Incisor crowding has traditionally been attributed to discrepancies in either tooth-jaw size or interarch tooth-size ratios. Such concepts have led orthodontists to develop mixed and permanent dentition space and interarch tooth-size analyses to assist in the diagnosis of crowded dentitions. Treatment plans have emphasized the removal of 4 premolars in an attempt to stabilize the dentition. Although individuals with large teeth may tend to have more incisor crowding, several factors other than tooth size may contribute to incisor crowding, for example, altered resting or functional activity in the facial and masticatory muscles. Thus, changes in occlusion, incisor crowding-spacing, lower anterior face height, and mandibular and maxillary retrognathism or prognathism have all been induced in primates through the application of a single chronically acting, environmental impact, such as either altered tongue posture or oral respiration.1-4 In addition, similar changes have been shown in human beings that were partially reversible after removal of the environmental impact.5,6 Thus, adverse neuromuscular changes, such as chronic mouth open breathing, have been associated with narrowing of both arches and lingual inclination of the incisor teeth and crowded dentitions.1,7-10 These dentoalveolar and skeletal changes were partially or fully reversible without orthodontic therapy after removal of the chronic input8,10 It follows that judicious orthodontic expansion procedures might be warranted to assist recovery in such cases after removal of the neuromuscular insult. We are indebted to the University of Washington for their documentation of late developmental crowding up to age 40 in orthodontically untreated as well as treated individuals. Study of untreated individuals at the University of Toronto shows that this phenomenon continues to at least age 70. Such crowding seen during the teen and adult years cannot be called tooth-jaw size discrepancy and must be neuromuscular in nature. Strong evidence supports the view that many of the crowdings we see during the mixed dentition are also neuromuscular or developmental. In a previous study9 of the relationship between mandibular incisor crowding and nasal mucosal swelling, cephalometric and dental cast variables from 30 male and 20 female children (8 to 13 years old) with chronic nasal mucosal swelling were compared with matched controls. These controls were orthodontically untreated and had no history of airway obstruction. The nasal mucosal swelling was confirmed with active posterior rhinomanometry and a headout volume-displacement plethysmograph. The subjects with nasal mucosal swelling had significantly (P < .001) more mandibular incisor crowding aDepartment of Orthodontics, University of Toronto. Reprint requests to: Donald G. Woodside, CM, DDS, MSc(D), PhD(hc), Department of Orthodontics, University of Orthodontics, 124 Edward Street, Toronto, Ontario, Canada M5G 1G6. Copyright © 2000 by the American Association of Orthodontists. 0889-5406/2000/$12.00 + 0 8/1/106117 doi.10.1067/mod.2000.106117 The significance of late developmental crowding to early treatment planning for incisor crowding