Questions recieved from Orthodontists and Dentists
1: How successful is the appliance? Does it really work?
Dr Chris Farrell developed the TRAINER System™ in 1990 in response to the need for an appliance system that was easy to use and would assist in the correction of myofunctional (muscle function) habits that cause malocclusion and TMJ problems.
Most of the Dental and Orthodontic profession were not recognising these problems at this time and few were treating them.
The ability to correct these soft tissue problems with the TRAINER System™ has been shown to improve the facial growth, dental alignment, plus decrease the complexity and improve the stability of orthodontic treatment. See the case histories in the brochures, web and the other articles.
Orthodontists, Dentists and Paediatric Dentists in more than 65 countries use the TRAINER System™ worldwide. They ALL confirm it works.
2: What if the child refuses to wear the appliance?
The key to TRAINER success is the child's compliance. This should be established at the first consultation visit with the parent being told the importance of correcting bad myofunctional habits. This is not an alternative form of orthodontics. It is a treatment for the soft tissue causes of malocclusion and poor facial growth.
Therefore, the treatment is necessary for correct facial growth and stability of future orthodontic treatment.
If the child refuses to wear the T4K™ (which is rare to start) this is a contraindication for treatment. If the parent is not motivated, this is another contraindication. This is all in the manual.
3: What do I do if the TRAINER falls out of the child's mouth during the night?
When first starting treatment, the TRAINER WILL fall out at night. The more there is a mouth breathing and tongue thrusting problem, the more likely there will be problems with falling out. A child with no myofunctional problems will keep the TRAINER in at night easily. So this is the goal for the treatment . Increase daytime use if the night use is a problem. See manual.
4: It is not going to work.
The TRAINER System™ is designed to assist in correcting the causes of malocclusion. If used as directed, it is always effective in making an improvement to these bad oral habits. The resulting improvement in malocclusion and facial growth is dependent to a great extent to the individual.
However it is passive with no risk. Starting early, the benefits of improved facial growth, (as seen in the case histories) and the potential for less complex orthodontics, alone is sufficient to demand its implementation.
Without treatment there is great probability of worsening malocclusion and poor facial growth particularly in mouth breathers. It is essential to treat these problems - which also prevent TMD from developing later. The widespread use worldwide also proves its effectiveness. It is important not to deny the choice of TRAINER treatment to the patient.
If you would like to know more about the modus operandi of the TRAINERs, please read Issues No.1 and 2 of the MRC Newsletter: 'Scientifically Speaking' by Dr. German O. Ramirez-Yañez.
5: Are there known harmful side-effects of the TRAINER?
There have been no reported harmful effects of the TRAINER System™.
As it is a passive and a very flexible appliance that assists in retraining the musculature and mode of breathing, there is little possibility of doing harm. However the recommendation is always to review patients regularly and ensure the soft tissue improvements are progressing, there is no irritation and that the dental changes are being supported by the surrounding structures.
6: Are the Myofunctional products registered with health authorities and is there data on the type of material used in them? Certificate of non-toxicity/Material safety Data Sheets?
The TRAINERs and TMJ APPLIANCE™ have been made from medical grade materials approved by USA and European health agencies for use in the mouth. The CE certification and FDA 510k in addition to other government approvals have been granted to the Myofunctional Research Co. products.
Some allergy (Mucous) has been reported with a very small number of hyper- allergenic patients. This stops after suspended use. No reported problems with liability have occurred as these materials are in very common use in baby's dummies and medical infusion tubes plus many other medical applications. There have not been reported liability problems with any of these materials.
7: What exactly is the colouring agent? Do we have proven evidence of non-toxicity and Non-allergy of these substances?
The colouring agents are vegetable based and similar to those approved for use in food. They have to go through the same certification process as the materials.
8: The products colouring is fading away over time. Is the patient/child swallowing the colouring agent? Is this safe?
The colour does not wash out of the material, but can fade with time and use.
The surface of the silicone material can also become dull from the effect of saliva. This makes the colour look less bright but presents no health hazard.
9: Suggested TRAINER use is for at least 6-8 months each phase. How long does the TRAINER (T4K™) last if used according to instructions? For instance, does a bruxism case need more TRAINERs?
You will find usually the appliances last for the length of the case. It is important for the Doctor to tell the child not to chew on the TRAINER, as this will cause premature splitting. Reinforce this with the parent. As the soft T4K™ needs to be flexible and compliant, the silicone material is resilient but cannot withstand a lot of chewing or bruxing. If it gets chewed up, the Doctor can issue another to the patient and charge them if they have been informed of this from the start .
Normally the T4K™ starting appliance will just last the 6-8 months and then the T4K™ harder (pink/red) will last longer. Sometimes it is OK to either issue another T4K™ blue or commence the T4K™ hard earlier than 6 months. Also the hard TRAINER can be used initially for day use and continue the soft TRAINER at night. This allows the Doctor to start the second phase earlier and still get good compliance and extending the life of the soft TRAINER.
The T4A™ can be used with the distal the ends cut off as an alternative for a T4K™ soft if the child is a heavy bruxer or chews through the T4K™ prematurely. It is a softer material than the T4K™ hard (red).
For malocclusion and soft tissue dysfunction use the TRAINER till the patient has lips together at rest and correction of swallowing pattern. This is usually more than 12 months.
10: In cases that the child's arches are considerably different from the shape of TRAINERs ideal arches (i.e. narrow maxilla) should I still use the TRAINER as my first treatment option?
Yes. If the child is between 6 and 8 years of age, this is the best treatment to start. The improvement in tongue position and keeping the lips together assists the growing child to improve and widen arch form. If there is a posterior cross bite, this is best corrected first with a transverse expansion appliance or the BENT WIRE System™ (BWS™). Older children (late mixed dentition) it is best to start with the TRAINER but also to do some simultaneous arch development with the BWS™ or other appliances.
Generally, if the patient can put the TRAINER in their mouth and keep their lips together for 5 minutes or more, the TRAINER System™ is the first choice for most cases of malocclusion . See manual for more details.
If the child cannot breathe through the nose and/or has a nasal obstruction, they need medical assistance first before commencing treatment. Extreme Class II and Class III cases may have a problem as well, physically fitting the TRAINER to their mouth. These cases are the only ones the TRAINER System™ cannot be readily used.
11: What is the indication that myofunctional bad habits have been corrected and the TRAINER treatment has been successful?
The most important part of the myofunctional correction is that the lips are together at rest. So when the child is sitting down and not talking the lips should be together. When the child swallows, there should be no perioral activity; i.e. no mentalis contraction. Once this occurs, treatment is finished.
12: After the two TRAINER phases, how can i retain any result achieved? Is the result stable or could the bad habits appear again and destroy the result?
Once the bad oral habits are corrected, they generally stay corrected, unless allergies reoccur. Since we swallow 2000 times a day, whatever habit is present will be constantly reinforced, just like any other training of the rest of the body. If correct lip seal and no perioral activity on the swallow are achieved, then the case will be stable.
13: My experience with removable appliances is not good. This is due to the poor compliance that children show. I am not sure that I could convince more young children to use these appliances like the TRAINER.
This is a common misconception, but the point is valid. Some children we find are really good and others do not persist with the programme.
If you would like to know more about how to improve patient compliance, please read Issue No.3 of the MRC Newsletter: 'Scientifically Speaking' by Dr. German O. Ramirez-Yañes.
14: I can understand how the TRAINERs design could help children with stopping their bad oral habits. However, not all the children with bad oral habits develop malocclusions and not all the malocclusions are linked to bad oral habits. This shows to me that muscles are just one of the factors. Why should I expect so much when dealing with one of the factors?
There are many references to the close association between myofunctional habits, facial growth and malocclusion. Just the references to mouth breathing and craniofacial growth are extensive enough to warrant more attention to the diagnosis of soft tissue dysfunction. (see research references). Angle wrote that his observations would indicate "almost EVERY" malocclusion has some soft tissue case. It is important to look at the patient and see the close association between the myofunctional bad habits, arch form and tooth position.
You may wish to attend a course run by Myofunctional Research to further educate you in what are the diagnostic signs that need to be treated. Also the Educational DVD by Dr. John Flutter is very useful. Contact your local MRC dealer for a copy.
Once recognised that the majority of children have this problem and this is driving the malocclusion, then the TRAINER programme becomes an essential in every Dental and Orthodontic practice. You must treat the muscles even when there are other factors involved.
15: There is no serious evidence, like clinical trials, demonstrating the benefits of TRAINERs.
Studies always come after good clinical results. There is a lot of research over the last 100 years that proves the influence of the soft tissues is far more significant on craniofacial growth and tooth position than genetic factors. Most doctors do not read or implement these findings in their treatment. Research clearly shows that the current practice of orthodontics is not consistently successful and the majority of cases relapse after some time. Also, research demonstrating that mouth breathing is a cause of poor facial growth, narrowed arches and malocclusion is well documented.
The TRAINER research is ongoing and studies are now being published like the Mondo study, and others (Serdar Usumez, Angle Orthodontist, 2004). Clinical cases showing the success of the TRAINER System™ are being published 12 years after its first clinical use.
It is important to understand that the inadequacies of measuring soft tissue dynamics and the changes brought about then by the TRAINER are difficult to measure. Analysing the secondary changes to the hard tissues with currently available techniques is all we have available. Arch form and dental alignment clearly improve in every clinical trial conducted.
16: What ensures that the TRAINER System™ is not a waste of time to the children and myself?
17: It should be ideal correcting some abnormalities in the early stages. This could make any future Orthodontic treatment easier and more successful. However, in case the TRAINER will not provide the expected result, the parents will not trust me for any future treatment. Simply, they will change Orthodontist. I want to know one by one the cases where the TRAINER shows predictable results.
The reverse is true. Many Orthodontists observe young children whose parents see the early signs of malocclusion. All too often nothing is done. Parents prefer to start some treatment at this stage. The TRAINER System™ is ideal for maintaining the contact with the patient, instead of saying "go away and come back when all the permanent teeth are in." Parents also will understand that you are treating the causes of the problem as well as straightening the teeth later. See TRAINER System™ video.
18: At what age can you start using the T4K™?
The best effect is at the eruption of the permanent anteriors. At this stage you not only have a growth spurt, but also the T4K™ assists the guidance of the new teeth into position. This is in addition to the treatment of myofunctional habits. Between 6 and 8 years is optimum.
With open bite and class III you can start earlier if the patient is co-operative. Cut off the distal end if all first molars are not present.
19: Can you use the T4K™ as a bruxism or TMJ APPLIANCE™ for children?
Yes. However, heavy bruxers can destroy the T4K™ soft easily, so using the T4A™ with the distal ends cut off is often better in these cases. All our appliances help with bruxism.
20: When should the child move to the hard T4K™?
6-8 months. Use the soft T4K™ to have maximum compliance, then once the T4K™ is staying in at night and the dental alignment is improved enough for the harder T4K™ to be fit the mouth without discomfort this can be changed. The harder T4K™ does put more force on the anterior teeth so the child needs to have reasonable alignment at this stage. Often it its best to phase in the harder T4K™ by using it through the day and the soft T4K™ while sleeping. Do this for the first month to ensure a smooth changeover.
21: If you need to try the TRAINER (T4K™) in a patient's mouth and decided to use, for example, the T4A™ instead, how you can sterilize/clean that appliance which has been in mouth?
Autoclave on the lowest temperature cycle for the soft TRAINERs/TMJ APPLIANCE™. The harder ones cold sterilization is better. Same with the T4F™ and T4U™.
22: Can the TRAINER (T4K™ or T4A™) be used if a patient has posterior cross bite? Or should the posterior cross bite be treated first?
23: When fitting the appliance and trimming is required, should scissors or some special bur be used?
Scissors are OK for the TRAINERs. A fine stone off bur is good to finish.
24: How should the TRAINER be cleaned? How often - daily/weekly?
Clean in running warm water each time the TRAINER is used. A toothbrush and toothpaste can be used if desired. Boiling of the silicone TRAINERs is possible but is not really necessary.
25: How does the T4K™ work if a patient has rotated cuspids? Can you rotate cuspids with appliance?
The T4K™ is not particularly good at aligning teeth in the permanent dentition. The T4A™ is higher in the cuspid area and will bring them in but will not de-rotate cuspids.
26: Are there a lot different sizes?(A common question from users Occluso-Guide® from Ortho-Tain).
Myofunctional Research Co. pioneered the use of computer-aided design (CAD) to make single sized appliances. This allows one single size to be the only required for each product. The size and thickness vary between particular appliances like T4K™/T4A™ and TMJ. This makes the system easier than previous appliances. The focus is on myofunctional correction so individual tooth slots are not needed.
27: Does it work like Occluso-Guide®?
No. The Occluso-Guide® is an eruption guidance appliance for the sole purpose of correcting dental alignment. It is also a very old system. It has a lot more bulk than the TRAINER System™ and no myofunctional training features. When in place it is difficult to obtain lip seal. The Occluso-Guide® does not address all muscle dysfunction and in fact has the ability to cause some facial lengthening due to its bulkiness.
28: There are no slots for teeth (typical Occluso-Guide® user question).
The TRAINER System™ is not for teeth but it is for the muscles . It is for the correction of soft tissue dysfunction. There is no need for the individual tooth slots. The tooth channels and labial bows give a similar effect as well as the improvement in the myofunctional habits. Removal of aberrant muscular forces and the light forces on the teeth align the dentition. The Occluso-Guide® works more like braces and has the same relapse problem when treatment finishes. The amount of daily use is also much higher at 4 hours per day. However it is better for de-rotating anterior teeth if this is all that is required.
29: Are these like oral screens (by Dr Hinz)?
Yes. The front part of the TRAINERs incorporate the design of the oral screen. This makes the child breathe through the nose. This is an important feature of the oral screen and the TRAINERs.
The TRAINER System™ has more features than the oral screen, particularly to re-train tongue position, function and lip bumpers discouraging overactive mentalis.
30: Can the TRAINER be used as a mouth guard?
No. They are not designed for protection and do not stay in during sporting activities. Myofunctional Research Co. has a range of mouthguards for this purpose. These are the world's most technically advanced mouthguard design. See web section on POWRGARD® mouthguards.
31: Is the TRAINER treatment painful?
No. Some sensitivity is experienced in the first few days, after this, there is usually no pain.
32: How much time should the TRAINER be in the mouth during the daytime?
A minimum use of one hour during the day, for conscious habit retraining of the tongue position, keeping the lips together and breathing through the nose. Then use while asleep at night to have sufficient overall time to change these habits.
33: What are the reasons of TRAINER splitting?
Chewing on the ends. This happens over time, which is normal wear. Usually after 6 months some splitting will occur with the soft TRAINER.
34: What is the difference between soft and hard TRAINER action?
The Soft TRAINER is for compliance and to adapt to any malocclusion. The Hard TRAINER is best for teeth alignment, but too hard to use at first. See T4K™ manual for more information.
35: Is it necessary to use both TRAINER (T4K™) soft and hard?
Yes. It is better to follow the 2-phase system. However there are times when the malocclusion is minor and use of only the hard T4K™ is OK. When there is only a myofunctional problem just the soft T4K™ can be used. The majority of cases require the 2-phase system.
36: Are there any statistics for the percentage of successful treatment cases with use of ONLY TRAINERs in comparison with treatment with any other appliances?
This varies so much with the selected group and the malocclusion. Generally the 6-8 year old patients will be the most likely to have complete resolution of the malocclusion with T4K™ system only. Still probably only about 50% at most without severe problems will require no other treatment. All others will get benefits of less complex treatment, better facial development, no extractions and better stability.
The main advantage of the TRAINER System™ is the correction of the soft tissues, which no other appliance system addresses.
37: What are the contraindications for the TRAINER treatment?
There are only a few. Generally if you have a non-motivated patient, or an extreme malocclusion where the child cannot hold the TRAINER in their mouth. Also complete nasal obstruction. See the manual for full information.
38: What adjustments can be applied to the TRAINERs and in which cases?
All trimming instructions are in the manual.