o'rourke spreecast 11 9-15
TRANSCRIPT
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...