IntroducingtheAdvancedLightForce(ALF) Appliance
03/01/2015by James M Bronson, DDS; J Alexander Bronson, DMD; Cathy Holway, PT, DPT
ABSTRACT
Theuseofalight-forceoralmechanismtofacilitateorofacialreorganizationandoptimizeoralmotorfunction.
INTRODUCTION
Thisorofacialreorganizationandoptimizedoral-motorfunctionalsoallowsforanenhancedgenetic expressionincranialfacialgrowthanddevelopment.Challengestoorofacialformandfunction havecapturedtheattentionandresourcesofthedentalprofessionfordecades.In1982,thequestfor moreeffective,lightweightinterventionsalignedwithosteopaths’focusoncranialrhythmand movement;Dr.DarickNordstromdevelopedtheAdvancedLightForce(ALF)appliance.1This novelapproachtoorthodonticsystemsworkstointegratecranialmobilitywithpalate,tooth,and jawalignment,therebypromotingbetterswallowing,breathing,speechandsleep.Byfocusingon theformandfunctionoftheneuro-andviscera-cranium,thegentleactionoftheALFappliance providesasafesensorystimuluswithinthemouththatallowsforagreaterrangeofneurological regulationtooccur,especiallythroughthecranialnervesandtheautonomicnervoussystem.Thus patientswearingtheALFapplianceexperiencedfar-reachingchangesinbite,body,brain,and behavior.AsDr.Nordstromhasnoted,“WithinsertionoftheALFappliancewehaveseen seeminglyunrelatedhealthissuesimproveorcompletelyresolve.”2Herewewillexplorethe neurophysiologicalfoundationoforal-motorfunctiontoseehowsuchasubtleALFdevicecan facilitatesuchprofoundrealignment.
EMBRYOLOGICDEVELOPMENT
Thestoryofthedentalandcraniofacialstructuresthatdentistsobserveintheirpatientsbegins duringtheembryologicalprocess.Byfourweeks’gestation,theectodermalbraintubeisfollowing thestimulationofnewneuralcrestcellstoorganizethegenetically-drivenprimordialorofacialcells andstructures.3Neuralcrestcellsthatwillbecomesensorycranialnervesmigrateintotheir pharyngealpouches,wherecellsforthemandibleandmaxillaareorganizingtosprout.Neuralcrest cellsalsomigrateforwardtoguidetheformationofthefronto-nasalprominencesandthepalatal shelves.Thesefutureorofacialbonesareassemblingtoformthescaffoldingfortheproliferationof brainstructuresaswellastheorganizationofthemeso-endodermaloropharyngealstructures.In normalembryologicaldevelopment,thepalateformsfromthreeshelves.Ananteriorprimary palate,thatemergesfromthefrontonasalprocess,andtwolaterallyplacedsecondarypalatalplates thatareoutgrowthsofthemaxillaryprominences.4Thesetwosecondarypalatalplatesare originallyverticallyoriented,alongsidethegrowingtongue.Attheseventhweekofgestation,they pivottotheirhorizontalorientationandfusebothforwardtotheanteriorplate,aswellasmedially witheachother Atthatpoint,thetongueshouldcontinueitsdownwardandforwardprogression withinthemandibularframe.5Theexactprocessoftonguemorphogenesisfromneuralcrestcells andparaxialmesodermisnotwellunderstood,6butitappearsthattheprogramdirectingtongue myogenesisismoresimilartoaxialmuscles(limbanddiaphragm)thantomasticationmuscles (temporalisandmasseter).7
Thefusionofthepalatalshelvesisacomplexprocess,bothwithinitsownsuturalsignalingandin coordinationwithtonguedynamics(failureofpalatalfusionmanifestsascleftpalate.)Thepalatal shelfelevationandfusionprocessreflectstheimportanceofcraniofacialmovementintriggering properneurologicalresponse.
Statedanotherway,thefusionprocessisanexquisitedanceofmotionthatsignalsthenervesto connecttothetargettissues.Thistwo-waysignalingaffectstheproperdynamicformationofour craniofacialstructures,andaswewillsee,informsusofthepotentialtointroduceasubtle mechanicalinputthatwillpromptarestorativeneurologicaloutput.8
GENETICMISHAPS
Duringthedynamicperiodofembryologicaldevelopment,allofthestructuralorganizationjust describedisdrivenbygeneticexpression.Awiderangeoftranscriptionfactors,enzymes,proteins, andadhesionmoleculespromptthemigrationandspecializationoftheneuralcrestcells.However thesecraniofacialpathwaysarehighlyvulnerabletogeneticmutations.9Althoughoveradozen differentgenesarebeingstudiedfortheirroleinthesedisturbances,10therearetwogenetic mutationsthatareespeciallyfrequentlyimplicated.ThefirstinvolvestheMTHFR (methylenetetrahydrofolatereductase)enzymeproducedbytheMTHFRgene;variationsinthegene disruptpropermethylation,andaltertranscriptionofDNA,affectingproperneurotransmitter functionduringpalatogenesis,10MTHFRgenedisuptionsalsoblockfolatemetabolism,which disturbsnormalcelldevelopmentandcancauseneuraltubedefects.Asecondcommongenetic mutationinvolvestheTBX22gene,whichregulatesdownstreamgeneticbehaviorinformingnasal, palatal,pharyngeal,andtonguestructures.9,10,11
Themostcommongeneticmishapsthatdentistsseeinpracticeincludehighpalateand ankyloglossia(tongue-tie),whichsetthestageforcompromisedairwayfunction(leadingtosleep dysregulation),aswellasimpairedoral-motorfunctionsofsuck,swallow,andbreathing. AnkyloglossiaisanX-drivencongenitalanomalywithafourpercentprevalenceexpressedmore ofteninmales12,characterizedbyanabnormallyshortlingualfrenum.Itmayalsoinvolveahighly attachedgenioglossusmuscle.13TheTBX22genemutationthatgiverisetoankyloglossiaalso producesahigharchedpalate(possiblyreflectingasubmucosalcleftpalateduetopoor osteogenesis);andadeformedvomer.Thelatter,mayleadtochoanalatresiaandapersistent oronasalmembrane,whichrestrictsnasalbreathing.14Thesefactorscombinedcanmanifestasa restrictednasopharyngealpassagewayandaberrantbuccopharyngealdynamics,includingenlarged tonsilsandadenoidsandanamplifiedgagreflex.
Althoughgeneticaberrationsmaybetheunderlyingcauseofcraniofacialandoraldeformities,they don’tonlydisruptproperalignmentofteethandjawfunction.Theycanalsoimpairneuro-hormonal function,autonomicnervoussystemregulation,andbrainandbodysensorymotorfunctions, becausedynamicallyandfunctionally,thebackofthethroatisthefrontofthebrainstem.Everybite bringsamessagetothebrain.Thesensoryinputfromtheentirefaceandmouthisreceivedinthe trigeminalsensorynucleus,whichthencoordinatesinterpretationoftheincomingsignalswithother brainstemnuclei,generatingamotoroutputthroughmotorcranialnerves.Statedanotherway orofacialmovementisitsownformofsensoryinputtothebrainstem,whereitiscross-referenced withpreviousinterpretationstomakeoutputpatterns.Geneticdisruptionsthatresultinmalformed craniofacialstructuresthatdon’tmoveproperlyalsoimpairthiscranialnervedialogue.Fetalor neonataltraumascanplasticizethebrainstemcircuitstointerpreteverycriticalsurvivalfunction (suck,swallow,breath,heartbeat,digestion)asconfusionorevendanger.
PRIMITIVEREFLEXES
Craniofacialdysfunctionisthereflectionofbrainstemandcranialnervedisorganizationanda disrupted“setpoint”oftheAutonomicNervousSystemcircuits.Normally,wearealreadywiredat birthtomaintainourinternalhomeostasisviatheparasympatheticsystem,evenaswefaceour externalenvironmentviathesympatheticsystem.Ourprimitivereflexes(forsuck,swallow, rooting,grasping,andgazing)arebuilttoserveoursurvivalinthisregard.Thesebrainstemmediated,automaticmovementsbeginbygestationweek26,andarefullypresentatbirthinfullterminfants.15The primitivereflexresponsesaremeanttobesuppressed,or“integrated”whenhigher-order,conscious neuralfunctionscantakeovermanagementofthoseactivities.Astheinfant“settlesin”andcreates sensoryinputpatterns(olfaction,vision,taste,sound)fromthefamiliarenvironment,andinternal functionsbecomemorereliable,andsocialengagementandcommunicationcangrow.However,in casesofprematurebirthorneurologicalimpairment,primitivereflexesmaybeabsent,weak,or dysregulatedand,therefore,persistent.Life-savingmeasuressuchasventilationalsomayinterfere withproperexpressionofcriticalreflexes,especiallysuckingandtheMororeflex.16Childrenwho laterdisplaychallengeswithsensoryprocessing,grossorfinemotordelays,centralcoordination disorder16orbehavioralissuesmaybeexperiencedwiththepersistenceofthesenon-integrated primitivereflexes.Inessence,theretainedprimitivereflexesblockthehigher-ordercentralnervous systemprocessingthatisnecessaryforthefullinternalhomeostaticfunctionthatallowsfornormal engagementinhome,school,andtheworkenvironments.
NEUROBIOLOGICALCONNECTIVITYANDBIOTENSEGRITY
Neuroscienceresearchisjustbeginningtoexaminetheunderlyingneurobiologicalconnectivity issuesthatmaybeattherootofthesechallenges.17Ifbehaviorssuchashyperactivity,poor attentionoremotionalregulation,sensoryprocessing,gutdysfunction,balanceandmotorcontrol, sleepdisorders,orevenbedwetting18mightbeareflectionofunderlyingneurobiologicalissues thatrelatebacktooriginalcentralandautonomicnervoussystemwiringandfunction,isitpossible togentlyprovideanalternativeoralinputthatinturnallowsanovel,organizingoutputtooccur frombraintobite,body,andbehavior?Cluestoansweringthisquestioncanbefoundbyexamining oral-motordevelopmentandfunction,theuniversallawofdesignconcernedwithbalancingforces andtensionisTensegrity.19RestorationofthebalancesofstressandtensioninthecraniomandibularsystemthroughthescaffoldingeffectoftheAdvancedLightForce(ALF)applianceon thepalatefollowstheprinciplesofengineeringdesigncalled“Tensegrity”,discoveredbyRichard BuckministerFuller.Thisbalancingoftheforcesofstressandtensioninthehumanbodyhasbeen termed“Biotensegrity”.20“Researchintobiotensegrityhasnowestablishedthatprestressed tensegritycells,linkedhierarchicallytotheirextracellularenvironmentandtotheirnucleus,receive mechanicalsignals(termedmechanotransduction)andintegratethemwithotherbiochemical signalstoproduceanorchestratedcellularresponse.Itisevidentthatcellsfunctionasbiotensegrity structuresthatareabletoreceivemechanicalsignalsandintegratethosesignalswithother biochemicalsignalstomodulatesecondmessengersignalingandgeneexpression”.20In1983, IngberwroteinalettertoBuckminsterFuller,“thearchitecturalformofatissuemayitselfserveto coordinateandregulatetheshape,orientation,andgrowthofindividualcellsthroughtransmission ofthephysicalforcesoftensionandcompressioncharacteristicofagiventhreedimensional configuration.”21Fetaldevelopmentoforofacialbonesreliesonthisinterplaybetweenforce, tension,andfunction.Toregulateosteogenesis,anossifyingboneneedsamechanicalinput, providedbymeetingthesuturaledgeofanotherbone,andfeelingthatpush-back.Thiskindof “mechanicalstressmodulation”promotesskeletalmodelingofbonesandcartilage.10Post-natal, whatkindofmechanicalstressmodulationmightfacilitaterestorativemodelingoftheoralcavity? Studiesingrowingratsinvolvingorthodonticwireexpansionhaveshowedthat“secondarycartilage canundergochondrogenicandosteogenicdifferentiationinthemaxillaryarch”,8meaningthata mechanicalstimulusinthenaturalgrowthcyclefacilitatesreorganizationinboneandcartilage.Can
thesubtleinputoftheALFwirestimulateorofacialreorganization?Ifthebonesresumetheirinnate growthprocess,thentheneurosensoryconversationwithbrainstemandcranialnervecircuitscan reorganizeaswell.Moreover,whenbrainstemandcranialnervecircuitsfindeaseoffunctioninone specificroute,thateasedownregulatessympatheticoutput,andclearsapathforothercircuitsto downregulateaswell.Asbrainstemcircuitsclearandcorticalconnectivityisabletoorganize, delayedreflexescanbeintegratedandcorticalneuralintegrationcanproceed.
MECHANICALSTIMULIFORCRANIOFACIALDEVELOPMENT
Innormalorofacialdevelopment,properinfantsucklingbeginsthestimulationprocessforboth oral-motorandneuralorganization.Propersuckingrequirescoordinationoftheanteriortongue, whichlatchesontoinitiatethevacuumextractionofbreastmilk,andthenrollstoposteriortongue depression,22,23whichleadstoswallowing(whilecoordinatingbreathingforasafeO2saturation level).Thisisacriticalfirststepinaffirmingtheinput-outputregulationofthecranialnervesthat governsuck,swallow,andeventuallymastication.Aninfantileswallowthatisnotwellorganized, candetertheneurosensoryandmotorfunctionoftheentireorofacialcomplex.Thetoneand functionoftheorbicularisoris,thebuccinators,themasseters,andoropharyngealmuscles, (includingthetongue),maynotdevelopproperly,whichmayleadtoapoortransitionto mastication(aswellasspeechandbreathingissues).Thetransitionfrombreastfeedingtosolidand semisolidfoodsisinstrumentalinensuringproperdevelopmentofthebones,muscles,andteeth. Whereassoftfoodsrequirelittleornomasticatoryforce,relyinginsteadonmashingand swallowingthatinvolveastraightup-and-downmotionofthejawswithlittleornoforce.The introductionofsolidandsemi-solidfoods,initiatestheactivationofthemasticatorycycle.The vigorousgrindingandtearingmotionsthatcharacterizemasticationprovidethemechanical stimulusforbonesandteeth.Specifically,thismasticatorycycletransmitsthroughtheteeth(which aretinyorgansfullofproprioceptors)andtheperiodontalligaments(moreproprioceptors), signalingthenecessaryosteogenesisforjawdevelopment.24Thisstimulationisessentialforthe propersizeandshapingofthejaws,whereaspoormasticationdynamicsfailtoprovidethe necessarymechanicalstimulusforpropercraniofacialbonegrowth.Anindicationofnormal transversebonedevelopmentinthejawsistheemergenceofdiastemas(spaces)formingbetween theteethbyagefour.25
THEROLEOFTHEALF
Dr.DennisStrokonandDr.GavinJameshavewrittennumerousarticlesontheuseoftheALF applianceinthetreatmentandcorrectionofcranialstrainpatterns,torsions,sidebendlesions, superiorandinferiorverticalstrainpatternsandotherproblems.26,27,28Ifpropermastication dynamicsarenotoccurring,andcraniofacialdevelopmentbecomesdistorted,theinsertionofan ALFappliancemayprovidethecriticalsensoryinputthatisneededtopromoteneurosensory organization.Aswehaveseen,everybitesendsamessagetothebrainstem,whichsendsa formativeoutputbacktotheoralstructures.Thus,thedelicatesensoryinputprovidedbytheALF canalterosteogenesis,addressingandrelievingcranialstrainpatterns1andpromoteproper transversedevelopmentofthejaws.Ascranialnervesensoryinputchanges,andspontaneous correctivemotoroutputfollows,autonomicandneuro-hormonalbrainstemcircuitscanreorganize aswell.Rebalancingoftheparasympatheticandsympatheticdrivespromotescalmerinternal function,lesssensorydefensiveness,andbetterattentiontoconsciousprocesses.Thisinturn,can setthestageforcognitiveengagementwithcorrectivetongueexercises.Thecombinationof myofunctionaltrainingexerciseswiththeALFcanfacilitatepropertongueplacementfor swallowingandmovementoftheteeth,setti nginmotion,neurologicalfeedbackloopsthatpromptmoreeffectivemanagementoforal-motor function.TheALFstimulatestransversebonegrowth,inmuchthesamewayasthechewingof solidandsemi-solidfoodsinthedevelopingchild.Throughitsgentleandsubtlepressuretothe
toothorgans,theALFexertsalateralforce24hoursadayandsevendaysaweek.Thetooth proprioceptorsandperiodontalfibersinterpretthislateralforceassensoryinputsimilartochewing, inputthatinchildrenspursthecreationofspaceforthedevelopingdentitionthroughappositional boneandcartilagegrowthinadults,thisoccursthroughappositionalgrowth.29Althoughthe standardALFtouchesonlyfourteeth,itpromotesspacesbetweenalltheteeth.Thedesignand placementoftheanteriorandposterioromegaloopsencouragesthetonguetoassumethecorrect oralrestpostureposition,andtoparticipateinthetransverseandantero-posteriorforcesnecessary tostimulategrowthandpositioningofthemaxillaforthedevelopmentofapalateofpropersize andshape.3Inessence,theALFisfunctioninglikeasurrogateorbiomimetictonguegiving stabilitytothecranio-facialcomplexsimilartoascaffoldinginthepalate,(restoringbiotensegrity tothecranial-mandibularsystem).Itfunctionsasaneurophysiologicstimulus,asan orthopedic/orthodonticdevice,anditencouragesthetonguetoassumeamorenormalrestposture position.Thepalateliesincloseproximitytothebrainstemanddirectlybeneaththesellaturcica, whichhousesthepituitarygland.Thishighlyinnervatedpalatalarea,coupledwiththe proprioceptorsinthetoothorgansandtheperiodontalligamentstransmitasubtlestimulatoryinput notonlytotheroofofthemouth,butalsotothebrainstemandtheendocrinesystem.More specifically,theALF’ssensoryinputtothepalateproducesacalmingeffectonthesympathetic nervoussystem,muchliketheeffectsofapacifier30inaninfantorthumbsuckinginayoungchild. Thebenefitofthistranquilizingeffectisthatitallowsthebrainstemtorefocusonissuesotherthan sympatheticprotection(survival).
NITRICOXIDEANDNASALBREATHING
Dr.JonLundberg,aphysicianintheDepartmentofPhysiologyandPharmacology,atthe KarolinskaInstituteinStockholm,discoveredthattheparanasalsinusesarepowerfulproducersof nitricoxide(NO).Althoughthisgasisconsideredapollutantintheatmosphere,insmalldoses,itis lethaltobacteriaandviruses.Becausethesinusesarewarm,moist,andbacteria-friendly, theoreticallyprovidingperfectplacesforbacteriatolive.Dr.LundbergbelievesthatNOkeepsthe sinusessterile.31OtherresearchersagreethatNOproduction“isimportantforcontrolling intracellularbacterialpathogens”.32
TheproductionofNOisalsoessentialforhormonalandgrowthregulationandservesanumberof otherfunctions,includingimprovesbloodflow,lowersbloodpressure,limitingthedamaging effectsofinflammation(c-reactiveprotein),andlimitingtissuedamageindisease.33NOactivates cytosolicguanylatecyclase,elevatingintracellularlevelsofcyclicGMP(cGMP),whichisessential forsmoothmusclerelaxationandiontransport.NOinducedformationofcGMPalsoisinvolvedin hippocampallong-termpotentiation(LTP),along-lastingenhancementofsynaptictransmission efficacythatisconsideredthebasisforsomeformsoflearningandmemory.34Theproductionof NOinthesinusesmaybefundamentalinkeepingthetonsilsandadenoidsfreeofinfection,itis contingentuponnormalnasalbreathingduringsleep.Fromabiomechanicalperspective,ahigh palateandinadequatetonguetonecontributetodecreasedorabsentnasalbreathing,especiallyat night.Inastudyexaminingobstructivesleepapneasyndrome(OSAS)inKoreansoldiers, researchersfoundasignificantlyhigherprevalenceof“higharchedpalate,tongueindentation,long uvula,largetonsilsandretrognathia(atypeofmalocclusion)inthehighriskOSASgroupand concludedthatahigharchedpalate,longuvulaorlowlyingsoftpalate,andtonsilsizeIIIorIV, wereindependentlypredictorsofOSAS.”35ThecalmingeffectoftheALFonthesympathetic nervoussystemcaninfluenceNOproductionand,thus,enhancethebenefitsofadequateNO supply.Specifically,whentheALFhelpsachildsleepmoreprofoundly,havefewerrestless episodes,andachievebetterbreathingpatternsandamorerelaxedstate,neuronalnitricoxide synthase(nNOS)–theenzymethattriggerstheproductionofnitricoxideincreases.33Inaddition, normalizationofbreathingpatternsandotherautonomicfunctionsmayfinallypromptresolution
andintegrationofretainedprimitivereflexes.Thisintegrationcansometimesoccurquiterapidly followingintroductionoftheALF,oritmaytakeplacemoreslowlyoverseveralweeksormonths. Resolutionofretainedbrainstemmediatedprimitivereflexesinturnmayleadtoanumberof dramaticoutcomes,includingcessationofdrooling,thumb-sucking,andbed-wetting;enhanced immunesystemfunctioningwithasubsequentdecreaseinallergicincidentsandgastrointestinal issues;improvedcognitiveattentionandfunction,motorcoordination,andathleticperformance. Othershaveobservedsimilarsymptomaticimprovementthroughneurotherapydevelopment programs18andreprogrammingthroughprogramsofsensoryinput(e.g.BrainGym).Furthermore, astheautonomicnervoussystemregulationcontinuestoimprove,hormonalfunctionthroughthe hypothalamic-pituitary-adrenal(HPA)axisalsonormalizes,whichmayaffectlearningandmemory function,regulationoffertility,andgrowthspurts.
CONCLUSION
ThesubtlesensoryinputfromtheALFprovidesasafe,consistent24/7inputthatmirrorseffective orthopedic,orthodontic,osteopathic,andneurosensoryregulation.Thetherapyallowsareturntoa normalbalancedbiotensegritysysteminthecranio-mandibulercomplex.TheALF’sbiomimetic effectsonthepalateencouragespropertongueplacementfornormalizedoralrestpostureposition, itpromotescorrectiveorofacialformandfunction.Itfacilitatesbothcranialnerveandautonomic circuitregulation,promptingasynthesisofcellular,biochemical,hormonal,neurological,and behavioralorganization.Frombitetobraintobehavior,theALFpromotesoptimalformand functionwithmechanismssupportedbyscience.OH
Dr. Bronson graduated “Cum Laude” from Georgetown University School of Dentistry in 1983. He has General Dental Practices in McLean and Charlottesville, Virginia, and a practice limited to ALF Orthodontics and TMD therapy in Santa Cruz, CA. In 2013, Dr. Bronson founded The ALF Educational Institute, LLC (AEI) and is Director of Clinical Programs.
Dr. James “Alex” Bronson is a 2012 graduate of Midwestern University, Arizona College of Dental Medicine. He is on the Clinical Faculty at the ALF Educational Institute. His interests lie in ALF Transformational Orthodontics, TMD treatment, Implant and Cosmetic Dentistry, and Orofacial Myofunctional Therapy. With his father, James M. Bronson, DDS operate two dental practices based on “Whole Body Dentistry”, in McLean and Charlottesville, Virginia.
Dr. Cathy Holway received her BS and certificate in Physical Therapy from Russell Sage College/Albany Medical College School of Physical Therapy, Troy, NY in 1979. She received her Doctor of Physical Therapy degree from Boston University in 2008. Upon completion of her doctoral studies, she founded The Neurovascular Institute, Inc.
Oral Health welcomes this original article.
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