A mix of international experience, ongoing education and innovative thinking has meant Dr John Flutter and his groundbreaking knowledge is in massive demand around the globe. Chris Sheedy spoke with the thought leader in between flights.
As he travelled to 66 countries since 1998 to run courses, give lectures and carry out volunteer dentistry work, Dr John Flutter noticed some alarming irregularities that ultimately changed the direction of his career. He quickly recognised the fact that in some of the world’s most underdeveloped nations—in Africa and the Pacific Islands, for instance—the children have noticeably straighter, whiter and stronger teeth than those in Australia, the USA and the UK. “I did voluntary dentistry work on a tiny island in the Pacific and the children there had lovely, straight teeth,” says Dr Flutter, who owns and manages John Flutter Dental in Brisbane’s Fortitude Valley, and also spends half of every month in Europe doing consulting and teaching work. “Why is this? It’s all about diet. The muscles we use to chew food are the muscles we use to close our mouths. But these days the food in developed nations such as Australia is soft and highly processed, so the chewing muscles are underdeveloped. As a result the kids walk around with their mouths hanging open. They breathe through their mouths and not their noses. This means the tongue hangs low in the mouth rather than staying firmly planted in the top of the mouth, where it belongs. Of course, this leads to a lack of development in the upper jaw, the associated nasal airway and crooked teeth.” And this is a recent problem, Dr Flutter says.
The issue of crooked teeth only really became widespread as diets changed and supermarkets offered simpler options for families. These offerings took away the necessity to chew—they were a lazier option. The chemicals within the processed foods also have their own uniquely negative effects, Dr Flutter explains. They typically cause an adrenalin response within the body, resulting in faster breathing. Combine the lack of muscular development around the jaw with increased breathing rates and you have a recipe for mouth breathing. The training for poor breathing habits in fact begins even earlier, Dr Flutter says. When children are increasingly bottle fed rather than breast fed, a vacuum is created within the bottle as the milk is drunk. This, in turn, means the baby learns to release the lip seal to let air into their own mouth and back into the bottle. “That’s where mouth breathing begins,” he says. “A mother’s breast does not create that vacuum effect so the child instead breathes through their nose as they feed. This is another reason children’s teeth in more advanced nations are worse than those in developing nations, where breastfeeding is more common.”
“Humans are the only mammals to breathe through their mouths when they’re breathing heavily. Look at a horse and jockey at the end of a horse race. The horse will have its nostrils flared, taking in as much air as it can. But the jockey will have his mouth agape as he sucks in air.” Considering his levels of knowledge in the field of tooth mechanics, one could be forgiven for thinking Dr Flutter is an orthodontist. But he is instead a dentist whose teachings have led to him sometimes rubbing up the wrong way against certain specialists in the orthodontic community. Dr Flutter’s views are best described as ‘holistic’, considering teeth as a part of the cranium and the entire body, rather than something that should be treated on their own. “Orthodontists see teeth that need to be moved, but I developed a different understanding,” he says. “I look at the cranium and see poor cranial development and the evidence for that poor development is the crooked teeth. Modern day orthodontic appliances are really good at moving teeth. Teeth can be incredibly well positioned by mechanics, but that is not addressing the skeletal or growth issue causing the problem. And if you’re removing teeth to make that alignment happen, you may be reducing the airway and making the problem even worse.” Born in England and educated in London, Dr Flutter worked in a general practice in the British capital for five years. The system encouraged general dentists to do orthodontics, and help from the specialists was freely given.
However, he became disillusioned with the National Health Service and its fee-for-service mentality. “It’s a very different system now and in fact is now a very good one,” he says, “but back then it discouraged quality. It meant that if you wanted to make a decent living then you had to work quickly.” In 1977, he sold his practice, retired from dentistry and bought a Land Rover, intending to drive around the world. His next career would expose itself to him as he travelled, he believed. And indeed it did, but it was back in dentistry again. Having spent two years driving and shipping to Australia, with a six-month stop-off in Singapore where he worked as he waited for his Australian visa, Dr Flutter landed Down Under suffering a severe shortage of cash and desperately in need of work. He sold his Land Rover, which had faithfully carried him over 160,000 kilometres through such territories as Nepal, Afghanistan and Iran, and began locum work in Melbourne. The medical system Dr Flutter discovered in Australia was one that inspired him to re-enter the world of dentistry. “It was a system in which the fee could match the service,” he explains. “It wasn’t all about how quickly you could get to your next patient. If you wanted to do quality work, that was encouraged and rewarded.” In 1980, Dr Flutter opened a practice in Gladstone, Queensland. The nearest orthodontist was over 140 kilometres away so he continued seeking orthodontic education to better serve the community in that field. After travelling to the USA and Europe to attend courses and be trained by some of the most respected minds in dentistry, Dr Flutter began doing quite a lot of work in the arena usually occupied by orthodontists.
But soon he realised a mismatch between the industry’s practices and the root causes of issues around alignment of teeth. “It’s important to note that perfectly aligned teeth are not always the best result for the particular patient,” Dr Flutter says. “The teeth should be in balance with the cranium. If there is a natural imbalance within the cranium then a healthy set of teeth, for the specific individual, should follow that imbalance.” Dr Flutter’s new and somewhat controversial theories led to his second retirement—he decided to teach what he had learnt rather than practise in a clinic. In 2002 he sold his Gladstone surgery and began teaching myofunctional orthodontics. The problem he discovered, though, was the fact that dentists couldn’t figure out how to remain profitable while operating in his more holistic fashion. A dental service that treated the root causes of the problem, poor cranial growth, rather than treating the result of the problem, crooked teeth, required a radically different facility to deliver the service. “I knew it could work,” Dr Flutter says, “but I knew the service could not be delivered well in a traditional dental or orthodontic practice that revolves around dental chairs in small rooms. The only way to prove it was possible was to set up a model and demonstrate that it could work. So I bought a building in Fortitude Valley and opened a surgery. I was convinced the system could work in the right facility and become a viable business.” Walk in to the wildly successful John Flutter Dental clinic today and you’ll discover a child-friendly environment, over half of which is a brightly coloured training area. Most children (and children make up the bulk of Dr Flutter’s clients right now—over 350 of them) on their first visit don’t even see the dental chair. If they do then it is for the purpose of going on a fun ride, not for any oral inspections or work. “We spend a lot of time talking to the children and their parents about the cause of crooked teeth and the health implications of poor cranial development. In Gladstone we built a tooth fairy’s cubby house where on their first visit the kids could stand up as we looked at their posture, face, jaw structure as well as their teeth. The children were relaxed and I began to appreciate that the tooth position was closely related to the cranial development of the child.” So how do you correct this cranial dystrophy that leads to tooth misalignment? Dr Flutter says it’s all about educating and treating the child while the cranium is still developing and growing. It is about helping the children to establish a lip seal and nasal breathing. It also involves the re-training of the tongue to rest in the top of the mouth, constantly exerting positive pressure on the teeth and bone structure around it. Breathing exercises, lip and tongue exercises and postural exercises all play a part in helping the child to improve the growth and development of the cranium which allows children to grow straighter teeth the natural way. In his Brisbane clinic Dr Flutter sees patients from as far away as Singapore and the Pacific Islands. Some fly in for personal visits and others attend their consultation and training sessions using technology such as Skype. “Through the use of webcams I can see changes taking place in lip function and in breathing patterns,” he says. “I am able to do exercises with the patients and train them in new techniques and see them once a month without the expense and inconvenience of monthly flights, etc.”
Now 65 years old, Dr Flutter plans to stop clinical work at age 70 but to continue his training and lecturing around the globe after that. Perhaps when he finally retires for the third time he’ll make it stick. Then again, maybe not.