Dr. Barry Raphael gives an overview of a new subspecialty in orthodontics call Airway Orthodontics. This segment provides the rationale for this paradigm shift. (Animations and movies not included).
A series of lectures by Dr. Barry Raphael on Airway-focused orthodontics from 2013.
Chapter 1: An editorial look at the forces that are changing orthodontics today and how they will influence what orthodontics is to become in the 21st century.
Airway analysis and its relevance in orthodonticsMiliya Parveen
Introduction
Anatomy
Naso – respiratory function and craniofacial growth
Methods of analysis
Clinical examination
Otorhinolaryngology tests for upper airway
Supplementary examinations
LC
CBCT
Airway and skeletal patterns
Obstructive Sleep Apnoea
Mouth breathing
Effect of orthodontics on airway
Extraction cases
Expansion
Mandibular advancement
Orthognathic surgery
Adenoidectomy or tonsillectomy
Role of orthodontist
Conclusion
This document provides an overview of obstructive sleep apnea (OSA), including its diagnosis and treatment. It discusses the orthodontist's role in diagnosing OSA using tools like Mallampati scoring and lateral cephalograms. Treatment options covered include rapid maxillary expansion, distraction osteogenesis, hypoglossal nerve stimulation, and pranayama breathing exercises. The document concludes that a multidisciplinary approach including orthodontic, orthopedic, and surgical craniofacial treatments throughout life can effectively manage sleep-disordered breathing with craniofacial risk factors.
Upper airway constiction and its effects on growth & developmentIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
A series of lectures by Dr. Barry Raphael on Airway-focused orthodontics from 2013.
Chapter 5: The Goals of Airway Orthodontics and some of the approaches to preventing deficiencies in facial growth in young children.
This document discusses soft tissue analysis for orthodontic treatment planning. It begins by explaining the importance of soft tissue examination in addition to hard tissue analysis. It describes various methods of clinical soft tissue examination including natural head position, facial thirds, lip lengths, tooth to lip relationships, and frontal analysis of symmetry and facial levels. Specific landmarks and average measurements are provided. The document emphasizes that soft tissue proportions and relationships should be considered along with skeletal changes when developing treatment plans.
Indics /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document provides an overview of the activator appliance and its modifications. Some key points:
- The activator was developed in the early 1900s as a way to induce functional growth modifications. It works by applying muscle forces to the jaws through light contact between the appliance and teeth.
- There are different types of activators (H-activator and V-activator) depending on the amount of vertical opening and anterior positioning in the construction bite.
- The appliance is indicated for Class II and III malocclusions, open bites, and other functional issues in growing individuals. Contraindications include non-growing patients and severe vertical growth patterns.
- The activator is thought to work
A series of lectures by Dr. Barry Raphael on Airway-focused orthodontics from 2013.
Chapter 1: An editorial look at the forces that are changing orthodontics today and how they will influence what orthodontics is to become in the 21st century.
Airway analysis and its relevance in orthodonticsMiliya Parveen
Introduction
Anatomy
Naso – respiratory function and craniofacial growth
Methods of analysis
Clinical examination
Otorhinolaryngology tests for upper airway
Supplementary examinations
LC
CBCT
Airway and skeletal patterns
Obstructive Sleep Apnoea
Mouth breathing
Effect of orthodontics on airway
Extraction cases
Expansion
Mandibular advancement
Orthognathic surgery
Adenoidectomy or tonsillectomy
Role of orthodontist
Conclusion
This document provides an overview of obstructive sleep apnea (OSA), including its diagnosis and treatment. It discusses the orthodontist's role in diagnosing OSA using tools like Mallampati scoring and lateral cephalograms. Treatment options covered include rapid maxillary expansion, distraction osteogenesis, hypoglossal nerve stimulation, and pranayama breathing exercises. The document concludes that a multidisciplinary approach including orthodontic, orthopedic, and surgical craniofacial treatments throughout life can effectively manage sleep-disordered breathing with craniofacial risk factors.
Upper airway constiction and its effects on growth & developmentIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
A series of lectures by Dr. Barry Raphael on Airway-focused orthodontics from 2013.
Chapter 5: The Goals of Airway Orthodontics and some of the approaches to preventing deficiencies in facial growth in young children.
This document discusses soft tissue analysis for orthodontic treatment planning. It begins by explaining the importance of soft tissue examination in addition to hard tissue analysis. It describes various methods of clinical soft tissue examination including natural head position, facial thirds, lip lengths, tooth to lip relationships, and frontal analysis of symmetry and facial levels. Specific landmarks and average measurements are provided. The document emphasizes that soft tissue proportions and relationships should be considered along with skeletal changes when developing treatment plans.
Indics /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document provides an overview of the activator appliance and its modifications. Some key points:
- The activator was developed in the early 1900s as a way to induce functional growth modifications. It works by applying muscle forces to the jaws through light contact between the appliance and teeth.
- There are different types of activators (H-activator and V-activator) depending on the amount of vertical opening and anterior positioning in the construction bite.
- The appliance is indicated for Class II and III malocclusions, open bites, and other functional issues in growing individuals. Contraindications include non-growing patients and severe vertical growth patterns.
- The activator is thought to work
This document describes a new soft tissue cephalometric analysis tool developed from Arnett and Bergman's facial analysis philosophy. Forty-six adult models were used to create a cephalometric database. Key midface structures are marked using metallic beads on lateral cephalograms. Measurements are made of soft tissue and hard tissue landmarks relative to the True Vertical Line (TVL) to diagnose dentoskeletal factors, soft tissue components, facial lengths, TVL projections, and harmony of facial parts. Cephalometric treatment planning uses the soft tissue analysis to optimize occlusal and facial results through positioning of the incisors, moving the mandible, defining the maxillary occlusal plane, and assessing chin projection.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document provides information on performing a functional examination as part of an orthodontic diagnosis. It discusses examining the postural rest position and maximum intercuspation, as well as the temporomandibular joint, orofacial dysfunction, and various functional movements. Methods for determining and registering the postural rest position are described. Examination of swallowing, tongue posture, speech, lips, respiration, and craniofacial skeletal relationships are also covered to evaluate orofacial dysfunction. The document emphasizes that a functional examination is important for a complete orthodontic diagnosis beyond just a static evaluation of dental relationships.
This document discusses cephalometric analysis and the Downs analysis in particular. It provides details on the following:
- Cephalometric analysis involves measuring skeletal and dental relationships on lateral cephalograms using landmarks and reference planes.
- The Downs analysis, published in 1948, uses 10 parameters (5 skeletal, 5 dental) measured based on a sample of patients with excellent occlusion.
- It describes each of the 10 measurements used in the Downs analysis, including facial angle, N-A to point A-Pg, mandibular plane angle, and others.
- The document emphasizes that the Downs analysis was one of the first comprehensive analyses and is still widely used today.
This document provides information on various non-patient compliant fixed functional appliances used to treat Class II malocclusions, including the Herbst appliance, MARA, Advansync, and fixed twin block. It discusses the history, design, advantages, disadvantages, and effects of each appliance. In general, these fixed functional appliances can eliminate patient compliance issues compared to removable appliances, have continuous effects, and shorter treatment times, but may have higher breakage and mechanical dislodgement risks.
Genetics and malocclusion /certified fixed orthodontic courses by Indian dent...Indian dental academy
This document discusses the role of genetics in malocclusion. It begins by outlining that the influence of genetics versus environment in malocclusion has been debated. Genetics are clearly predominant in early development, but environment can also influence dentofacial morphology postnatally. Twin studies provide evidence that genetics play a strong role in many malocclusions and dental anomalies. Recent advances in molecular genetics have identified homeobox genes and other genes that control craniofacial development and dental patterning. A better understanding of genetics is needed to appreciate their influence and potential for manipulation in orthodontic treatment.
This document discusses various orthodontic appliances used for intrusion, including the three-piece intrusion arch, Rickets utility arch, K-SIR appliance, and Connecticut Intrusion Arch. It describes how each appliance works and its advantages. The three-piece intrusion arch uses an intrusive cantilever to simultaneously intrude and retract anterior teeth. The Rickets utility arch engages two molars and four incisors to intrude lower incisors. The K-SIR appliance modifies loop mechanics to simultaneously intrude and retract teeth. The Connecticut Intrusion Arch incorporates characteristics of the utility arch and conventional intrusion arch to achieve absolute intrusion of anterior teeth.
Anchorage management is essential in orthodontics to control unwanted tooth movement during treatment. Various classifications and sources of anchorage are discussed. Anchorage planning and different savers like reinforcement, subdivision, tipping, and skeletal anchorage can help minimize anchorage loss. Different appliance systems utilize anchorage differently, like the edgewise appliance relying on distal tipping of posterior teeth to neutralize forces. Maintaining optimal force levels and proper anchorage are key to achieving desired tooth movements.
Physical properties of orthodontic materials /certified fixed orthodontic cou...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
in Orthodontics, Torque is a vital ingredient in the achievement of optimal esthetics, function and health of teeth and surrounding tissues, as also in stability of the treatment results
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Hi this is a very good powerpoint presentation on a limited topic on net that is DEPROGRAMMING SPLINT just have a look to it and any suggestions most heartly welcome
1. A study compared long-term stability of adolescent versus adult surgery for treatment of mandibular deficiency, finding that beyond 1 year post-surgery, younger patients showed significantly greater changes in horizontal and vertical positions of mandibular landmarks and angles.
2. Early mandibular advancement surgery may be less stable long-term than performing the same surgery on older, growth-completed patients.
3. Younger patients undergoing two-jaw surgery experienced even greater long-term changes than those receiving isolated mandibular advancement.
Analysis mc namara /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
1) The document discusses the evolution of jaws, maxilla, mandible, and temporomandibular joint (TMJ) in humans and other primates based on fossil evidence and comparisons to other species. Key evolutionary changes included a decrease in jaw size and the emergence of a protruding chin in humans.
2) The evolution of these structures was influenced by dietary changes from soft, frugivorous diets to harder foods requiring more chewing. This placed new selective pressures on the masticatory system.
3) The TMJ is unique to mammals and allows both rotational and translational movements, showing variation between species related to differences in feeding mechanisms.
This document discusses natural head position (NHP) in cephalometric radiography. It outlines limitations of traditional reference planes like sella-nasion and discusses how NHP provides a more reproducible and clinically relevant orientation. NHP is defined as the small range of positions where the subject looks at a distant eye-level point with relaxed posture. Several methods are described for standardizing and measuring NHP, including the use of mirrors, fluid levels, and inclinometers. Maintaining NHP is important because variations can influence the appearance and measurements of craniofacial structures.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Cybernetic theory of craniofacial growth /certified fixed orthodontic courses...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses the cranial base angle and its relationship to malocclusion. It begins with an anatomy section describing the cranial base. It then discusses how the cranial base functions to support the brain and provide passageways. Growth of the cranial base is attributed to displacement from brain growth and synchondroses like the spheno-occipital synchondrosis. The cranial base angle is defined and factors like an increased or decreased angle or length are associated with Class II or III skeletal patterns. Larger cranial base angles tend to position jaws in a Class II relationship while smaller angles a Class III relationship.
1) Multiple studies have found anatomical factors such as a narrow maxilla, retrognathic mandible, enlarged tonsils, and increased neck circumference are risk factors for obstructive sleep apnea.
2) Craniofacial morphology plays an important role in determining airway size, with a constricted maxilla placing the upper pharynx at greater risk of collapse during sleep. Maxillary deficiency is a key predictor of sleep apnea severity.
3) Chronic mouth breathing in children is associated with narrower pharyngeal airway space and forward head posture, which can negatively impact craniofacial growth patterns and increase risk of sleep disordered breathing.
This document describes a new soft tissue cephalometric analysis tool developed from Arnett and Bergman's facial analysis philosophy. Forty-six adult models were used to create a cephalometric database. Key midface structures are marked using metallic beads on lateral cephalograms. Measurements are made of soft tissue and hard tissue landmarks relative to the True Vertical Line (TVL) to diagnose dentoskeletal factors, soft tissue components, facial lengths, TVL projections, and harmony of facial parts. Cephalometric treatment planning uses the soft tissue analysis to optimize occlusal and facial results through positioning of the incisors, moving the mandible, defining the maxillary occlusal plane, and assessing chin projection.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document provides information on performing a functional examination as part of an orthodontic diagnosis. It discusses examining the postural rest position and maximum intercuspation, as well as the temporomandibular joint, orofacial dysfunction, and various functional movements. Methods for determining and registering the postural rest position are described. Examination of swallowing, tongue posture, speech, lips, respiration, and craniofacial skeletal relationships are also covered to evaluate orofacial dysfunction. The document emphasizes that a functional examination is important for a complete orthodontic diagnosis beyond just a static evaluation of dental relationships.
This document discusses cephalometric analysis and the Downs analysis in particular. It provides details on the following:
- Cephalometric analysis involves measuring skeletal and dental relationships on lateral cephalograms using landmarks and reference planes.
- The Downs analysis, published in 1948, uses 10 parameters (5 skeletal, 5 dental) measured based on a sample of patients with excellent occlusion.
- It describes each of the 10 measurements used in the Downs analysis, including facial angle, N-A to point A-Pg, mandibular plane angle, and others.
- The document emphasizes that the Downs analysis was one of the first comprehensive analyses and is still widely used today.
This document provides information on various non-patient compliant fixed functional appliances used to treat Class II malocclusions, including the Herbst appliance, MARA, Advansync, and fixed twin block. It discusses the history, design, advantages, disadvantages, and effects of each appliance. In general, these fixed functional appliances can eliminate patient compliance issues compared to removable appliances, have continuous effects, and shorter treatment times, but may have higher breakage and mechanical dislodgement risks.
Genetics and malocclusion /certified fixed orthodontic courses by Indian dent...Indian dental academy
This document discusses the role of genetics in malocclusion. It begins by outlining that the influence of genetics versus environment in malocclusion has been debated. Genetics are clearly predominant in early development, but environment can also influence dentofacial morphology postnatally. Twin studies provide evidence that genetics play a strong role in many malocclusions and dental anomalies. Recent advances in molecular genetics have identified homeobox genes and other genes that control craniofacial development and dental patterning. A better understanding of genetics is needed to appreciate their influence and potential for manipulation in orthodontic treatment.
This document discusses various orthodontic appliances used for intrusion, including the three-piece intrusion arch, Rickets utility arch, K-SIR appliance, and Connecticut Intrusion Arch. It describes how each appliance works and its advantages. The three-piece intrusion arch uses an intrusive cantilever to simultaneously intrude and retract anterior teeth. The Rickets utility arch engages two molars and four incisors to intrude lower incisors. The K-SIR appliance modifies loop mechanics to simultaneously intrude and retract teeth. The Connecticut Intrusion Arch incorporates characteristics of the utility arch and conventional intrusion arch to achieve absolute intrusion of anterior teeth.
Anchorage management is essential in orthodontics to control unwanted tooth movement during treatment. Various classifications and sources of anchorage are discussed. Anchorage planning and different savers like reinforcement, subdivision, tipping, and skeletal anchorage can help minimize anchorage loss. Different appliance systems utilize anchorage differently, like the edgewise appliance relying on distal tipping of posterior teeth to neutralize forces. Maintaining optimal force levels and proper anchorage are key to achieving desired tooth movements.
Physical properties of orthodontic materials /certified fixed orthodontic cou...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
in Orthodontics, Torque is a vital ingredient in the achievement of optimal esthetics, function and health of teeth and surrounding tissues, as also in stability of the treatment results
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Hi this is a very good powerpoint presentation on a limited topic on net that is DEPROGRAMMING SPLINT just have a look to it and any suggestions most heartly welcome
1. A study compared long-term stability of adolescent versus adult surgery for treatment of mandibular deficiency, finding that beyond 1 year post-surgery, younger patients showed significantly greater changes in horizontal and vertical positions of mandibular landmarks and angles.
2. Early mandibular advancement surgery may be less stable long-term than performing the same surgery on older, growth-completed patients.
3. Younger patients undergoing two-jaw surgery experienced even greater long-term changes than those receiving isolated mandibular advancement.
Analysis mc namara /certified fixed orthodontic courses by Indian dental aca...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
1) The document discusses the evolution of jaws, maxilla, mandible, and temporomandibular joint (TMJ) in humans and other primates based on fossil evidence and comparisons to other species. Key evolutionary changes included a decrease in jaw size and the emergence of a protruding chin in humans.
2) The evolution of these structures was influenced by dietary changes from soft, frugivorous diets to harder foods requiring more chewing. This placed new selective pressures on the masticatory system.
3) The TMJ is unique to mammals and allows both rotational and translational movements, showing variation between species related to differences in feeding mechanisms.
This document discusses natural head position (NHP) in cephalometric radiography. It outlines limitations of traditional reference planes like sella-nasion and discusses how NHP provides a more reproducible and clinically relevant orientation. NHP is defined as the small range of positions where the subject looks at a distant eye-level point with relaxed posture. Several methods are described for standardizing and measuring NHP, including the use of mirrors, fluid levels, and inclinometers. Maintaining NHP is important because variations can influence the appearance and measurements of craniofacial structures.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Cybernetic theory of craniofacial growth /certified fixed orthodontic courses...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
This document discusses the cranial base angle and its relationship to malocclusion. It begins with an anatomy section describing the cranial base. It then discusses how the cranial base functions to support the brain and provide passageways. Growth of the cranial base is attributed to displacement from brain growth and synchondroses like the spheno-occipital synchondrosis. The cranial base angle is defined and factors like an increased or decreased angle or length are associated with Class II or III skeletal patterns. Larger cranial base angles tend to position jaws in a Class II relationship while smaller angles a Class III relationship.
1) Multiple studies have found anatomical factors such as a narrow maxilla, retrognathic mandible, enlarged tonsils, and increased neck circumference are risk factors for obstructive sleep apnea.
2) Craniofacial morphology plays an important role in determining airway size, with a constricted maxilla placing the upper pharynx at greater risk of collapse during sleep. Maxillary deficiency is a key predictor of sleep apnea severity.
3) Chronic mouth breathing in children is associated with narrower pharyngeal airway space and forward head posture, which can negatively impact craniofacial growth patterns and increase risk of sleep disordered breathing.
This document provides an overview of obstructive sleep apnea (OSA), including its causes, symptoms, diagnosis, and management options. It discusses that OSA is characterized by repetitive collapse of the upper airway during sleep, disrupting breathing. Risk factors include obesity, male gender, age, and craniofacial abnormalities. Diagnosis involves questionnaires, physical exams, and polysomnography. Treatment includes positive airway pressure and oral appliances, which work by advancing the mandible to open the airway. Oral appliances effectively treat mild to moderate OSA and reduce snoring but have side effects like teeth pain that require follow-up.
This document discusses the hypothesis that outdated diagnostic tools like the Angle Malocclusion Classification System and Steiner cephalometric norms can lead to inaccurate diagnoses, inappropriate treatment recommendations, and increased risk of airway disease. It questions whether McNamara's "Ideal" is anthropologically informed and examines if malocclusion is a disease of westernization not seen in ancient skeletons. Evidence suggests jaw and facial size may be reduced due to softer modern diets. Non-surgical approaches like Biobloc may help increase airway space in pediatric sleep apnea patients. Risk factors for malocclusion and sleep disordered breathing may be detectable in utero.
This document discusses the connections between breathing disorders like sleep apnea and asthma and their impacts on facial development and dental health. It suggests that medicine and dentistry should be in conversation to address these issues. Early intervention is important to guide proper facial growth and establish nasal breathing. Removing obstacles to nasal breathing like tonsils/adenoids and using palatal expansion or orthotropic techniques can help. Establishing proper tongue posture is also key to supporting development.
This document discusses hearing screening in newborns. It begins by defining different types and levels of hearing loss. It then discusses the importance of early identification of hearing loss in newborns through universal screening. Screening can be done using otoacoustic emissions testing or auditory brainstem response testing. Otoacoustic emissions testing evaluates the function of the outer hair cells in the cochlea by measuring sounds produced in response to sound stimuli. Early identification of hearing loss allows for early intervention, which research shows leads to better language development and academic outcomes for children.
This document summarizes a presentation on obstructive sleep apnea (OSA) given by Dr. Jean-Marc Retrouvey. The presentation defines OSA, discusses its manifestations, describes common patient types, recognizes the difference between OSA and snoring, and suggests treatment approaches. It provides details on quantifying OSA severity using the apnea-hypopnea index and discusses common contributing factors like obesity, allergies, and genetics. The role of orthodontics in treating OSA and potential craniofacial impacts of untreated OSA are also summarized.
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- The document discusses a retrospective study of 27 children referred for suspected sleep-disordered breathing who were found to have non-syndromic short lingual frenulums.
- The children showed anatomical changes associated with enlarged tonsils and abnormal orofacial growth. Treatment including tonsillectomy, frenectomy, and orthodontics improved but did not fully resolve abnormal breathing.
- Short lingual frenulums can impair orofacial development early in life by altering tongue position, leading to increased risk of sleep disordered breathing. Early recognition and treatment of short frenulums may improve normal development.
Otitis media with effusion in children Augustine raj
Otitis media with effusion, also called glue ear, serous otitis media is a very common problem encounterd in children . most of the times it is missed leading to deafness , social adjustment disorders, poor scholastic performance of kids. this slideshare is to create an awareness amonf general physicians and ENT specialists
Dr. Dr. h.c. Monika Lehnhardt - Highlights of xxxi world congress of audiolog...Monika Lehnhardt PhD
Day 1 of the Congress covered basic research on the biological and genetic basis of hearing loss, auditory research, electrophysiology and psychoacoustics. Day 2 included a symposium on implantable technologies for hearing loss rehabilitation, a round table discussion on criteria for cochlear implantation, and parallel sessions on newborn hearing screening and speech perception. The round table discussed appropriate ages for implantation and communication methods. Day 2 also had four sessions on cochlear implantation covering experiences with a totally implantable device, electrode array modifications, and a new electrode designed to preserve residual hearing.
Highlights of xxxi World Congress of Audiology-eng 2012-05-06MonikaLehnhardt
Day 2 of the Congress featured several parallel sessions on topics related to cochlear implants and hearing screening. In the Cochlear Implantation I session chaired by Roland Laszig, Robert Cowan from Melbourne presented on his six years of experience with a totally implantable cochlear implant and discussed challenges with the microphone and developing a long-term rechargeable battery. He also presented on modifying cochlear implant electrode surfaces to improve performance and deliver drugs to modulate tissue response. Additionally, he shared early promising results from a new slim straight electrode array designed to preserve residual hearing.
Make a SOAP Note Assessing Ear, Nose, and ThroatMost ear, nose, a.docxeubanksnefen
Make a SOAP Note: Assessing Ear, Nose, and Throat
Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.
In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
Note:
By Day 1 of this week, your instructor will have assigned you to one of the following case studies to review for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance.
Remember that not all comprehensive SOAP data are included in every patient case.
Case 1:
Nose Focused Exam
Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he's taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.
Case 2:
Focused Throat Exam
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn't take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
Case.
The document discusses various linguistic structures and provides examples of how to simplify scientific writing. It recommends keeping subject and verb close together, using parallel structure, and avoiding unnecessary words. The goal is to make complex concepts and methods clear and unambiguous for readers. Simplifying language, using an outline, and following conventions for scientific writing can help achieve this objective.
1. Sleep Apnea Prepared by: dr. Mohamad Ghazi 1
2. Outline: • Sleep Apnea definition • Epidemiology • Types of Sleep Apnea • Risk factors for Obstructive sleep apnea • Diagnosis • OSA can increase the risk of ? • Treatment Options for Sleep Apnea • Conclusion 2
3. Sleep Apnea is defined as the stopping of airflow during sleep and preventing air from entering the lungs caused by an obstruction.(1) What is Sleep Apnea? 1.British Snoring & Sleep Apnoea Association . 2. Orthodontics - Current Principles and Techniques - Graber 5th edition - 2011 Just as allergic disease significantly affects quality of life, obstructive sleep apnea, if it is untreated, may affect adversely the ability of adults and children to function adequately at work and at school.(2) 3
4. 4
5. Is Sleep Apnea Significant Health Issue ? 22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed. (3) 3.American Sleep Apnea Association 4.Young et al 1993 5.Young et al 2002 15. Marcus CL, Brooks LJ, Draper KA, Gozal D, Halbower AC, Jones J, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012; 130: 576-84. EPIDEMIOLOGY: OSA present in 25-58% of Male and 10-37% of Female. (4)(5) According to a report by American Academy of Pediatrics, depends on the population studied, the prevalence of OSAS is in the range of 1% to 5% (15) 5
6. Types of Sleep Apnea: Obstructive sleep apnea is the most common type of sleep apnea. It occurs when the soft tissue in the back of your throat relaxes during sleep and blocks the airway, often causing you to snore loudly. 6
7. Central sleep apnea is a much less common type of sleep apnea that involves the central nervous system, occurring when the brain fails to signal the muscles that control breathing. People with central sleep apnea seldom snore. Complex sleep apnea is a combination of obstructive sleep apnea and central sleep apnea. A) Obstructive sleep apnea. Note continued chest and abdominal effort in the absence of airflow. B) Central sleep apnea. Note absence of chest and abdominal effort, as well as absence of airflow 7
8. You have a higher risk for obstructive sleep apnea if you are: Overweight ??? (Most Important Factor) 5.Young et al 2002 6.National Institutes of Health 14.Malhotra et al 2002 • About 70% of those with OSA are obese (14) • Higher BMI associated with higher prevalence – BMI>30: 26% with AHI>15, 60% with AHI>5 – BMI>40: 33% with AHI>15, 98% with AHI>5 Obese people have extrinsic narrowing of the area surrounding collapsible region of the pharynx and regional soft tissue enlargement. Increased fat deposits posteriolateral to oropharyngeal airspace at level of soft palate, in the soft palate, and in submental area. Risk factors for Obstructive sleep apnea(6) 8
9. • Sex : Male are more likely than Female to have sleep apnea. • Age : the risk increases as you get older. • A family history of sleep apnea.
The document provides information about cochlear implants, including:
1) Cochlear implants bypass damaged parts of the inner ear to electrically stimulate the auditory nerve. They allow access to sound and can help develop speech recognition and communication.
2) The history of cochlear implants dates back to the 18th century but modern multi-channel implants were developed in the 1980s and have improved performance.
3) Over 100,000 people worldwide have received cochlear implants, including over 6,000 procedures annually in the US. The number of recipients is growing as criteria have expanded to include milder and unilateral hearing losses.
This document discusses the relationship between restricted breathing mechanics, airway, and posture. It outlines assessments that should be performed to evaluate the temporomandibular joint (TMJ), cervical spine, breathing, and posture. These include tests of joint range of motion, muscle strength, hypermobility, and breathing efficiency. Restricted breathing is found in many patients and is linked to forward head posture. Correcting breathing mechanics and posture can help resolve TMJ and neck pain by restoring proper joint alignment in the upper body.
What's new in Imaging of Hearing loss - Brescia AINR 2018Felice D'Arco
My presentation on genetic, embryology and radiology correlations in inner ear malformations.
Extended version of the presentation done for the Italian Congress of Pediatric Neuroradiology in October 2018
Similar to Airway Mini-residency: Intro to Airway Orthodontics (20)
This document provides information about multiple episodes of "The Airway and Facial Development Collaborative", a podcast produced by Drs. Mark A. Cruz and Barry Raphael. It lists the episode numbers, dates, guest speakers, and brief episode titles for over 50 past episodes dating back to January 2014. The episodes discuss various topics related to airway dentistry, sleep, breathing, orthodontics, posture, and interdisciplinary collaboration between dental and medical professionals.
This document discusses respiratory and breathing physiology. It provides an overview of evaluating upper airway function, including tests like HRPO, pharyngometry, rhinometry, and CBCT. It also discusses treating conditions like UARS, LPR, and OSA with therapies like CPAP, OAT, MMA, and MFT. The document lists potential medical sequelae that can result from untreated airway and breathing issues, such as bruxism, anxiety, depression, fatigue, nocturia, hypertension, cognitive impairment, reflux, cough, asthma, mood swings, infertility, and more.
This document discusses airway and facial development, evolution, and how environmental stressors can lead to unintended physiological consequences and compromises. It explores the difference between competencies developed through genetic evolution and design, and compensations developed through environmental influences and stress, which can result in secondary dysfunctions. Specifically, it examines how competent behaviors and functions in children can be replaced by compensatory parafunctions due to environmental factors like mouth breathing, which can ultimately lead to malocclusions and other structural asymmetries if left unaddressed.
This document announces an upcoming webinar titled "Current Topics in Airway Dentistry" hosted by The Airway and Facial Development Collaborative on June 13, 2016 at 9:30 EST. The webinar will be produced by Dr. Mark A. Cruz and Dr. Barry Raphael and will discuss evolution, Darwinian dentistry, competencies, stressors, physiology, and consequences as they relate to airway dentistry.
This document provides a brief history of myofunctional orthodontics, listing important contributors from 1850 to present day. It focuses on two pioneers: Wilhelm Roux, a German anatomist in the late 19th century who first conceptualized "Functional Orthopedics"; and Alfred P. Rogers, an orthodontist in the early 20th century who advocated total-child treatment including muscular exercises to improve posture and breathing. The document presents several of Rogers' publications from 1918-1926 where he emphasized the importance of muscle training and exercises alone in orthodontic treatment.
This document discusses bringing together different approaches to orthodontics that consider airway health, including Rogers MewAngleCrozat, myofunctional orthotropics, fixed appliances, and lightwire/cranial techniques. It advocates for interdisciplinary collaboration between orthodontics and other medical fields like pediatrics, musculo-skeletal medicine, and more to implement airway-conscious treatment protocols, improve diagnostics, and raise awareness of airway health issues. The goal is improved patient outcomes through validated multi-system diagnoses and addressing the epidemiology of airway problems.
The document announces upcoming events on airway orthodontics and a new collaborative medical/dental care model. It provides information on upcoming spreecasts and mini-residency courses on airway assessment, causes of airway dysfunctions, treatment, and practice. It also includes a call for participants in a white flag initiative and invites people to subscribe to updates, provide feedback, and share invitations with others. It closes with a parting quote about evidence-based practice and the need for ongoing curiosity and discourse.
This document discusses orthodontics and airway issues. It mentions that three orthodontists who attended an AARD meeting were curious about airway problems after one mentioned speakers on health and airway journeys. The friend spent two days promoting airway awareness and ALF programs, hoping other practitioners would understand the problems and solutions. The friend suggests crafting a vision for what they hope to achieve.
The document also lists researchers and outlines a research protocol studying the relationship between malocclusions, orofacial dysfunctions, and space conditions in primary and mixed dentition.
This email from a friend discusses a presentation they saw that focused on mandibular advancement for correcting malocclusions. The friend critiques the presentation for overlooking important factors like tongue position and swallowing pattern. They believe the actual problem in the cases was a low resting tongue level caused by issues like tongue tie or bottle feeding rather than mandibular position. Correcting mandibular position without addressing the underlying tongue issues risks open bite recurrence and TMJ problems later in life. The friend argues the study design did not fully consider all impactful information needed to accurately reflect what was occurring.
This document summarizes an episode of "The Airway and Facial Development Collaborative" podcast. The episode features Darick Nordstrom discussing the power of proper facial development. Nordstrom is a dentist from a rural practice who studied osteopathy and developed several appliance designs. He focuses on empowering practitioner teams through airway, sleep, and facial development techniques. The podcast is produced by Drs. Mark Cruz and Barry Raphael and covers topics related to the evolution of dentistry and its impact on facial development and physiology.
The document announces an upcoming Spreecast event on April 25th featuring Mark Cruz and a guest discussing a new medical/dental care collaborative model. It also advertises upcoming airway mini-residencies on the east and west coast in June 2016 that will cover assessment, causes, treatment, and practice of airway-related dysfunctions. Finally, it provides parting words questioning the concept of evidence-based practice and calls for more curiosity and discourse on what remains unknown.
This document summarizes an upcoming webinar titled "Pat McBride: Reading the PSG and The DDS/MD Collaboration" hosted by The Airway and Facial Development Collaborative on March 28, 2016. The webinar will feature Pat McBride discussing how to read polysomnography reports and the collaboration between dentists and medical doctors. It provides details on McBride's background and experience in dental and sleep medicine. The webinar producers are listed as Dr. Mark A. Cruz and Dr. Barry Raphael.
The document contains announcements for upcoming events including a Spreecast on April 11th with Darick Nordstrom discussing stabilizing orthodontic patients and an event on April 25th with Mark Cruz on multidisciplinary wellness collaboratives. It also lists information on an airway mini-residency in June 2016 and a call for participants in the AAPMD White Flag initiative. Contact information is provided to subscribe, give feedback, and find out more information on the listed events and programs.
This document discusses sleep scoring and interpretation. It begins by introducing the speaker and their background and disclosures in the field of sleep medicine. It then covers the basics of how sleep studies are scored, including scoring sleep stages, respiratory events, arousals, and periodic limb movements. It discusses the specifics of what is involved in scoring each of these components and provides examples. The document raises some issues that can arise in testing and reporting, and how failures in the system can negatively impact patients. It advocates for partnership between sleep professionals to better understand sleep disorders.
This document provides information about an upcoming episode of "The Airway and Facial Development Collaborative" podcast hosted by Drs. Mark Cruz and Barry Raphael. The episode scheduled for March 14th at 9:30 EST will focus on the legacy of James Garry and his contributions to the fields of dental occlusion and craniomandibular disorders. It will feature guests Clayton Chan and Ron Reeves discussing their history working with and being mentored by James Garry.
Clayton and Ron are thanked for something. An announcement is made about an upcoming webinar on March 28th with Pat McBride about working with medical offices. Another webinar is announced for April 11th with Mark Cruz on multidisciplinary wellness collaboratives. Information is provided about an upcoming airway mini-residency in June on both coasts covering assessment, causes, treatment, and practice regarding airway-related dysfunctions. Contact information is given for Darick Nordstrom and the AAPMD website. A call for participants is made for an AAPMD white flag initiative for orthodontists and others. Instructions are given to subscribe and pass invitations to others. Feedback can be provided to
James F. Garry was considered the "Einstein of Dentistry" for his pioneering work in upper airway obstruction, upper airway deformities, and craniomandibular disorders. He helped develop technologies like the Nuk pacifier and aspirator. Garry was inspired by Dr. Bernard Jankelson, the father of neuromuscular dentistry, and began incorporating neuromuscular techniques after seeing their success in treating his sister's pain. Garry was a leader in the field who published extensively, lectured worldwide, and held many positions in professional organizations throughout his career.
The document announces upcoming events including a Spreecast on Dr. James Garry on March 14th and a talk by Pat McBride on working with medical offices on March 28th. It also advertises East and West Coast airway mini-residencies in June 2016 and the AAPMD White Flag conference in Tucson in September. It provides contact information for the events and asks readers to subscribe, pass on invitations, and provide feedback. It closes with a quote about arguing and listening.
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TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
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Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Airway Mini-residency: Intro to Airway Orthodontics
1. !
dr. barry raphael
the raphael center for integrative education
!
www.learnairwayortho.com
drbarry@learnairwayortho.com
Airway-focused Dentistry Mini-Residency
Introduction to Airway Orthodontics
4. Sabuncuoglu O., Med Hypotheses. 2013 Jan 7. pii: S0306-9877(12)00566-X. doi: 10.1016/j.mehy.2012.12.017.
[Epub ahead of print]
5. RO since1983 (31 years...yikes)
Bucknell University 1974
University of Pennsylvania DMD1978
(Three Years in General Practice)
Fairleigh-Dickenson University Ortho 1983
14. Breathing and Sleep
Buteyko Mentorship
The Breathing Center
Woodstock
2010
Breathing Well Programme
John Flutter
2010 Ortho-Postural Training
Roger Price
2013
Sleep Dentistry
Michael Gelb, et.al
NYU
2012,2013
19. It’s about the Airway
BTW….I lost 30lbs
“It’s all about Barry
And The World of
Mouthbreathing”
20. • Honorarium and Travel Expenses but no vested interest in
Myofunctional Research Co.
!
• Director, Raphael Center for Integrative Education
Disclosure
24. Shelter from
the!
Storm
HVAC!
Comfortable
Environment
Family Living
Together
Decor and
Activity
“The Roof is
Leaking”
“The A/C is
broken. I can’t
sleep.”
“Mommy,
Lisa’s hogging
bathroom!”
“This place is
a mess!”
Chronic
Diseases of
Lifestyle
Airway and
Breathing
Inefficiency
Soft Tissue
Dysfunction
Malocclusion
and
Orthodontics
Airway-focused
Pathology
Airway Orthodontics
26. The Spectrum of SDB
Snoring
8-10%
Normal
Prevalence:
OSAS
1-3%
UARS
?
27. Anatomic Determinants of SleepDisordered Breathing Across the Spectrum of Clinical and Nonclinical Male Subjects*
Jerome A. Dempsey, PhD; James B. Skatrud, MD; Anthony J. Jacques, BS; Stanley J. Ewanowski, PhD; B. Tucker Woodson, MD; Pamela R. Hanson, DDS, MS; and Brian Goodman, PhD
CHEST September 2002 vol. 122no. 3 840-851
•Craniofacial morphology and obesity are
independent risk factors for apnea
•Maxillary depth predicts AHI
•Jaw shape explains susceptibility to AHI from
weight gain
Small maxilla + obesity = 3x SDB
Small maxilla + non-obese = 5-7x SDB
28. • Short maxilla means smaller
airway
• Narrow maxilla puts
nasopharynx at risk for
collapse with loss of muscle
tone
Anatomic Determinants of SleepDisordered Breathing Across the Spectrum of Clinical and Nonclinical Male Subjects*
Jerome A. Dempsey, PhD; James B. Skatrud, MD; Anthony J. Jacques, BS; Stanley J. Ewanowski, PhD; B. Tucker Woodson, MD; Pamela R. Hanson, DDS, MS; and Brian Goodman, PhD
CHEST September 2002 vol. 122no. 3 840-851
29. •Risk Factors for Increase AHI (Apnea-
Hypopnea Index)
• Age
• BMI
• Position of Hyoid Bone
• Size of Airway (and resistance to flow)!
• Neck Circumference
OSA Risk Factors
Analysis of anatomical and functional determinants of obstructive sleep apnea.
Aihara K, et. al ,Sleep Breath. 2012 Jun;16(2):473-81. Epub 2011 May 15.
32. Which would you rather have?
Analysis of anatomical and functional determinants of obstructive sleep apnea.
Aihara K, et. al ,Sleep Breath. 2012 Jun;16(2):473-81. Epub 2011 May 15.
33. Narrow, irregular airway >
> increased shear forces >
> negative pressure pulls on soft tissue >
> tissue pulling and trauma (snoring) >
> impairment of mechanoreceptors >
> uncoordinated diaphragm and upper airway muscle contraction >
>DISORDERED BREATHING
Narrow Airway Dynamics
Powell N, Guilleminault C. “Abnormal pharyngeal airflow in obstructive sleep apnea using computational fluid dynamics:
Feasibility study.” Proceeding of the 9th World Congress on Sleep Apnea (Seoul, Korea) 2009
34. Morphology and SDB in children
“Abnormal craniofacial morphology, but not excess
body fat, is associated with an increased risk of
having SDB in 6–8-year-old children.”
Ikävalko, et.al.,Eur J Pediatr (2012) 171:1747–1752
35. • 491 Finnish children 6–8 years of age
• studied: BMI, occlusion, sleep survey
• Looked for: Frequent snoring, apeas, open-mouth
posture
Ikävalko, et.al.,Eur J Pediatr (2012) 171:1747–1752
Morphology and SDB in children
36. Risk Factor Incidence
Obesity 0
Tonsilar Hypertrophy 3.7x
Crossbite 3.3x
Convex Facial Profile 2.6x
Ikävalko, et.al.,Eur J Pediatr (2012) 171:1747–1752
Morphology and SDB in children
37. “A simple model of necessary clinical
examinations (i.e. facial profile, dental occlusion
and tonsils) is recommended to recognize
children with an increased risk of SDB.”
Ikävalko, et.al.,Eur J Pediatr (2012) 171:1747–1752
Morphology and SDB in children
40. Form problems
Associations between sleep-disordered breathing symptoms and facial and dental morphometry, assessed with screening ,
Hyunh, et.al., AJODO, 2011, 140:762-70
Sleep Disordered Breathing associated with:
Long and narrow face
High mandibular plane angle
Narrow palate
Severe crowding
Swollen Tonsils and Adenoids
Allergies
Frequent Colds and Infections
Habitual Mouth Breathing
Function problems
41. •16% had long facial form!
•86% had convex profiles (mandible set back from maxilla)!
•Over 50% had daytime mouth open posture
Associations between sleep-disordered breathing symptoms and facial and dental morphometry, assessed with screening ,
Hyunh, et.al., AJODO, 2011, 140:762-70
Of the 600 orthodontic patients with SDB...
42. The smallest space behind the tongue (minAx) is the best predictor of NP airway volume
Small mandible: small airway
Airway volume for different dentofacial skeletal patterns!
Hakan Ela and Juan Martin Palomob, Am J Orthod Dentofacial Orthop 2011;139:e511-e521
43. Pharyngeal Airspace is Smaller in Mouthbreathers
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves, M, et.al., Int J Ped ORL 75 (2011) 1195–1199
Cone Beam and Airway analysis tool
44. • Exam for Mouthbreathing
• the habitual posture of the lips (apart, even slightly)
• size and shape of the nostrils
• control reflex of the Alar Nasalis
• Glatzel mirror test
• Rhinoscopy
• Adenoid hypertrophy
25 Mouth breathers,
25 Nasal breathers,
Avg 8-9 y/o
Pharyngeal Airspace is Smaller in Mouthbreathers
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves, M, et.al., Int J Ped ORL 75 (2011) 1195–1199
45. Mouth breather Nasal breather
Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children
Alves, M, et.al., Int J Ped ORL 75 (2011) 1195–1199
Pharyngeal Airspace is Smaller in Mouthbreathers
47. “In this large, population-based, longitudinal study,
early-life SDB symptoms had strong, persistent
statistical effects on subsequent behavior in childhood.
!
Findings suggest that SDB symptoms may require
attention as early as the first year of life.”
Snoring and SDB is dangerous in infants
Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years!
Karen Bonuck, PhD,a Katherine Freeman, DrPH,b!
Ronald D. Chervin, MD, MS,c and Linzhi Xu, PhDa
PEDIATRICS Volume 129, Number 4, April 2012
48. “The 2 clusters with peak symptoms before 18 months
that resolve thereafter still predicted
40% to 50% increased odds of behavior problems at 7 years.”
“...early childhood SDB effects may
only become apparent years later.”
Snoring and SDB is dangerous in infants
Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years!
Karen Bonuck, PhD,a Katherine Freeman, DrPH,b!
Ronald D. Chervin, MD, MS,c and Linzhi Xu, PhDa
PEDIATRICS Volume 129, Number 4, April 2012
49. Nighttime symptoms of SDB in kids
• Abnormal sleeping position
• Bruxism
• Chronic, heavy snoring
• Delayed sleep onset
• Difficulty breathing
• Difficulty waking up in AM
• Drooling
• Enuresis
• Frequent awakenings
• Insomnia
• Bed Dread
• Mouth breathing!
• Nocturnal migraine
• Nocturnal sweating
• Periodic Limb Movement
• Restless sleep
• Sleep talking
• Sleep terror
• Sleep walking
• Witnessed apnea
Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years!
Karen Bonuck, PhD,a Katherine Freeman, DrPH,b Ronald D. Chervin, MD, MS,c and Linzhi Xu, PhDa!
PEDIATRICS Volume 129, Number 4, April 2012
50. Daytime symptoms of SDB in kids
• Morning headache
• Mouthbreathing
• Morning thirst
• Excessive fatigue
• Abnormal shyness,
withdrawn, and
depressive presentation
• Behavioral problems
• ADHD pattern
• Aggressiveness
• Irritability
• Poor concentration
• Learning difficulties
• Memory impairment
• Poor academic
performance
Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years!
Karen Bonuck, PhD,a Katherine Freeman, DrPH,b Ronald D. Chervin, MD, MS,c and Linzhi Xu, PhDa!
PEDIATRICS Volume 129, Number 4, April 2012
51. Damage to Cognitive Function
Childhood OSA is associated with
•Deficits of IQ
•Deficit of executive function
•Possible neuronal injury in the
hippocampus and frontal cortex.
Childhood Obstructive Sleep Apnea Associates with Neuropsychological Deficits and Neuronal Brain Injury
Ann C. Halbower, et.al, PLoS Medicine,August 2006 | Volume 3 | Issue 8 | e301
52. Death, nasomaxillary complex, and sleep in young children
Caroline Rambaud & Christian Guilleminault, European Journal of Pediatrics DOI 10.1007/s00431-012-1727-3 Pub Online: April 11, 2012
“all children present a
visually recognizable
abnormal high and
narrow hard palate”
Abrupt Sleep-associated Death
• chronic indicators of abnormal sleep
• enlargement of upper airway soft tissues
• a narrow, small nasomaxillary complex, with or
without mandibular retroposition
53. • Maxillary Retrusion
• Midface Deficiency
• Maxillary Hyperdivergency
• Long Face Syndrome
• Adenoid Facies
• Bimaxillary Retrusion
• Craniofacial Dystropy
The small maxilla is a major factor in
Sleep Disordered Breathing
What causes it?
54. • The shape of the face determines the shape of the
pharyngeal airway
• The smaller the airway, the easier it is to obstruct
• Obstructed breathing affects the growing brain
Take Home Message:
56. Daniel E. Lieberman
“….there is much circumstantial evidence
that jaws and faces do not grow to the same
size that they used to…” - Daniel Lieberman
61. When the tongue rests in the roof of the mouth
the teeth erupt around the tongue forming a
normal shaped and sized jaw.
The tongue is the scaffold for the
upper jaw
62. Those children who breathe through the mouth
or have the lips apart at rest will not have the
tongue in the roof of the mouth.
All of these children will have
an underdeveloped upper jaw.
It will not be big enough for all of the teeth and when
the adult teeth erupt they will be crooked.
64. Posture changes Teeth
Lowered mandibular posture, tongue protrusion, and open biteOpen mouth posture retained for 1 year after nose reopened.
Facial features retained
65. • “Orthotropics”
• Normal growth of maxilla > Down and Forward
• Dysfunctional growth > Down and Narrow
• “Maxillary undergrowth is such a constant
feature of modern malocclusion” - AJODO,1979
• Biobloc Therapy
John Mew’s Tropic Premise
66. “Because the genetic control of
skeletal growth is not precise,
the articulation of the teeth and jaws depends
upon additional guidance from oral posture.”
John Mew’s Tropic Premise
67. “ If the tongue at rest is against the palate with
the lips lightly sealed and the teeth in or near
contact, there will be ideal facial and dental
development…something RARE in
industrialized societies…”
John Mew’s Tropic Premise
68. If the tongue is chronically held away from the palate…
…the maxilla collapses in all three dimensions.
The Tropic Premise
69. If the mandible keeps up: Class I Crowded
Then the Mandible Adapts
76. Soft Tissue Dysfunction
is THE cause of
malocclusion
The Maxilla and Upper Dentition
take the Shape of the Muscles
and Muscular Functions that
Surround them.
Craniofacial Dystrophy
Soft Tissue Dysfunction
is THE cause of
malocclusion
“Bone sets the tone but tissue is the issue”
- Mark Cruz
77. Open Mouth Posture !
is the most common and significant
Soft Tissue Dysfunction
In children today.
79. • The tongue is the scaffold for the growing maxilla (nature’s
palate expander
• Soft Tissue Dysfunction is the cause of Craniofacial Dystrophy
• Open Mouth Posture is the most common and significant soft
tissue dysfunction in children today.
• Craniofacial Dystrophy is a developmental problem
• In CFD, BOTH jaws are retruded
Take Home Message
83. Who said…
•The cause of modern man’s maladies is his lack of
“a quiet and natural sleep”.
•Proper breathing regulates digestion and
circulation to every part of the body.
•Improper breathing brings imbalance and disease.
•The nostrils are intended to measure and temper
the air in support of proper breathing.
George Catlin
85. “Shut Your Mouth and Save Your Life” 1870
“That man knows not the pleasure of
sleep; he rises in the morning more
fatigued than when he retired to rest -
takes pills and remedies through the day,
and renews his disease every night.”
86. Weston Price
1870-1948
Nutrition and Physical Degeneration
Weston A. Price, DDS, 1939
Malocclusion is a product of the diet of
industrialized societies
87. Obesity
Hypertension
Cardiovascular Disease
Type 2 Diabetes
Fatty Liver Disease
Some Cancers
Osteoporosis
Depression
The Results of the Mismatch
Between Genes and the Environment
Chronic Non-Communicable Diseases of Civilization
Western Lifestyle Diseases
Metabolic Syndrome
Asthma
Autism
Asperger’s
Alzheimers
ADD/ADHD
Chronic Back Pain
Caries!
Malocclusion!
Sleep Apnea
88. Its not just
Growth and Development
!
Its
Growth, Development and Adaptation
!
The Missing Link in Orthodontics Today...
89. If Malocclusion is caused by
Growth and Development...
Genotype Phenotype
Total Growth
90. If Malocclusion is caused by
Growth and Development and Adaptation...
Genotype Phenotype
Total Growth
93. One of them has crooked teeth.
Another set of twins
94. 3 August 2003 3 August 2003
RHYS - 10Y 11MHow did these teeth get this way?
Different genes than his brother…
95. 1 March 2007 1 March 2007
RHYS - 14Y 5MFour years later, after successful MFO
Text
(Treatment by Dr. Chris Farrell)
96. RHYS - 16 AUGUST 2007 KYLE - 16 AUGUST 2007
TRAINER BWS MYOBRACE MINIMAL SWA
RHYS & KYLE - 13Y 8MDid genetics make the teeth crooked?
Did genetics fix the face?
97. • Anthropology informs us that malocclusion is an
adaptation - a consequence - of contact with the modern
environment
• Genetic predispositions can be influenced by a change in
the environment
Take Home Message
….for better or for worse.
99. !
”... more often than is recognized,
the peculiarities of lip function
may have been the cause of
forcing the teeth into the
malpositions they occupy”.
Edward H. Angle
1855-1930
101. Light intermittent forces can affect skeletal growth
Crozat Philosophy and Appliance
•Preserve the natural dentition and
•Develop the bony structures
•Assist the natural shape of the face and jaws to develop to
their full biologic potential.
•Overall health and well being of the patient
102. Edward Angle vs Calvin Case
Witzig vs McNamara
NewConn 2009 Extraction vs Non-extraction Debate
The Extraction Wars
1855-1930
5-10% extraction rate
V. Kokich F. Bogdan
103. Passive-Self Ligation
The Damon System
“to match each phase of treatment with the natural force
systems of normal growth and development…”
126. Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of Class I bimaxillary protrusion!
Qingzhu Wanga; Peizeng Jiab; Nina K. Andersonc; Lin Wangd; Jiuxiang Line,Angle Orthodontist, Vol 00, No 0, 0000 !
(pre-publication 2012)
“the dimension of the velopharynx,
glossopharynx, and hypopharynx were
decreased after maximal retraction of anterior
teeth with extraction of four premolars…”
“Any factors that can influence the
posture and position of tongue and
soft palate may displace them
backward and
encroach upon {the pharynx}.”
“the more the incisors were
retracted, the more the pharyngeal
airway was reduced.”
Retraction affects the airway
127. Bilateral SSRO: “the pharyngeal airway was constricted
significantly at the oropharyngeal and hypopharyngeal
levels at both the short-term and the long-term follow-ups”
Effects of bimaxillary surgery and mandibular setback surgery on pharyngeal airway measurements in patients with Class III skeletal deformities!
Fengshan Chen, Kazuto Terada, Yongmei Hua, Isao Saito American !
Journal of Orthodontics & Dentofacial OrthopedicsVolume 131, Issue 3 , Pages 372-377, March 2007
Retraction affects the airway
Sagitall Split Ramus Osteotomy
Lefort I plus SSRO: “bimaxillary surgery rather than only
mandibular setback surgery is preferable to correct a Class III
deformity to prevent narrowing of the pharyngeal airway space
130. If snoring is likely to lead to obstruction someday,
how much snoring is “normal” for a child?
131. • Orthodontics is about the teeth
• Orthopedics is about the bones
• Orthotropics is about the direction of growth
• Most orthodontic technique are Retractive - even
“functional appliances” - and work against forward growth
Take Home Message
133. “If it were possible to improve faces to the disadvantage
of the teeth, where would our duty lie?” -AJODO, 1979
John Mew
Esthetics? Proper
Breathing?
142. Effect of mono- and bimaxillary advancement on pharyngeal airway volume: cone-beam computed tomography evaluation.!
Hernández-Alfaro F, Guijarro-Martínez R, Mareque-Bueno J.J Oral Maxillofac Surg. 2011 Nov;69(11):e395-400. Epub 2011 Jul 27
The pharyngeal airway gets larger
!
The average percentage of increase was:
69.8% with MMA
78.3% with Mandibular Advancement
37.7% with Maxillary Advancement
Protraction affects the airway
From Dr. K. Li
143. • MMA 100% successful
!
• Results similar to CPAP
Maxillomandibular Advancement Surgery in a Site-Specific Treatment Approach for Obstructive Sleep Apnea!
in 50 Consecutive Patients*!
Jeffrey R. Prinsell, DMD, MD, CHEST / 116 / 6 / DECEMBER, 1999
Protraction affects the airway
144. • 25 x 11 year olds
• Reverse Pull HG, 350 g, 14h/d for 6 months
• Follow-up 4 years post-treatment
• 2D analysis only (cephs)
“...the maxilla continued to grow
forward after treatment, which
was maintained in the long-term
observation.”
“improved the nasopharyngeal and
oropharyngeal airway dimensions
initially, …. was maintained at long-
term follow-up.”
Protraction affects the airway
Effects of Maxillary Protraction and Fixed Appliance Therapy on the Pharyngeal Airway !
Emine Kaygısız et.al., Angel Orthodontist, Volume 79, Issue 4 (July 2009)
145. Mandibular
Advancement
Appliances
open the airway
by bringing the
tongue forward.
Mandibular advancement devices are an alternative and valid treatment for pediatric obstructive sleep apnea syndrome.
Maria Pia Villa, Silvia Miano, Alessandra Rizzoli,Sleep Breath (2012) 16:971–976
Protraction affects the airway
146. Mandibular advancement devices are an alternative and valid treatment for pediatric obstructive sleep apnea syndrome.
Maria Pia Villa, Silvia Miano, Alessandra Rizzoli,Sleep Breath (2012) 16:971–976
Expansion affects the airway
RME may relieve nasal
breathing problems by
increasing the
transverse dimensions of
the maxilla, which in turn
widens the nasal cavity.
147. Mandibular advancement devices are an alternative and valid treatment for pediatric obstructive sleep apnea syndrome.
Maria Pia Villa, Silvia Miano, Alessandra Rizzoli,Sleep Breath (2012) 16:971–976
“Orthodontic therapy should be encouraged
in pediatric OSAS, and an early approach
may permanently modify nasal breathing
and respiration, thereby preventing
obstruction of the upper airway.”
Protraction affects the airway
148. • 53 patients, avg 12 years old
• Biobloc treatment for avg 20 months
• Posterior airway measured on ceph
Evalutation of the Posterior Airway Space Following Biobloc Therapy: Geometric Morphometrics.
G. Dave Singh, Ana Barcia-Motta, William Hange, Cranio April 2007, (25:2)
Orthotropics affects the airway
31% Increase in nasopharynx area
23% Increase in oropharynx area
9% Increase in hypopharynx area
150. Repenting for past sins affects the airway
What really matters is whether treatment increases,
or at least does not reduce, the tongue space.
- Bill Hang
151. Orthodontics in the 21st Century
Conventional!
Orthodontics
Airway!
Orthodontics
Genetic
Tooth-Focused
Esthetics Primary
Treating Symptoms
Airway Ignorant
Adaptation
Muscle-Focused
Esthetics Secondary
Treating Causes
Airway Concious
154. A Pathology Cycle
Declining Health
Function
MouthBreathing and
Low Tongue
FormLong Face
Function Weak MMuscles
FormNarrow Palate
Function Deviate Swallow
FormSwollen T&A
Crooked Teeth
Form
155. Breaking The Cycle
Declining Health
Function
MouthBreathing and
Low Tongue
FormLong Face
Function Weak MMuscles
FormNarrow Palate
Function
Swallowing with Active
Facial Muscles
Crooked
Teeth
Form
FormSwollen T&A
Conventional Orthodontics
156. Backed into a corner...
Stuck with Retractive Orthodontics
157. Breaking The Cycle
Declining Health
Function
MouthBreathing and
Low Tongue
FormLong Face
Function Weak MMuscles
FormNarrow Palate
Function
Swallowing with Active
Facial Muscles
Crooked
Teeth
Form
FormSwollen T&A
Airway-Centric Orthodontist
158. • Chad M. Ruoff & Christian Guilleminault
• Sleep Breath, 2011, pub online, May 11
Orthodontics and Pediatric OSA
“Although dentists and orthodontia recognize
the importance of evaluating and treating OSA,
they have yet to realize how well-positioned
they are for the prevention of sleep-disordered
breathing (SDB).”
159. The “environment plays an important role in the
development of SDB. Therefore, manipulation of
environmental factors may decrease the
development of OSA.
!
There is a need to better define these
environmental factors and predict those at risk
for the development of OSA so that orthodontists
and dentists can both treat and prevent OSA.”
• Chad M. Ruoff & Christian Guilleminault
• Sleep Breath, 2011, pub online, May 11
Orthodontics and Pediatric OSA
160. Dr. Stephen Sheldon
Professor of Pediatrics, Northwest University School of Medicine
Director, Sleep Medicine Lurie Children’s Hospital, Chicago
162. •Chronic Naso-pharyngeal Obstruction
•Tongue form aberrations (Frenum and tongue-tie)
•Open Mouth Rest Posture
•Myofunctional disorders (Swallowing, chewing,etc.)
•Chronic Hyperventilation and Hypocapnia
•Breathing Disordered Sleep (OSA, UARS, snoring)
•Bruxism and parafunctions
•TMD and facial pain components
•Cranial and postural issues
• Malocclusion
Airway-Related Craniofacial Dysfunctions
163. • Early Feeding and Nutrition
• Allergies, Asthma, URT infections
• Posture
• Airway, Breathing, and Sleep Disorders
• Soft Tissue Dysfunctions (Tongue Thrust, Open
Mouth)
Treating the Cause
Instead of crooked teeth being The Problem,
They are just a SYMPTOM of something larger
164. • Adult SDB and OSA
• Narrow Jaws and Faces
• Soft Tissue Dysfunction
• Early Parafunctional Habits, esp Open Mouth Posture
• Environmental Stressors
• CPAP, MARA,UPPP, Surg
Where’s the best
place to start
treatment? Here?
OrHere?
Treating the Cause
165. • The primary goal of Airway Orthodontics is to enhance
and protect the NP airway.
• It is always Form AND Function, spiraling in time.
• AO intervenes with Form AND Function.
• AO addresses the Causes of malocclusion
• Malocclusion is a Symptom of another Imbalance
• Malocclusion is the body’s Solution to an imbalance
elsewhere in the body.
Take Home Message
167. • In session Three we will learn
• The Goals of Airway Orthodontics (Breathe through the…)
• The Strategies of Airway Orthodontics (An ounce of…)
• The Techniques of AO (This is not you father’s palate expander)
• Ways to bring AO into your practice.
More to come….