Functional therapy

Dr Tony O’Connor’s article on orofacial myofunction has been credited for its well researched logic into early intervention

Dear Editor,

I would like to congratulate Dr O’Connor on his well presented and researched article in the December issue of Ireland’s Dental magazine, titled ’Orofacial myofunction’. In it he cogently and eruditely expounds on the absolute medical necessity of early orthodontic intervention to help reduce, and hopefully even prevent, the ongoing detrimental effects on those growing patients who have genetically inherited myofacial malformation problems.

He warns with well researched logic against the still prevalent modality of orthodontic authorities that would contend delaying orthodontic until, at the very least, all the permanent teeth have erupted at age 12 approximately, or some would argue even later. In general, the pictures of the cases presented in Dr O’Connor’s article are examples of those many patients born with skeletal class 2s and, as he correctly points out, by not intervening early we are ignoring the fact that apart from the physiological distress that is the bedfellow of the ugly unaesthetic appearance of the class 2 malocclusion, i.e. the bugs bunny appearance, that the “child’s dentofacial growth may not be proceeding normally” (which, of course, it is not!). His article tabulates in clear, concise detail the dire consequences of not intervening at as early an age as possible.

The anomaly of all of this is that this syndrome is, in most, so easily tackled and corrected with functional orthopaedic/orthodontic appliances, such as the well–made and constructed Twin Block appliance which can be provided from at least the age of seven onwards. I have, over the years of my professional life since I was first properly introduced in 1990 to functional appliances and the benefits of functional therapy, often voiced my view that the ability to correct these medically challenging malocclusions with the simple use of Schwarz type arch developers and for the correction of Class 2 malocclusions that most amenable and easily used therapy, i.e. the Twin Block functional appliance, should made be a kernel part of undergraduate dental training above nearly all else.

The prevalence of this malocclusion and its consequences made worse, unfortunately, as still happens when treated incorrectly, i.e. the extraction and retraction modality. It is my own experience as a general practitioner practising orthodontics, having treated many hundreds of patients with this therapy, is that patients take to the well constructed – and I emphasise well constructed – Twin Blocks like the proverbial duck to water. This is particularly true of the very young, i.e mixed dentition patient, as some innate self–conscious realisation seem to makes them appreciate the forward translation into its correct position of the retruded mandible.

Of course, particularly appreciative are ’the bugs bunny ones’ as that ugly appearance ’disappears’ and a lip seal is created from day one of the fitting of the appliance – be it the simple Twin Block or the fixed in Herbst appliances like the user–friendly Advanc Sync from Ormco. Another thing that the article emphasises, without actually saying it, is the absolute clinical ’inappropriateness’ of the criteria of treatment selection of our school orthodontic services which prioritises or dismisses such sufferers depending on whether their malocclusion is associated with an overjet of over 10mm or less than 10mm.

To emphasise this last point I am enclosing a few photographs of an adult who has just commenced her Twin Block treatment but who told me that she was deemed, when examined by the school service, as not having a malocclusion appropriately severe enough for them to offer her treatment. Unbelievably this patient had only been offered short term treatment effecting only the anterior segments and recommended as a choice of treatment which totally ignored the state of the laterally contracted posterior segments. But that wrong and nowadays frequent recommendation could be the subject of whole book. Suffice to say it makes my hair stand on end how often I see this modality recommended, in complete oblivion to the state of the contracted posterior segments. Something needs to change drastically, and again I sincerely thank Dr O’Connor for his article.

Is mise,
Liam Ó Droma

In reply

I’d like to thank Dr Liam O’Droma for his kind words but I do beg to differ regarding the use of Twin Block appliances in young patients.

I personally do not recommend them in young children, as they are potentially retractive to the face and hence the airway.

This is why Orthotropics is a far better technique as it does not retract the mid face (upper jaw) at all. Please see Dr John Mews web site ( for more details on this technique.

Dr Tony O’Connor


Dr O’Connor would like to apologise to Dr Paula Fabbie for an oversight in his article, ’Orofacial myofunction’ (IDM Dec 2015, p27). Dr O’Connor would like to give credit to Ms Fabbie’s article/course, Myofunctional Analysis and its Role in Dental and Oral Health Assessments from Oct. 2015, a Pennwell publication, and apologise for the omission in the references.

Paula Fabbie, RDH, BS, is an orofacial myofunctional therapist and consultant based in New York.

She has enjoyed more than 30 years of practice in clinical dental hygiene and currently teaches children and adults with orofacial myofunctional disorders on improving proper rest postures and oral functions. As part of a team approach, she works closely and consults with referring dentists and physicians. She has lectured to physicians and dentists on orofacial myofunctional disorders in the US and Europe.

She can be contacted by email at