READERS’ FORUM
Letters to the editor*
The curve of Spee
An article in the September issue was an excellent
presentation of the characteristics and development of the
curve of Spee (Marshall SD, Caspersen M, Hardinger RR,
Franciscus RG, Aquilino SA, Southard TE. Development
of the curve of Spee. Am J Orthod Dentofacial Orthop
2008;134:344-52). The authors accept that “Craniofacial
morphology is just one of the many factors influencing
its development.” Their broad inference is that it is largely
an inherited condition with little input from the environ-
ment; a viewpoint common within the orthodontic com-
munity.
A mild curve of Spee, as found in many animal species
and ancient humans, is of little concern to orthodontists,
but many are troubled by deeper curves that can be so
difficult to resolve. There was no mention of factors that
might be associated with an increase in this curve, other
than possible variations in eruption times.
Interestingly, the word “tongue” did not appear once in
the article. Whenever the curve of Spee is increased, the
margins of the tongue will be seen to overlay the lingual
cusps of the mandibular premolars, and the greater the
curve, the more likely it is to overlay both the lingual and
buccal cusps, often with scalloping. As a student many
years ago, I was taught that the tongue adapts to dental and
skeletal forms, but I know of no evidence to support this
view or to suggest that tongue posture is not the determin-
ing factor of arch form, either then or now.
For the specialty as a whole to ignore such an obvious
correlation is worrying. It is almost impossible to measure
tongue posture, but that does not mean we can ignore it; at
the very least, we should accept that it is equally likely that
any increase in the curve of Spee is due to lateral spread of
the tongue. This could explain many idiosyncratic varia-
tions in arch form and offer additional options for treat-
ment.
Orthodontics depends on logic as much as observation,
and we must not allow the present popularity of evidenced-
based orthodontics to blind us to obvious constant rela-
tionships. My own research strongly suggests that correct
occlusion highly depends on correct tongue posture, and,
as far as I am aware, this view has never been challenged
scientifically.1,2
John Mew
Heathfield, Sussex, United Kingdom
Am J Orthod Dentofacial Orthop 2009;135:3
0889-5406/$36.00
Copyright © 2009 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2008.10.009
*The viewpoints expressed are solely those of the author(s) and do not reflect
those of the editor(s), publisher(s), or Association.
REFERENCES
1. Mew JRC. The aetiology of malocclusion: can the tropic premise
assist our understanding. Br Dent J 1981;151:296-302.
2. Mew JRC. The postural basis of malocclusion: a philosophi-
cal overview. Am J Orthod Dentofacial Orthop 2004;126:
729-38.
Author’s response
We thank Dr Mew for his compliment and his thought-
ful letter regarding our article (Marshall SD, Caspersen M,
Hardinger RR, Franciscus RG, Aquilino SA, Southard TE.
Development of the curve of Spee. Am J Orthod Dentofa-
cial Orthop 2008;134:344-52). We agree that, in the
orthodontic community, many view the curve of Spee, or
other aspects of dentofacial form, as a product of inheri-
tance “with little input from the environment.” However,
we did not intend to assign a level of importance for any 1
factor, inherited or environmental, for the development of
the curve of Spee. Adding this thought to our literature
review would have made this point more clear. Our
sentence, “. . . craniofacial morphology is just 1 of many
factors influencing its development,” was written to reflect
what we found in the anthropologic and dental literature.
That is, most studies that contribute to our knowledge of
the reason for the curve of Spee are products of “hard-
tissue” measurement. Contributions from the other “many
factors,” including soft tissues, have not been well de-
scribed.
It was not possible for us to measure the influence of
the tongue in our retrospective longitudinal study. Our
omission of “tongue” in our article was not intended to
discount the role of muscle activity in the development of
dentofacial form. We agree that muscle activity and other
essential data, much of which is not easily measured, are
needed to fully understand the confluence of heredity and
environment that results in the curve of Spee. In this
regard, we find Dr Mew’s treatise on the postural basis of
malocclusion1 thought-provoking and a valuable contribu-
tion toward greater understanding of the biology of our
specialty.
Steve Marshall
Iowa City, Iowa
Am J Orthod Dentofacial Orthop 2009;135:3-4
0889-5406/$36.00
Copyright © 2009 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2008.11.009