Should Medicine and Dentistry be in conversation?

Photos from this book by a Pediatric Allergist

Allergic Shiners due to Allergic Rhinitis

Open mouth posture leading to dental distortions; V-shaped, high vaulted palates.

Open mouth/ Facial tension

Bruxism (tooth grinding) may be classified as a major sleep disorder. Univ. of Miami School of Medicine ( pediatric allergy division) has ascertained a three-fold incidence of bruxism in allergic vs. nonallergic children. Over 50% of the children studied have previously had numerous attacks of secretory otitis media. Bruxism opens the orifice and normalizes pressure on both sides of the eardrum. During the daytime, talking and yawning accomplish this equalization.

Allergic Edema of Mucosal Membrane

Blockage of Eustachian Tube from Allergic Edema

MOUTH BREATHING AND ASTHMA

We speculate that asthmatics may have an increased tendency to switch to oral breathing, a factor that may contribute to the pathogenesis of their asthma.

Chest. 1999 Dec;116(6):1646-52. Route of breathing in patients with asthma. Kairaitis K, Garlick SR, Wheatley JR, Amis TC http://chestjournal.chestpubs.org/content/116/6/1646.full http://www.ncbi.nlm.nih.gov/pubmed/10593789

Announced 10/15/2014 -Mike Napoli to have jaw surgery for Obstructive Sleep Apnea

THESE%KIDS%ARE%SLEEPING%WITH%THEIR%MOUTHS%OPEN.%%NASAL%BREATHING%IS%OBSTRUCTED.%

THEY%ARE%MOUTH%BREATHERS.%%THE%TONGUE%IS%IN%THE%FLOOR%OF%THE%MOUTH%.%%THIS%WILL%

AFFECT%THEIR%FACIAL%DEVELOPMENT%AND%THE%POSITION%OF%THEIR%DEVELOPING%TEETH

It Can Cause Poor Facial Development, Compromised Airway, Exacerbate Asthma

Symptoms As Well As Crooked & Crowded Teeth!

• 1980 - 7 million with asthma

• 2013 - 26 million with asthma

• 2013 - 30 million adults with moderate sleep apnea

• 1965 - a French physician and his colleagues studied sleep issues

Parallels in breathing disorders

Randall Brown,MD Univ. of Mich.

Am J Respir Crit Care Med Vol 165

Latest research begins to connect the dots between breathing disorders...

“Association Between Asthma and Risk of Developing Obstructive Sleep Apnea”

...Asthma patients faced an almost 40% greater risk for sleep apnea than asthma-free participants.

JAMA. 2015, January, The Wisconsin Sleep Cohort Study

Are we doomed to be a society of Darth Vaders?

I think there has to be a better answer...

This dental arch has a long way to grow to develop as it was intended.

Neanderthal Man 100,000 yrs. ago Homo Sapiens 35,000 yrs. ago

Comparing nasal volume with different palate shapes. Imagine the red box is the nose...

Remember:The roof of the mouth is the floor of the nose/ with expansion of the palate

you get more air and better breathing.

The story of this gentleman that goes with the high palate in the previous slide...

- tonsils removed age 3- severe allergies all his life- crowded teeth leading to removal of 4 permanent teeth and braces- prostate cancer age 49- worsening heart disease- restless legs- many fractured teeth and crowns

Spinning instructor at the Mac- physically fit; no sleep issues identified prior to sleep testingAHI- 53

N.S. 8 y/o Medical history: was significant for allergies, anxiety, disruptive behavior disorder, developmental delay, bed wetting, snoring bruxing , sleep walking, and restless sleep. He was diagnosed with Obstructive Sleep Apnea and an AHI of 11. Following the sleep study he was referred for removal of tonsils and adenoids. His symptoms improved and his AHI came down to 4, but he was noted to snore and still have episodes when he stopped breathing. He was referred for maxillary expansion and orthotropic treatment. Dental history: gummy smile, narrow arch, deep bite, crowding and flat profile- showing maxillary and mandibular retrusion.

irway

reathing

irculationRemembering CPR, we need to circulate oxygen to the brain, or we can be brain dead in 4 minutes.

FOOD WATER AIR

The tongue is the only skeletal muscle with an origin and without an insertion. The palate is the point of

insertion.

THESE%KIDS%ARE%SLEEPING%WITH%THEIR%MOUTHS%OPEN.%%NASAL%BREATHING%IS%OBSTRUCTED.%

THEY%ARE%MOUTH%BREATHERS.%%THE%TONGUE%IS%IN%THE%FLOOR%OF%THE%MOUTH%.%%THIS%WILL%AFFECT%THEIR%FACIAL%DEVELOPMENT%AND%THE%POSITION%OF%THEIR%DEVELOPING%TEETH

THESE%KIDS%ARE%NOSE%BREATHERS,%SLEEPING%WITH%THEIR%M

OUTHS%

CLOSED.%%THEIR%TONGUE%IS%IN%THE%ROOF%OF%THE%MOUTH%FACILITATING%

NORMAL%GROW

TH%OF%THE%PALATE,%BROAD%DENTAL%ARCHES%STRAIGHT%

TEETH%AND%BEAUTIFUL%SMILES%

How early do problems start? Do you see problems in the faces of the children on the left?

What makes us suspect an airway issue in a child?

1. Recognize the signs ....

Look for strains or contractions in the

facial features.

Shiners or darkness under the eyes.

Neck ExtensionCrowded Teeth

Listen to your patient for symptoms

▷ snores

▷ difficulty breathing during

sleep▷ stops breathing during

sleep▷ teeth grinding

▷ sleep walking

▷wets bedRapid maxillary expansion in the treatment of nocturnal enuresis- Timms In the ten cases examined in this study, nocturnal enuresis ceased IN EVERY CASE within a few months of maxillary expansion.

Symptoms associated with Sleep Apnea in Adults

▷ Asthma

▷ Allergies

▷ GERD

▷ Heart Disease; Hypertension

▷ Depression

▷Stroke

▷Diabetes

▷ADHD

▷Restless Leg Syndrome

Sleep Health QuestionnaireCurrent Sleep Symptoms

Symptom Y N Symptom Y N

Difficulty breathing during sleep Morning headaches

Stops breathing during sleep Learning issues

Snores Resists going to bed

Restless sleep Teeth grinding

Sweating during sleep Wets the bed

Daytime sleepiness Gets out of bed at night

Nightmares Trouble getting up in the morning

Sleepwalking Falls asleep in school

Sleeptalking Naps after school

Screaming during sleep Behavioral issues – ADD/ADHD

Kicks legs during sleep/uncomfortable feeling in legs

Reports feeling unable to move when falling asleep

Name: Birthday:

What allergies does your child have?

Drugs: Environmental:

Does your child have asthma? Y N

What diagnosed health conditions does your child have?

What surgeries has your child had?

Physician’s name: Phone:

2. Remove obstacles preventing tongue to palate posture

What can you do??? Eliminate activities that interfere with the tongue

to palate posture.

Release tongue-ties as soon as possible

Avoid pacifier use

Discourage thumb-sucking in infancy

The infant must use muscles from the beginning to nurse. Continue that use of muscles in

transitional food choices...

Avoid pureed foods Give foods in natural form ( with handles) the baby can grip

∅

Transition to a normal cup by way of an inverted sippy cup to allow a normal swallow to occur.

∅www.maddak.com

WHAT CAN YOU DO? Book geared to teach nasal breathing

via the Buteyko Method

I think Dentistry can contribute meaningfully and non-surgically to the

solutions...

Karen O’Rourke DDSTransforming Smiles...

Transforming Lives...

We like to start treatment as early as...

years old!

Karen O’Rourke DDSTransforming Smiles...

Transforming Lives...

Treating abnormal growth at older ages is far more difficult and less likely to succeed than effective growth guidance in the young child.

Research compiled by Robert Ricketts DDS

A t P u b e r t yT h e F a c e I s

o f A d u l t P r o p o r t i o n

Too Late

A t A g e 5 T h e F a c e I s

o f A d u l t P r o p o r t i o n

Louisa

A t A g e 8T h e F a c e I s

o f A d u l t P r o p o r t i o n

Louisa

Patient with OSA…High Indicator line…Retrusive profile

Ideal Indicator line Normal profile

Biobloc Orthotropics®

Orthotropics- Greek for Growth Guidance

Adult Manifestation of Downward Growth

Expansion Phase

Better oxygenation 10 months later

• Facial Changes/ Relaxed Musculature

BEFORE 11/24/10

AFTER 3/16/2011

Before- lower teeth were outside upper teeth

Interceptive Treatment - age 4 1/2 : 4 months treatment

Biobloc Orthotropic Treatment

Before AfterGrow the jaw forward and allow the lips to

come together comfortably

Karen O’Rourke DDSTransforming Smiles...

Transforming Lives...

What are the potential pitfalls of Orthodontics?

Tale of two boys in my practice

Traditional Orthodontics

Biobloc Orthotropics

What did I ask of you?

•Recognize the problem

•Remove obstacles to nasal breathing - tonsils and adenoids and/or palatal expansion - a great non-surgical option

•Remove obstacles for tongue to palate posture, like pacifiers, thumbs

•Consider Orthotropics and early treatment; avoiding extraction of permanent teeth correcting Form

•Consider Buteyko Breathing, correcting Function

What’s so Great About Breathing Through My

Nose?

• Nasal Breathing is critical to proper oral /facial development and asthma management

Nasal Breathing

Leading Researcher in Pediatric Sleep Apnea Christian Guilleminault, MD, recently stated “

Elimination of oral breathing, i.e. restoration of nasal breathing during wake and sleep, may be

the only valid end point when treating Obstructive Sleep Apnea.

09/06/2014

Healthy Living Magazine 2015 - Is this the current state of children’s dental health?

I hope that I have helped you to look at your patients in a new light, and that together we can accomplish more

than either of us could alone...