Archive for November, 2014
The British College of Osteopathic Medicine, London. 2nd visit.
About 60 students and members of staff attended this introduction to the wider role of dentistry which was entitled “the Effect of Jaw Problems on the Rest of the Body”. The connection between the airway and malocclusion was demonstrated. This was followed by a brief presentation on Posture, Temporo-Mandibular Joint Dysfunction, Sleep Disorders and Movement Disorders. Dr Brendan Stack’s video included several cases of Tourette’s and other movement disorders and showed how an oral appliance could reduce symptoms by a considerable degree.
Mention was made of the merger of the British Society for the Study of Cranio-Mandibular Disorders with the Cranio Group (BSSCMD), and the students were encouraged to join. Annual student membership is £20 which includes two issues of the journal Cranio UK and several study group meetings held in London. http://www.jawache.com. The next meeting is on 8 January, 6.30pm at the RAC club, Pall Mall, London.
Observing the early signs of malfunction enables corrective treatment in the growing child.
The meeting ended with a lively question session.
Sleep Disorder Problems
The airway, it seems, has now become a buzz word in dentistry. Sleep disorders are increasingly being treated by dentists. Guy’s and St. Thomas’ have a NHS patient information sheet for patients suffering from snoring and obstructive sleep apnoea. It advises patients to have a Mandibular Repositioning Appliance fitted by a dentist.
Professor Mark Woolford, Associate Dean at King’s Dental Institute, fits these appliances in his clinic at Guy’s and tells me that the number of patients presenting for this treatment is escalating.
This begs the question as to why these patients need this appliance. Well, the answer is simple, they have a retrognathic mandible which restricts their pharyngeal airway. To counter this they adopt a forward head posture which, in turn, impacts on the back muscles. Furthermore a retrognathic mandible is usually associated with a narrow palate which also means a smaller nasal airway.
So the cause is obvious but what can we do to improve the situation? This is where Dentofacial Orthopaedics comes in to play. Almost all children exhibiting a malocclusion will have an under developed upper jaw and a retrognathic lower jaw. In fact the majority of Class II malocclusions are retrognathic in the maxilla as well as the mandible. Most malocclusions have an underlying orthopaedic cause.
Appliances which develop the maxilla will also improve the nasal airway. In young patients the lower jaw will often track forwards spontaneously after upper arch development. Functional appliances used in the growing child will reposition the mandible and improve head posture.
In the past snoring has been regarded as a social inconvenience but obstructive sleep apnoea (OSA) is now recognised as a life threatening condition. ADHD has also been linked with low oxygenation and bruxism, an early sign of a reduced airway.
To date the dental profession has had little, if any, dialogue with ENT practitioners and yet, as guardians of the airway, it can only be a matter of time before dentists and their medical colleagues realise the important role of Dentofacial Orthopaedics in the growing child.
Myobraces
Myobraces – the new pre-orthodontic corrective system
In the last month I have attended two Myobrace courses and I have been most impressed by the treatment possibilities it could offer our patients.
Over the past 25 years Myoresearch has been developing a series of trainers aimed at correcting unfavourable muscle patterns which are so often associated with malocclusions. The originator of this system is UK trained Dr Chris Farrell who worked with John Mew before moving to Australia. The designs combine a number of principles from the Frankel appliance and John Mew’s Bioboc system.
These “trainers” have undergone a gradual fine tuning and the Myobrace system now offers a range of appliances for patients aged 4 – 14 years of age. The designs of the appliances are supported by extensive research programmes and are now in use in over one hundred countries. The UK and the USA have lagged behind in this trend, possibly because both patients and parents in these countries regard fixed braces as the Gold Standard for orthodontic treatment.
However, delaying treatment until the permanent teeth have erupted has obvious drawbacks, not least the psychological implications of having unsightly teeth. Restriction of the airway can have serious side effects and low oxygenation has now been associated with Attention Deficit and Hyperactivity Disorder.
This system relies on the patient wearing the appliance for one waking hour a day and during sleep. Results have shown that in some cases a second stage of fixed appliance orthodontics is not required and when it is indicated the treatment is simpler and, therefore, shorter. This will reduce the side effects of hygiene problems, root shortening and relapse.
The Myobrace system is now being taught in three universities in the USA; Linda Loma, Mount Sinai and Tufts. Myoresearch will be staging courses in the UK in 2015 and the dates will be displayed on their website: www.myoresearch.com. I firmly believe that this system is the way forward for early correction of developing malocclusions and I look forward to following the progress of its introduction here.
Connecting Heads 