Tired Teens
Orthodontists Diagnose Sleep Apnea More Easily with X-Rays
August 1, 2005
http://www.sciencedaily.com/videos/2005 ... _teens.htm
CLEVELAND--Being a teenager is tough these days, but it's especially tough if you're always tired. Now a simple X-ray taken at your children's orthodontist could hold the key to helping them sleep better.
Sixteen-year-old Andrew Dudash would come home from school each day and go straight to bed. "I actually got a detention in school for sleeping during a class," he says.
Doctors diagnosed him with sleep apnea, a chronic condition that causes him to stop breathing during sleep. Diagnosing the condition is difficult and often means staying at an overnight sleep lab. But orthodontist Mark Hans wants to make that diagnosis easier. He's studying whether the same X-rays teens get before getting braces will help determine if they're at risk for sleep apnea.
"We're trying to give the sleep doctor a better chance of examining the right patients for this condition," says Dr. Hans, of Case Western Reserve University School of Dental Medicine in Cleveland.
Dr. Hans looks at the position of the tongue and hyoid bone. If the bone sits higher, patients are not at risk for sleep apnea. If it falls lower, they are more likely to have the condition.
In a recent study, the X-rays correctly identified 70 percent of teens with sleep apnea. Dr. Hans says, "When you identify chronic illness early and treat it early, you really prevent more long-term problems."
Case School of Medicine pediatric pulmonologist and sleep specialist Carol Rosen, says the X-rays would help. "This would add another feature that we would look for in our evaluation." So teens like Dudash can get the treatment they need.
"There's definitely a difference in my sleep because I'm not waking up much during the night," Dudash says. And his sleep is not something he's willing to gamble on.
Dr. Hans says there's no disadvantage to performing the X-ray other than a minimal dose of radiation, which is equivalent to a day in the sun. He says most insurance covers the X-rays, which cost about $100. A sleep lab evaluation could cost thousands.
Family OSA
Re: Family OSA
Avoid tooth extractions (including wisdom teeth) & train-track braces; find a functional orthodontist at http://iaortho.org/.
Re: Family OSA
THE SIMPLE TRUTH ABOUT CROOKED TEETH — Excerpts
http://www.fasttraxortho.com/when_to_be ... atment.htm
Teeth become crooked if the jaws grow incorrectly. The most common causes are simple things like thumb sucking, bad swallowing habits, or hanging the mouth open (airway problems). Bad growth of the jaws will also spoil the look of the face. This can be avoided if the jaws can be encouraged to grow correctly from a young age.
Scientists have known this for ages (evidence provided later) but most orthodontists are currently taught that it is too difficult to alter the growth of the jaws, or not worth the effort, and prefer the more reliable option of fixed braces, often accompanied with extractions and sometimes jaw surgery. This form of traditional treatment has been used for about 100 years and orthodontists are fully aware that it can damage the teeth and face and also the crowding tends to return later. Despite this, braces and extractions are still widely used all over the world because that is how they were trained. In America, currently over 60% of the cases in “traditional treatment” involve extraction of usually four to eight teeth. In England, over eighty percent of the orthodontic cases involve extraction. Austin Powers pokes fun at the English smile in his movies. Treatment in my office involves extraction less than 1% of the time and typically only adult patients.
Treatment. Occasionally a simple appliance to widen the upper jaw will have the same effect as removing tonsils. This is because the nose is attached to the top jaw and widens with it, making it easier to breath. In more severe cases treatment should begin by the age of six. In mild cases, an excellent result can be achieved in the teens or later. Unfortunately, unless the child learns to keep their mouth closed, treatment will not last a long time, and the problem will tend to return afterwards. If correct growth and oral posture can be achieved there can be a dramatic improvement in the appearance of the face and no extractions should be necessary.
When to Bring in Your Child
We like to see children as young as 4 years old if they are mouthbreathers or their upper teeth are inside the lower teeth when your child bites down. Actual treatment often begins in the 6-10 year age group if there is crowding or less than ideal facial balance. If the child is not a mouthbreather and has proper dentofacial development, we will wait for all 28 teeth (all teeth but the wisdom teeth) to be in the mouth before orthodontics. This minimizes the time children are in braces.
We would much prefer seeing a child early before it is the appropriate time for treatment than having to tell a parent it is too late for ideal treatment.
Reasons to treat early:
If space is made for the permanent teeth to erupt into relatively good positions they will tend to be more stable in those positions.
Improper skeletal relationships, poor facial balance and gummy smiles can be corrected at an early age with orthopedic appliances. By the time a child is over 10 the window of opportunity is starting to close on females, and a year later for males.
A narrow airway can be expanded 4-5 times in area with the use of orthopedic appliances at a young age. Establishing a good airway contributes to good facial development, stability of the orthodontic result, and a healthier child. An ideal airway can become of critical importance in later years since obstructive sleep apnea (a life threatening problem) is a direct result of a reduced airway! Posture also improves with the proper development of a restricted airway.
Does Airway Matter?
An adequate airway is THE most important factor in a child's facial development. Genetics determines factors such as hair color, eye color, and height. In contrast, it is altered oral posture usually caused by an altered nasal airway which determines whether or not the face will be well balanced.
Can orthodontic treatment change faces?
While it is certainly possible to damage a face, most orthodontists do not believe it is possible to improve the shape of the face with appliances. This may be true with traditional treatment but it does seem that Orthotropics can achieve changes in facial appearance, as well as oral posture.
Can Orthodontics Damage Your Face?
The attractiveness of a child's face depends largely on two things:
• The shape of their parents faces
• Whether their face grows forwards or downwards.
While the first is fixed at conception, the second displays a range between 'horizontal' which orthodontists label favorable and 'vertical' which is considered unfavorable. Horizontal growth is associated with good looks, square jaws and straight teeth, while vertical growth produces the reverse, and the effects of this may range from the barely perceptible to the markedly unattractive. The direction of growth can be affected by a range of simple things like thumb sucking or hanging the mouth open, both of which encourage 'vertical' growth and the degree of damage will depend on the severity of the habit.
Facial Damage.
The public have a strong preference for 'horizontally' growing faces. Unfortunately there is clear evidence that almost any kind of orthodontic treatment encourages an increase in the unattractive 'vertical' growth (Battagel 1996).
It is interesting to note that orthodontists seem to prefer the flatter profiles seen with 'vertically' growing faces. (Peck and Peck)
Recent evidence (Clark et al 1998) would suggest that the large majority of orthodontists in Britain are not interested in the relationship between oral habits and the direction of facial growth. Furthermore that 91% are prepared to extract teeth, even if there is no crowding and 63% to pull teeth back despite strong evidence to show that this encourages 'vertical' growth. Not only is this approach likely to damage facial appearance but the teeth often re-crowd after treatment despite the extractions. This approach plays right into the hands of Austin Powers who mocks the bad teeth found in Great Britain.
Extraction versus Non-extraction
The treatment of irregular teeth has evolved over the last century, largely by trial and error. Many types of treatment have been tried during this period, most of which have been superseded. Most treatment has been based on two underlying alternatives.
• Accept that the jaws are too small and extract teeth to provide the space.
• Enlarge the jaws to accommodate the teeth.
Over the last 100 years, treatment has alternated between these two concepts and there have been decades when no orthodontists extracted teeth and decades when they all extracted teeth. At the moment most countries are leaving a period of extraction but some are moving towards it. This might suggest a degree of discontent with both methods.
Both methods work well in the short term but unfortunately tend to fail in the long term with re-crowding of the teeth. In Europe teeth are extracted in around 75% of cases while at the moment in the USA it may be closer to 60%. Most orthodontists will say they extract teeth only when absolutely necessary, but clearly there is considerable disagreement about when this might be so. Whatever the treatment, very few patients treated by these methods finish with all their teeth and a large proportion loose eight teeth as there is not room for the wisdoms.
Some orthodontists avoid extractions by pulling the side teeth back with a strap aground the back of the head or neck, so making room to straighten the front teeth. However this tends to reduce the room for the wisdom teeth. It also encourages downward growth of the face and there is no doubt that this can damage the face, sometimes severely.
Are Extractions Necessary?
Orthodontic clinicians in the past have been severely criticized by scientists for ignoring the scientific evidence. Here are some of the comments about orthodontics from world scientific heavyweights they are “behind homeopathy and on a par with scientology” (Sackett 1985), their work is “based on trial and error” (Johnston 1990), the schools “teach technical skills rather than scientific thinking” (Richards 2000), “Sadly it is hard to see this situation change unless the inadequacy of current knowledge is acknowledged” (Shaw 2000), their treatment of crowding “treats a symptom, not the cause”. (Frankel 2001).
Traditional Orthodontists are taught that the size and shape of the jaws is inherited and most of their treatment is based on this belief. Clearly if the teeth were too large for the jaws some teeth would have to be extracted but there is almost no evidence to show that this is true.
Many orthodontists consider crowded teeth are caused by interbreeding between humans with different sized jaws. Biologists do not support this view, and even if a 100 kg Great Dane were crossed with a 1kg Chihuahua the offspring would be unlikely to have a malocclusion. There is evidence to suggest that the size of the teeth and jaws is inherited, but little to suggest that disproportionate growth is.
Some orthodontists believe that evolution has caused jaws to become smaller over the last few thousand years (Walpoff 1975). Certainly crowding has become worse, but this has been mostly within the last 400 years (More 1968), which is far too short a period for an evolutionary change. Also an evolutionary change would have to start in one area and spread, but irregular teeth are found all over the world, wherever people take their standard of living above a certain level.
Despite this overwhelming evidence, most orthodontic treatment is still carried out on the basis that disproportionate jaws are inherited and that little can be done to change them. Based on this belief and in contradiction to the evidence the teeth are moved into line mechanically usually coupled with the extraction of either four or eight permanent teeth. If the jaws are in the wrong position orthodontists may recommend that they are cut and corrected surgically. Many thousands of children and young adults have this surgery each year although a substantial proportion of those who have been told that surgery is the "only answer" have subsequently been corrected with Orthotropics and dento-facial orthopedics. Despite this, the dental profession are not informing their patients that there might be an alternative, or they are not aware of alternative treatment.
Iatrogenic Damage caused by Braces.
Scientists have clearly shown that braces can damage both the roots and the enamel. "Over 90% of the roots of the teeth show signs of damage following treatment with fixed appliances". (Kurol, et al 1996). "40% of patients show shortening of more than 2.5mm". (Mirabella and Artun 1995). This is a substantial proportion of the root length and must shorten the life of the teeth. Enamel damage, with fixed appliances, is rapid, widespread and long-term. (Ogaard et al 1988) (Ogaard 1989) (Alexander 1993). According to the AAO Orthodontist’s Journal, the type of bioeffecient non-friction bracket system used at Fast Trax Orthodontics is the safest on the market.
All orthodontists accept that faces can be damaged by inappropriate treatment but they disagree about which approach will cause least damage. "The maxillary retraction associated with braces (Edgewise) contributes to the poorer aesthetic result." (Battagel 1996) and may be "accompanied by exaggerated vertical facial growth".
It is known that Braces tend to lengthen the face (Lundstrom,A. &Woodside,D.G. 1980) and that longer faces look less attractive’ (Lundstrom et al 1987). However there is little sound research to establish how often or how severe the damage may be.
Twins, who are genetically identical, still show more contrast in the shape of their jaws than any other part of their skeleton (Krause 1959) proving that much of the variation is due to non-genetic environmental factors such as open mouth postures and unusual swallowing habits that distort the growth of the jaws. Orthodontists in the past have found it difficult to explain why modern children have so much malocclusion, but the following new hypothesis appears to fit the known facts better than those put forward previously: -
"Environmental factors disrupt resting oral posture, increasing vertical skeletal growth and creating a dental malocclusion, the occlusal characteristics of which are determined by inherited muscle patterns, primarily of the tongue" (Mew 2004).
Most children with upper front teeth sticking out are treated by pulling them back. However, if you look at the side of such a child's face, you can see that the fault is often their lower jaw which is too far back (see Antonia below). Almost all orthodontists pull back the top teeth in this situation risking an increase in downward growth with subsequent damage to the face. It is important that prospective patients are warned of this risk, because little research is being done to establish how often it occurs. However Antonia had Orthotropics to take both her upper and lower jaws forward.
In conclusion, space to align the teeth can be provided by extractions and braces but the crowding is likely to return, especially of the lower front teeth (Little 1988). There is also a risk of damage to the teeth and face. Orthotropics aims to avoid extractions by early correction of the cause rather than later treatment of the result, but is highly dependent on the ability of the child to comply with wearing appliances and learning to keep their mouth closed.
http://www.fasttraxortho.com/when_to_be ... atment.htm
Teeth become crooked if the jaws grow incorrectly. The most common causes are simple things like thumb sucking, bad swallowing habits, or hanging the mouth open (airway problems). Bad growth of the jaws will also spoil the look of the face. This can be avoided if the jaws can be encouraged to grow correctly from a young age.
Scientists have known this for ages (evidence provided later) but most orthodontists are currently taught that it is too difficult to alter the growth of the jaws, or not worth the effort, and prefer the more reliable option of fixed braces, often accompanied with extractions and sometimes jaw surgery. This form of traditional treatment has been used for about 100 years and orthodontists are fully aware that it can damage the teeth and face and also the crowding tends to return later. Despite this, braces and extractions are still widely used all over the world because that is how they were trained. In America, currently over 60% of the cases in “traditional treatment” involve extraction of usually four to eight teeth. In England, over eighty percent of the orthodontic cases involve extraction. Austin Powers pokes fun at the English smile in his movies. Treatment in my office involves extraction less than 1% of the time and typically only adult patients.
Treatment. Occasionally a simple appliance to widen the upper jaw will have the same effect as removing tonsils. This is because the nose is attached to the top jaw and widens with it, making it easier to breath. In more severe cases treatment should begin by the age of six. In mild cases, an excellent result can be achieved in the teens or later. Unfortunately, unless the child learns to keep their mouth closed, treatment will not last a long time, and the problem will tend to return afterwards. If correct growth and oral posture can be achieved there can be a dramatic improvement in the appearance of the face and no extractions should be necessary.
When to Bring in Your Child
We like to see children as young as 4 years old if they are mouthbreathers or their upper teeth are inside the lower teeth when your child bites down. Actual treatment often begins in the 6-10 year age group if there is crowding or less than ideal facial balance. If the child is not a mouthbreather and has proper dentofacial development, we will wait for all 28 teeth (all teeth but the wisdom teeth) to be in the mouth before orthodontics. This minimizes the time children are in braces.
We would much prefer seeing a child early before it is the appropriate time for treatment than having to tell a parent it is too late for ideal treatment.
Reasons to treat early:
If space is made for the permanent teeth to erupt into relatively good positions they will tend to be more stable in those positions.
Improper skeletal relationships, poor facial balance and gummy smiles can be corrected at an early age with orthopedic appliances. By the time a child is over 10 the window of opportunity is starting to close on females, and a year later for males.
A narrow airway can be expanded 4-5 times in area with the use of orthopedic appliances at a young age. Establishing a good airway contributes to good facial development, stability of the orthodontic result, and a healthier child. An ideal airway can become of critical importance in later years since obstructive sleep apnea (a life threatening problem) is a direct result of a reduced airway! Posture also improves with the proper development of a restricted airway.
Does Airway Matter?
An adequate airway is THE most important factor in a child's facial development. Genetics determines factors such as hair color, eye color, and height. In contrast, it is altered oral posture usually caused by an altered nasal airway which determines whether or not the face will be well balanced.
Can orthodontic treatment change faces?
While it is certainly possible to damage a face, most orthodontists do not believe it is possible to improve the shape of the face with appliances. This may be true with traditional treatment but it does seem that Orthotropics can achieve changes in facial appearance, as well as oral posture.
Can Orthodontics Damage Your Face?
The attractiveness of a child's face depends largely on two things:
• The shape of their parents faces
• Whether their face grows forwards or downwards.
While the first is fixed at conception, the second displays a range between 'horizontal' which orthodontists label favorable and 'vertical' which is considered unfavorable. Horizontal growth is associated with good looks, square jaws and straight teeth, while vertical growth produces the reverse, and the effects of this may range from the barely perceptible to the markedly unattractive. The direction of growth can be affected by a range of simple things like thumb sucking or hanging the mouth open, both of which encourage 'vertical' growth and the degree of damage will depend on the severity of the habit.
Facial Damage.
The public have a strong preference for 'horizontally' growing faces. Unfortunately there is clear evidence that almost any kind of orthodontic treatment encourages an increase in the unattractive 'vertical' growth (Battagel 1996).
It is interesting to note that orthodontists seem to prefer the flatter profiles seen with 'vertically' growing faces. (Peck and Peck)
Recent evidence (Clark et al 1998) would suggest that the large majority of orthodontists in Britain are not interested in the relationship between oral habits and the direction of facial growth. Furthermore that 91% are prepared to extract teeth, even if there is no crowding and 63% to pull teeth back despite strong evidence to show that this encourages 'vertical' growth. Not only is this approach likely to damage facial appearance but the teeth often re-crowd after treatment despite the extractions. This approach plays right into the hands of Austin Powers who mocks the bad teeth found in Great Britain.
Extraction versus Non-extraction
The treatment of irregular teeth has evolved over the last century, largely by trial and error. Many types of treatment have been tried during this period, most of which have been superseded. Most treatment has been based on two underlying alternatives.
• Accept that the jaws are too small and extract teeth to provide the space.
• Enlarge the jaws to accommodate the teeth.
Over the last 100 years, treatment has alternated between these two concepts and there have been decades when no orthodontists extracted teeth and decades when they all extracted teeth. At the moment most countries are leaving a period of extraction but some are moving towards it. This might suggest a degree of discontent with both methods.
Both methods work well in the short term but unfortunately tend to fail in the long term with re-crowding of the teeth. In Europe teeth are extracted in around 75% of cases while at the moment in the USA it may be closer to 60%. Most orthodontists will say they extract teeth only when absolutely necessary, but clearly there is considerable disagreement about when this might be so. Whatever the treatment, very few patients treated by these methods finish with all their teeth and a large proportion loose eight teeth as there is not room for the wisdoms.
Some orthodontists avoid extractions by pulling the side teeth back with a strap aground the back of the head or neck, so making room to straighten the front teeth. However this tends to reduce the room for the wisdom teeth. It also encourages downward growth of the face and there is no doubt that this can damage the face, sometimes severely.
Are Extractions Necessary?
Orthodontic clinicians in the past have been severely criticized by scientists for ignoring the scientific evidence. Here are some of the comments about orthodontics from world scientific heavyweights they are “behind homeopathy and on a par with scientology” (Sackett 1985), their work is “based on trial and error” (Johnston 1990), the schools “teach technical skills rather than scientific thinking” (Richards 2000), “Sadly it is hard to see this situation change unless the inadequacy of current knowledge is acknowledged” (Shaw 2000), their treatment of crowding “treats a symptom, not the cause”. (Frankel 2001).
Traditional Orthodontists are taught that the size and shape of the jaws is inherited and most of their treatment is based on this belief. Clearly if the teeth were too large for the jaws some teeth would have to be extracted but there is almost no evidence to show that this is true.
Many orthodontists consider crowded teeth are caused by interbreeding between humans with different sized jaws. Biologists do not support this view, and even if a 100 kg Great Dane were crossed with a 1kg Chihuahua the offspring would be unlikely to have a malocclusion. There is evidence to suggest that the size of the teeth and jaws is inherited, but little to suggest that disproportionate growth is.
Some orthodontists believe that evolution has caused jaws to become smaller over the last few thousand years (Walpoff 1975). Certainly crowding has become worse, but this has been mostly within the last 400 years (More 1968), which is far too short a period for an evolutionary change. Also an evolutionary change would have to start in one area and spread, but irregular teeth are found all over the world, wherever people take their standard of living above a certain level.
Despite this overwhelming evidence, most orthodontic treatment is still carried out on the basis that disproportionate jaws are inherited and that little can be done to change them. Based on this belief and in contradiction to the evidence the teeth are moved into line mechanically usually coupled with the extraction of either four or eight permanent teeth. If the jaws are in the wrong position orthodontists may recommend that they are cut and corrected surgically. Many thousands of children and young adults have this surgery each year although a substantial proportion of those who have been told that surgery is the "only answer" have subsequently been corrected with Orthotropics and dento-facial orthopedics. Despite this, the dental profession are not informing their patients that there might be an alternative, or they are not aware of alternative treatment.
Iatrogenic Damage caused by Braces.
Scientists have clearly shown that braces can damage both the roots and the enamel. "Over 90% of the roots of the teeth show signs of damage following treatment with fixed appliances". (Kurol, et al 1996). "40% of patients show shortening of more than 2.5mm". (Mirabella and Artun 1995). This is a substantial proportion of the root length and must shorten the life of the teeth. Enamel damage, with fixed appliances, is rapid, widespread and long-term. (Ogaard et al 1988) (Ogaard 1989) (Alexander 1993). According to the AAO Orthodontist’s Journal, the type of bioeffecient non-friction bracket system used at Fast Trax Orthodontics is the safest on the market.
All orthodontists accept that faces can be damaged by inappropriate treatment but they disagree about which approach will cause least damage. "The maxillary retraction associated with braces (Edgewise) contributes to the poorer aesthetic result." (Battagel 1996) and may be "accompanied by exaggerated vertical facial growth".
It is known that Braces tend to lengthen the face (Lundstrom,A. &Woodside,D.G. 1980) and that longer faces look less attractive’ (Lundstrom et al 1987). However there is little sound research to establish how often or how severe the damage may be.
Twins, who are genetically identical, still show more contrast in the shape of their jaws than any other part of their skeleton (Krause 1959) proving that much of the variation is due to non-genetic environmental factors such as open mouth postures and unusual swallowing habits that distort the growth of the jaws. Orthodontists in the past have found it difficult to explain why modern children have so much malocclusion, but the following new hypothesis appears to fit the known facts better than those put forward previously: -
"Environmental factors disrupt resting oral posture, increasing vertical skeletal growth and creating a dental malocclusion, the occlusal characteristics of which are determined by inherited muscle patterns, primarily of the tongue" (Mew 2004).
Most children with upper front teeth sticking out are treated by pulling them back. However, if you look at the side of such a child's face, you can see that the fault is often their lower jaw which is too far back (see Antonia below). Almost all orthodontists pull back the top teeth in this situation risking an increase in downward growth with subsequent damage to the face. It is important that prospective patients are warned of this risk, because little research is being done to establish how often it occurs. However Antonia had Orthotropics to take both her upper and lower jaws forward.
In conclusion, space to align the teeth can be provided by extractions and braces but the crowding is likely to return, especially of the lower front teeth (Little 1988). There is also a risk of damage to the teeth and face. Orthotropics aims to avoid extractions by early correction of the cause rather than later treatment of the result, but is highly dependent on the ability of the child to comply with wearing appliances and learning to keep their mouth closed.
Avoid tooth extractions (including wisdom teeth) & train-track braces; find a functional orthodontist at http://iaortho.org/.
-
Wonderbeastlett
- Posts: 186
- Joined: Thu Jul 12, 2012 4:55 pm
- Location: Florida
Re: Family OSA
I understand that dental/orthodontal work can cause sleep apnea in some people but my initial question was why has it not been considered hereditary because it tends to run in families. I have never had any form of dental work at all (braces/alignment etc) I do realize there are a lot of different causes and obviously we can't really base it off one specific cause, dental work included.
I guess a more intriguing question would be if OSA runs in families, does the cause of OSA run in families as well? For example one family might have narrow throats while another might have small jaws. It's really hard for me to accept that OSA is just random from person to person!
I guess a more intriguing question would be if OSA runs in families, does the cause of OSA run in families as well? For example one family might have narrow throats while another might have small jaws. It's really hard for me to accept that OSA is just random from person to person!
Re: Family OSA
I asked my doc this question at my 6-week PAP checkup a few weeks ago. He is a 'diplomate' and is part of a practice where they are doing actual clinical research.
His answer was the only generational factor he could say for certain was environment, specifically poor eating habits leading to obesity.
And yes, I know thin people get it too as I am one of them. Just passing on what I was told.
His answer was the only generational factor he could say for certain was environment, specifically poor eating habits leading to obesity.
And yes, I know thin people get it too as I am one of them. Just passing on what I was told.
-
chunkyfrog
- Posts: 34545
- Joined: Mon Jul 12, 2010 5:10 pm
- Location: Nowhere special--this year in particular.
Re: Family OSA
I have to believe there are an assortment of contributing factors, both heritary and environmental.
My bone and muscular structure had to be a factor, as my brother has OSA, too.
My childhood habit of sucking my thumb may have done some damage.
Ignorantly done extractions prior to orthodontia may have also 'helped'.
It is too late to lay blame; so I'm left to work this out with the tools available.
I do believe that the apnea led to the obesity; at least in my case.
It is simply too easy to blame the patient--that's not 'medicine' at all; when will they learn?
My bone and muscular structure had to be a factor, as my brother has OSA, too.
My childhood habit of sucking my thumb may have done some damage.
Ignorantly done extractions prior to orthodontia may have also 'helped'.
It is too late to lay blame; so I'm left to work this out with the tools available.
I do believe that the apnea led to the obesity; at least in my case.
It is simply too easy to blame the patient--that's not 'medicine' at all; when will they learn?
_________________
| Mask: AirFit™ P10 For Her Nasal Pillow CPAP Mask with Headgear |
| Additional Comments: Airsense 10 Autoset for Her |
Re: Family OSA
10 Things every Mother needs to know about teeth and sleep
July 9, 2012 by Michael L. Gelb DDS
The Value of a Bicuspid
http://www.facebook.com/AestheticDental ... comments=8
What’s the value of a tooth? Not a baby tooth but a fully formed adult premolar or bicuspid. How about priceless. It could cost you your life. Taking out permanent teeth to make room for crowded teeth could be robbing your child of reaching their potential as well as closing their airway and increasing headaches and neck pain. And later in life there is a greater chance of obesity and sleep apnea with all the health problems that follow. Who is telling parents the value of a tooth not to mention the value of four teeth.
Johnny Z was a happy, energetic kid who got good grades and behaved himself like any other 12 year old. That is until his oral surgeon extracted four permanent teeth and the orthodontist put on braces with headgear. His grades plummeted and his behavior became changed and became erratic. Johnny was given the diagnosis ADHD and put on Strattera.
His attention deficit improved but soon headaches and neck pain became daily occurrences. At graduation Johnny weighed 250 pounds. In college his drug use escalated to speed and cocaine to keep going during the day and pot and alcohol to quiet things down and get him to sleep. His snoring was so bad that his roommates resorted to earplugs.
After college Johnny could only get a job delivering pizza. After falling asleep at a red light and subsequent car accidents an overnight sleep study was mandated. Obstructive sleep apnea was diagnosed and CPAP was prescribed. One Thanksgiving Johnny didn’t show up to dinner for fear and embarrassment he would fall asleep at the table .
The story doesn’t end well. One night, two hours after pulling off his CPAP Johnny suffered a massive coronary and died in his sleep.
What does this have to do with four teeth? Consider the bulldog. Our faces are starting to look like the bulldog. Upper and lower jaws retruded and pushed in, nostrils are pinched and noses congested and teeth are crooked. We have large tongues and are mouth breathers. Now take out four teeth and slap on some headgear. Like the bulldog we are being bred for extinction. Obesity and heart disease are approaching 25% in many states with obstructive sleep apnea following closely behind at 20%.
Parents need to know that in many cases this is preventable. By establishing normal nasal breathing and tongue posture in the first few years of life the stage is set for ideal growth and development. Breast feeding aided by lactation consultants develops neural patterns in the brain as well as lip and facial tone. Early palatal expansion with the Biobloc technique or similar technology can encourage ideal horizontal growth and development.
Mothers need to understand the value of a tooth and the importance of finding the right pediatric dentist and orthodontist. It could be the difference between life and death.
10 Things every Mother needs to know about early development
1. Breast feed for at least 6 weeks and preferably 3 months
2. Make sure your child is a nasal breather
3. Avoid thumb sucking and pacifiers
4. Find an orthodontist recommended by Save our Kids
5. Don’t allow anyone to pull out permanent teeth with the exception of wisdom teeth
6. Avoid headgear
7. Get tonsils and adenoids out early if they are blocking the airway
8. Get your child tested with a sleep study if they have behavioral issues, ADHD, bed wetting, nightmares, colic or make noise at night.
9. Remember that clicking, popping and locking of the jaws are signs of pathology and are treatable (aapmd.com) as are headaches and neck pain
10. By following these steps you will insure your child develops the most beautiful face and smile in the world with a healthy airway.
July 9, 2012 by Michael L. Gelb DDS
The Value of a Bicuspid
http://www.facebook.com/AestheticDental ... comments=8
What’s the value of a tooth? Not a baby tooth but a fully formed adult premolar or bicuspid. How about priceless. It could cost you your life. Taking out permanent teeth to make room for crowded teeth could be robbing your child of reaching their potential as well as closing their airway and increasing headaches and neck pain. And later in life there is a greater chance of obesity and sleep apnea with all the health problems that follow. Who is telling parents the value of a tooth not to mention the value of four teeth.
Johnny Z was a happy, energetic kid who got good grades and behaved himself like any other 12 year old. That is until his oral surgeon extracted four permanent teeth and the orthodontist put on braces with headgear. His grades plummeted and his behavior became changed and became erratic. Johnny was given the diagnosis ADHD and put on Strattera.
His attention deficit improved but soon headaches and neck pain became daily occurrences. At graduation Johnny weighed 250 pounds. In college his drug use escalated to speed and cocaine to keep going during the day and pot and alcohol to quiet things down and get him to sleep. His snoring was so bad that his roommates resorted to earplugs.
After college Johnny could only get a job delivering pizza. After falling asleep at a red light and subsequent car accidents an overnight sleep study was mandated. Obstructive sleep apnea was diagnosed and CPAP was prescribed. One Thanksgiving Johnny didn’t show up to dinner for fear and embarrassment he would fall asleep at the table .
The story doesn’t end well. One night, two hours after pulling off his CPAP Johnny suffered a massive coronary and died in his sleep.
What does this have to do with four teeth? Consider the bulldog. Our faces are starting to look like the bulldog. Upper and lower jaws retruded and pushed in, nostrils are pinched and noses congested and teeth are crooked. We have large tongues and are mouth breathers. Now take out four teeth and slap on some headgear. Like the bulldog we are being bred for extinction. Obesity and heart disease are approaching 25% in many states with obstructive sleep apnea following closely behind at 20%.
Parents need to know that in many cases this is preventable. By establishing normal nasal breathing and tongue posture in the first few years of life the stage is set for ideal growth and development. Breast feeding aided by lactation consultants develops neural patterns in the brain as well as lip and facial tone. Early palatal expansion with the Biobloc technique or similar technology can encourage ideal horizontal growth and development.
Mothers need to understand the value of a tooth and the importance of finding the right pediatric dentist and orthodontist. It could be the difference between life and death.
10 Things every Mother needs to know about early development
1. Breast feed for at least 6 weeks and preferably 3 months
2. Make sure your child is a nasal breather
3. Avoid thumb sucking and pacifiers
4. Find an orthodontist recommended by Save our Kids
5. Don’t allow anyone to pull out permanent teeth with the exception of wisdom teeth
6. Avoid headgear
7. Get tonsils and adenoids out early if they are blocking the airway
8. Get your child tested with a sleep study if they have behavioral issues, ADHD, bed wetting, nightmares, colic or make noise at night.
9. Remember that clicking, popping and locking of the jaws are signs of pathology and are treatable (aapmd.com) as are headaches and neck pain
10. By following these steps you will insure your child develops the most beautiful face and smile in the world with a healthy airway.
Avoid tooth extractions (including wisdom teeth) & train-track braces; find a functional orthodontist at http://iaortho.org/.
Re: Family OSA
The Journal of the American Dental Association (JADA), Vol. 135, May 2004
LETTERS
JADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
SLEEP APNEA
Dr. Marc Ackerman made good points in his February JADA cover story, “Evidence-Based Orthodontics for the 21st Century.” However, as a general dentist who has been treating patients with sleep apnea and other sleep disorders for nearly 20 years, I have concerns regarding lack of use of rapid palatal expansion, and extraction versus nonextraction cases.
The evidence presented by Dr. Ackerman has to do with correcting anterior crowding, not with the airway. Rapid expansion of the palate at an early age not only increases oral width and volume, but also cross-sectioned nasal volume. Extraction of bicuspids leads to a decreased oral volume. The relative size of the tongue to the oral cavity (that is, tongue box) has a great deal to do with snoring and sleep apnea.
These factors must be taken into account, as even simple snoring in children is considered problematic by the pediatric community today, and apnea and hypopnea may be related to attention deficit disorder, attention deficit hyperactivity disorder and other behavioral disorders.
I see a large number of adult apnea patients, many of whom have had four-bicuspid extractions, or who would have benefited from widening of the nose and/or mouth as children. The common finding is a large tongue in a small-volume mouth. The airway blockage most often occurs at the base of the tongue, and surgical procedures are sometimes used to anteriorize and reduce tongue volume.
Why not make the mouth wider, and reduce the problem? Before making conclusions on evidence-based dentistry, let’s look at all of the evidence relating to health, and not just crowding of lower anterior teeth.
Ira L. Shapira, D.D.S.
Gurnee, Ill.
Author’s response: The anecdotal evidence regarding rapid palatal expansion and the treatment of obstructive sleep apnea syndrome, or OSAS, snoring in children and increased oral airway resistance in adults following fourpremolar- extraction orthodontic treatment offered by Dr. Shapira provides us with some insight into the microcosm of his “nearly 20 years” of practice. Although selected case series add valuable information to our clinical database, they fall on the opposite pole of the research spectrum in comparison to the randomized clinical trial. I would highly recommend to Dr. Shapira a review of the current literature for controlled studies regarding these clinical issues.
A significant finding in an article by Miles and colleagues1 was that “only mandibular body length demonstrated a clinically significant association with and diagnostic accuracy for OSAS [obstructive sleep apnea syndrome].”
Another study worth reading is by Hershey and colleagues.2 An interesting finding was “the change in nasal resistance of subjects who noticed an improvement in their ability to breathe through the nose was not significantly different from nasal resistance in children who did not notice any change in their breathing.”
An article by Pirila and colleagues3 concluded, “Sleeping predominantly on one’s back was associated with a reduced maxillary intercanine width, while prolonged head extension during sleep correlated inversely with the overjet. We suggest that sleeping on the back causes a more posterior tongue position, reducing its moulding effect on the anterior dental arch.”
These are but a small sample of the great wealth of literature in existence that both supports and rejects Dr. Shapira’s assertions on these clinical topics. In an evidence-based debate, the argument supported by data will always prevail over anecdote.
Marc B. Ackerman, D.M.D.
Private Practice, Orthodontics
Bryn Mawr, Pa.
Clinical Associate Professor Department of Orthodontics
Temple University School of Dentistry
Philadelphia
Miles PG, Vig PS, Weyant RJ, Forrest TD, Rockette HE Jr. Craniofacial structure and obstructive sleep apnea syndrome: a qualitative analysis and meta-analysis of the literature. Am J Orthod Dentofacial Orthop 1996;109(2):163-72. 2. Hershey HG, Stewart BL, Warren DW. Changes in nasal airway resistance associated with rapid maxillary expansion. Am J Orthod 1976;69(3):274-84. 3. Pirila K, Tahvanainen P, Huggare J, Nieminen P, Lopponen H. Sleeping positions and dental arch dimensions in children with suspected obstructive sleep apnea syndrome. Eur J Oral Sci 1995;103(5):285-91.
EARLY VERSUS LATE
I find it disingenuous that the February JADA article, “Evidence-Based Orthodontics for the 21st Century,” by Dr. Marc Ackerman, was given cover-story status. Data from the first randomized clinical trial in orthodontics and selected literature review are popping up in the media and dental journals. The apparent intent is to gather support for maintaining conventional delivery systems of orthodontic care.
The poster child for this onslaught has become one-phase versus two-phase treatment, or simply early versus late treatment of Class II malocclusions, as evidenced by the University of North Carolina randomized trial funded by the National Institutes of Health.1
The researchers who conducted the trial found no difference in the quality of the dental occlusion between the children who had early treatment and those who did not, as judged by both an occlusal index (peer assessment rating scores) and the percentage of the subjects with excellent and less-than-optimal outcomes.
It is suspicious that a preliminary report of this trial, “When It Comes To Kids Getting Braces, Earlier Is Not Always Better,” found its way into the Sept. 29, 2000, Wall Street Journal,2 with the aftershock of confusing parents looking for orthodontic care for their children. Also, when was the last time a feature opinion article on orthodontics was found on the cover of JADA? Is this another ploy by a protective guild to influence the gatekeepers of orthodontic care?
The nature of this controversy can never be resolved philosophically because of the variability between patients, and the uncertainty about growth and treatment response. It remains a personal preference. A fairer approach to this issue would be to put unbiased, fully documented, unconventional early treatment as presently practiced versus conventional late treatment on the same playing field, and allow the practitioner/consumer to judge without bias.
What about skeletal relationship correction? A large percentage of late treatment Class II outcomes, as evidenced in the literature and private practice, show dentoalveolar Class I correction, but a remaining Class II skeletal relationship with a retrognathic mandible or retrognathic maxilla and mandible.
Let me offer a common pediatric case in point that challenges Dr. Ackerman’s treatise. A 3-year-old child initially presents with a posterior crossbite, a multifactorial malocclusion. Correction is recommended, but the parent refuses. The parental decision may have been influenced by the media reports, or by a consulting dentist who uses the so-called evidence referenced by Dr. Ackerman.
On recall, this same child may present with a Class II Division 1 type malocclusion. The occlusion accommodated for the constricted upper arch by posturing the mandible into a retrognathic position, so that the lower teeth occlude with the wider part of the constricted upper arch without the crossbite. The child transitions through growth and development with a deficient arch perimeter, causing continual crowding, and progressing into a full Class II molar relationship.
The orthodontic gold standard for treating this Class II patient in late mixed dentition or early permanent dentition, as reported by Dr. Ackerman, is distalization-retraction mechanics of the upper arch to a Class I dental relationship. This conventional protocol frequently results in dentoalveolar correction with a locked mandible.
Wouldn’t common sense dictate that at a younger age the maxillary arch form should be developed, so that the mandible has the opportunity to come forward in a normal growth pattern? Does not distalization mechanics at adolescence put the patient at risk of developing retrognathic facial and jaw position, with greater potential for relapse because the mandible, in its natural attempt to posture forward posttreatment, becomes restricted by the coupling of the upper and lower incisors? This orthodontically produced therapeutic matrix causes a lingualization and breaking of contact points of lower anterior teeth with resultant relapse. Could not all of these issues be prevented with proper early treatment objectives: proper overbite, overjet, molar relationship, jaw relationship, serial guidance and lip seal?
To a certain degree, of course, this is a moot question, since most orthodontists rarely get the opportunity to see the child in the primary dentition phase, when the true etiology of the Class II problem evidences.
A major ethical issue related to this controversy is that a good number of practitioners place only acrylic appliances or headgear (Phase I) in the patient as the engagement ring, at considerable cost, until it’s comfortable to consummate the marriage at a later date (Phase II comprehensive orthodontic treatment).
All forms of orthodontic care would benefit from scientific research that determines what works, and what doesn’t. However, early treatment strategies— not necessarily the ones reported in the University of North Carolina trial—are expected to meet a higher standard of validation than conventional orthodontic care simply because the conventional is more customary, even when the conventional may contain more risk.
The challenge facing orthodontics in the 21st century is the need to integrate early treatment education and strategies into the undergraduate programs, so that 90 percent of common-type malocclusions can be treated by the general and pediatric dentists, and the 10 percent of complex orthodontic cases can be identified for treatment by the true specialist.
This is the only way that 70 percent of the total population with orthodontic needs can be serviced effectively and efficiently. This resistance— obstruction to change—prevents a needed health service to the pediatric population.
Leonard J. Carapezza, D.M.D.
Private Pediatric Dentistry
Wayland, Mass.
Assistant Clinical Professor
Post-graduate Pediatric Dentistry
Tufts University
School of Dental Medicine
Boston
Tulloch JF, Phillips C, Proffit WR. Benefit of early Class II treatment: progress report of a two-phase randomized clinical trial. Am J Orthod Dentofacial Orthop 1998;113(1):62-72. 2. Parker-Pope T. When it comes to kids getting braces, earlier is not always better. The Wall Street Journal; Sept. 29, 2000: B-1.
Author’s response: Thank you for asking me to respond to the letter to the editor submitted by Dr. Carapezza. I’ve read it carefully. I couldn’t help but notice that the remarks by Dr. Carapezza aimed at JADA and my own motives for publishing “Evidence-Based Orthodontics for the 21st Century” were fueled by his own practice management/ business decisions, and not by a genuine adherence to the ethics of informed consent and patient autonomy. The University of North Carolina and Boston University data cannot be compared to the clinical anecdote offered by Dr. Carapezza. With regard to Dr. Carapezza’s take on “the orthodontic gold standard for treating this Class II patient … as reported by Dr. Ackerman,” I cannot find any use of the term “distalization-retraction mechanics” in my article. It is no secret that health care professionals are trained to make clinical decisions based on best possible evidence, available to both the clinician and patient. As much as a dialogue with Dr. Carapezza to discuss the available scientific evidence might be fun, I am unable to engage in such a conversation; Dr. Carapezza has not presented any new evidence. Meanwhile, I shall hope he finds my essay inspiring.
Marc B. Ackerman, D.M.D.
Private Practice, Orthodontics
Bryn Mawr, Pa. Clinical Associate Professor
LETTERS
JADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.
SLEEP APNEA
Dr. Marc Ackerman made good points in his February JADA cover story, “Evidence-Based Orthodontics for the 21st Century.” However, as a general dentist who has been treating patients with sleep apnea and other sleep disorders for nearly 20 years, I have concerns regarding lack of use of rapid palatal expansion, and extraction versus nonextraction cases.
The evidence presented by Dr. Ackerman has to do with correcting anterior crowding, not with the airway. Rapid expansion of the palate at an early age not only increases oral width and volume, but also cross-sectioned nasal volume. Extraction of bicuspids leads to a decreased oral volume. The relative size of the tongue to the oral cavity (that is, tongue box) has a great deal to do with snoring and sleep apnea.
These factors must be taken into account, as even simple snoring in children is considered problematic by the pediatric community today, and apnea and hypopnea may be related to attention deficit disorder, attention deficit hyperactivity disorder and other behavioral disorders.
I see a large number of adult apnea patients, many of whom have had four-bicuspid extractions, or who would have benefited from widening of the nose and/or mouth as children. The common finding is a large tongue in a small-volume mouth. The airway blockage most often occurs at the base of the tongue, and surgical procedures are sometimes used to anteriorize and reduce tongue volume.
Why not make the mouth wider, and reduce the problem? Before making conclusions on evidence-based dentistry, let’s look at all of the evidence relating to health, and not just crowding of lower anterior teeth.
Ira L. Shapira, D.D.S.
Gurnee, Ill.
Author’s response: The anecdotal evidence regarding rapid palatal expansion and the treatment of obstructive sleep apnea syndrome, or OSAS, snoring in children and increased oral airway resistance in adults following fourpremolar- extraction orthodontic treatment offered by Dr. Shapira provides us with some insight into the microcosm of his “nearly 20 years” of practice. Although selected case series add valuable information to our clinical database, they fall on the opposite pole of the research spectrum in comparison to the randomized clinical trial. I would highly recommend to Dr. Shapira a review of the current literature for controlled studies regarding these clinical issues.
A significant finding in an article by Miles and colleagues1 was that “only mandibular body length demonstrated a clinically significant association with and diagnostic accuracy for OSAS [obstructive sleep apnea syndrome].”
Another study worth reading is by Hershey and colleagues.2 An interesting finding was “the change in nasal resistance of subjects who noticed an improvement in their ability to breathe through the nose was not significantly different from nasal resistance in children who did not notice any change in their breathing.”
An article by Pirila and colleagues3 concluded, “Sleeping predominantly on one’s back was associated with a reduced maxillary intercanine width, while prolonged head extension during sleep correlated inversely with the overjet. We suggest that sleeping on the back causes a more posterior tongue position, reducing its moulding effect on the anterior dental arch.”
These are but a small sample of the great wealth of literature in existence that both supports and rejects Dr. Shapira’s assertions on these clinical topics. In an evidence-based debate, the argument supported by data will always prevail over anecdote.
Marc B. Ackerman, D.M.D.
Private Practice, Orthodontics
Bryn Mawr, Pa.
Clinical Associate Professor Department of Orthodontics
Temple University School of Dentistry
Philadelphia
Miles PG, Vig PS, Weyant RJ, Forrest TD, Rockette HE Jr. Craniofacial structure and obstructive sleep apnea syndrome: a qualitative analysis and meta-analysis of the literature. Am J Orthod Dentofacial Orthop 1996;109(2):163-72. 2. Hershey HG, Stewart BL, Warren DW. Changes in nasal airway resistance associated with rapid maxillary expansion. Am J Orthod 1976;69(3):274-84. 3. Pirila K, Tahvanainen P, Huggare J, Nieminen P, Lopponen H. Sleeping positions and dental arch dimensions in children with suspected obstructive sleep apnea syndrome. Eur J Oral Sci 1995;103(5):285-91.
EARLY VERSUS LATE
I find it disingenuous that the February JADA article, “Evidence-Based Orthodontics for the 21st Century,” by Dr. Marc Ackerman, was given cover-story status. Data from the first randomized clinical trial in orthodontics and selected literature review are popping up in the media and dental journals. The apparent intent is to gather support for maintaining conventional delivery systems of orthodontic care.
The poster child for this onslaught has become one-phase versus two-phase treatment, or simply early versus late treatment of Class II malocclusions, as evidenced by the University of North Carolina randomized trial funded by the National Institutes of Health.1
The researchers who conducted the trial found no difference in the quality of the dental occlusion between the children who had early treatment and those who did not, as judged by both an occlusal index (peer assessment rating scores) and the percentage of the subjects with excellent and less-than-optimal outcomes.
It is suspicious that a preliminary report of this trial, “When It Comes To Kids Getting Braces, Earlier Is Not Always Better,” found its way into the Sept. 29, 2000, Wall Street Journal,2 with the aftershock of confusing parents looking for orthodontic care for their children. Also, when was the last time a feature opinion article on orthodontics was found on the cover of JADA? Is this another ploy by a protective guild to influence the gatekeepers of orthodontic care?
The nature of this controversy can never be resolved philosophically because of the variability between patients, and the uncertainty about growth and treatment response. It remains a personal preference. A fairer approach to this issue would be to put unbiased, fully documented, unconventional early treatment as presently practiced versus conventional late treatment on the same playing field, and allow the practitioner/consumer to judge without bias.
What about skeletal relationship correction? A large percentage of late treatment Class II outcomes, as evidenced in the literature and private practice, show dentoalveolar Class I correction, but a remaining Class II skeletal relationship with a retrognathic mandible or retrognathic maxilla and mandible.
Let me offer a common pediatric case in point that challenges Dr. Ackerman’s treatise. A 3-year-old child initially presents with a posterior crossbite, a multifactorial malocclusion. Correction is recommended, but the parent refuses. The parental decision may have been influenced by the media reports, or by a consulting dentist who uses the so-called evidence referenced by Dr. Ackerman.
On recall, this same child may present with a Class II Division 1 type malocclusion. The occlusion accommodated for the constricted upper arch by posturing the mandible into a retrognathic position, so that the lower teeth occlude with the wider part of the constricted upper arch without the crossbite. The child transitions through growth and development with a deficient arch perimeter, causing continual crowding, and progressing into a full Class II molar relationship.
The orthodontic gold standard for treating this Class II patient in late mixed dentition or early permanent dentition, as reported by Dr. Ackerman, is distalization-retraction mechanics of the upper arch to a Class I dental relationship. This conventional protocol frequently results in dentoalveolar correction with a locked mandible.
Wouldn’t common sense dictate that at a younger age the maxillary arch form should be developed, so that the mandible has the opportunity to come forward in a normal growth pattern? Does not distalization mechanics at adolescence put the patient at risk of developing retrognathic facial and jaw position, with greater potential for relapse because the mandible, in its natural attempt to posture forward posttreatment, becomes restricted by the coupling of the upper and lower incisors? This orthodontically produced therapeutic matrix causes a lingualization and breaking of contact points of lower anterior teeth with resultant relapse. Could not all of these issues be prevented with proper early treatment objectives: proper overbite, overjet, molar relationship, jaw relationship, serial guidance and lip seal?
To a certain degree, of course, this is a moot question, since most orthodontists rarely get the opportunity to see the child in the primary dentition phase, when the true etiology of the Class II problem evidences.
A major ethical issue related to this controversy is that a good number of practitioners place only acrylic appliances or headgear (Phase I) in the patient as the engagement ring, at considerable cost, until it’s comfortable to consummate the marriage at a later date (Phase II comprehensive orthodontic treatment).
All forms of orthodontic care would benefit from scientific research that determines what works, and what doesn’t. However, early treatment strategies— not necessarily the ones reported in the University of North Carolina trial—are expected to meet a higher standard of validation than conventional orthodontic care simply because the conventional is more customary, even when the conventional may contain more risk.
The challenge facing orthodontics in the 21st century is the need to integrate early treatment education and strategies into the undergraduate programs, so that 90 percent of common-type malocclusions can be treated by the general and pediatric dentists, and the 10 percent of complex orthodontic cases can be identified for treatment by the true specialist.
This is the only way that 70 percent of the total population with orthodontic needs can be serviced effectively and efficiently. This resistance— obstruction to change—prevents a needed health service to the pediatric population.
Leonard J. Carapezza, D.M.D.
Private Pediatric Dentistry
Wayland, Mass.
Assistant Clinical Professor
Post-graduate Pediatric Dentistry
Tufts University
School of Dental Medicine
Boston
Tulloch JF, Phillips C, Proffit WR. Benefit of early Class II treatment: progress report of a two-phase randomized clinical trial. Am J Orthod Dentofacial Orthop 1998;113(1):62-72. 2. Parker-Pope T. When it comes to kids getting braces, earlier is not always better. The Wall Street Journal; Sept. 29, 2000: B-1.
Author’s response: Thank you for asking me to respond to the letter to the editor submitted by Dr. Carapezza. I’ve read it carefully. I couldn’t help but notice that the remarks by Dr. Carapezza aimed at JADA and my own motives for publishing “Evidence-Based Orthodontics for the 21st Century” were fueled by his own practice management/ business decisions, and not by a genuine adherence to the ethics of informed consent and patient autonomy. The University of North Carolina and Boston University data cannot be compared to the clinical anecdote offered by Dr. Carapezza. With regard to Dr. Carapezza’s take on “the orthodontic gold standard for treating this Class II patient … as reported by Dr. Ackerman,” I cannot find any use of the term “distalization-retraction mechanics” in my article. It is no secret that health care professionals are trained to make clinical decisions based on best possible evidence, available to both the clinician and patient. As much as a dialogue with Dr. Carapezza to discuss the available scientific evidence might be fun, I am unable to engage in such a conversation; Dr. Carapezza has not presented any new evidence. Meanwhile, I shall hope he finds my essay inspiring.
Marc B. Ackerman, D.M.D.
Private Practice, Orthodontics
Bryn Mawr, Pa. Clinical Associate Professor
Avoid tooth extractions (including wisdom teeth) & train-track braces; find a functional orthodontist at http://iaortho.org/.
Re: Family OSA
Undoing Extraction Orthodontics? (one page)
ArchedWire.com: Metal Mouth Message Board
http://www.archwired.com/phpbb2/viewtopic.php?p=396739
ArchedWire.com: Metal Mouth Message Board
http://www.archwired.com/phpbb2/viewtopic.php?p=396739
Avoid tooth extractions (including wisdom teeth) & train-track braces; find a functional orthodontist at http://iaortho.org/.
Re: Family OSA
Avoid tooth extractions (including wisdom teeth) & train-track braces; find a functional orthodontist at http://iaortho.org/.
Re: Family OSA
Which Kind of Extractions Are Best for Bi-maxillary Protrusion?
http://www.realself.com/question/kind-e ... protrusion
My question is what is the difference between extracting first and second bicuspids for bi-maxillary protrusion? I saw two videos showing examples of the two types of extractions and it seems that with first bicuspid extractions, the lip retraction is more greater. I also noticed with second bicuspid extractions, the back teeth moves forward along with the front and thus less lip retraction. Is this right? Which one provides better profile ( I have a very full profile) results?
Bicuspid Extractions for Orthodontics
Unless your facial profile is very full, I would recommend against having bicuspids removed - get another opinion. Removing the bicuspids and pulling the teeth back to close the spaces can lead to TMJ issues and more importantly sleep breathing disorders like Sleep Apnea because there is not enough room for the tongue. Having said that, the deciding factor is usually how much space is needed, as the second bicuspids are slightly wider than the first bicuspids.
Carlo Biasucci, DDS
Ontario Cosmetic Dentist
Bi-Maxillary Protrusion and Extractions
Try to find an orthodontist that can treat your mouth without ANY bicuspid extractions! I have seen too many people suffer later on with TMJ, Sleep Apnea (snoring), and other airway problems, all due to a narrowing of their dental arch as a result of bicuspid extractions by orthodontist. If there is any alternative to extracting the bicuspids, go for it!
Jay Neuhaus, DDS
New York Cosmetic Dentist
http://www.realself.com/question/kind-e ... protrusion
My question is what is the difference between extracting first and second bicuspids for bi-maxillary protrusion? I saw two videos showing examples of the two types of extractions and it seems that with first bicuspid extractions, the lip retraction is more greater. I also noticed with second bicuspid extractions, the back teeth moves forward along with the front and thus less lip retraction. Is this right? Which one provides better profile ( I have a very full profile) results?
Bicuspid Extractions for Orthodontics
Unless your facial profile is very full, I would recommend against having bicuspids removed - get another opinion. Removing the bicuspids and pulling the teeth back to close the spaces can lead to TMJ issues and more importantly sleep breathing disorders like Sleep Apnea because there is not enough room for the tongue. Having said that, the deciding factor is usually how much space is needed, as the second bicuspids are slightly wider than the first bicuspids.
Carlo Biasucci, DDS
Ontario Cosmetic Dentist
Bi-Maxillary Protrusion and Extractions
Try to find an orthodontist that can treat your mouth without ANY bicuspid extractions! I have seen too many people suffer later on with TMJ, Sleep Apnea (snoring), and other airway problems, all due to a narrowing of their dental arch as a result of bicuspid extractions by orthodontist. If there is any alternative to extracting the bicuspids, go for it!
Jay Neuhaus, DDS
New York Cosmetic Dentist
Avoid tooth extractions (including wisdom teeth) & train-track braces; find a functional orthodontist at http://iaortho.org/.
Re: Family OSA
Great question wonderbeastlett. Regarding my family history, I don't see a consistent factor. A few of us are thin and the the other folks are overweight although not obese. A few of have narrow facial features. I am the only one who never smoked.Wonderbeastlett wrote:I understand that dental/orthodontal work can cause sleep apnea in some people but my initial question was why has it not been considered hereditary because it tends to run in families. I have never had any form of dental work at all (braces/alignment etc) I do realize there are a lot of different causes and obviously we can't really base it off one specific cause, dental work included.
I guess a more intriguing question would be if OSA runs in families, does the cause of OSA run in families as well? For example one family might have narrow throats while another might have small jaws. It's really hard for me to accept that OSA is just random from person to person!
49er
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Re: Family OSA
my brother has osa thats when we started talking about this mums snoring used to shake the house (she passed aged 68 just wen t into bath to wash her hair head down bam dead) dad used to snore but we used to laugh when he used to gasp awake little did we know wed do the same! a couple of other brothers snore but not too much
-
Wonderbeastlett
- Posts: 186
- Joined: Thu Jul 12, 2012 4:55 pm
- Location: Florida
Re: Family OSA
I guess in my own family my dad and I are the only ones (so far) that have sleep apnea. We both are overweight but one thing I noticed we both shared in common was having a hard time swallowing pills! My dad has choked several times on small and large pills as have I. That makes me want to think we both have narrow or small throats. His side of the family and my mothers side all have sleep apnea as well. Although I dont know what their specific reason is. (narrow throat, big tongue, small jaw etc)
Re: Family OSA
Will Bicuspid Extraction Cause TMJ?
http://www.realself.com/question/bicusp ... action-tmj
After a number of consultations for braces (all recommended Damon), I have been informed by multiple ortho that the extraction of four bicuspid is necessary to adequately address my bite alignment (don't remember if its class I or class II malocclusion), and overbite/deepbite, overjet, crowding and bi-maxillary protrusion. But after doing a little bit of research online, it seems like such an extraction will cause TMJ? Is this true, even if the teeth were to be aligned properly after extraction?
Extracting bicuspids is RARELY the best treatment option.
Extracting teeth would only be recommended if crowding is a major problem. However, extracting four bicuspids almost always creates excess space that requires upper front teeth to be pushed too far back and arch width to be decreased in order to close the excess space. You must also remember that your face covers the teeth so if you pull your upper front teeth back too far your lower face goes with it. This will often cause your nose to appear large. The doctor who moves your teeth must pay close attention to how it will affect your face.
Brad Lockhart, DDS
Tustin Cosmetic Dentist
Bicuspid extractions can cause TMJ
If orthodontic extractions are recommended, it typically is because of either an overbite or crowding is present. Both crowding and overbites are the result of the upper jaw being too narrow. This also sets up the trapping of the lower jaw into a retruded position which is the primary reason for a TMJ Dysfunction to occur. If it is not corrected at the time of orthodontics, then the TMJ problem can surface later, potentially even years after the finishing of orthodontics. A non-extraction approach is the safest as that approach lets the lower jaw naturally come forward as development occurs allowing healthy TMJ function for the future. . My advice is to go with an orthodontist who avoids extractions, uses functional orthopedic treatment with a non extraction approach and pays attention to proper TMJ function
Extractions do NOT cause TMJ.
There are multiple documented causes of TMJ disorders (TMD). The most common include a bad bite, stress, tooth grinding, trauma, and oral habits such as constant gum chewing. Extraction of one or more teeth is not among those causes. But if the extraction leads to teeth shifting (or being shifted by a doctor) in a way that the bite doesn't fit properly, than you could realistically develop TMJ symptoms. There are thousands of patients treated every day with extractions who never develop TMJ symptoms. Likewise there are patients treated without extraction who do develop TMD. There are even plenty of people with no treatment at all who develop TMD. Yes, it is a moving target.
With the skill of an experienced doctor and no pre-existing symptoms chances are you will be fine with the approach that they recommend after a careful evaluation.
Doug Depew, DMD
Atlanta Orthodontist
Misinformation (Excerpts)
It is truly unfortunate when misinformation is disseminated to the unsuspecting and trusting public. Certainly, matters of professional opinion can differ but are best resolved by professionals and one of those methods is through the use of research and peer-reviewed publication. Making brash, bold, and unsubstantiated claims and generalizations not based in reality, especially in this type of forum where patients may use the information to make treatment decisions is at best, simply unbecoming of a learned profession. Statements such as "creates excess," "often cause," "are the result," "primary reason" attended without in fact are a disservice by the uniformed to the layperson.
In regards to your question, there is a plethora of data on the question at hand. Doing a simple PubMed search using keywords is a good place to start. Also contacting the NIH for their position white paper (i.e., paraphrasing "orthodontics is not a cause or cure of TMD (including the extraction of premolars") might be useful. To give you a start, below is the abstract from a peer-reviewed paper (one of numerous others) that provide with the answer: Extracting premolars (a procedure that provides substantial improvements for patients that need them) is not a risk factor for TMJ (PERIOD).
Orthodontic risk factors for temporomandibular disorders (TMD).
Steven Jay Bowman, DMD, MSD
Portage Orthodontist
Extractions and TMJ
If the orthodontic treatment is well done there is absolutely no scientific proof that extraction of premolars cause TMJ problems. This does not mean that TMJ problems can not occur after extraction treatment but that this is no more likely to occur than if the patient was treated without extractions.
Unfortunately, some dentists and orthodontists use the fear of TMJ problems to promote their nonextraction orthodontic philosophy....when in doubt ask for the scientific proof of what they say!
Robert Waxler, DMD, MS
Saint Louis Orthodontist
Extractions for braces is less common today
It used to be standard, pull all 4 first premolars and place braces. This practice is less common for a variety of reasons, including anecdotal evidence of TMJ issues and sleep apnea complications. Many orthodontists quote studies stating that teeth have nothing to do with TMJ issues, so it IS debatable. However, there are strong opinions against those studies, so one must decide for themselves.
If your case is of severe crowding, then pulling teeth may be the only way. Keep in mind that you may be choosing a 25 mm solution for a 10 mm problem (meaning arch expansion may work as well or better).
In my practice, the EXCEPTION is pulling teeth, not the rule.
Lance Timmerman, DMD
Seattle Cosmetic Dentist
http://www.realself.com/question/bicusp ... action-tmj
After a number of consultations for braces (all recommended Damon), I have been informed by multiple ortho that the extraction of four bicuspid is necessary to adequately address my bite alignment (don't remember if its class I or class II malocclusion), and overbite/deepbite, overjet, crowding and bi-maxillary protrusion. But after doing a little bit of research online, it seems like such an extraction will cause TMJ? Is this true, even if the teeth were to be aligned properly after extraction?
Extracting bicuspids is RARELY the best treatment option.
Extracting teeth would only be recommended if crowding is a major problem. However, extracting four bicuspids almost always creates excess space that requires upper front teeth to be pushed too far back and arch width to be decreased in order to close the excess space. You must also remember that your face covers the teeth so if you pull your upper front teeth back too far your lower face goes with it. This will often cause your nose to appear large. The doctor who moves your teeth must pay close attention to how it will affect your face.
Brad Lockhart, DDS
Tustin Cosmetic Dentist
Bicuspid extractions can cause TMJ
If orthodontic extractions are recommended, it typically is because of either an overbite or crowding is present. Both crowding and overbites are the result of the upper jaw being too narrow. This also sets up the trapping of the lower jaw into a retruded position which is the primary reason for a TMJ Dysfunction to occur. If it is not corrected at the time of orthodontics, then the TMJ problem can surface later, potentially even years after the finishing of orthodontics. A non-extraction approach is the safest as that approach lets the lower jaw naturally come forward as development occurs allowing healthy TMJ function for the future. . My advice is to go with an orthodontist who avoids extractions, uses functional orthopedic treatment with a non extraction approach and pays attention to proper TMJ function
Extractions do NOT cause TMJ.
There are multiple documented causes of TMJ disorders (TMD). The most common include a bad bite, stress, tooth grinding, trauma, and oral habits such as constant gum chewing. Extraction of one or more teeth is not among those causes. But if the extraction leads to teeth shifting (or being shifted by a doctor) in a way that the bite doesn't fit properly, than you could realistically develop TMJ symptoms. There are thousands of patients treated every day with extractions who never develop TMJ symptoms. Likewise there are patients treated without extraction who do develop TMD. There are even plenty of people with no treatment at all who develop TMD. Yes, it is a moving target.
With the skill of an experienced doctor and no pre-existing symptoms chances are you will be fine with the approach that they recommend after a careful evaluation.
Doug Depew, DMD
Atlanta Orthodontist
Misinformation (Excerpts)
It is truly unfortunate when misinformation is disseminated to the unsuspecting and trusting public. Certainly, matters of professional opinion can differ but are best resolved by professionals and one of those methods is through the use of research and peer-reviewed publication. Making brash, bold, and unsubstantiated claims and generalizations not based in reality, especially in this type of forum where patients may use the information to make treatment decisions is at best, simply unbecoming of a learned profession. Statements such as "creates excess," "often cause," "are the result," "primary reason" attended without in fact are a disservice by the uniformed to the layperson.
In regards to your question, there is a plethora of data on the question at hand. Doing a simple PubMed search using keywords is a good place to start. Also contacting the NIH for their position white paper (i.e., paraphrasing "orthodontics is not a cause or cure of TMD (including the extraction of premolars") might be useful. To give you a start, below is the abstract from a peer-reviewed paper (one of numerous others) that provide with the answer: Extracting premolars (a procedure that provides substantial improvements for patients that need them) is not a risk factor for TMJ (PERIOD).
Orthodontic risk factors for temporomandibular disorders (TMD).
Steven Jay Bowman, DMD, MSD
Portage Orthodontist
Extractions and TMJ
If the orthodontic treatment is well done there is absolutely no scientific proof that extraction of premolars cause TMJ problems. This does not mean that TMJ problems can not occur after extraction treatment but that this is no more likely to occur than if the patient was treated without extractions.
Unfortunately, some dentists and orthodontists use the fear of TMJ problems to promote their nonextraction orthodontic philosophy....when in doubt ask for the scientific proof of what they say!
Robert Waxler, DMD, MS
Saint Louis Orthodontist
Extractions for braces is less common today
It used to be standard, pull all 4 first premolars and place braces. This practice is less common for a variety of reasons, including anecdotal evidence of TMJ issues and sleep apnea complications. Many orthodontists quote studies stating that teeth have nothing to do with TMJ issues, so it IS debatable. However, there are strong opinions against those studies, so one must decide for themselves.
If your case is of severe crowding, then pulling teeth may be the only way. Keep in mind that you may be choosing a 25 mm solution for a 10 mm problem (meaning arch expansion may work as well or better).
In my practice, the EXCEPTION is pulling teeth, not the rule.
Lance Timmerman, DMD
Seattle Cosmetic Dentist
Avoid tooth extractions (including wisdom teeth) & train-track braces; find a functional orthodontist at http://iaortho.org/.
Re: Family OSA
Straight Talk About Crooked Teeth: The New Orthodontics—Learn About the Lawson System and What You Must Know To Get That “Movie Star Smile,” Without Extractions or Surgery
By S. Kent Lauson, DDS, MS, Orthodontist
May 1, 2012
219 pages
http://straighttalkaboutcrookedteeth.or ... 2_Full.pdf
Excerpts
Chapter 9
Key #6: Avoidance of Obstructive Sleep Apnea
Page 77
A young person with a narrow upper jaw and developing overbite is already set up for future OSA. If the narrow upper jaw and overbite are not corrected in the ideal manner—by enlarging the constricted upper jaw and freeing up the lower jaw to come forward into the ideal position—the die is cast for OSA. An enlightened orthodontist or dentist performing orthodontics should recognize this fact and be instrumental in the prevention of a future OSA condition. This is a huge opportunity for proper progressive orthodontic treatment to eliminate the future problem of OSA and to give a lifelong benefit to the patient.
A nagging flaw in traditional orthodontic education exists. As a result of the removal of permanent teeth, the jaws are left in their less-than-ideal narrow state and a restriction of the upper-air passageway that exists is made worse by diminishing the airflow through it This happens to be the first choke point in the airflow system of the head and neck. The removal of teeth also causes the lower jaw to remain trapped in a retruded position, causing the airflow to the throat area (the second and final choke point) to also be lessened. Consequently, the removal of permanent teeth has a twofold effect, making a future of OSA much more likely.
Appendix B: Pertinent Articles and Blogs
Page 183
It is important to note that even though Invisalign Teen is making a major move on the scene of orthodontics today, the objectives of The Lauson System, explained in my book, remain intact. All of the principles that I have talked about still need to be the objective of the orthodontist and dentist doing orthodontics. That includes the keys that make it necessary to use FFO prior to Invisalign or braces to achieve the desired results. Invisalign may replace the braces part, but will not replace necessary treatment for the FFO part or more complex corrections, such as for TMJ dysfunction or obstructive sleep apnea. However, as complicated as it may seem, the replacement of the braces part is a very major accomplishment and therefore holds great promise for Invisalign and Invisalign Teen. Stay tuned. For current information on this great technology, see our website at http://www.AuroraInvisalignDentist.com.
Another area of great importance is the evaluation of the upper airway in orthodontic patients. The cone beam x-ray, in addition to showing the skeletal anatomy or hard tissue, can also show some of the desired soft tissue anatomy, namely the upper air passageway. This becomes very important in working for the avoidance of obstructive sleep apnea. This is something I believe every dentist doing orthodontics should be aware of and concerned with regarding the future health of his or her patients.
Reviews
“Timely and insightful, this profound work is brilliant in its simplicity. Dr. Lauson cuts to the core, outlining the real connection between the human airway, mouth breathing, crooked teeth, TMJ disorders, and latent disease. Straight Talk about Crooked Teeth clearly outlines how to achieve the coveted movie star smile with a deeper understanding of how debilitating conditions like obstructive sleep apnea, ADD/ADHD, bedwetting, and headaches can be avoided. It is refreshing to finally have these important lessons and concepts in one easy-to-understand book for every parent, patient, dentist, and physician who really cares about straight teeth, healthy TMJs, quality of life, and longevity. Colleagues, it is time for my beloved dental profession to not only change lives with a winning smile, but more importantly, to SAVE LIVES!”
J. Brian Allman, DDS, Noted author and lecturer
Diplomate, American Board of Dental Sleep Medicine, American Academy of Pain Management
Director, TMJ Therapy and Sleep Center of Nevada,
Elite Dental Institute—www.EliteDental Institute.com
Online Sleep Academy—www.OnlineSleepAcademy.com,
Reno, NV
“The book Straight Talk about Crooked Teeth should be mandatory reading for every orthodontic provider in the United States and Canada. This book should also be read by every parent contemplating making an orthodontic investment in his or her child’s future health and well-being. Its principles embody the fundamentals of what is necessary for long-lasting, highly cosmetic, and highly functioning results, which if not followed, will result in only a compromised solution to the presenting orthodontic problems. I can only pray that Dr. Lauson’s treatment principles will seep deeply into the conscience of the world’s orthodontic profession.”
Brendan C. Stack, DDS, MS, Orthodontist, noted author, and lecturer
Vienna, VA
“Dr. Kent Lauson’s book, Straight Talk about Crooked Teeth, is an excellent resource for parents, patients, doctors, and dentists. Dr. Lauson clearly explains the connection between a beautiful smile and the keys to overall health. Dr. Lauson is a university-trained specialist in orthodontics and has spent his career building on this education and finding synergy from related medical and dental fields in order to more effectively help his patients. Now these years of study, work, and real-world application are set forth in an easy-to-understand guide. When followed, the principles that Dr. Lauson describes will not only result in maximum facial aesthetics, but also the best foundation for lifelong optimal health. I have spent my career helping people who suffer with TMJ problems, facial pain, and sleep apnea. I applaud Dr. Lauson for publishing information that I know will help many people avoid such problems and help parents make informed decisions that will help their children avoid such problems later in life.”
Jamison R. Spencer, DMD, MS, Noted lecturer and author of Small Airway, Big Problem: How Sleep Apnea Often Goes Undiagnosed in Women, Children, and Skinny Dudes
President, American Academy of Craniofacial Pain, Diplomate, American Board of Craniofacial Pain and American Board of Dental Sleep Medicine
Boise, ID
“Dr. Lauson has done an excellent job of integrating the orthodontic-TMD sleep connection in the treatment of his patients. This book clearly illustrates why orthodontic clinicians must embrace the functional, nonextraction philosophy. Failure to deal effectively with TMD and sleep apnea with our orthodontic patients can result in serious health problems in the future. I would encourage all clinicians who want to diagnose and treat holistically to read this book. Dr. Lauson shows many successfully treated patients throughout the book. It is a must read for patients as well as all orthodontic clinicians who want to improve the quality of their patients’ lives.”
Brock Rondeau, DDS, Noted author and lecturer of orthodontics, TMJ dysfunctions, and dental sleep medicine President, Rondeau Seminars
Ontario, Canada
“I would recommend this book for any parent contemplating orthodontic treatment for his or her child or any adult who is unsure which brace option is the best for him or her. This book dispels some of the myths associated with ‘traditional orthodontics,’ such as ‘don’t treat till the child has all his or her adult teeth’ or ‘extractions of premolar teeth, to resolve crowding, is the ideal treatment solution.’ This book is long overdue as it also links the medical/ dental interface, e.g., nasal airway obstruction, TMD, snoring/OSA, and maligned jaws. Dr. Lauson must be applauded for his continual search for answers beyond the confines of his traditional training. His results speak for themselves.”
Derek Mahony, DDS, MS, Orthodontist, author, and international lecturer
Sydney, Australia
“Spot on! This is the book every mother should read before choosing an orthodontist for her family. Most practitioners doing orthodontics don’t pay enough attention to the airway and TMJ. The nine keys to lower facial harmony should be part of every graduate orthodontic curriculum. Why not have a more beautiful smile while opening the airway, alleviating headaches and clicking jaws, and improving posture. A must read for every parent, dentist, and orthodontist.”
Michael Gelb, DDS, MS Clinical Professor, NYU College of Dentistry
New York City, NY
“In all my years in dentistry, I have never seen a book like this; certainly nothing out there is comparable at this time. This book is a “possibility” book—showing that beautiful life changes are possible as a result of the treatment that Dr. Lauson has to share. He has shown that even the most complicated of cases are treatable with predictability when the principles in the book are implemented. I would recommend this book to anyone.”
Jay W. Barnett, DDS, FACD, Orthodontist, noted author, and lecturer Former Chairman, L.D. Pankey Institute Orthodontic Program
Parker, CO
“Dr. Lauson has produced a timely book that was written for parents and patients, which helps them to understand the relationship between the head, neck, and in particular the mouth as it relates to the general health of the individual. He is a professional who has incorporated this holistic approach into his orthodontic practice as it relates to health in general.”
David T. Grove, DMD, MS, MSEd, MSc, Orthodontist Associate Professor of Orthodontics, Next Generation Orthodontic Education
Las Vegas, NV
By S. Kent Lauson, DDS, MS, Orthodontist
May 1, 2012
219 pages
http://straighttalkaboutcrookedteeth.or ... 2_Full.pdf
Excerpts
Chapter 9
Key #6: Avoidance of Obstructive Sleep Apnea
Page 77
A young person with a narrow upper jaw and developing overbite is already set up for future OSA. If the narrow upper jaw and overbite are not corrected in the ideal manner—by enlarging the constricted upper jaw and freeing up the lower jaw to come forward into the ideal position—the die is cast for OSA. An enlightened orthodontist or dentist performing orthodontics should recognize this fact and be instrumental in the prevention of a future OSA condition. This is a huge opportunity for proper progressive orthodontic treatment to eliminate the future problem of OSA and to give a lifelong benefit to the patient.
A nagging flaw in traditional orthodontic education exists. As a result of the removal of permanent teeth, the jaws are left in their less-than-ideal narrow state and a restriction of the upper-air passageway that exists is made worse by diminishing the airflow through it This happens to be the first choke point in the airflow system of the head and neck. The removal of teeth also causes the lower jaw to remain trapped in a retruded position, causing the airflow to the throat area (the second and final choke point) to also be lessened. Consequently, the removal of permanent teeth has a twofold effect, making a future of OSA much more likely.
Appendix B: Pertinent Articles and Blogs
Page 183
It is important to note that even though Invisalign Teen is making a major move on the scene of orthodontics today, the objectives of The Lauson System, explained in my book, remain intact. All of the principles that I have talked about still need to be the objective of the orthodontist and dentist doing orthodontics. That includes the keys that make it necessary to use FFO prior to Invisalign or braces to achieve the desired results. Invisalign may replace the braces part, but will not replace necessary treatment for the FFO part or more complex corrections, such as for TMJ dysfunction or obstructive sleep apnea. However, as complicated as it may seem, the replacement of the braces part is a very major accomplishment and therefore holds great promise for Invisalign and Invisalign Teen. Stay tuned. For current information on this great technology, see our website at http://www.AuroraInvisalignDentist.com.
Another area of great importance is the evaluation of the upper airway in orthodontic patients. The cone beam x-ray, in addition to showing the skeletal anatomy or hard tissue, can also show some of the desired soft tissue anatomy, namely the upper air passageway. This becomes very important in working for the avoidance of obstructive sleep apnea. This is something I believe every dentist doing orthodontics should be aware of and concerned with regarding the future health of his or her patients.
Reviews
“Timely and insightful, this profound work is brilliant in its simplicity. Dr. Lauson cuts to the core, outlining the real connection between the human airway, mouth breathing, crooked teeth, TMJ disorders, and latent disease. Straight Talk about Crooked Teeth clearly outlines how to achieve the coveted movie star smile with a deeper understanding of how debilitating conditions like obstructive sleep apnea, ADD/ADHD, bedwetting, and headaches can be avoided. It is refreshing to finally have these important lessons and concepts in one easy-to-understand book for every parent, patient, dentist, and physician who really cares about straight teeth, healthy TMJs, quality of life, and longevity. Colleagues, it is time for my beloved dental profession to not only change lives with a winning smile, but more importantly, to SAVE LIVES!”
J. Brian Allman, DDS, Noted author and lecturer
Diplomate, American Board of Dental Sleep Medicine, American Academy of Pain Management
Director, TMJ Therapy and Sleep Center of Nevada,
Elite Dental Institute—www.EliteDental Institute.com
Online Sleep Academy—www.OnlineSleepAcademy.com,
Reno, NV
“The book Straight Talk about Crooked Teeth should be mandatory reading for every orthodontic provider in the United States and Canada. This book should also be read by every parent contemplating making an orthodontic investment in his or her child’s future health and well-being. Its principles embody the fundamentals of what is necessary for long-lasting, highly cosmetic, and highly functioning results, which if not followed, will result in only a compromised solution to the presenting orthodontic problems. I can only pray that Dr. Lauson’s treatment principles will seep deeply into the conscience of the world’s orthodontic profession.”
Brendan C. Stack, DDS, MS, Orthodontist, noted author, and lecturer
Vienna, VA
“Dr. Kent Lauson’s book, Straight Talk about Crooked Teeth, is an excellent resource for parents, patients, doctors, and dentists. Dr. Lauson clearly explains the connection between a beautiful smile and the keys to overall health. Dr. Lauson is a university-trained specialist in orthodontics and has spent his career building on this education and finding synergy from related medical and dental fields in order to more effectively help his patients. Now these years of study, work, and real-world application are set forth in an easy-to-understand guide. When followed, the principles that Dr. Lauson describes will not only result in maximum facial aesthetics, but also the best foundation for lifelong optimal health. I have spent my career helping people who suffer with TMJ problems, facial pain, and sleep apnea. I applaud Dr. Lauson for publishing information that I know will help many people avoid such problems and help parents make informed decisions that will help their children avoid such problems later in life.”
Jamison R. Spencer, DMD, MS, Noted lecturer and author of Small Airway, Big Problem: How Sleep Apnea Often Goes Undiagnosed in Women, Children, and Skinny Dudes
President, American Academy of Craniofacial Pain, Diplomate, American Board of Craniofacial Pain and American Board of Dental Sleep Medicine
Boise, ID
“Dr. Lauson has done an excellent job of integrating the orthodontic-TMD sleep connection in the treatment of his patients. This book clearly illustrates why orthodontic clinicians must embrace the functional, nonextraction philosophy. Failure to deal effectively with TMD and sleep apnea with our orthodontic patients can result in serious health problems in the future. I would encourage all clinicians who want to diagnose and treat holistically to read this book. Dr. Lauson shows many successfully treated patients throughout the book. It is a must read for patients as well as all orthodontic clinicians who want to improve the quality of their patients’ lives.”
Brock Rondeau, DDS, Noted author and lecturer of orthodontics, TMJ dysfunctions, and dental sleep medicine President, Rondeau Seminars
Ontario, Canada
“I would recommend this book for any parent contemplating orthodontic treatment for his or her child or any adult who is unsure which brace option is the best for him or her. This book dispels some of the myths associated with ‘traditional orthodontics,’ such as ‘don’t treat till the child has all his or her adult teeth’ or ‘extractions of premolar teeth, to resolve crowding, is the ideal treatment solution.’ This book is long overdue as it also links the medical/ dental interface, e.g., nasal airway obstruction, TMD, snoring/OSA, and maligned jaws. Dr. Lauson must be applauded for his continual search for answers beyond the confines of his traditional training. His results speak for themselves.”
Derek Mahony, DDS, MS, Orthodontist, author, and international lecturer
Sydney, Australia
“Spot on! This is the book every mother should read before choosing an orthodontist for her family. Most practitioners doing orthodontics don’t pay enough attention to the airway and TMJ. The nine keys to lower facial harmony should be part of every graduate orthodontic curriculum. Why not have a more beautiful smile while opening the airway, alleviating headaches and clicking jaws, and improving posture. A must read for every parent, dentist, and orthodontist.”
Michael Gelb, DDS, MS Clinical Professor, NYU College of Dentistry
New York City, NY
“In all my years in dentistry, I have never seen a book like this; certainly nothing out there is comparable at this time. This book is a “possibility” book—showing that beautiful life changes are possible as a result of the treatment that Dr. Lauson has to share. He has shown that even the most complicated of cases are treatable with predictability when the principles in the book are implemented. I would recommend this book to anyone.”
Jay W. Barnett, DDS, FACD, Orthodontist, noted author, and lecturer Former Chairman, L.D. Pankey Institute Orthodontic Program
Parker, CO
“Dr. Lauson has produced a timely book that was written for parents and patients, which helps them to understand the relationship between the head, neck, and in particular the mouth as it relates to the general health of the individual. He is a professional who has incorporated this holistic approach into his orthodontic practice as it relates to health in general.”
David T. Grove, DMD, MS, MSEd, MSc, Orthodontist Associate Professor of Orthodontics, Next Generation Orthodontic Education
Las Vegas, NV
Avoid tooth extractions (including wisdom teeth) & train-track braces; find a functional orthodontist at http://iaortho.org/.