This lovely 61 year old woman came in to have a new set of dentures. Her old ones were already twelve years old and pretty much worn down, but still comfortable and doing their job as a set of “choppers.” Moreover, they did not represent how her own teeth and smile looked in the past. But the patient was happy with them and came in only because she was advised to renew dentures every five years. The final result is on the right - her smile is restored.
There is more to these pictures than just an aesthetically improved smile. The patient’s new dentures were designed in a special way to strengthen her overall health. Construction of these dentures was done while keeping in mind basic principles of head anatomy and physiology of breathing. Her previous dentures did not meet anatomical and physiological requirements for functioning “as if her own teeth.” They did allow her to chew, speak, and smile. Unfortunately, they were also a heavy burden on her heart and her nervous system.
Attention to detail is extremely important because a small change can shift one’s body from health to dis-ease. That’s whythe making of this denture is so time consuming. The amount of time it took to make her new dentures was about five times more then the old ones. While people can get used to almost anything, it is far better to get used to an excellent result. Dentures in the top photo were a burden on this woman’s central nervous system. It became obvious to her after she put her new dentures in. She reported immediate improvements: “I feel calmer and I think I am in a better mood?!” The next day the patient reported that she enjoyed a deeper, more restful sleep. Patient was seen several more times afterwards. The change was unmistakable. A “lighter” version of the same woman appeared: her eyes were open, mood was much improved.
In addition to her improved smile and overall sense of well being, it was important to verify objectively the physiological changes that took place.
Under the photographs is the “before” and “after” test we conducted to scientifically measure physiological changes. On the left is before, on the right is after. It can be seen that measure of the “Levels of Functioning of the Physiological systems” is drastically improved. It went from 11 to 6. This means that overall functioning of the body went from “in the red” to “average.” This is a significant improvement for someone who only got a new set of teeth.This is the difference that a holistic approach can offer.
A study in the August 1 issue of the journal Sleep shows that people with severe sleep apnea have a much higher mortality risk than people without sleep apnea, and this risk increases when sleep apnea is untreated. Results show that people who have severe sleep apnea, which involves frequent breathing pauses during sleep, have three times the risk of dying due to any cause compared with people who do not have sleep apnea. This risk is represented by an adjusted hazard ratio of 3.2 after controlling for age, sex and body mass index. When 126 participants who reported regular use of continuous positive airway pressure (CPAP) therapy were removed from the statistical analysis, the hazard ratio for all-cause mortality related to severe sleep apnea rose to 4.3.
“We found that both men and women with sleep apnea in the general population - not patients - mostly undiagnosed and untreated, had poorer survival compared with persons without sleep apnea, given equal BMI, age and sex,” said principal investigator and lead author Terry Young, PhD, professor of epidemiology at the University of Wisconsin-Madison.
According to Young, most previous studies of sleep apnea and mortality have involved patients referred for a clinical sleep diagnostic evaluation; the mortality risk for sleep apnea in the general population has not been previously reported.
The study was an 18-year follow-up of 1,522 participants in the ongoing Wisconsin Sleep Cohort Study, which was established in 1988 and involved a random sample of men and women from the community who were between the ages of 30 and 60 when the study began. After spending one night at the University of Wisconsin General Clinical Research Center for assessment by polysomnography, participants were categorized by apnea-hypopnea index (AHI), which is the average number of breathing pauses (apneas) and reductions (hypopneas) per hour of sleep. Sixty-three individuals (about four percent) had severe sleep apnea at baseline with an AHI of 30 or more and a range of 30 to 97 apneas and hypopneas per hour. About 76 percent of the study group (1,157 individuals) had no sleep apnea with an AHI of less than five.
For the follow-up study, state and national death records were reviewed up to March 1, 2008, to identify participants who had died and to note the causes of death listed on the death certificates. Eighty deaths were recorded, including 37 deaths attributed to cancer and 25 deaths attributed to cardiovascular disease and stroke.
About 19 percent of participants with severe sleep apnea died (12 deaths), compared with about four percent of participants with no sleep apnea (46 deaths). Although participants with mild sleep apnea (AHI of five to 14) or moderate sleep apnea (AHI of 15 to 29) had a mortality risk that was 50 percent greater than those with no sleep apnea, the results did not achieve statistical significance.
Hazard ratios for all-cause mortality remained high after further adjustments for other factors such as smoking, alcohol use, sleep duration and total cholesterol. Severe sleep apnea was associated with increased mortality whether or not participants experienced daytime sleepiness.
About 42 percent of deaths in people with severe sleep apnea (5 of 12 deaths) were attributed to cardiovascular disease or stroke, compared with 26 percent of deaths in people with no sleep apnea (12 of 46 deaths). When the 126 participants who reported regular CPAP use were removed from the analysis, the hazard ratio for cardiovascular mortality soared from 2.9 to 5.2 for people with severe sleep apnea. The results suggest that regular CPAP use may protect sleep apnea patients against cardiovascular death.
“I was surprised by how much the risks increased when we excluded people who reported treatment with CPAP,” Young said. “Our findings suggest - but cannot prove - that people diagnosed with sleep apnea should be treated, and if CPAP is the prescribed treatment, regular use may prevent premature death.”
Statistical adjustments show that high blood pressure, cardiovascular disease, stroke and diabetes may play a role in the association between sleep apnea and mortality, but the specific mechanisms by which sleep apnea contributes to mortality remain unclear.
The study was supported by grants from the National Institutes of Health.
According to the American Academy of Sleep Medicine, obstructive sleep apnea (OSA) involves a decrease or complete halt in airflow despite an ongoing effort to breathe. It occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway.
The most common treatment for OSA is CPAP therapy, which provides a steady stream of air through a mask that is worn during sleep. This airflow keeps the airway open to prevent pauses in breathing and restore normal oxygen levels.
TMJ stands for Temporo Mandibular Joint. This fancy name means it is connected to the lower jaw and touches temples of the head.TMD stands for Temporo Mandibular Disease.
Treatment of TMD (jaw joint disease) has two phases.Phase one is pain relief.Phase two is changing the structure so that pain does not return.Sometimes surgical intervention is necessary.Unless you ask a surgeon, surgery is the last resort.
First, what is normal?
Normal joint does not make sounds. It has never made sounds.If you jaw joint ever made clicking, popping, sand grating sounds – you have a problem.It can also be that sound was present but not now.Odds are there is a problem. Due to our bodies’ amazing capacity to repair and accommodate often times structural change is not felt.
Normal opening of your mouth is at least 52mm from edge of lower front tooth to the edge of the upper front tooth.Another way to measure is to be able to fit four fingers in your mouth.
Normal joints go together with teeth that don’t look worn out.However, it is possible to have teeth that look “brand new” and still have TMD.
Here is a checklist that may help you decide if you are a candidate for TMJ treatment:
-Do you have clicking, popping or grating noises in one or both of your jaw joints when you open and/or close?
-Do you ever have a sensation of ear “stuffiness”, pressure or blockage of your ears? Is there excessive ear wax production?
-Do you ever get ringing, whooshing, roaring, hissing or buzzing noises in your ears?
-Do you ever feel dizzy when you turn around?
-Are there imprints of your teeth in the sides of your tongue? Are your teeth excessively worn?
-Does your jaw deviate to one side when you open slowly and fully.Check by looking in the mirror.
-Do you have missing back teeth? Does your “bite” feel wrong?
-Do you have pain or soreness in any of the following areas: jaw joints, upper jaw or teeth, side of neck, back of head, forehead, and sides of head (temples), tongue, chewing muscles and/or behind the eyes, lower back?
-Does your jaw ever lock or get stuck?
This is a partial list.TMD is a multi factorial disorder.In the next few pages you will see why.
Holistic means all inclusive.When any disorder is addressed, the entire person should be considered – body and mind.If a person has a kidney problem, it is not necessarily their kidneys that are malfunctioning.Problem literally can be coming from anywhere and its manifestation could be through the kidneys.TMJ problems and others in dentistry should be addressed in the similar fashion.Problems can arise as a result of body’s compensation to maintain an optimal level of function.To remove the need to compensate is to treat holistically.Remove the proverbial pebble from the shoe and you will stop limping.
To treat a TMJ problem, often times, is to address a breathing problem.
Lower jaw has a unique joint in that its position is controlled entirely by muscles.If there is a pebble in the shoe than muscles of the leg and foot will pull to avoid pain in the foot.Hence the limping.While limping can be tolerated indefinitely choking cannot be.Suboptimal breathing is registered instantly and muscles of throat, mouth, and chest move respective structures around to allow for unobstructed breathing.One example of compensation for choking is an open mouth.Here a jaw is pulled down for air to get in. A body has to work constantly and use energy to keep pulling the jaw.This will result in sore muscles in neck, back and inside of mouth.To ease pain of neck, back, and jaw is to remove the need to compensate for choking.
How does one remove the need to compensate for choking?Get the thing out of the throat that chokes you in the first place.What could be sitting in your throat that’s not food?A piece of meat we call tongue.Its normal home is a mouth, but for many people their mouths are too small.The tongue then has to compensate for the lack of space.Options are limited.It cannot shrink.It can either go forward and hang out of the mouth or go back into the throat.Once your tongue is partially obstructing your airway, an alarm in the brain goes off!Brain then sends a signal to the muscles of the throat and jaw to keep the airway open as best as possible.Since the tongue will be sitting not where it should be all the time, the alarm will be sounding continuously.Muscles of the jaw and throat will be working overtime continuously as well.Jaw joint muscles are therefore never relaxed. We come the full circle now. To treat a TMJ problem, often times, is to address a breathing problem.
This problem can be remedied with a dental appliance that repositions the jaw to make more room in the mouth and therefore throat.
Now that you have learned something about TMJ and hopefully snoring and sleep apnea we can continue.
In this author’s experience TMJ problems, snoring, sleep apnea, teeth grinding and clenching are one and the same ball of wax.So far it has been shown to be caused either by structural imperfections or infections.
Infections such as Lyme disease or chronic dental infections can make throat tissues swell up and cause narrowing of the wind pipe.People that have medical diagnosis of sleep apnea often times also have elevated C-reactive protein. Positive C-reactive protein blood test is indicative of inflammation in the body.
Now let’s talk about structure.One anatomical structure that we must be aware of when treating all of the above mentioned problems is tongue.Ideally, one’s tongue should be in the mouth gently resting on the palate behind upper front teeth.Very few people now days have this luxury.Most people have their tongues sitting partially in their throats.That’s a fact that can easily be confirmed with an x ray.
This misplaced position creates a constant stress for the body.As a result body and mind are never truly relaxed.A person rarely, if ever, is at peace. Physically, this is equivalent to having a pebble in the shoe that you are not aware of. You know you walk crooked, but you don’t know why.Common complaint here would be: “I carry stress in my shoulders.”Mentally, you may be annoyed or irritable, but here your mind will instantly willconcoct a reason for you feeling this way.In practice, once breathing is made easier than what’s been accustomed to irritability, fearfulness, and mental racing calm down. The main idea here is to reduce stress.Once stress is reduced it is easier for the body to begin repairing.
Today it is a common thing to have wisdom teeth removed or to go to an orthodontist to have teeth straightened out. Jaws that do not grow to their proper size will not be able to house the tongue.In order for the person to stand comfortably his posture has to be relaxed.In order for the person to breathe comfortably his oral posture has to be relaxed.Relaxed and comfortable oral posture means sufficient room to rest against the palate behind upper front teeth.Relaxed and comfortable oral posture means breathing through the nose is easy and effortless.
In the early nineteen hundreds a dentist named Weston Price traveled the world.He visited just about every corner of the globe. After that he published his book Nutrition and Physical Degeneration.There he showed how what person eats affects his teeth and jaws.Basically, when people ate of the earth they had straight, cavity free teeth with well developed jaws.Once people started eating processed, modern foods they instantly developed cavities and their jaws could no longer grow large enough to accommodate all the teeth.
A beautiful flower grows and blossoms when the right conditions are present. Flower needs sunshine, good soils, and water.
In order for a child to grow and blossom one very important criteria needs to be met. Oxygen needs to be plentiful and easy to get.
If the nose is stuffed up or tonsils are swollen it is harder to breath. When a child has to struggle to breath, immune system becomes weaker.
This leads to more colds, infections, antibiotics, and missed school days. Childhood years are forming years. Relationships, life views, self esteem all get affected when a child struggles to perform the most basic action necessary to survive. Breathing is the one action we cannot do without. Nose and mouth are the two gateways that let the air in. Optimal breathing is through the nose only. Mouth plays a pivotal role, however, if there is a breathing problem.
Any parent can spot if her child may potentially have breathing difficulty. Just look at your child’s teeth. Baby teeth need to have spaces, especially in the front.
It’s that simple.
Children that have their teeth tight together are prone to mouth breathing, ear infections, eye problems, croocked teeth in adulthood, neck and back problems, snoring and grinding, and even overeating.
To help correct these problems a simple dental appliance can be made that is easy to wear. Over time as more room is created in the mouth and your child no longer needs to struggle to breathe many other conditions should start to resolve.
