Discussion of Small Jaws as Cause of Obstructive Sleep Apnea

[roster]

Hobbling together some old posts and adding a new link at the bottom:

IMO, and some physicians opinion, the vast majority of obstructive sleep apnea cases are caused by an underdeveloped jaw which results in a narrow airway. The jaw may be narrow side-to-side or front-to-back. When the muscles in the tongue and soft palate relax during sleep, the narrow airway is blocked.

Symptoms of an underdeveloped jaw are crowded teeth possibly corrected by braces and extractions; wisdom teeth which had to be extracted; recessed chin; and a tongue which is scalloped on the sides where it is jammed against the teeth.

Why do we have underdeveloped jaws? It is the modern diet. In the old days, many foods required a lot of chewing in order to consume enough calories. During the developing years, the chewing put stress on the jaw skeletion which caused it to grow wide and deep. Today, with minimal chewing during the developing years, the jaw is left undersized.

Gaining weight, especially while eating well and exercising regularly, is often the result of untreated sleep apnea. It has been commonly believed that weight gain causes sleep apnea. I believe underdeveloped jaws cause sleep apnea and the damage to sleep and the hormone system causes weight gain. The weight gain can cause the apnea to worsen and worse apnea causes more weight gain - the so-called deadly circle.

Check the sides of your tongues for scalloping:

One past study showed that having tongue scalloping can positively predict the presence of apneas or hypopneas and oxygen desaturation in 89% of cases. Overall, having scalloping is about 70 sensitive in picking up obstructive sleep apnea.

See: http://doctorstevenpark.com/tongue-scal ... leep-apnea

and http://drkam.files.wordpress.com/2009/0 ... 0teeth.jpg

Orthodontists and dentists need to become the front line for lifetime prevention of sleep-disordered breathing. They can use palatal expanders in children to make jaws wider permanently. I just recently found out palatal expanders are also effective on adults but it takes up to three years of wearing them to get significant expansion.

I just saw this article this morning:

For patients with sleep apnea, or a temporary stopping of breathing, they usually have a high palate, narrow dental arch and an extreme overbite. We can put an orthopedic retainer to correct their overbite and expand the arch, so they can breathe better. When everything is out of alignment, their air is constricted, their nose is clogged. Even a little overbite, like a millimeter, can cause the trouble.

What does this have to do with a clogged nose?

If your dental arch is narrow, your nose is clogged. When you expand the upper arch, that expands the nasal floor, which will enable the patient to breathe better from their nose. We treat mouth breathing by improving the ability to breathe from the nose.

Full article: http://www.dailybreeze.com/ci_15579664

In the last quote, the dentist is talking about children but the photo in the article shows an adult patient. It was once believed that palatal expansion would not work in adults. However, it has been found it will work and the body will generate additional bone for the widening. It will take longer (up to three years) than in children.

[M.D.Hosehead]

body will generate additional bone for the widening. It will take longer (up to three years)

And then you can start to deal with the resulting malocclusion. This road is not for the faint of heart. If OSA is that severe and xpxp completely ineffective, I'd start to wonder whether tracheotomy might not be less painful, less risky, as well as quicker, cheaper, and more certain to work. If it were me, that is.

[socknitster]

FASCINATING, Rooster!

I'm going to print this stuff and take it to my dentist to talk about (just happen to have an appt coming in a couple weeks!). I do have an overbite and scalloped tongue and they have talked about doing the MMA/GA surgery on me. My most recent polysom results show that even at a pressure of 8 I had zero apnea/hypopneas---ZERO in a 6 1/2 hour study. This would indicate to me that my obstruction is now minimal--you might remember I had a tonsilectomy about 3 years ago, shortly after my diagnosis.

The comment by MDHosehead is valid--but my bite is extremely screwed up to begin with. I have one sideways molar--yep, grew in sideways. My mouth is incredibly small and I frequently bite my cheek or tongue--have all my life.

I had always read that palate expanders wouldn't work for adults but this is very exciting news indeed. I will gladly get braces, palate expanders, whatever--if I could have the potential of the multiple rewards of, a better bite, better smile, and elimination of sleep apnea. I don't care if I had to wear a retainer the rest of my life! I've seen retainers and they are incredibly small compaired to the TAP appliance I tried which was a complete disaster and a complete waste of my money--it was so large in my tiny mouth and so difficult to remove that I felt like I was suffocating.

I'm 38. I'm habituated to cpap, 100% compliant. But if there is another possiblity, I will explore it (and stay on my bipap until it is proven by a psg I can do otherwise).

[roster]

And then you can start to deal with the resulting malocclusion. This road is not for the faint of heart. If OSA is that severe and xpxp completely ineffective, I'd start to wonder whether tracheotomy might not be less painful, less risky, as well as quicker, cheaper, and more certain to work. If it were me, that is.

Yes. You might enjoy reading Dr. Mack Jones's book, Deadly Sleep, http://www.amazon.com/Deadly-Sleep-Your ... 341&sr=1-1.

In it he describes the devastating effects of SDB and goes into detail about his travails and inability to effectively treat his condition with CPAP. He now has a skin-lined tracheotomy and makes a convincing case that this is a good cure for "CPAP-resistant" cases and not too awfully inconvenient.

Note Dr. Jones was slim and fit at the time of the surgery. He says the surgery and trach may come with more problems in obese patients due to all the fatty folds in the neck among other problems.

About palatal expansion, I also wonder about creating troublesome malocclusion and can't imagine how it is prevented in adults.

[socknitster]

Rooster, or anyone else, you going to pursue this?

[roster]

I had always read that palate expanders wouldn't work for adults but this is very exciting news indeed. I will gladly get braces, palate expanders, whatever--if I could have the potential of the multiple rewards of, a better bite, better smile, and elimination of sleep apnea.

If you are willing to get braces, I am guessing they could expand upper and lower jaws and avoid malocclusion.

Would it not be wonderful to be cured of SDB?!!

[roster]

Rooster, or anyone else, you going to pursue this?

Have a look at this, http://www.facialdevelopment.com/.

Impressive sounding, but of course I don't know how well it works.

I did call the company and was referred to a dentist in my area who fits Homeoblock appliances. I emailed the dentist's office to ask about prices. They owe me a reply.

[socknitster]

I like how they show detail. I would put up with that in my mouth for sure. I don't give a flying crap if it makes my face look younger! I wonder if insurance will pay anything toward this? I'm guessing no.

I copied this all to a file, including the pics, that I will take with me to the orthodontist. I don't need this name brand appliance, but I'm sure there are similar items out there that could be less expensive. There are two excellent oral surgeons in my area. I think I will go for two opinions.

Jen

[SleepingUgly]

This is maxillary expansion (in children they sometimes do rapid maxillary expansion, meaning expanding it quickly in the initial phase). I think there's a time limit to doing this. Our skeletons change as we age, and become...err, more permanent? I haven't researched this in adults. I thought surgery was perhaps entailed.

[socknitster]

THat is what I thought too SU, but I have been researching this all day. There is a branch of orthodontics called "Functional Orthodontics" and that is the basis, I believe of the system mentioned above. This doctor says that the palate is still maleable to separate and move without surgery. I'm trying to find a functional orthodontist near me now. The nearest Homeoblock Orthodontis is in another state. But I believe there are funtional orthodontists within an hour from me who use what I believe may be similar appliances. I'm going to be calling around on Monday to try to find more information. If you saw how small my jaw/mouth/chin are, you would agree looking into this is a good idea.

I've been discussing palatatial expansion with my son's dentist (my son is almost 7) but he keeps putting me off like I'm being silly. I have heard of starting this by age 5.

Think about the big beautiful smiles you see in native people eating native foods and compare them in your mind to the typically narrow modern American face, many Americans, like me have almost non-existant chins and narrow smiles.

If I could have a chance of getting my mouth closer to what it was genetically intended to be, it will be worth the risk associated with it. If I'm willing to contemplate the MMA/GA surgery, then I have to try this first.

[SleepingUgly]

I have consulted an orthodontist about my son, who just turned 7, but we have to meet again. Let me know if you come across any good articles for adults.

[chunkyfrog]

I remember the very first thing my orthodontist said to me. "The other dentist shouldn't have removed my impacted 12-year molars; I could have made room for them." --And had it gone that way, the Quattro and the Liberty may have actually FIT me; or I may not even need CPAP. (insert expletive here)

[nobody]

Makes sense. I have a small jaw and very severe sleep apnea. Not really fat, just a little.

[Janknitz]

The Damon systemhttp://www.bernsteinbraces.com/braces-s ... ystem.aspx was used on my daughter who has Noonan's syndrome and all of the structural issues we're talking about.

This treatment was AWESOME! It was fast, painless, and she only needed adjustments every 2 months. It is very different from the medieval torture devices in the roof of the mouth. Her mouth looks gorgeous--though she still has two phases ahead to bring her jaw forward (http://www.bernsteinbraces.com/braces-s ... -rosa.aspx and fix any malocclusions. ($$$$ OY!)

Her orthodontist is South African trained and they are very big on development and growth (Gross generalization here, but American training tends to focus on "fixing problems" instead of fostering normal growth and development). He said that (for kids, at least) it's very important that the tongue be allowed to go to its natural position for normal palate development (pushing the teeth out and forward where they belong)--the palate widening devices in the roof of the mouth prevent that.

I don't know if these systems will work on adults, but it's worth asking about. I'm thrilled that she will have these options and hoping that they will prevent her from having OSA.

My mouth was worse than hers, and my state of the art 1970's orthodontics removed teeth and pushed the rest back to meet my receded jaw. I'm sure that didn't help me at all in terms of OSA. And with the missing teeth, my jaw grew even more narrow over time.

[roster]

Think about the big beautiful smiles you see in native people eating native foods and compare them in your mind to the typically narrow modern American face, many Americans, like me have almost non-existant chins and narrow smiles.

At the risk of "setting off" one or two forum members again, let me mention the phrase "watermelon-eating grin". This phrase has been used by some as an insult against certain darker-skinned people. The irony is that a "watermelon-eating grin" is indicative of a well-developed jaw and beautiful teeth and good health. I bet we don't have any members here who have watermelon-eating grins. And that is our problem!

Do Rick Barry and Bill Russell come to mind? https://www.youtube.com/watch?v=bb9Qfp_3Sfo

If CBS executives and Russell had been educated on jaw development, they would have recognized a compliment and Rick Barry would not have been fired.