ALF Presents a New Solution for an Old Problem—Malocclusion

Martin N. Gorman, DDS


Here’s something to chew on. Archaeologists have found that skulls collected from across the ages show that until relatively recently, everybody pretty much had perfectly aligned teeth. Generally, our ancient ancestors had fewer dental problems due to their environment and diet (no refined sugar!), although cavities and infected gums were not uncommon. But what’s really amazing is their uniform bites. 

Today, malocclusion affects one in five Americans. Yet as a profession, we’re still treating the problem like it’s 1999. Thousands of orthodontists and dentists treat millions of children and teens for crooked, misaligned teeth with a procedure that should be thrown on the scrap heap of dental history—extracting healthy teeth.

For too long, the misinformed idea that healthy teeth should be pulled to make room for other teeth has reigned free in the profession. Even worse, today we have the technology to make this procedure once and for all a relic of the past. Now, we just need to inform ourselves and put it into practice.

Why So Many Crooked Teeth?

The epidemic of modern-day malocclusion likely finds its roots in not one but several contributing factors to one overarching problem. Many of us no longer have a mouth big enough to fit our teeth. It’s not that we have too many teeth, but rather our jaw bones are too small to fit them all.

Why have our mouths grown smaller? Theories abound. Some say the nature of our modern-day diet is the chief culprit. Our soft, mushy fast food and packaged sweets are a far cry from the tough meat and fibrous fruits and vegetables that sustained our hunter-and-gatherer predecessors. Our jaws have grown weaker and smaller because large jaws with lots of teeth aren’t needed as much. 

Another theory holds that with the advent of the Industrial Age, women along with their men left the farms and headed to the cities to work in factories. Working mothers no longer had the time to nurse their children by breast milk for years on end, so they began nursing for a much shorter time and using bottles instead. How a baby nurses from a bottle is different from a breast. It’s much easier. Once again, critical muscles in the jaw were no longer needed, but this time it happened in the formative infant stage of growth. The result? A narrowing of the mouth cavity.

Still another theory posits that facial narrowing is a result of a vitamin deficiency in the modern-day diet, specifically vitamins A, D, and K2. Researchers have shown that in lab animals, deficiencies in these vitamins during pregnancy result in facial abnormality.

The Case for ALF

Regardless of the reasons for our malocclusion epidemic, the solution to mismatched teeth is the same—expand the jaw bone so there’s enough room for all of the healthy teeth to fit naturally. (Imagine, we had this backwards for all these years.)

The most effective means for expanding the jaw to achieve bite between the upper and lower front teeth and a healthy large arch is Advanced Lightweight Functionals (ALF). ALF is a cranial osteopathy-based orthodontic system that uses a custom appliance made of light, flexible wire.

The ALF device applies subtle forces to the bones, teeth, and gums that can resolve underlying causes of crowded, misaligned teeth and imbalanced facial aesthetics. Using gentle pressure that closely mimics the natural growth and development process, rather than more aggressive conventional therapies, ALF orthodontics can effectively widen and/or reposition the jaws according to the patient’s unique needs. 

Beyond facial aesthetics, ALF orthodontic devices offer a wide range of benefits: 

  • More comfortable and hygienic than many other orthodontic options
  • Versatile and customizable
  • Virtually undetectable wires
  • Improved tongue function and positioning, breathing, and swallowing
  • Encourages optimal facial and neurological development
  • Can be performed prior to Invisalign treatment

Good Candidates for ALF

A custom ALF appliance can benefit both children and adults with a variety of orthodontic, cranial, and neurological challenges. The natural, gentle force of ALF is well-tolerated and accepted by the body and can bring about significant changes in patients of all ages.

In young children (7 years old or younger), custom ALF appliances are typically used to guide proper facial growth and balance, as soon as a diagnosis is made. This type of treatment helps alleviate the severity of neurological, craniofacial, and orthodontic obstacles later in life. ALF devices can create adequate room for the tongue, which is a key component of proper breathing and facial development. 

For children between the ages of 7 and 11, ALF appliances can remodel suboptimal growth from earlier years and redirect proper development in the remaining years of active growth. Around the age of 15 and on, ALF can be used to correct orthodontic relapse and restore a more functional and beautiful smile.

For adults with certain neurological challenges, temporomandibular joint disorder, and other structural issues, an ALF device can provide an effective method for achieving improved balance, alignment, function, and aesthetics. ALF also can guide proper healing of craniofacial damage after a traumatic injury.

Treatment with an ALF Appliance

During my initial consultation with a patient considering ALF, I perform a detailed diagnostic exam and review of the patient’s medical history to help determine the nature of the orthodontic challenges. Based on the patient’s unique needs, I may choose to use ALF techniques to complete all or a part of the treatment plan. 

Using 3-D scans and impressions of the patient’s mouth, I can then customize the design for an ALF appliance. When it arrives from the lab, the device will be adjusted for an optimal fit, and the patient will be educated about wearing and removing it. As teeth and bones gently shift as a result of wearing the ALF, the appliance may be adjusted or replaced with subsequent designs to continue advancing toward the ultimate treatment objective. The final portion of treatment may include finishing touches with the Invisalign system.

For too long, we as a profession have sanctioned the extraction of healthy teeth in the misguided assumption that their removal had no other consequences. Now, we know better. Pulling otherwise healthy teeth results in an unnaturally small mouth cavity and a jaw misalignment that can cause a whole host of problems from sleep apnea to migraine headaches. It’s time for our profession to embrace a 21st century fix for this age-old problem.

Dr. Gorman is a highly trained practitioner with more than 40 years of experience in dentistry. He specializes in the treatment of temporomandibular joint dysfunction, sleep disorders, and epigenetic orthodontics. Dr. Gorman is a Diplomate of both the American Academy of Dental Sleep Medicine and American Sleep and Breathing Academy. He is a Fellow of the International College of Oral Implantology (2006) and a Fellow of the International Academy of Dental Facial Esthetics (1998). His office is an Accredited Facility for the American Academy of Dental Sleep Medicine. He is a certified provider for the ALF as well as the DNA appliance. Dr. Gorman has been an active member of the Lee Institute for Oral Bioesthetics and Function since 1995. Since 1999, he has completed more than 5,000 hours of continuing education in various disciplines of dentistry, including dental sleep medicine, dental implants, bioesthetic dentistry, orthodontics, and temporomandibular joint dysfunction. He can be contacted at

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