for misaligned teeth.
2. They do not take into account that for most of us one side of our body is more flexible than the other. At the root of this are strain patterns that can originate as early as in utero, get aggravated during the birth process and further altered by accidents. Traditional orthodontic treatment tends to drive the patient further into his/her strain pattern, thereby negatively impacting health.
3. With a narrow focus on cosmetics, teeth are retracted and some may even be extracted. This reduces the space for the tongue and alters facial growth and features unfavorably.
4. The importance of the airway is not recognized. It takes ORTHOPEDIC changes (affecting bones) to develop the maxilla FORWARD. Otherwise the mandible is trapped behind and the tongue, attached to the lower jaw, gets displaced. If it stays mainly back, in the pharyngeal area, it causes narrowing of the airway, often followed by mouth breathing and head forward posture. A compromised airway sets the patient up for snoring, sleep disordered breathing (a general term for breathing difficulties occurring during sleep), obstructive sleep apnea, as well as TMJ disorders.
5. Treatment with full braces is started around age 12, after most permanent teeth have erupted. By then, the golden opportunity has passed: using growth to create a solid functional matrix for lasting results. That’s why results achieved with full braces have a high tendency to relapse.

1. Nutritional deficits: Our modern diet contains processed and otherwise adulterated foods which do not help us to thrive; quite the opposite is the case. Food intolerances add to the problem. The parents’ eating habits prior to conception, as well as the patient’s diet affect teeth and jaw alignment.
2. Oral posture: The position of the tongue (resting up against the palate, sitting in between the teeth, or close to the floor of the mouth), whether the lips are together at rest, and whether breathing occurs through the nose or the mouth all influence the teeth and jaws.
3. Cranial strains: Stresses and tensions in the head and neck area express themselves throughout the body and are reflected in misalignment of the teeth.
4. Inadequate Airway: Mechanical obstructions, allergies, an underdeveloped maxilla, and mouth breathing can all take a toll on health, including the teeth and jaws.

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ALF stands for Alternative Lighwire Functionals (other descriptors have been used as well). Dr. Darick Nordstrom, a general dentist, developed the method in the early 1980s while working together with osteopathic physicians. He soon realized that his patients got relief from seemingly unrelated symptoms.

The basic ALF is a light and flexible wire appliance, running along the inside of the teeth. Some of the treatment goals are:

• Resolution of cranial strains
• Dental arch development
• The establishment of good facial myofunctional habits
• Creation of an adequate airway and good TMJ function

The philosophy builds on acknowledging that all of us have the inherent ability to heal ourselves, as well as to guide this process.

The ALF can be combined with other orthodontic / orthopedic approaches as deemed necessary.

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The most significant difference might be the practitioner’s attitude: we build on the core foundation that our bodies have inherent wisdom. As doctors, we want to be facilitators of the healing process but we don’t want to dictate the course of treatment.

The ALF appliance has some special properties:

• It is minimally intrusive on the intra-oral function because it has an elegant, minimalistic design.
• It has a biomimetic effect by mimicking the forces of the tongue in a mature, teeth-together swallowing reflex.
• It is flexible - not rigid, which makes it “cranially friendly”.
• It is capable of freeing up restrictions between the cranial bones.

The applied forces stay within the physiologic limit and therefore stimulate the body’s healing ability.

ALF treatment offers opportunities to improve a patient’s well-being on all levels: physical, mental, emotional, and spiritual.

ALF treatment facilitates a child’s face to develop forward and can improve jaw alignment in grown individuals.

Preservation and improvement of the airway are of high priority.

Well-aligned teeth and a beautiful smile are a natural treatment outcome.

• Children and adults alike who want to address misalignment of their teeth and jaws while improving health and well-being
• Patients with pain in the head or neck, or shoulder or back area
• People with previous orthodontic treatment particularly if it included tooth extractions and/or headgear
• Individuals who experience problems with their jaw joints (TMJ disorders)
• Patients who clench or grind, snore, or suffer from obstructive sleep apnea

• ALF treatment is a multi-disciplinary approach and more complex than traditional braces. It is challenging to integrate it into a busy practice schedule because the dentist needs to spend more personal chair-time with the patient.
• Providing ALF treatment requires additional training and expertise in cranial osteopathy and oro-facial myology.
• While the appliances may look deceivingly simple, it requires knowledge and experience to adjust them appropriately.

Physical growth is the most potent factor supporting ALF treatment. Therefore, starting patients at a young age is ideal, but ALF treatment can begin at any age as long as the teeth have sufficient bone support.

Growth is our biggest ally during orthodontic treatment when our goals are to help a child develop its full potential and to create stable results.

When a child has early signs of crowded teeth, poor facial development will occur. The expectation that the child will “grow out” of its dental problems during the teenage years is unlikely to come true for the following reasons:

The maxilla follows the growth pattern of the brain:
By age 4, the facial skeleton has reached 60% of its adult size;
By age 12, 90% of growth has occurred.

WHEREAS

The mandible follows the development of the extremities which means growth in females until the age of ~18, in males until ~ 20 or 22.

Since the width and position of the upper jaw determines how much the lower jaw can grow forward, treatment initiated after age 11 has only a limited impact on the maxillary position, has less long-term stability, and a higher degree of complexity.

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As early as age four, you can tell whether your child will need help with jaw growth and development.

Here are the telltale signs:

• No gaps between the primary front teeth
  The permanent incisors are about 5 mm wider than their predecessors. Unless the baby teeth are aligned like a Picket fence, with spacing in between, the permanent teeth will erupt rotated or out-of-place.
• The occlusion exhibits a crossbite
  The maxillary teeth are supposed to align outside of the lower teeth when biting down. If this is reversed facial development is negatively affected.
• Your child is breathing through its mouth instead of through its nose.
  Habitual mouth breathing sets up a vicious cycle leading to poor facial development, airway restrictions, and misaligned teeth.
• Swallowing seems laborious for your child with recruitment of many facial muscles.
• Snoring as well as clenching and grinding are indicative of cranial strains and airway problems.
• Pain symptoms like headaches, migraines, or neck and shoulder pain can originate in underdeveloped jaws and inadequate tongue space.

As permanent teeth erupt, watch out for

• Crowding and teeth rotations
• Extremes of incisal alignment
  The upper incisors should slightly overlap with the lower ones; the lower ones should be touching the upper ones.

Yes, ALF treatment is a good modality to undo damage from tooth extractions and headgear wear.

Cranial osteopathy is a refined and subtle type of diagnosis and treatment, that encourages the release of stresses and tensions throughout the body, including the head.

It is a gentle yet extremely effective approach and may be used in a wide range of conditions for people of all ages.

MORE: www.cranialacademy.org and www.upledger.com

Orofacial myofunctional therapy treats a variety of postural and functional disorders including sucking habits and inappropriate oral postures or functions of the muscles of the tongue, lips, jaw, and face. Unless corrected, these habits negatively influence facial development, as well as jaw and teeth alignment.

MORE:

International Association of Orofacial Myology, www.iaom.com

Academy of Orofacial Myofunctional Therapy, www.myoacademy.net