12th Annual Presentation to the Osteopathic Centre for Children, London.
“The Effect of Jaw Problems on the Rest of the Body” was the title of my presentation. This time by Zoom!
12 participants tuned in from various regions of the country. The aim of the lecture was to inroduce the concept of an integrated approach to treatment involving dentists/orthodontists, ENT specialists and Myofunctional therapists. Ostepaths and Chiropractors also have their part to play , especially in early diagnosis and treating cranial strains.
Their is now a heightened awareness of the need to establish a good airway and nasal breathing in the early years in order to achieve optimal oxygenation for health and wellbeing.
Whole Body Connection
An in depth comment by Dr Derek Mahony, Specialist Orthodontist, Sydney, New South Wales Australia, from an on-going correspondence.
- I would avoid talking about bulging of the skull, better to refer to jamming of the cranial sutures which we know are expansion/contraction joints with a blood supply. There are over 300 published papers that show cranial suture movement and histologically the sutures are almost identical to periodontal fibres that allow micro movements of the teeth
- The reciprocal relationship between the C spine and the lumbar spine is called the Lovett Brother relationship. When one is out the other is also out therefore very hard for a chiro to stabilise the lumbar spine in a patient with a C spine that is subluxated because of a forward head posture to open an airway
- The meningeal or dural system connects the head to the pelvis. Within the skull you have the tentorum cerebelli and the falx cerebri that pass out through the foramen magnum attaching at C1, 2 and 3 before reattaching at the sacrum. Any tension in this system has the potential to cause pain.
- Casey Gauzy proposed a theory called Quadrant Theorem in the 70’s whilst in Chicago. He clearly demonstrated that the physiological point of rotation of the mandible is C3 not the glenoid fossa of the TMJ. What this means in reality is that patients’ with a retruded mandible, either naturally or iatrogenically often have a displaced C3, usually a rotation which affects normal lordotic curvature of the neck and consequentially the rest of the spine must compensate. I have a really nice CT scan of a patient with retruded mandible post exo ortho, diminished airway and rotated C3 if you want it. (NB. also available by using my contact form).
- Your cranial assessment is spot on. I would also talk about the sphenoid bone too. Explain the relationship of the maxilla to sphenoid in ortho terms (SNA and SNB). The sphenoid is the central bone of the skull, many chiros regard it as the “real” first vertebrae of the spine. It can be in a roll/pitch/yaw position and is often torqued by a retruded maxilla.
- Mention the ALF appliance and how Darick Nordstrom developed it with his osteopath, Tasha Turzo to balance cranial strains prior to orthopaedic and orthodontic work.
- Gerry Smith has a good DVD series about the ALF and a good book called the “Cranial sacral dental complex” available on his website.
- Differentiate internal and external derangements of the TMJ. Muscle splinting to protect the joint causes a lot of craniofacial and neck pain.
- In my clinical practice treating head, neck and spine disorders I found that the patients that didn’t respond to localised treatments of the spine within a few sessions all have cranial strains and malocclusions with or without extractions. Problems of the spine are almost always descending in nature, you must correct the head and occlusion for any chiropractic adjustment to hold long term.
Prevent Crooked Teeth Campaign
For decades crooked teeth have been accepted as just bad luck – a genetic inevitability that often requires extractions and fixed braces. This is seen almost as a rite of passage for teenagers. However, there is increasing awareness that such treatment can exacerbate obstructive sleep apnoea and TMJ disorders, leaving people with a lifetime of health problems.
The petition has 15,419 signatures to date, 8 August 2020.
This is a global petition so anyone can sign.
I do hope that many of you reading this will want to get involved.
Working Towards a Common Goal
This excellent Zoom Presentation on Facebook, 17 May, Sunday 07.00 Queensland time & Saturday 16,May, 22.00 UK. http://www.youtube.com/watch?v=R9Fwtbnsioc
Dr David McIntosh, ENT surgeon, associate professor, Queensland, Australia, and Dr Bill Harrell, Orthodontist with an interest in Dental Sleep Medicine, Alabama,USA, discussed the roles which each of them could perform to improve a patient’s airway. This integrative approach to treatment has been completely overlooked as dentistry and medicine advanced but along separate pathways.
The connection between a compromised airway and health issues has been recognised for many years. Dr McIntosh recalls that Joe, the fat boy, in Charles Dickens’ Pickwick Papers, presents with a sleep disturbance which later became known as “obstructive sleep apnoea syndrome”.
Sleep disorder breathing (SDB) results in lowered blood oxygenation leading to reduced brain activity.
During nasal breathing nitric acid from the paranasal sinuses is added to the air. This substance has a multitude of roles in the working of the body and one of significance is its affect on the growth hormone. Mouth breathing misses out on this most important compound.
Methods of treatment were discussed and the role of CPAP together with Oral Advancement Therapy was found to be a good combination as it reduced the reliance on the CPAP machine, which many patients find uncomfortable or impractical on a full time basis.
The message was:
– Screen routinely for Sleep Disordered Breathing.
– Correct the airway early & establish nasal breathing – 50% of facial growth is completed by the age of 5, 80% by 8 & 90% by 12-14.
– Medicine and Dentistry should be working together to fulfil these goals.
It’s time to put the mouth back in the body.
Dr Derek Mahony’s recent video
Here is the link:
The new College of General Dentistry
The new College of General Dentistry is asking for your support. This initiative, promoted by Professor Nairn Wilson and the Faculty of General Dental Practice, will launch in 2020.
In January 2017 a joint article by Dr Mikako Hayashi, Osaka University, and Professor Nairn Wilson was published on the Opinion page of the British Dental Journal.
“ Medical authorities should encourage doctors, dentists, and other healthcare professionals to cooperate closely in daily clinical practice, education, and research to promote an inter-professional wellness regime—especially given their common interest in conditions such as diabetes and obesity, linked through sugar intake and (un)healthy eating.”
https://blogs.bmj.com/bmj/2017/01/10/time-to-put-the-mouth-back-in-the-body/
With this integrated approach to treatment being made a cornerstone of their mandate, it is my belief that we would do well to get involved and help drive this project forward.
“By registering as a Supporter, you will be adding your name to our growing list of people who believe that now is the time for general dentistry to be given the standing of its own medical college. By registering, you can also receive updates on our progress in founding the College.”
General dental practitioners, dental therapists, dental hygienists and dental technicians are being asked to give their support.
https://www.fgdp.org.uk/news/college-general-dentistry-seeks-your-support
For the time being the college will be housed within the Royal College of Surgeons in London but in due course it is the intention to move to a separate location and pursue a Royal Charter. This will bring it in line with our medical colleagues and will raise the standing of general dental practice as a discipline in its own right.
This has been a long term ambition of Professor Nairn Wilson, CBE FDS, FFGDP, FFD, FKC. He is the Honorary Professor of Dentistry, former Professor of Restorative Dentistry and Dean and Head of King’s College London Dental Institute from 2001 until 2012.
.
As I live and breathe
As I live and breathe
Vogue magazine September 2019
This was the issue with guest editor, Meghan Markle, HRH the Duchess of Sussex. The main theme was “Strong Women” and pictured 15 examples on the front cover. Vogue also has features on Wellness & Beauty.
Kathleen Baird-Murray entitles her article “ As I live and breathe” . It includes comments and advice by Augusto Vegas, a breathing expert and the co-founder of Survival Apnea.
In his own words:
“Breathing too much or too little, in any situation, will limit performance and have negative effects on health “.
Vegas points out that we are all prone to “over-breathing”- the term he gives to a reliance on our ribs and chest muscles instead of the diaphragm.
As a surfer, Vegas practised his breathing technique initially to improve his stamina and resilience in the water, but quickly realised how much it positively affected his daily life.
So the message about breathing is out there. What we need to do is to get the even more important message across to the general pubic that establishing nasal breathing in the young is paramount to their wellbeing.
You can read the whole article by following this link.
Smile Direct Club – the New Kid on the Block
The launch of this new supplier of “invisible” braces is yet another reminder of how technical advances are rapidly changing the world around us. This international tele-dentistry company was founded in the US five years ago and has rapidly become the largest provider of orthodontic treatment in the US. Last year, revenue nearly tripled to $423m from about $146m in 2017. According to their website Smile Shops have already opened in twelve locations in the England & Scotland and will be launching in Canada and Australia next year. So, how does it differ from mainstream orthodontics and what does this mean for the future of orthodontics as we know it?
Smile Direct Club uses 3D scanning and computer technology to create a programme of treatment using clear braces that are posted to the customer. Only one appointment is required and the treatment is 60% cheaper than the market average. In the US some orthodontists are so fearful of the threat that Smile Direct Club pose that they have sought unsuccessfully to have tele-dentistry banned. It is easy to be scathing of treatment that involves less contact with a qualified clinician, but Smile Direct Club appear to have the winning combination of competitive pricing, good results and reliable standards of customer service.
Until now, orthodontics in the UK has been dominated by small clinical practices owned and run by qualified orthodontists who treat a mix of private and NHS patients. Small clinics already face onerous costs to ensure they meet statutory legislation on employment, care quality and so forth. Can they survive the downward pressure on prices presented by this direct-to-consumer business model?
Strange as it may seem, this threat may actually be what will spur the speciality, at last, to change tack! Orthodontics at its best is so much more than mere tooth straightening. Early diagnosis and intervention can reduce and even prevent the presentation of crooked teeth. By treating the face and not just the teeth, orthodontists can offer something that mail order clear braces never can.
The orthodontic profession has the knowledge and practical skills to impact on the health and wellbeing of young children and their future lives. There are progressive orthodontists like William Clark and John Mew who spent decades pushing the boundaries to develop appliances like the twin block and the biobloc, that have been shown to encourage jaw growth to make room for the adult teeth. Yet, despite international recognition, they have never been properly recognised for their achievements at home. Neither one of these men has been invited to speak at a British Orthodontic Society conference. It is time for the arguments between different factions of the orthodontic profession to end and for collaboration to begin. If the orthodontic profession wants to survive, it needs to properly understand the causes of malocclusion, its relationship with other conditions like sleep apnoea and TMD and the best ways to prevent and treat it.
In the long run, Smile Direct Club’s quantum leap approach could bring about the changes which so many of the non-establishment practitioners have been calling for decades! Good news for us and better health for patients.
Interceptive Orthodontics
Dr Howard Farran interviews Dr Derek Mahony on Interceptive Orthodontics. This video also includes descriptions of technical advancement which have made adult treatment more acceptable. Topics discussed are more aesthetic options and shorter treatment times.
new techniques now available for adult treatment.
The Benefits of Early Treatment
* The MARA appliance is one of several that are used for early correction.
Dr Derek Mahony’s YouTube channel.
* Below is a section taken from the journal of the American Association of Orthodontics and Dento-Facial Orthopedics, July 2016 by the editor-in-Chief, Dr Rolf G Behrents.
“One phase of two – For example, there is now clear and compelling evidence that early treatment for the first of two phases should be performed when a patient has protruding maxillary incisors. Such treatment is justified because reducing the protrusion protects the incisors from trauma and also improves esteem and social adjustment. This is simple to explain to patients and parents and is justified by the available evidence.”
* The Dispatches programme on Extraction versus Non – Extraction treatment.
https://www.fullfaceorthodontics.com.au/media cut & paste
