Dr. Tim Wheeler guides dentistry's orthodontics department in finding new solutions to old problems in straightening teeth

Parents concerned about having their children's teeth properly straightened-and the dentists who provide the treatment - have for many decades asked when is the best time to start orthodontic treatment? Should you start putting retention braces on the teeth when the child is only 8 or 9 or wait until all adult teeth are in?

Timothy Wheeler, D.M.D., Ph.D., chairman of the orthodontics department at the University of Florida College of Dentistry, has found the answer through a dozen years of federally funded clinical studies that have brought him international recognition.

"I was very surprised, and so was everyone working with me, to discover it doesn't make any difference whether you start orthodontic treatment early in childhood or wait until the teenage years," Wheeler said. "Through the research we've conducted since 1990 in more than 300 children with the most common form of buckteeth, we have found that regardless of which of these time frames you choose, you can achieve the same good results in terms of the way the teeth fit together and in the amount of change of the jaws."

Even before the final data appears in upcoming journal articles, dentists worldwide are hearing about Wheeler's research and asking for more information. Consequently, he has stepped up his professional travel agenda to meet requests for presentations to dental groups around the country and abroad. At the same time, he and his colleagues are continuing follow-up studies on the patients to better evaluate long-term stability of their realigned teeth. Grants from the National Institute for Dental and Craniofacial Research continue to fund the project.

The studies also have put UF's faculty dental clinic on the national radar screen as a referral site for patients with complicated orthodontic problems and/or allergies to conventional orthodontic appliances. Wheeler, whose academic background in both immunology and dentistry aid his ability to treat difficult problems, cares for 50 or more patients in clinic every week, and his colleague Cal Dolce, D.D.S., Ph.D., sees an equally large number. This doesn't include the patients participating in clinical trials.

In addition to his almost-completed studies of malocclusion treatment in children, Wheeler is in the third year of an industry-supported clinical study of "invisible" clear plastic aligners, which are increasing in popularity because of their cosmetic advantage over conventional metal brackets. The study involves 100 patients who are being evaluated closely to determine the effectiveness of certain new attachments on tooth movement with the new aligners, as well as the effects on tooth roots, gum tissues and the temporomandibular joint.

"One of the nice findings so far is that we've noted that many of the patients have experienced improved periodontal health during treatment," Wheeler said. "The apparent reason is that these clear plastic braces are easy to remove when you want to clean your teeth, so the patient doesn't have as many "plaque traps" in the mouth." He noted that the braces, produced by Align Technology Inc., also can be removed while eating.

Clinical studies make up only a small part of the orthodontics department's broad spectrum of research aimed at improving care for patients of all ages. Faculty scientists garnered $1.9 million in research grants in 2001, making orthodontics a key factor in the College of Dentistry's seventh-place ranking among 55 U.S. dental schools in grants from the National Institute for Dental and Craniofacial Research.

Current basic science projects include investigations of the basic biological processes involved in tooth movement and bone remodeling, as well as the origins and progression of chronic facial and jaw pain. "Orthodontics has advanced on the basis of using biomechanical forces to move teeth the way we want to move them so that they will fit together well and function properly," Wheeler said. "Usually, we can do a good job of inducing tooth movement by exerting physical pressures on the teeth with braces, but the future control of tooth movement will be even better by controlling the biologic process of tooth movement."

"Now, with support from the National Institute for Dental Research, we're investigating oral tissues at the cellular level to better define the process of bone turnover and tooth movement," Wheeler said. "We have Dr. Dolce and Dr. Shannon Holiday doing this research to see if it might be possible to control tooth movement with the use of chemical agents that would turn off the production of substances that cause bone tissue to break down."

Wheeler said his department's expanded focus on facial pain includes both old and new programs that integrate the talents of researchers in neuroscience and neurology, oncology, oral biology, general surgery and maxillofacial surgery, molecular biology, biochemistry, orthodontics, orthopedics and rheumatology.

Collaborative studies are carried out largely through two UF centers that are housed in orthodontics and work synergistically:

The Parker E. Mahan Facial Pain Center, founded in 1984 under the guidance of Distinguished Service Professor Parker Mahan, D.D.S., Ph.D. The center provides a multidisciplinary team of health-care specialists who treat a variety of painful conditions affecting the head and neck. Patients with complicated pain conditions come from all over the United States. Now directed by Henry Gremillion, D.D.S., the center is expanding studies of muscle involvement in facial pain.

UF's Comprehensive Center for Pain Research, founded in 2001 under the direction of Robert Yezierski, Ph.D., as a partnership between the dental college and UF's McKnight Brain institute. The center involves more than 30 scientists from various disciplines campuswide, who collaborate in studies of various forms of chronic pain.

A new faculty member, arriving in July, will bring additional expertise in facial pain.

Outside research and patient care, Wheeler said a chunk of his time goes to overseeing a "very competitive residency training program in orthodontics," involving the enrollment of nine residents each year from a field of about 150 applicants. He also is assistant dean for advanced and graduate education at the college, where a total of 75 students now are enrolled.

Wheeler is increasingly tapped for international leadership in his profession. His current roles include president-elect for the Craniofacial Biology Section of the International Association for Dental Research; director of the North Atlantic Section of the Edward H. Angle Society of Orthodontics; councilor of the Orthodontic Section of the American Dental Educators Association; and consultant to the Commission on Dental Accreditation.

Workdays typically stretch from 8 a.m. to 9 p.m., but Wheeler said he enjoys the specialty he chose and likes the academic life where every day brings different challenges.

In managing a rapidly growing department, Wheeler said he derives the greatest pride from seeing how all of our clinical and basic researchers, all of the clinicians, support staff, residents and fellows interact with each other well and appreciate what each brings to the department. We have had a lot of success, and in my view, it is due to this factor: the way our people work together.

Outside the workplace, Wheeler enjoys spending time with his wife Janet, a private practitioner of orthodontics in Gainesville, and their four children, including 5 -year-old Lynna and 8 -year-old Morgan, whose current top interest is in horses. The older children are 22 -year-old Jennifer, who soon will graduate from Flagler College in St. Augustine, and 24 -year-old son Tim Jr., an independent journalist currently working in Bogota, Columbia.