ABSTRACT: Evolutionary Medicine (EM), also known as Darwinian Medicine, is a new approach providing a useful framework for understanding modern systemic diseases. Evolutionary Oral Medicine, or Darwinian Dentistry is a branch of EM whose goals are to understand the evolutionary origins of oral disease and to use this understanding for diagnosis, prevention and treatment. Worldwide, dental caries and malocclusion (crooked/crowded teeth, impaired jaw/facial growth) are common oral diseases afflicting people of all ages. Surprisingly, within the pre-historic and fossil records, and in many present-day non-westernized cultures, malocclusion is barely detectable; in fact, there is little evidence to suggest that malocclusion appeared appreciably in humans until around the mid-17th century, and mostly in Europe. Dental caries has been plaguing mankind since the advent of agriculture and there is even fossil evidence of tooth decay as far back as 400,000 years ago in one A. Heidelbergensis skull. A sharp rise in caries prevalence, however, doesn't appear in humans until nearly 1,000 years ago with the introduction of sugarcane to the Western World, and only began to reach epidemic proportions in the late 19th/early 20th centuries. Susceptibility to dental caries, clearly a dietary-infectious disease caused by increased sugar consumption resulting in increased acid production by oral bacteria, is not likely influenced by genetic changes that might have occurred since the Agricultural Revolution some 10-15,000 years ago. While the cause of malocclusion is less clear, it is also not likely a result of recent genomic change. We will develop the hypothesis that malocclusion, like caries, results from a “mismatch” between current Western diets and the lifelong dietary regimes under which our teeth and masticatory mechanisms evolved. As modern orthodontic thinking is relatively uninformed by the new EM paradigm, the second part will focus on a novel approach to orthodontic diagnosis and treatment called Orthotropics.

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