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Scoliosis in children and teenagers: could dental problems be the cause?

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During a patient’s first medical visit, the parents were concerned after taking their twelve-year-old daughter to the dentist. During the dental check-up, a problem of malocclusion and swallowing emerged. The dentist suggested that this combination of factors might have contributed to the development of scoliosis.
But is it really possible that a problem in the mouth could lead to scoliosis? Let’s clear things up.

Malocclusion is a problem of how the teeth fit together: the upper and lower teeth do not align properly. It may mean crooked or crowded teeth or a jaw that protrudes or recedes. Sometimes it can affect chewing, the posture of the neck, or cause discomfort such as cervical pain.

Scoliosis. The majority of scoliosis cases in young people (around 80%) are defined as idiopathic, meaning without an identifiable cause. Despite decades of research, we still do not have a clear understanding of its origin.
What we do know, however, is that idiopathic scoliosis tends to appear in individuals with a genetic predisposition: it is often found to run in families. It is not a condition caused by bad habits, poor posture, injuries, or factors such as malocclusion.

It is important to stress this point to avoid attributing unnecessary blame or choosing therapeutic approaches that are not supported by scientific evidence.

At present, according to the data available, we know that malocclusion can influence the posture of the head and neck. In fact, malocclusion may cause the head to tilt forward or backwards and, in some cases, may even be associated with increased cervical pain. Nevertheless, while malocclusion can directly affect head position, it does not seem to have any effect on the risk of developing scoliosis, nor on the potential worsening of spinal curvature.

The same is true the other way around: a worsening scoliosis does not seem to influence malocclusion.

In patients with scoliosis, slight asymmetries are often seen in other parts of the body, including the face: this also involves the teeth and jaw. Studies have shown that people with scoliosis are about twice as likely to present with malocclusion (Class II or crossbite).
The correlation between malocclusion and scoliosis, although without a proven causal link and still not fully understood, highlights the importance of a multidisciplinary approach. Teamwork is essential in these cases.

How? Dentists and orthodontists may be among the first to detect possible postural changes that require attention. In the same way, the rehabilitation team managing conservative treatment for scoliosis can recommend a preventive orthodontic consultation.

Working as a team makes it possible to:

• monitor both conditions during growth;
• optimise the timing and therapeutic pathways;
• avoid false expectations: not assuming that one treatment will automatically affect the other, whether positively or negatively.

How should treatment proceed?
There are no contraindications to treating scoliosis and malocclusion at the same time: both orthodontic treatment and rehabilitation based on specific exercises can run in parallel, even when a brace is being worn, without fears of negative interference. No orthodontic treatment worsens scoliosis, and vice versa.

As far as we know today, no orthodontic treatment can worsen or improve scoliosis, just as no scoliosis treatment can worsen or improve malocclusion.

Dental treatment is essential for oral health and aesthetics, while scoliosis treatment is crucial for managing and controlling the curve over time.

Even though each specialist works on a different area, and there is no definite cause-and-effect relationship between malocclusion and scoliosis, working as part of a team made up of medical specialists, physiotherapists, and psychologists ensures higher-quality care.
This allows families to receive clear, timely, and reliable answers and enables professionals to share expertise in order to optimise timing and offer a clear, comprehensive, and highly personalised care pathway, tailored to each child.

Back to school with a brace

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Going back to school is not always easy for adolescents with scoliosis who wear a brace.—-> with scoliosis, and who need to wear a brace
Some are able to talk about it and share their difficulties, while others keep everything inside — and often they are the ones who suffer the most.

Of course, not all of our adolescent patients will struggle, but we need to pay particular attention to those who are changing schools: moving from primary to middle school, from middle to high school, or even simply to a new class.

Facing new teachers, new subjects, and above all new classmates is always an exciting challenge, full of curiosity… but no one knows  is aware about the brace!

It is natural, when entering a new environment, to want to give our best and show the best version of ourselves. It’s natural to want to give your best and show the best version of yourself when entering a new environment.But then comes the question: what about the brace?

“What will they think of me?”
“I can’t let them see me with the brace! Please, Mom, Dad, just the first few days without it and then I promise I’ll wear it again!”
“I’ll take it off at school and I promise I’ll put it back on afterward. In the afternoon I just do homework, I never go out anyway!”

Who could blame them? And above all, when this happens, how can we really help? It’s difficult — for the teenagers, for you the parents, and also for us professionals who care for them.

How to deal with it

If the prescribed “brace-free” hours allow it , it’s fine to leave the brace at home in the very first days. But if the free hours are limited (at least 3–4 in addition to school hours), then after a short initial adjustment it becomes important to face the class with the brace on. No adolescent will spend every afternoon locked indoors: there will be sports, birthdays, parties, get-togethers…

If, on the other hand, many hours of therapy are still required and free time is very limited, then it’s better to tackle the challenge right away. We know it’s tough, but once the “wall” is broken down, the path becomes much easier.

What we usually tell our patients

First of all, we remind them that they cannot live in seclusion. They have done nothing wrong to deserve a sort of “house arrest”: wearing the brace is already challenging enough, they shouldn’t also give up their social life.

Then we propose a kind of exercise: imagine it isn’t you with the brace, but one of your classmates. This classmate, afraid of being judged, chooses not to follow the treatment properly and doesn’t wear the brace the required hours. Nobody will ever know, because this classmate never had the courage to show up with the brace. But meanwhile, their spine is getting worse.

And then we ask: what would you want for this classmate? That they trusted you and asked for help, or that they considered you incapable of supporting them — so much so that they gave up their own health?

As always, when we put ourselves in someone else’s shoes, the answer becomes clear.

A special wish

Good luck to all the adolescents who are about to return to school wearing a brace — and good luck also to all their parents!

ISICO Online Master 2026: let’s start

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Registrations for the 11th edition of the ISICO Online Master “Principles and Practice of Scoliosis Conservative Treatment – PPSCT” will open on October 15th, 2025. The course will start in January 2026.

This training program has now become a well-established part of ISICO’s educational offer, alongside the Italian Master, the SEAS courses, and the course on Sforzesco brace construction.

A truly international training program

Since its launch in 2016, the Master has welcomed 334 participants from 66 different countries:

  • 126 European
  • 96 Asian
  • 74 from the Americas
  • 18 from Africa
  • 20 from Oceania

A genuine global learning event, giving professionals from different cultures the chance to meet, exchange ideas, and grow together.

“The organisation is very didactic, starting with the basic knowledge and evaluation techniques, evolving to more specific subjects, and finally, when the students already have some knowledge framework, focusing on the suggestion and discussion of clinical cases. The live lecture was a perfect conclusion for the discussion groups. Most of the recorded lectures had great quality content and very good visual presentation.”
— Leonardo, Brazil

Course structure

The Master is delivered entirely online and self-administered through a dedicated learning platform. It is organized into 16 modules lasting two or three weeks each, including:

  • three recorded lectures of about 45 minutes;
  • scientific papers for in-depth study;
  • a final assignment for each module;
  • discussion sessions for interaction and exchange among participants.

The experience of a global community

One of the most valued aspects is the opportunity to connect with colleagues from all over the world: a unique chance to discover treatment practices, expectations, and experiences in different countries.

“From this course, I hope to gain in-depth knowledge of scoliosis, learn from renowned experts, and connect with specialists from all over the world to understand how they manage it in their own countries.”
— Joy Igudia-Akumabor, Nigeria

Early bird registration is available until December 8th, 2025.

From therapy to dance: ISICO patients perform at AIFI

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Two young ISICO patients made the recent AIFI event truly special, held on 13 September in Pavia, in the Aula Magna of ICS Maugeri.

The meeting, “Connected Bodies: the Physiotherapy of the Future between Human Relationships, Identity and Digital Innovation”, featured not only contributions from professionals and lecturers, but also the performance of Chiara and Silvia, dancers, who brought to the stage the fruits of their passion and determination.

Chiara first came to ISICO three years ago, already a professional dancer, performing for the Ukrainian Academy in Milan. “During my fitness-for-competition assessment, they noticed an anomaly in my back,” recalls Chiara. “From there, together with my parents, we looked for a specialist centre and arrived at ISICO, where I was diagnosed with adolescent idiopathic scoliosis, with a thoracic curve of about 40 degrees. The journey was not easy, especially at the beginning when I had to wear the brace for 23 hours a day while doing SEAS exercises daily. I had to find a balance between treatment and passion, without giving up my four hours of lessons each day.”

Chiara wore a “Sforzesco Open Pelvis” brace, designed to leave the hips completely free and allow greater mobility of the hip joints. This meant she was able to take part in her daily classes wearing the brace, using her hour of freedom for modern dance lessons, as the brace was too restrictive for this discipline.

Today, as she nears skeletal maturity, Chiara wears her brace for only 14 hours a day and has achieved a stability that allows her to look to the future with a healthy, functional back—ready to support her on stage as in life.

Silvia, on the other hand, completed her treatment some time ago but still does maintenance exercises and, of course, continues to dance!

We thank them both for this moving moment, which reminded us that, alongside innovation and professional perspectives, physiotherapy is above all about caring for people—their talents and their dreams.

Scientific free Tools for Clinical Practice: ISYQOL and IS-GROWTH

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With a demanding condition such as scoliosis, it is essential to build a relationship of trust with the patient and guide them through a treatment path that allows for a good quality of life.

For this reason, at ISICO we have developed two free tools available online.

ISYQOL – Italian Spine Youth Quality of Life

Originally created as a questionnaire in which our patients could describe the impact of brace treatment on their daily life, ISYQOL has evolved into a digital model consisting of 10 questions, allowing anyone to evaluate their own well-being in the presence of scoliosis, kyphosis, or other spinal disorders.

Its strength lies in being based on the concerns expressed directly by patients, making it particularly suitable for adolescents with idiopathic scoliosis who have not undergone surgery. Over the years, it has been translated and validated into several languages ( English, Chinese, Polish, Korean, Arabic, Persian, French, Spanish, Greek, and Turkish) and is now recognised as one of the most reliable questionnaires for measuring quality of life in brace wearers.

Measure your ISYQOL online

IS-GROWTH – Idiopathic Scoliosis Graphical Representation Of Worsening Trend of Natural History

IS-GROWTH is a visual model that shows the expected evolution of a scoliosis curve in each patient during growth (pre-pubertal, pubertal, and post-pubertal phases).

Developed from more than 3,000 radiographs of nearly 2,000 untreated patients, and validated on more than 500 additional cases, the model reaches 95% accuracy after correcting for radiographic measurement error. The graph displays a range of expected progression (between minimum and maximum scenarios), into which the patient’s real clinical data are gradually added over time.

This tool has proven extremely useful in clearly communicating the natural history of scoliosis and in supporting long-term treatment decisions during growth.

Access it here – IS-GROWTH online

Watch the video alongside to see how to use them in practice.

ISYQOL video: https://youtu.be/bFLuaTNrsA4  
Is-Growth video: https://youtu.be/0dt_38tTiCQ

Artificial intelligence and rehabilitation medicine: the revolution has begun

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Artificial intelligence (AI) is already a concrete reality at ISICO, where it is actively used in daily clinical practice, as a research tool in studies published in scientific journals, and as part of the European PREPARE project, in which our institute is a partner. AI is fundamentally transforming the work of rehabilitation professionals, opening up new possibilities in early diagnosis, patient monitoring, treatment personalisation, and therapeutic education.

The potential of AI is immense. In a context where the volume of clinical, instrumental and functional data is growing exponentially, intelligent algorithms enable the rapid and efficient analysis of this information, turning it into tangible support for clinical decision-making.

“We are only at the beginning of a transformation that will become increasingly far-reaching” – explains Francesco Negrini, physiatrist at ISICO and Associate Professor at the University of Insubria – “Just as the first computers revolutionised our work in the 1980s, AI is set to become an indispensable tool in the daily work of clinicians”.

In recent years, research on AI in the medical field has experienced a dramatic acceleration. Between 2022 and 2023 alone, funding in this sector increased eightfold, reaching $25 billion. Applications range from imaging diagnostics and outcome prediction to motor rehabilitation support and functional assessment.

ISICO has contributed to this evolution. One example is a 2023 study on the use of AI to improve scoliosis screening. The team developed an algorithm capable of combining multiple variables (ATR, age, sex, BMI, family history, prominence height, curve location) to detect the condition early — going beyond the limitations of traditional tools like the scoliometer.

But AI’s applications in rehabilitation go far beyond scoliosis. Through data collection from wearable sensors, surface electromyography, and robotic devices, it is now possible to analyse patients’ movements in real time, support the monitoring of gait and speech disorders, classify levels of motor dysfunction, and adapt treatment plans in a truly personalised way.

At ISICO, AI is also used to enhance the patient experience through projects such as ISAIA (ISICO AI Assistant) — a virtual assistant designed to improve communication between clinicians and patients, answer frequently asked questions, and support the management of emails and FAQs. This approach helps maintain an informative and educational dialogue beyond the consultation, responding to patients’ ongoing concerns during treatment.

Another promising frontier is the integration of AI into telerehabilitation. Smartwatches and dedicated apps now make it possible to monitor home exercises with precision, optimising therapeutic pathways remotely. One recent study, for instance, demonstrated that AI could automatically recognise post-stroke rehabilitation exercises with over 99% accuracy.

Of course, with opportunity comes challenge. The handling of sensitive data, the lack of transparency in algorithms (often still “black boxes”), the risk of over-reliance on automated solutions, and the quality of training data are all critical issues requiring careful oversight and regulation. A responsible adoption of AI must be grounded in strong clinical supervision, ongoing human oversight, and the scientific quality of the sources used.

In conclusion, artificial intelligence will not replace clinicians — it will support them, helping them become more accurate, more efficient, and better equipped to offer truly personalised care.
At ISICO, that revolution has already begun.

When the Brace Goes Travelling: Tips and Hints to Enjoy Your Holidays

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At some point during treatment, every young person wearing a brace finds themselves asking the same questions:

“What should I do with my brace while I’m on holiday or a school trip? Should I bring it with me or can I leave it at home? I’ve always worn it consistently and followed my prescribed hours – surely missing a few days won’t hurt…”

Let’s start by repeating a golden rule:
Brace treatment should be followed with the same precision and consistency throughout the year, whether you’re at home or away for a few days or even several weeks.

Why? There are several reasons.
First of all, taking the brace off for many more hours than usual — or not wearing it at all for a few days — could undo the hard-earned results achieved in the previous months.

Secondly, your back relies on the daily brace break to gradually learn how to support itself actively. Suddenly being left unsupported for much longer than usual could lead to back pain, and those long-awaited holiday days might not be quite so enjoyable after all.

The next questions usually are:
“Alright, I’ll take it with me… but where do I put it? Can I take it on the plane?”

The best way to bring your brace with you is also the simplest: wear it.

There are several advantages to this. First of all, it saves space — no need to worry about which suitcase or bag to squeeze it into, and there’s also less risk of damaging it in transit.

What’s more, wearing your brace during the journey means you won’t lose valuable treatment hours, and once you arrive at your destination, you can take it off and be freer to enjoy your time.

A handy tip if you’re travelling by train or plane: try to sit in an aisle seat, so you can get up from time to time, stretch your legs and change position.

Feeling reassured, the final question inevitably pops up — and often with the hope that there’s no comeback:
“But what if the metal detector goes off? How do I explain what I’m wearing? Surely they’ll make me take the brace off…”

No need to worry. Simply ask your doctor in advance for a certificate explaining the importance of wearing the brace during travel, so you can show it if necessary to the security staff during checks.

Safe and smooth travels to all of you! 

Scoliosis Through the Centuries: From Galen to Modern Rehabilitation

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Scoliosis, now recognised as a complex three-dimensional deformity of the spine, is a condition known since antiquity.
The first documented accounts date back to the 5th century BCE, when Hippocrates, the father of medicine, described various spinal anomalies — including scoliosis — and attempted rudimentary therapeutic approaches involving traction, manual manipulations, and mechanical devices such as the so-called Hippocratic ladder.

In the 2nd century CE, Galen coined the term scoliosis, from the Greek skolios, meaning “curved” or “twisted.” Galen continued the classification of spinal deformities, introducing the concepts of kyphosis and lordosis, and investigated their possible causes, suggesting links to trauma, systemic illnesses, and congenital abnormalities. For centuries, however, scoliosis was considered solely as a structural orthopaedic condition to be “straightened”, with no development of preventive strategies or targeted rehabilitation treatments.

It was only in the Middle Ages that the first rudimentary corrective tools began to appear. In the 7th century CE, references were made to wooden sticks used to support the back, and by 1575, in France, the first metal corrective brace had been designed. The 19th century marked another step forward with French surgeon Jules René Guérin, who was the first to attempt surgical correction of the scoliotic curve — though with limited success.

A true turning point occurred in 1921, when Katharina Schroth, a German scoliosis patient, developed a rehabilitation method based on postural and breathing exercises. Her insight — using three-dimensional breathing to address spinal rotation and trunk asymmetry — opened the way for the concept that scoliosis could be managed conservatively, not solely through surgery or bracing.

In the 1950s, American surgeon Paul Harrington developed a system of metal rods (the Harrington rod) for surgical implantation in young patients, aimed at halting the curve’s progression. While revolutionary for its time, this method often resulted in rigidity and reduced functionality. To refine surgical treatment, French specialists Cotrel and Dubousset introduced a dual-rod system in the 1980s, offering a more stable and harmonious correction of spinal deformities.

Today, the management of scoliosis has evolved into a multidisciplinary and individualised approach. While no definitive cure exists, effective intervention is possible to prevent progression and minimise the condition’s impact on quality of life. Early diagnosis, physiotherapeutic scoliosis-specific exercises (PSSE)  such as SEAS – Scientific Exercise Approach to Scoliosis-, targeted use of braces, and, in severe cases, surgical treatment, are the primary therapeutic strategies.

The journey of medicine over the past two millennia reveals how knowledge and awareness of scoliosis have evolved, transforming what was once a poorly understood condition into a field of ongoing scientific advancement, where research, prevention, and rehabilitation play a central role.

Annasofie, a Champion in a Brace: Determination on Ice

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Annasofie began skating at the age of just four, inspired by admiration for her older sister. From her very first steps on the ice, she showed remarkable balance and a deep passion for figure skating — a passion she now pursues with six training sessions a week, both on and off the rink. Her commitment recently earned her a silver medal at the Italian Championships, despite being diagnosed with congenital scoliosis at the age of eleven.

Figure skating demands great dedication and intense training — qualities Annasofie has demonstrated from a very young age. She tackles each day with courage, following a tailored physiotherapy programme that includes specific exercises and wearing the Sforzesco brace (ISICO) full-time, except during on-ice training.

This brace, designed to fit seamlessly into daily life, allows her to move freely, study, and continue training without compromise.

Her perseverance has paid off: after two years of consistent effort, she has seen improvement not only in her posture but also in her control and balance on the ice. This year has brought great success for Annasofie — she placed second in the final of the Italian Gold Division Championship, confirming her status as a rising star in figure skating.

Congratulations to our young patient — a truly exceptional athlete!

Below is a video where we can admire Annasofie engaged in a competition on ice:

https://youtu.be/eajmaaxDLws

From Natural History to IS-GROWTH: ISICO’s New Tool to Predict and Communicate the Evolution of Idiopathic Scoliosis

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Understanding the natural history of idiopathic scoliosis—how the condition evolves in the absence of treatment— is the starting point for any effective care pathway. But to truly guide clinical practice, this knowledge must be translated into reliable predictions and into tools that facilitate communication with patients and their families. 

This is precisely the aim behind IS-GROWTH, the focus of our study entitled “The Idiopathic Scoliosis Graphical Representation Of Worsening Trend of Natural History (IS-GROWTH) communication tool provides a reliable prediction useful to manage long-term treatment during growth”, which was awarded the 2025 SOSORT Award just a few weeks ago during the international conference held in Dubrovnik.

Today, IS-GROWTH is freely available to everyone through its dedicated website.  

Step One: Mapping Natural History through a Meta-Analysis

Until just a few years ago, the natural history of idiopathic scoliosis was described in a fragmented and inconsistent way. To address this, ISICO conducted a meta-analysis, published in 2018 (Di Felice et al., Am J Phys Med Rehabil), that reviewed 13 studies. This work clearly showed the lack of solid and coherent data, making it difficult to guide long-term treatment decisions.

To bridge this gap, ISICO launched a large-scale research project involving thousands of untreated patients. The goal was to build reliable prediction models based on real-world, untreated progression data.

Step Two: From International Collaboration to a Clinical Model

The next milestone was a study we published in 2023 in collaboration with Dr. Eric Parent from the University of Alberta (Canada).
Titled “Prediction of future curve angle using prior radiographs in previously untreated idiopathic scoliosis: natural history from age 6 to after the end of growth”, this research aimed to predict curve progression based solely on X-rays taken before the start of any treatment.

The study won the 2022 SOSORT Award, confirming the feasibility of predictive modelling. However, while statistically robust, the model’s limitation was that it only allowed for short-term projections.

The recently awarded study builds directly on that work, transforming a retrospective analysis into a dynamic, visual, customizable tool for use in everyday clinical practice.

Step Three: IS-GROWTH

IS-GROWTH (Idiopathic Scoliosis Graphical Representation Of Worsening Trend of natural History) is a visual model that illustrates the expected progression of a scoliosis curve in each patient, segmented across the different growth phases (pre-pubertal, pubertal, post-pubertal).

Developed using 3,184 radiographs from 1,818 untreated patients, it was later validated on another 552 cases, achieving 95% accuracy after adjusting for radiographic measurement error. The resulting graph displays a range of expected progression (between minimum and maximum scenarios), into which the patient’s real-time clinical data is gradually added.

A Tool to Understand, Decide, and Communicate

“We initially focused on building a scientifically solid foundation, based on rigorous data,” explains Professor Stefano Negrini, first author of the study and Scientific Director of ISICO.
“But we soon realized that wasn’t enough. We needed a tool that could support everyday clinical communication. In idiopathic scoliosis, the best outcome is often not improvement, but simply avoiding progression.
This is a hard concept to convey without something that clearly shows the natural course of the curve in the absence of treatment.
That’s why we developed IS-GROWTH—a model built using alternative methods, specifically designed to be shared with patients. From the beginning, we’ve clarified that it offers a plausible projection, not an absolute prediction.”

IS-GROWTH was designed to:

  • help clinicians understand the expected evolution of the curve;
  • motivate patients—especially adolescents—by showing how even stabilization can be considered a success;
  • visually demonstrate the impact of treatment over time, incorporating new data at every follow-up.

The model has proven especially useful in clinical follow-up: 79% of doctors in ISICO use it to motivate patients, and 84% consider it valuable for monitoring progression and interpreting outcomes