Archive for April, 2015

11 May -Beyond BDS – Exploring the Wider Role of Dentistry – King’s Dental Institute, London.

By kind invitation of the Dean, Professor Dianne Rekow, this lecture was given to 20 final year students. The subjects covered were: the Airway, Posture, TMD and Movement Disorders. The Associate Dean, Professor Mark Woolford, has invited me to repeat this lecture next year to BDS level 5 students. He has remarked that it contained information that was useful to the students.

Professor Woolford is involved in the Sleep Disorder Clinic at Guy’s Hospital. I believe that there is a growing awareness that dentists could play a greater role in this area and that there is a need for more collaboration between the disciplines of medicine & dentistry and this view is strongly supported by Professor Rekow.

Omar Lalani, Vancouver, has a website:, and he is endeavouring to raise awareness of some of the limitations of teenage orthodontic treatment. His personal story makes disturbing reading.

This link is to a paper published in the Angle Orthodontist . vol.51 No.3 July 1981 177-202 Dr James A. McNamara

Components of Class II Malocclusion in 8-10 Years of Age.

It concludes that few Class II cases have a protrusive maxilla and most are either neutral or retrusive.

Another interesting paper:

Sleep. 2014 Oct 28. pii: sp-00423-14. [Epub ahead of print]

Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.

Camaco M, Certal V, Abdullatif J, Zaghi S,  Ruoff CM, Capasso R, Kushida CA.


Current literature demonstrates that myofunctional therapy decreases AHI (Apnea-Hypopnea Indices) by approximately 50% in adults and 62% in children. Lowest oxygen saturations, snoring, and sleepiness outcomes improve in adults. Myofunctional therapy could serve as an adjunct to other OSA treatments.

April 29, 2015 at 10:36 am 1 comment

BSGDS Spring Conference, Marrakech 18 – 21 April 2015

“Care, Competence and Continued Learning” is the mission statement of the British Society for General Dental Surgery. Founded over 30 years ago this society has organised speakers at the cutting edge of the profession. This conference was no exception and started with a presentation by member Dr Rash Patel who spoke about the Cone Beam CT (computerised tomography) scan technique. This gives exceptional information and is now accepted as a vital tool for implants and other advanced dental procedures.

On the second day Dr Derek Mahony gave his presentation on Obstructive Sleep Apnoea. He stressed that, as dentists, we are “Guardians of the Airway” and need to recognise the symptoms of sleep disorders in our patients. He routinely uses Cone Beam CT scans to evaluate the nasal & pharyngeal airways. Sleep disorders range from snoring to the most serious, OSA. He stated that mouth breathing in children is often overlooked and yet the lower oxygenation which ensues has now been linked with ADHD (Attention Deficit & Hyperactivity Disorder). Asthma is more common in mouth breathers. Simple appliances to develop the upper and lower jaw in growing children could bring about the change from mouth to nasal breathing. He emphasised the need for greater collaboration between dentists, general medical practitioners, ENT specialists and paediatricians.

April 24, 2015 at 2:56 pm Leave a comment

BSSCMD & Myobrace course follow-up article on OME

As a founder member of British Society for the Study of Cranio-Mandibular Disorders I would like to inform you that this society has now merged with the Cranio Group.

The aim of the society:

“To increase the knowledge and understanding of cranio-mandibular disorders (CMD) among all health care practitioners who are, or wish to be, actively involved in the treatment and management of patients suffering from this group of conditions.”

Since the majority of malocclusions are caused by underlying orthopaedic imbalances, the articles appearing in the BSSCMSD journal, Cranio UK, our meetings and study days should be of interest to anyone taking a more holistic approach to treatment. At the present time there is some resistance among mainstream practitioners to accept this approach. Our society upholds this philosophy and the greater our membership the more chance there is of moving dentistry into the 21st century to the benefit of our patients. Membership is £25 quarterly and £20 annual fee for students. You will find a link to the application form at the bottom of the home page on  www.craniogroup.comThese are interesting times and Professor Kevin O’Brien at Manchester University Dental School is in the process of re-evaluating this early treatment approach so do look at:

I recently gave a talk at the Myobrace meeting held in London on 21/22 March. My topic was the TMJ but there wasn’t time to include Otitis Media with Effusion so I followed up the delegates with the following article which may be of interest to you.

Otitis Media with Effusion (OME)

This condition is also known as Glue Ear. Since antihistamines, decongestants and antibiotics have little effect, patients may be advised to have Grommets fitted. This is a small tube which is inserted into the ear drum to drain the fluid and carried out under a general anaesthetic. The NHS website states that “Most grommets will fall out within 6-12 months of being inserted. Around one child in three will need further grommets.” Furthermore, permanent damage to the ear drum is not unknown and I had several patients in my practice who had suffered some degree of this complication.

As I mentioned in my lecture, TMD causes hyperactivity of the pterygoid muscles. Breathing dysfunction, ie: mouth breathing affects oral posture and results in poor oxygenation uptake which, in turn, also causes muscle dysfunction. Persistent hyperactivity of these muscles often results in recruitment of other closely related muscles. This may be one cause of headaches. Another outcome is the effect it has on the Eustachian tube. This tube is rather like a fire hydrant hose, it only opens under positive pressure. The scuba divers amongst you will be familiar with this equalisation. However, if the muscles around the tube are tense it cannot open and the fluid in the ear fails to drain.

Dento-Facial Orthopaedic practitioners prefer to treat the cause rather than the symptom by reducing the muscle hyperactivity. This can be done by decompressing the joint and increasing muscle length using composite build-ups (Myolays) on the lower deciduous molars. These build-ups can remain in place and will be active until the teeth are shed. My understanding is that Dr Merle Loudon, an orthodontist in Washington State, pioneered this technique.

Merle E. Loudon, DDS

Primary Molar Buildups

The Development and Benefits of Vertical Dimension Primary Molar

Buildup Crowns

Merle E. Loudon, DDS, and Thai Vinh Nguyen, DDS;
International  Journal for Orthodontics, Spring, 2015

 (Dental treatment of Otitus media with effusion and/or overclosed bites in children)

Primary Molar Buildups
Since Dr. Loudon discovered Vertical Dimension-Primary Molar buildups Thousands have been placed around the world.

Physicians who treat Otitis Media (world wide) give patients antibiotics and place grommets in the affected ears.  The placement of grommets will cause scarring and a permanent loss of 3-5% each time grommets are placed.  Primary molar buildups (VD-PMBs) is a none invasive dental technique which, in most cases, will eliminate Otitis Media with effusion in 24 to 48 hours.

Complications of having tubes placed in the ears are many:

  1. scarring of the eardrums.
  2. possible allergy to antibiotics.
  3. loss of 3-5% of hearing each time grommets are placed.
  4. thickening of the ear drum.
  5. Changes in the TM joint.
  6. Possible chance of getting meningitis.

Primary molar buildups corrects the vertical dimension (raises the bite) in children 3 to 12 years old.   It is a simple procedure where the dentist places composite on the lower primary molars to open the bite. It can be referred to as a mini splint.

There are numerous advantages to placing primary molar buildups

  1. Eliminates Otitis media usually in 24 to 48 hours.
  2. Lets the lower 1stmolars erupt increasing the vertical dimension.
  3. Reduces earaches and symptoms in 90% of children.
  4. Prevents continuous ear infections which can occur frequently over many months.
  5. Changes the resting tongue position from lateral tongue splinting to bisecting.
  6. Helps prevent TMD in later years.
  7. Helps increase breathing space.
  8. Positions the TM joint better in the glenoid fossa.
  9. Helps to open the airway.
  10. In most patients it improves esthetics by allowing the mandible to come forward.
  11. Helps balance muscle forces.

The Origin and development of Malocclusions: When, Where and How malocclusions develop.
International Journal for Orthodontics, IJO orthodontic journal, vol. 24, no. 1, spring 2013

This article is a must read for all dentists and especially for orthodontists and TMD specialists.  Copies of all articles  and VD-PMB manual may be obtained for $25.00 plus S & H from Merle Loudon, DDS, 2010 Autumn Drive, East Wenatchee, Wash. 98802

 In the spring issue of the IAO, IJO journal, Dr. Loudon’s publication describes how the forces of the muscles of the oral cavity control and shape the occlusion (bite), and or malocclusion. This important article should be read by every dentist, and a must read for orthodontists, pediatricians and TMD treatment specialists.


The Loudon-Chateau Anterior Advancement appliance
Article written in the IJO journal: Vol 25; No 3; Fall 2014
Merle E. Loudon, DDS and Thai Ving Nguyen, DDS

In 1986 Dr Loudon improved and revised an old mandibular anterior growth advancement appliance.  Dr Chateau first designed a wire appliance in 1904.  However it was harsh on the tissues in the mouth and lost favor.   Dr Loudon modernized it with acrylic so that it was comfortable and very efficient.  Now many dentists all over the world are using it.   With this new Anterior advancement appliance mandibular retruded children have grown the mandible forward as much as 7-9 mm.  The advantages of the appliance are many. 

  1. Grows the mandible forward on mandibular retruded children.
  2. Opens the airway.
  3. Improves esthetics.
  4. Eliminates extractions on most children.
  5. Allows the anterior border of the glenoid fossa to grow less steep on Class 2 Div 2 Children.
  6. Opens the bite which is needed on almost all Class 2 patients.
  7. Moves the condyle forward and may prevent TMD in later years.
  8. Orthodontics can be finished in a shorter time.

The DEAREV Formula

Dr Loudon invented the DEAREV formula, a method of diagnosis and treatment planning.  Basically there are only SIX major forces of movements used to move teeth.  He has incorporated this formula into the Loudon-Nguyen Orthologic Diagnosis and treatment Planning system.  This system is one of the most thorough systems for diagnosis in the world.

The Vertical overbite domino rule

The vertical overbite domino rule was discovered by Dr. Loudon in 1992.  It describes what happens when anterior overbites become more overclosed .  Excellent finishing  of orthodontic cases depends on the dentists knowledge related to deep overbite correction, vertical  and tooth size discrepancy knowledge.  An article written by Merle E. Loudon and Thai Vinh Nguyen called      “The overbite Complexity” will be published in the IJO journal in 2015


Upper Airway Obstruction and Resultant Growth Factors Influencing Malocclusion
International Journal for Orthodontics; Winter, 2014
Merle E. Loudon, DDS; and Thai Vinh Nguyen, DDS

This article explains the growth factors involved when children breath through their mouths and change the position of their resting tongue.  Mouth breathers lower their tongue to get more air through the mouth.  The resultant factors include many changes that result not only in malocclusions but influence the airways, cranial sutures, and many other structures of the cranium.





April 7, 2015 at 1:34 pm Leave a comment

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