Epigenetic Orthodontics in Adults by Dr. G. Dave Singh & Dr. James A Krumholtz

I recently borrowed and read my DNA Appliance provider’s copy of Epigenetic Orthodontics in Adults… and kind of wish I hadn’t. I think I understand now why Dr Singh hasn’t made it more widely available: In short, the book is poorly written, and having been published in 2008 is already quite outdated.

Dr Singh has claimed that DNA appliances signal adult stem cells in the periodontal ligament using mechano-transduction to cause bone growth via epigenetics. I was hoping this book would present a logical argument backed with scientific evidence to support this hypothesis.

Unfortunately, it does not.

In addition, it suffers badly from a combination of:

• Poor writing
• Weak structure
• Illogical arguments
• Unsupported claims
• Irrational conclusions
• Lack of in-text citations
• Irrelevant figures
• Misleading diagrams
• Excessive use of jargon
• Overly complex sentence structures
• Meaningless fluff: “It is known that…” “It is frequently noted that…”
• Needless repetition: “palatal expansion (induced maxillary morphogenesis)”

If this were a university assignment I submitted, I’d be expecting a pretty poor mark.

Even after reading the chapter titled The Spatial Matrix Hypothesis, I’m not clear on how Dr Singh’s hypothesis differs significantly from Moss’s widely accepted functional matrix hypothesis. I did a quick Google search for “spatial matrix hypothesis” to see if Dr Singh’s theory had caught on, and it hasn’t: only 366 results, principally by or including himself, compared to 5,620 for Moss’s widely-accepted “functional matrix hypothesis”.

Blatantly flawed pictures like Figure 4.2 on P127 aren’t helping either:

The woman in the original photo in the upper right is clearly tilting her head to her right, and it’s largely this that causes the differences in the resulting chimeras. I had a go at correcting this:

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The asymmetry reduces significantly when her head tilt is adjusted for:

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There’s clearly still some facial asymmetry, but it’s nowhere near as bad as made out in the book. The fact that such an obvious error/misrepresentation can slip past the book’s editor betrays the fact that the book obviously had no editor. And it needs one, something bad.

Many of the conclusions made in the text simply aren’t supported by the argument that came before them either. The mere use of the word “Therefore,” to link between sentences does not make an argument logical. Here’s one of the worst examples:

“Interestingly, in orthodontic extraction techniques, it is often mentioned that teeth will be judiciously extracted to ‘create’ space. According to current theories in quantum physics, however, space is only created at the edge of the universe. Therefore, an orthodontic extraction does not create any space but merely provides space for the remaining teeth to displace (i.e. occupy) once the extraction site has been vacated.” (P153)

Quantum cosmology is simply not relevant in an orthodontics textbook. One of the principles of quantum mechanics is that the physics of very tiny things is vastly different to the physics of very large things. The size of the universe is many orders of magnitude greater than the size of teeth so invoking quantum physics undermines the book’s argument; plus it’s the sort of thing new-age gurus spinning quantum consciousnonsense try to pull on their naive readers.

I would prefer to read more relevant facts, like that tooth extraction leads to bone loss making the underlying cause of malocclusion worse, potentially reducing the size of the patient’s compromised airway even further. Unfortunately, the book is littered with paragraphs like this where conclusions don’t flow logically from the preceding premise and have no supporting citation. This is frustrating because in many cases I agree with the conclusion, but I wanted to see a logical evidence-based argument that supported it.

Things get more interesting towards the end of the book, and some of the results produced by the protocol it describes in the patient case studies are visually impressive. However, I was stunned to discover that while the DNA appliance is mentioned and pictured in the book, the protocol it describes doesn’t use it.

The protocol described in the book uses a combination of a Schwarz palate expander, self-ligating braces, and elastics from the inside edge of the lower teeth to the outside edge of the upper teeth to upright lower teeth which have tipped inwards to compensate for an underdeveloped maxilla.

The case studies demonstrate that a simple Schwarz expander can do “epigenetic” slow palate expansion (induced maxillary morphogenesis!) in adults. Perhaps an expensive DNA Appliance is overkill then. Maybe those magic springs on the front really do make a difference but there’s no evidence to support this presented in this book. Also, I suspect that bonded braces and elastics are likely to be much more effective at uprighting teeth on the mandible than my lower mRNA expander is. Time will tell, but this has made me nervous about whether my appliance will really address my mandibular insufficiency sufficiently to cure my obstructive sleep apnea without having to result to double jaw surgery.

To be fair, this book was published in 2008 when the DNA Appliance was still quite new: the original patent was only granted in that year too. It’s understandable that there wouldn’t have been many case studies to back up Dr Singh’s theory that the DNA Appliance uses mechano-transduction to signal receptors within the periodontium that trigger bone remodelling via epigenetics. However, citing the existing science on bone remodelling would have helped support the theory. Fundamentals of Biomechanics by Ozkaya et al was first published in 1991 so an edition was available in 2008 when Drs Singh and Krumholtz were writing this book yet they don’t cite it, nor anything comparable.

The final chapter Results of Adult Osteogenetic Orthodontics does not include any evidence that the epigenetic orthodontic protocol cures obstructive sleep apnea, nor even resulted in a reduction in any patient’s AHI. There’s no mention of follow-up sleep studies or AHI’s so it appears that they just didn’t measure this.

Epigenetic orthodontics being an effective treatment for Obstructive Sleep Apnea is not listed in the conclusions at the end of the book.

Finally, the book is difficult and expensive to purchase, and the internet domain cited for the publisher SMILE Foundation is currently for sale.

Perhaps now I can understand why Dr Theodore Belfor bad-mouthed this book; although maybe that’s also because he isn’t credited on the acknowledgements page despite being a co-inventor of the DNA appliance with Dr Singh.

On the positive side, the book does cover:

• Slow palate expansion in adults works
• Treating the root cause of malocclusion
• Avoiding mouth breathing
• Impact of orthodontic treatment on the airway
• Myofunctional therapy

Also, some of the case study result photos showing jaw expansion are really impressive given the results were produced non-surgically… They just weren’t produced with a DNA Appliance.

I don’t know if this book represents the usual standard of orthodontic textbooks because it’s the only one I’ve read, but it does seem typical of the level of discourse I’ve seen between orthodontists online, and among their followers.

While writing this post I stumbled upon this lacklustre review of the book Jaws: The Story of A Hidden Epidemic, which I cited in my article on What Really Causes Obstructive Sleep Apnea. Drs Proffit & Ackerman’s review fails to cite a single publication refuting the claims made nor the scientific evidence cited in that book. Instead, they engage in the sort of rhetorical one-upmanship typical of debates in the comment threads of orthodontic blogs and YouTube videos. The fact that orthodontist Dr Kevin O’Brien described the review as “A brilliant ‘take down’…”, despite its lack of any supporting evidence, doesn’t bode well for the orthodontic community’s claim of being an evidence-based discipline.

In the comments below the review I see Dr Dave Singh (co-author of Epigenetic Orthodontics in Adults and co-inventor of the DNA Appliance I’m hoping will cure my obstructive sleep apnea), Dr Sandra Kahn (inventor The Bow facemask I’m using with it in the hope of getting greater forward growth) and Roger Price (breathing consultant I saw in the hope of further improving my health) all bickering with each other over what are to me relatively minor points. I’m doing a lot of hoping here based on their wealth of clinical experience without a lot of scientific evidence. It would be nice if everyone was playing on the same team while that evidence comes in. No wonder people like me and dangblog are skeptical.

All of this doesn’t necessarily mean that my Vivos mRNA Appliance won’t work for me, just that this book was a disappointment when it came to providing supporting evidence for Dr Singh’s claims about epigenetic orthodontics and the DNA Appliance. Perhaps that merely reflects the level of public discourse that goes on in the orthodontic community.

There are some great orthodontists out there leading the charge to transform the discipline, but they are currently in the minority. It’s time orthodontists who practise extraction/retraction started listening to long-term feedback from their clinical patients, acknowledged the damage outdated practices have caused in the past, stopped perpetuating them in the future and lifted their game in the scientific community. This book could make a valuable contribution to this endeavour if it was higher quality, so I hope Dr Singh publishes an update which rectifies the obvious flaws I’ve described above.