Re: Discussion of Small Jaws as Cause of Obstructive Sleep Apnea
Posted: Mon Aug 09, 2010 7:43 pm
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.
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.