Discussion of Small Jaws as Cause of Obstructive Sleep Apnea

socknitster · Post by **socknitster** » Sat Jul 24, 2010 9:46 am

chunkyfrog wrote: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)

Chunkyfrog,

I never had any teeth removed, but if my childhood dentist had his way I would have. My dentist recommended that I have orthodontia done and my parents were exceedingly poor. They looked at my fairly straight looking teeth and said that was ridiculous and I never even had a consult. Maybe that is lucky.

BUT, I still can't wear ANY full face mask. The irony pisses me off to no end! I have even heard a prominent doctor in the field of sleep apnea speak (on doctor radio, a Sirius satelite channel) and he made the comment, as though it were commonly known fact, that small jaws are a dominant factor in the development of OSA--YET not one manufacturer addresses this facial type in the development of full face masks!

Rooster, I have never heard the phrase watermelon grin, but when I think of the wide smiles of native peoples eating native foods--like Africans, like Native Americans, ANY aboriginal people eating tough, chewy foods that are more natural and less refined, I think of the gorgeous teeth and gorgeous smiles they have that are truly wide and relaxed like a big slice of watermelon. So, while it might have been used as a derogatory term in the past, it seems fitting, really and I hope no one will be torked by you using the term. We love watermelon at our house and it brings lots of smiles to our faces when we eat it, especially from a big slice (outside, of course, so you can spit the seeds!). Watermelon is one of the great fruits brought from Africa and adopted by Americans.

I'm still looking for good articles for adults. The typical widening system used for kids can't be used for adults and maybe shouldn't be used for kids either. I think this is a relatively new way to look at orthodontia. I'm guessing it will be a leap of faith for anyone deciding to try it, but I'll keep looking. I've always hated my weak chin and my profile, though I think I look fine straight on. The pics on the homeoblock website of the older woman and how her jaw grew--if that is REAL, wow that would probably be a cure for me and make me look a whole lot better.

I think the fact that I was active in theater and song in high school and college, keeping my throat muscles very well used, kept it under control somewhat then. As soon as I started a real job and typical adult life, that is when my previously minor sleep issues suddenly became huge and I spiraled slowly over the last 15 years until I got to this point.

Jen

asleep@thewheel · Post by **asleep@thewheel** » Sat Jul 24, 2010 9:58 am

amen to all of that socks. as far as I know. It is all about the jaw from the profile perspective. Makes me really start to consider the MMA with Dr. Kasey Li.

socknitster · Post by **socknitster** » Sat Jul 24, 2010 10:29 am

Back three years ago, I did a lot of research into oral appliances and there was one in particular that I was interested in, but ultimately never bought. It is called the nosebreathe and it is made by an orthodontist in Honolulu. This doctor's website contains information about widening the jaw in the same way we are discussing here. It talks about mouth breathing being bad developmentally for children and adults and how a wider jaw improves this. He talks about how he uses orthodontics to fix that in both children and adults. At the time I was very interested but couldn't find ANYTHING else on the internet about this kind of orthodontia.

http://nosebreathe.com/mouthbreathing.html
That is a link where he talks about mouthbreathing. Interestingly, he recommends reading Weston Price who was someone who first brought up this idea of modern processed foods leading to facial deformaties that cause health problems. Price is a guru in the natural foods/raw food community, I think. I have never delved very far into that community, but may one day.

Anyway, this orthodontist lists lots of published papers and other materials for research regarding these anatomical things. Some of them are quite old, but may be useful nonetheless.

http://nosebreathe.com/editorial.html

Dr. Sue makes some important points on this editorial about sleep disordered breathing. See link above.

http://nosebreathe.com/orthodontics.html

Here he talks about what he calls "non-extraction orthodontics." Using appliances rather than braces to expand the jaw in adults and children.

If you click on his links, there may be much more to explore there.

Three years ago, I contacted him regarding using the nosebreathe with cpap. He was very helpful and replied to my questions personally. If I had been in Honolulu, I would have been very interested in going for a consult. As it is, I am now quite excited to look for an orthodontist in my area who may do similar work, now that I am more familiar with the concept and how it might apply to me.

socknitster · Post by **socknitster** » Sat Jul 24, 2010 10:33 am

asleep@thewheel wrote:amen to all of that socks. as far as I know. It is all about the jaw from the profile perspective. Makes me really start to consider the MMA with Dr. Kasey Li.

I'd rather wear a retainer for 3 years than go thru the agony of that surgery with its long recovery time. I have chronic fatigue syndrome, I can't handle that kind of stress anymore. Three years ago, I really thought I would eventually do that surgery--once I was done with childbearing etc. But since then I have developed cfs. The thought of doing that surgery now makes my blood run cold. It is, however a CURE and I've been told I'm an excellent candidate. I wonder though, if the same thing can be accomplished by a good orthodontist without surgery at all!

socknitster · Post by **socknitster** » Sat Jul 24, 2010 11:24 am

http://www.smilepage.com/faq.htm

This webpage has a faq about "functional jaw orthopedics" which I believe to be, again, the same thing we are talking about here. There seems to be a variety of names for this jaw expansion we are talking about. The commonality seems to be using retainers rather than braces and the force on the teeth is the opposite of traditional orthodontia. Rather than "in and up" they force is placed "out and down" to force jaw expansion.

Rather than extracting teeth and making the teeth conform to the too-small jaw, the jaw is expanded to give the teeth the room they need. It makes a lot of sense to me.

roster · Post by **roster** » Sat Jul 24, 2010 11:28 am

Dr. Sue fitted me with one of his original nosebreathe appliances.

99.9% of its life is in the drawer.

If I want to strictly nose breathe at night, I can put a short narrow strip of tape vertically across my lips. This will allow a small amount of air to leak through my lips, but a small leak is of no concern because I still use a FFM.

Here is a thread on nosebreathing -> viewtopic.php?f=1&t=52653&st=0&sk=t&sd=a&hilit=religion

socknitster · Post by **socknitster** » Sat Jul 24, 2010 12:57 pm

When I type "functional jaw orthopedics" into pubmed, I get Belfore's study (the creator of Homeoblock). Abstract follows.

Int J Orthod Milwaukee. 2009 Summer;20(2):35-7.

The dentist's role in facial anti-aging.
Belfor TR.

OrthoSmile, Inc., USA.

Abstract
Facial aging is a dynamic process involving the aging of soft tissue and bony structures. The shape, size, and volume of the bones of the face have all been shown to change. The cosmetic community has focused on soft tissue changes, particularly changes in the skin and loss of fat volume. However, the bony components of the face are also important for overall facial 3D contour. "The bones of the face retain the capacity for remodeling at any age." Dentofacial orthopedics is the area of dentistry concerned with the supervision, guidance, and correction of the growing and mature orofacial structures. This includes conditions that require movement of the teeth or correction of malrelationships and malformations of related structures by the adjustment of relationships between and among teeth and facial bones by the application of forces or the stimulation and redirection of functional forces within the craniofacial complex. The use of intraoral appliances for this treatment is customary. Since we now recognize that the bony midface undergoes a process of bony resorption and volume loss with increasing age it should be of interest to the dental and cosmetic surgery community that we can show an increase in midface volume and significant bony remodeling with the use of a functional orthopedic orthodontic appliance.

PMID: 19739500 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/pubmed/11799699 An interesting abstract about breastfeeding and functional jaw orthopedics.

http://www.apneasupport.org/about15670.html
That is a thread where someone discusses their sleep apnea with Dr. Belfor and how he begins to help her.

http://www.ncbi.nlm.nih.gov/pubmed/15641449Another study about homeoblock.

http://www.ncbi.nlm.nih.gov/pubmed/20397512
This is an abstract about another type of appliance called the Flores Twin Block. But I couldn't find any other online information about it--not even what it looks like.

http://www.annals.org/content/127/8_Par ... type=HWCIT
This url leads you to a study of how oral measurments can predict OSA.

ANNOYINGLY, I cannot get the American Association for Functional Orthodontics webpage to open. I have been finding links to it all over the web, but it won't open for me. The url is:
http://www.AAFO.org

OK, gotta go do something else for a while.

socknitster · Post by **socknitster** » Sat Jul 24, 2010 1:12 pm

Janknitz wrote: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.

I wonder if the Herbst appliance is possible to be used in adults?

socknitster · Post by **socknitster** » Sat Jul 24, 2010 1:15 pm

The European Journal of Orthodontics Advance Access originally published online on April 27, 2006
© The Author 2006. Published by Oxford University Press on behalf of the European Orthodontics Society. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Herbst/multibracket appliance treatment of Class II division 1 malocclusions in early and late adulthood. A prospective cephalometric study of consecutively treated subjects
Sabine Ruf and Hans Pancherz
Department of Orthodontics, University of Giessen, Germany

Address for correspondence, Professor Dr Sabine Ruf, Poliklinik für Kieferorthopädie, Zentrum für Zahn-, Mund- und Kieferheilkunde, Schlangenzal 14, D-35392 Giessen, Germany, E-mail: sabine.ruf@dentist.med.uni-giessen.de

A prospective study of 23 consecutive adult Class II division 1 malocclusion subjects (19 female and 4 male) treated with the Herbst/multibracket (MB) appliance is presented. The skeletal, dental, and facial profile changes were evaluated in addition to the mechanism of Class II correction during the Herbst phase and the settling of the occlusion during the MB phase. The mean pre-treatment age of the subjects was 21.9 years (15.7–44.4 years). Lateral head films in habitual occlusion from before treatment (T1) and after the Herbst (T2) and MB (T3) phases were analysed using standard cephalometrics and the sagittal occlusion analysis. For the standard cephalometrics, normal growth standards were utilized as control parameters.

All patients were treated successfully to a Class I occlusal relationship with a normal overjet and overbite. The mandibular variables (SNB and SNPg) showed an angular increase (1.22 and 0.93 degrees, respectively) during T2–T1 followed by an angular reduction (0.40 and 0.23 degrees, respectively) during T3–T2. Compared with normal growth standards, all mandibular parameters were affected favourably by Herbst/MB treatment. Both the skeletal and soft tissue profile convexities were significantly reduced. Over the entire observation period (T3–T1), the largest amount of profile convexity reduction was seen for the soft tissue profile excluding the nose (mean 3.14 degrees). Class II correction was achieved by both skeletal and dental changes: overjet correction by 13 per cent skeletal and 87 per cent dental changes, and molar correction by 22 per cent skeletal and 78 per cent dental changes.

In conclusion, on a short-term basis, the Herbst/MB appliance combination was found to be a powerful tool for non-surgical, non-extraction, treatment of Class II division I subjects in early and late adulthood.

Apparantly in can.

socknitster · Post by **socknitster** » Sun Jul 25, 2010 2:33 pm

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.

Janknitz,

I have found 6 orthodontists within 1 hour of my location who do the Damon system, and most of them say on their websites that they use them on adults successfully as well as children. It seems like the Damon system only 'looks' like traditional braces. The forces on the teeth seem to be the outward force that is used in these other systems to make the mouth larger instead of smaller--exactly what we need. There are also a couple of Functional Jaw Orthodontists within an hour as well. It seems like the Damon system is more mainstream, and probably has more research done on it--I will be looking into publications on this system next. It seems that this, along with the Herbst appliance may be what I need, but I will need to schedule a few appointments for consults to see what the experts think about my case. Thank you so much for posting this information and I'm very glad to hear that it has helped your child. It is always wonderful to hear testimonials! You may want to speak with her orthodontist to see you you would benefit from treatment as well.

Jen

socknitster · Post by **socknitster** » Sun Jul 25, 2010 3:04 pm

Clin Orthod Res. 2001 Nov;4(4):228-34.

Treatment time, outcome, and patient satisfaction comparisons of Damon and conventional brackets.
Eberting JJ, Straja SR, Tuncay OC.

Temple University, School of Dentistry, Philadelphia, PA.

Abstract
Efficiency of treatment mechanics has been a major focus throughout the history of orthodontics. Self-ligating brackets were developed on the premise that elimination of ligature ties creates a friction-free environment and allows for better sliding mechanics. It is expected that the self-ligating bracket will reduce the treatment time. This study was designed to compare the effectiveness and efficiency of Damon self-ligating (SL) brackets to those brackets ligated with either steel ligatures or elastomeric 'O' rings. Not only treatment time and the number of appointments needed were addressed, but the quality of the treatment outcome was also assessed. American Board of Orthodontics (ABO) grading criteria for models and panoramic radiographs were employed. Additionally, a nine-question survey was sent to the 215-patients in this study (108 Damon, 107 conventionally-ligated) to elicit their perceptions of how their orthodontic treatment progressed and finished. The results showed that patients treated with Damon SL brackets had significantly lower treatment times, required significantly fewer appointments, and had significantly higher ABO scores than those treated with conventionally-ligated edgewise brackets. There were no significant differences in Damon or non-Damon ABO scores with respect to gender. Damon patients over the age of 21 had significantly higher ABO scores. Conversely, the non-Damon patients under the age of 21 had significantly higher ABO scores. For pre-treatment Angle classification, no significant differences were noted. Patient responses showed that Damon patients perceived their treatment time as being shorter than expected. It appears that faster orthodontic treatment can be better as measured by the ABO criteria.

PMID: 11683812 [PubMed - as supplied by publisher]

The Damon System of braces has been available for a long time and is associated with less pain and quicker tooth movement. They are also supposed to be smaller brackets and therefore less intrusive on the mouth. The cost is about the same or less than traditional braces due to fewer adjustments being necessary. This is a non-extraction method of braces. Rather than remove teeth and make the mouth smaller with braces, the aim is to accomodate the teeth Nature gave us.

http://www.davidjudyortho.com/damon.html

If you click on the link above and scroll down halfway you will see an animation of the difference between the two types of braces and the wider palate that results from the Damon system.

BlackSpinner · Post by **BlackSpinner** » Sun Jul 25, 2010 3:31 pm

socknitster wrote: http://www.ncbi.nlm.nih.gov/pubmed/11799699 An interesting abstract about breastfeeding and functional jaw orthopedics.

Well that sucks because I was breast fed, so was my youngest daughter and so was my granddaughter - but we all have narrow jaws.

Rooster - I will believe that stuff about native and black people when I see stats on OSA broken down by ethnic grouping. Yesterday I was at a life drawing class where the model was black - small receding chin and small full mouth - classical African look - you can see it on all African art work.

Nobody has eaten Paleolithic style for the last oh 5000 years. Except for maybe the Inuit and they lose their teeth young especially the women due to the food they eat.

Janknitz · Post by **Janknitz** » Sun Jul 25, 2010 6:53 pm

Thank you so much for posting this information and I'm very glad to hear that it has helped your child. It is always wonderful to hear testimonials! You may want to speak with her orthodontist to see you you would benefit from treatment as well.

LOL--We're too busy paying for my little one's orthodontia to think about it for me. And now the not so big one needs her wisdom teeth out, which is going to cost almost as much as the course of treatment with the Damon system cost for our little one--and the oral surgeon doesn't do payment plans We're trying to hold on to some savings for college which is looming for the not so big one--she's a senior this year. AWWWKKK!!!!!!!!!!!!!!!!

Anyway, I'm just grateful that we can do this for the little one. I noticed the studies you quote are still on fairly young adults in their 20’s. I wonder if there is an age limit as things must become more rigid as time goes on.

It was a truly interesting course of treatment. The wires are activated like springs--they pull outward, and warm beverages make them more active! My little one never complained once of pain, only that they felt "funny" the first week she got them and then for a day or so on her first wire change. She broke a couple of brackets along the way--very easily replaced, and flossing was a great challenge because she has fine motor control issues (because of the Noonan's Syndrome). But these were so much easier to deal with than the braces I went through with all those pokey wire ends sticking into my cheeks!

Before treatment her mouth was so crowded that teeth could not come down. On X-ray you could see teeth up by her nose! Once they opened everything up with this treatment, she lost many remaining baby teeth and the adult teeth are coming in beautiflly. I love looking at her smile!

socknitster · Post by **socknitster** » Sun Jul 25, 2010 7:45 pm

Janknitz,

Parenting is always such a sacrifice. Thanks for the additional information! I'm very excited about this. I have a list of orthodontists in the nearest big city that I am going to call tomorrow morning. After I make my initial decision about which one to go with (the initial assessments are free and I want to get more than one opinion before I dive in), I will take my 7 year old for an early assessment to see if we can prevent any of this from happening to him. I suspect, though, that he has more of Daddy's smile than Mommy's, thank goodness!

From everything I have read this weekend (hours and hours of research including reading PubMed abstracts) there doesn't seem to be any age limit on orthodontia. The only thing I read that gave me pause is that, depending on severity, some adults may need jaw surgery to accomplish their orthodontic goals. I hope I don't have to go that route. We will see what they say.

From what I can tell, this Damon technology is the way to go. It has been on the market for over a decade and has had lots of scientific studies on it. It is supposed to be less painful, which is a plus since I already have more than my share of pain with the chronic fatigue syndrome.

I've actually found two orthodontists in my area (an hour away) who do Damon braces and also offer functional appliance therapy. So, I may have more options if I go with one of them. They are the top two on my list. I hope they are taking new patients!

By the way, Janknitz, I'm curious about your screenname--are you a knitter? I'm a rabid knitter. Currently I'm experimenting with some crochet projects, but I always go back to knitting and socks are a personal favorite project (thus my screen name)!

roster · Post by **roster** » Sun Jul 25, 2010 8:08 pm

sockie,

Consider yourself quite young and continue to explore orthodontia aggressively. It has the potential to make a big difference in your life for decades to come.

Hopefully it will work for you without surgery. From what you have stated, I think there is a good chance.

Ciao.

Discussion of Small Jaws as Cause of Obstructive Sleep Apnea

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