Discussion of Small Jaws as Cause of Obstructive Sleep Apnea

Well, I went to the orthodontist today for my initial interview/exam and workup. I very thoroughly researched a ton of orthodontists and this guy was my first choice--primarily because he does continuing education each year, he does Damon system braces and non-extraction orthodontia as well as functional orthodontics. Well, he met and exceeded my expectations. I was pleased and decided to do the full work-up including 360 x-rays, full skull x-ray, molds taken of my mouth etc etc.

We discussed my situation at length. I told him that I had seen oral surgeons and ENT's who felt that they could see no other underlying structure abnormalities (now that my ginormous tonsils are gone) BESIDES my too large tongue/tiny mouth. I told him several solutions had been presented to me as options including radio frequency destruction of the base of the tongue, surgically removing part of my tongue (both of these are unacceptable and barbaric, in my opinion) as well as the MMA/GA surgery (breaking the jaw and moving it forward. I told him that I believed my dental conformation was the problem (overbite) and hoped that he would be abe to help me resolve that without any more invasive surgery. I also told him about my misadventure with the TAP appliance--how I couldn't use it at all because it was just too big for my mouth.

He examined and measured several things in my mouth and reiterated what several other dentists have told me in the past--my upper front teeth are tipped backwards, forcing my lower jaw back. My molars don't meet where they are supposed to. Both upper and lower jaws are more squared than oval shaped and too narrow at the front. He said he couldn't conjecture too much without looking at the 3D models he will be making, but he felt that if we did nothing else but move the upper front teeth into a more normal position, that alone might allow the jaw to naturally come forward into a more natural position and give my tongue (and consequently my airway) more room. He said he had seen that happen in some adult patients. But, while the braces are on there, it would be best to pull the teeth into a more oval shaped bite and align them (so that my molars actually meet where they are supposed to) which will give the tongue more room and possibly open the airway more. He said I might need rubber bands or possibly the herbst appliance eventually to try to coax my lower jaw forward, but he said we will take it step by step and re-evaluate as we go and make decisions about what to do next based on how things were going so far. He felt all of this will take probably 2+ years to accomplish.

He said I might be able to get about 80% there with braces and appliances alone (I have to say here that the fact that he didn't say, "oh, yeah, I can fix you no prob" was VERY reasuring to me--I wanted someone who would be honest and know his own limitations--I would be ECSTATIC with 80% improvement!). I would then have to decide if I still wanted to do the MMA/GA surgery or if I would be happy where I was at that degree of improvement. At any rate, as I had been told before, braces are a necessary precurser to the surgery--so I would be in a good place to make that decision at that point. I can't imagine myself ever seriously considering that surgery anymore, considering how sick I have been in the last year--I will be avoiding stress and any invasive procedure like the plague. He said he will be able to give me a better idea of what he can do after he reviews the 3D model of my mouth.

While he is not a dentist who specializes in sleep medicine, he seemed to understand the issue very well and wasn't at all uncomfortable with approaching this topic.

He said he would likely use traditional braces on my front teeth to torque those front teeth outward and the Damon type braces on the side and back to help those move outward, bringing upper and lower jaws into a more oval shape. He says using them in combination works quite well in his practice. I had read about some dentists using this combination approach online, so I wasn't surprised when he said this. He said that functional orthodontics would not work well in my case because my mouth is so small and the appliances would impinge even more on my tongue-room. That makes sense to me.

At any rate, I will be getting the cost breakdown and his recommended treatment plan in two weeks.

I never thought I would be so glad to get braces! I honestly can't wait. I'll post more after my next visit with him and his team.

That sounds excellent. I hope you become our poster girl for "Adult Cured by Orthodontia".

I will bookmark this thread and check it from time to time.

roster wrote: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

Rooster,
I have finally settled on the Mirage Liberty and know you are a big advocate and user of the similar type Hybrid mask, Though these are both Full Face masks I find that my mouth and throat have a real problem (beyond the norm due to a vocal cord dysfunction) with the slightest bit of nightly mouth breathing despite all attempts at humidification with my S9. The Papcap chinstrap works but I want to reduce the gear on my head and increase comfort, and find taping causes significant skin irritations so it really isn't a long term solution for me. I recently ordered the Dr. Sue Nosebreathe appliance you said you tried seeing it as the only "simple" or elegant solution left to me. Though you personally do well with a piece of tape for nose breathing, I wondered what your experience with the device you bought was. Did it reduce or eliminate your mouth breathing? I have an overbite and there is a lot of space in my small jawed mouth at the front teeth area between top and bottom (they don't match up) and if I can just prevent the air rushing when I relax and my mouth falls open I think I have a good chance at continuing on with cpap in an effective and somewhat comfortable manner. The extreme dryness is my last hurdle to therapy, and I'd love to hear what you think. I read all the enthusiastic DIY oral device posts from the past yet the polls show no one using them. Is this a dead subject?

If 100 people try one of Dr. Sue's mouthpieces and it works well for one of them, maybe it is worth it. I see no harm in experimenting with these unconventional "longshot" devices as adjuncts to CPAP - as long as you stay within your budget.

It did nothing for me and currently I am experimenting with a Tomed fully adjustable MAD ($178). So far it looks like it will be resigned to the drawer. But it may be telling me that a $2000-$3000 custom-fitted MAD would be a waste of money. So spending $178 could save me a much bigger chunk.

Everyone is different, so maybe the Nosebreathe will work for you.

If it doesn't and you get the Liberty working well but have dry mouth, I can give tell you how I get relief from the dry mouth.

Good luck.

Socknitster, I hope you have a good experience with the braces. My daughter never complained of pain--just that they felt "funny" and she tolerated them very well.

She broke the wires a few times the first set--just getting used to a new chewing pattern, but after that it was smooth sailing and I can't believe how broad her mouth looks now.

Thanks for that info Janknitz--I am so looking forward to getting started. I have an appointment for the treatment plan/cost analysis on the 26th. I hope we can get started very soon after that--unless the sticker shock kills me, lol! I'm glad to hear it didn't cause much discomfort. I queried some of my friends who had them as kids and they said similar stuff. Frankly I just want to get started--the sooner we start, the sooner I can see the results!

Jen

An orthodontist we consulted about my son said that research shows that the distance between the back molars should be 36mm, and that is established early in life and doesn't change much. If so, one would think that these orthodontists/sleep docs could measure the distance and tell us whether our jaws are narrow or not, no?

SleepinUgly,

You are right--however I don't think these disciplines talk to each other much yet. Sleep medicine is still in its infancy. Eventually, hopefully, these things will be adressed/prevented early in life. But for now, we as patients are forced to search for the answers any way we can find them. This surely isn't the answer for everyone with OSA, but there HAS to be a percentage of OSA sufferers that will find relief with orthodontic work. Believe me, if this works, I will be making sure my sleep doc is very well informed about my treatment and all the research I've done to back up the theories behind why it works.

Jen

My sleep doctor told me that small jaw, large tongue, large tonsils, small nose and deviated septum are all risk factors for sleep apnea which I have. And also being overweight. Having a scalloped tongue is a sign that your tongue is too big for your mouth. I have a firm chin. I'm not sure how the chin relates to having a narrow airway.

I actually had my upper jaw widened as a teen so all my teeth would fit. My brother had his tonsils removed as a child and so did my dad. However, my dad has OSA.

My concern about orthodontic devices is that they push the lower jaw out so that can also affect your jaw and your chewing. It also doesn't address breathing through your nose.

Tovi wrote:My concern about orthodontic devices is that they push the lower jaw out so that can also affect your jaw and your chewing. It also doesn't address breathing through your nose.

Maxillary/palatal expansion does address breathing through your nose--or I should say CAN address it, but doesn't always--in that the maxilla is the floor of the the nasal cavity, and widening the maxilla widens the nasal cavity.

Tovi wrote: My concern about orthodontic devices is that they push the lower jaw out so that can also affect your jaw and your chewing. It also doesn't address breathing through your nose.

I assume you are referring to mandibular advancement devices. These are used to treat sleep-disordered breathing.

Yes, there is a difference between mandibular advancement devices and the kind of orthodontic treatment I'm seeking. I'm intending to permanently change the size and shape of my lower jaw by getting braces. If the lower jaw can come forward naturally, then the tongue comes with it, leaving more room in the back of the throat for air. A small jaw or receded chin can cause the tongue to take up too much room in the airway.

In my case, my upper teeth are slanted backwards--which pushes my lower jaw backwards and never allowed it to fully develop or come forward as it should have. The orthodontist believes that simply making my upper teeth vertical, correcting the inward tipping, will allow my lower jaw to come forward several millimeters naturally without any other interventions. Several millimeters is A LOT when it comes to airflow.

My teeth do not line up correctly. I have mild tmj already. I grind my teeth because my molars do not fit together as they should. I will not lose anything by getting braces--it can only be an improvement.

Jen

I'm just fascinated to hear how this works for you, Socknitster.

I don't think it's a possibility for me at this late date, but I'm excited that it has a very good chance of succeeding for my daughter. We are willing to sacrifice a lot financially so that she can have a chance to correct her facial structure, and If this prevents or delays apnea and it's comorbidities, then it's worth every penny.

Awesome, Rooster! Thanks--I put that as my facebook status just now!