725 S 51st. West Des Moines, IA 50265 ?(515) 224 1618

Jaw and Facial Development in Adults

It’s not just about the teeth!

An orthodontic approach focused on facial and jaw development, as well as the health of the airway and TMJ. 

 At Apex Dental, Dr. Mindy’s approach to orthodontic treatment goes far beyond the teeth. We strongly believe that beautifully straight teeth look best when they fit the smile and the face around them.


By idealizing the jaw form, we avoid extractions by making space for all the teeth to fit beautifully. Idealized jaw form means a well developed face, as the jaw bones make up the lower half of the face (Note the maxilla in yellow and the mandible in white).

This comprehensive approach allows for a more ideal and stable orthodontic result as well as an aesthetically pleasing face and profile. The ultimate goal is a broad, beautiful smile AND the lifelong health benefits of a healthy airway and TMJ. We invite you to contact our office at (515)224-1618 to learn more about the benefits of facially focused orthodontics, by scheduling an appointment with Dr. Mindy Richtsmeier.

How Is Facially Focused Orthodontics Different?

Crowding is the most common issue in what people deem to be a “bad bite”. It is very important to recognize that crowding is NOT a problem of too many teeth! Crowding is the direct result of improper jaw development.

In conventional orthodontics, problems of crowding, overbite, and underbite are often addressed with extraction of permanent teeth. The remaining teeth are then retracted (or moved backwards) in the mouth. While this makes it easy to align the remaining teeth, it worsens the root cause of crowded teeth. Jaws that were already too small are now smaller. This can have tremendous effects on facial esthetics, as well as on the health of the TMJ and the airway behind the jaws.

Treatment of the source of the problem (the underdeveloped jaws) results in not only the best esthetic outcome, but also the healthiest result. The goal is nice wide jaws with a full set of teeth. Enhanced development of the maxilla brings with it a full smile, improved lip support, more natural position of the mandible, a better profile, and a more open airway behind it, With all of this comes much lower risk of sleep apnea and TMJ disorders.

Dr. Mindy utilizes a number of different removable appliances, selection based on each particular case, to develop faces and jaws to their full genetic potential.

Let’s have a look at the two ladies in the photo. It is notable that both ladies have straight teeth, but note the differences in the face. Jaw development has tremendous effects on cheekbones, the jaw line, the nose, lips, and profile.

On the Left: Jaws are underdeveloped and recessed, or set back in the face. Cheek bones are flat and barely evident. Lips are thin due to inadequate support from the recessed jaws. The nose has a “hump” due to the nasal cartilage developing backward to the recessed jaw position. The set back jaws shrink the airway space behind them. The high angle of the mandible is a great risk for TMJ dysfunction.

On the Right: Jaws are fully developed. Cheek bones are prominent. Lips are full with ideal support from properly positioned jaws. The nasal cartilage is ideally positioned, giving a pleasing nose profile. Forward position of jaws leave wide airway space behind them. Angle of the mandible more conducive to healthy TMJ.

What Causes Adverse Face and Jaw Growth and Orthodontic Misalignment?

The “Big Three” in face and jaw development include:

  • Proper tongue posture (on the roof of the mouth)
  • Lips sealed with teeth lightly touching
  • Nasal breathing

When any of the “Big Three” are interrupted during development, we commonly see patients with an upper jaw that is too small (underdeveloped), a lower jaw that is too small (underdeveloped) and one or both jaws recessed.

Effects of Incorrect Tongue Position Due to Mouth Breathing or Poor Oral Posture

The Orthopedic and Orthodontic Effects of Poor Oral Posture

Mouth breathing, open mouth posture, tongue positioning habits and tongue tie are known to have a very destructive influence on a child’s developing face. Without the scaffolding effect of the tongue resting on the palate, the upper jaw deforms in three dimensions and changes the shape of the mid-face and lower half of the face causing:

  • High narrow palate
  • Deviated septum
  • Narrow jaws
  • Mid-face deficiency
  • Flattened face
  • Sloping forehead
  • Elongated lower face, “long face syndrome”
  • Narrow face
  • Thin lips
  • Recessed chin/retracted lower jaw
  • Sunken cheeks
  • Small jaws without room for all the
    permanent teeth
  • TMJ pain and dysfunction
  • Obstructive Sleep Apnea
  • Headaches/shoulder & neck pain/poor posture
  • Dental crowding and malocclusion

The Solution:

Jaw and Facial Development with Facially Focused Orthodontics

Innovative, cutting-edge technology combines facial growth analysis and development with non-retraction orthodontics to achieve straight teeth and a beautiful broad smile, more ideal facial proportions and profile, and healthy joints and airway.

Treatment, following establishment of proper oral posture, consists of an orthopedic and orthotropic growth phase to achieve aesthetic facial dimensions and profile, and an orthodontic phase to straighten teeth and preserve newly created space without retraction orthodontics. Sounds complex? It is! But, Dr. MIndy has had extensive education and training in facially focused orthodontics and the results are nothing short of amazing!


Phase 1:

Evaluate and Establish Correct Oral Resting Posture

Oral posture (lips together, tongue on palate, teeth together) is largely responsible for the normal growth and development of the face and jaws. The tongue is a powerful muscle and should rest against the upper palate (roof of mouth) and cause the upper jaw to broaden and grow forward in the healthy and esthetically appealing manner. When this does not happen, because of tongue tie and/or open mouth posture, the midface does not grow properly and the lower jaw is typically trapped behind a deficient upper jaw and midface.
Not only does poor oral rest posture cause changes in facial growth, they also impact long- term health because the jaws, palate and airways develop abnormally and can lead to:

  • TMJ issues
  • Obstructive Sleep Apnea
  • Headaches/shoulder & neck pain/poor posture
  • Dental crowding

The most common causes of poor oral rest posture and constricted face and jaw development include:

  • Mouth Breathing due to:
  • Enlarged tonsils and adenoids
  • Allergies
  • Frequents viral infections
  • Chronic open mouth posture
  • Tongue tie
  • Myofunctional (tongue) habits
  • Prolonged pacifier use or thumb sucking
  • Genetics – only 10%

Possible steps to re-establish proper oral posture may include: 

  • Gentle lip taping or a soft oral appliance to eliminate mouth breathing and confirm or train (if no obstruction) consistent nasal breathing
  • Myofunctional therapy
  • Tongue tie release
  • ENT evaluation and treatment
  • Allergist evaluation and treatment

Phase 2:

Palatal Expansion

Not everyone needs palatal expansion. For those who do, Dr. Mindy uses appliances that actually stimulate the production of new bone and models and reshapes existing bone to develop a more aesthetic face, as well as healthier airways and jaw joints.

At Apex Dental, we utilize different types of removable expanders, all designed with and custom made by specialized orthodontic labs. Selection of appliance is dependent on the degree of underdevelopment, on the presence of associated health issues such as sleep apnea, and on the overall treatment goals. If palatal expansion is indicated in a case, Dr. Mindy will likely use one of the appliances pictured below, both worn at nighttime and for limited hours in the evening.


Phase 3:

Controlled Arch Orthodontics  –  NO Retraction!

Typically, this is done with clear aligner therapy, such as Clear Correct. Innovative, modern orthodontics to preserve the newly created space and achieve straight teeth, a beautiful profile and faces developed to their genetic potential, a healthy airway and uncompromised jaw joints. It takes a dentist with a commitment to training and dedication to clinical excellence but it CAN be done!

There is a lot more to orthodontics than just straight teeth!!!


Facially Focused Orthodontics Could Be a Great Solution If:

  • You have an overbite
  • You have an underbite
  • You have a crossbite
  • You have crowding of your teeth
  • You have been told you need corrective jaw surgery
  • You have been told you need teeth extracted as part of orthodontic treatment
  • You suffer from TMJ symptoms
  • You suffer from obstructive sleep apnea
  • You have mid-face deficiency or long face syndrome
  • You have a very narrow face and recessed chin
  • Your bite is misaligned
  • You are a mouth breather

If this sounds like you, please call Apex Dental at 515-224-1618 today for more information or to schedule an appointment!

Dr. Mindy’s facially focused approach to orthodontic treatment could change your life.

We'd love to hear from you! Please give us a call at  (515) 224 1618 or complete the form below to message us or request an appointment.

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