Like all general and family dental clinics, Affinity Dental Care provides comprehensive dental treatments to patients and their families, the needed fillings, veneers, crowns, bridges, dentures, teeth whitening, implants, scaling, gum disease therapy, scaling, root planning, gum or bone graft, extraction, root canal treatment, orthodontics and cosmetic treatments.
One thing that makes us stand out is our holistic approach to providing treatments in our dental clinic. For “holistic” dentistry, we examine our patients’ mouths in the context of the whole body. Our focus embraces the surrounding head and neck, particularly the oro-facial structures, for signs and symptoms. With additional training in dental sleep medicine, myofunctional therapy and oro-facial pain, we like to screen and pay attention to disorders related to organic disease or structural abnormalities in the area.
Studies reveal obstructive sleep apnea (OSA) is more prevalent than we recognize. OSA is most common among older males but can also affect females and children. Women after menopause, however, are much more likely to develop OSA. Without estrogen and progesterone that help to maintain the airway’s muscle tone, older women have the same prevalence of OSA as their counterparts males in the same age group.
The estimated prevalence of OSA in North America is 15 to 30 percent in males and 10 to 15 percent in females. Approximately 936 million people worldwide have mild to severe OSA between 30 and 69. Most OSA sufferers do not know that they have the disorder.
The prevalence appears to be increasing and may relate to the increasing rates of obesity or increased awareness of the disorder among medical professionals, in turn, the higher detection rates of OSA.
Patients with untreated OSA can have a few prevalent illnesses caused by the condition. It includes stroke, insomnia, myocardial infarction, hypertension, hyperlipidemia, glucose intolerance, diabetes, arrhythmias including atrial fibrillation, pulmonary hypertension, congestive heart failure, and depression, particularly in females.
Healthcare providers must provide patients who suffer from the disease early recognition, diagnosis, and treatment to reduce cardiovascular burdens and other inflammation-mediated disorders.
How does a human develop OSA and other sleep-related breathing disorders? It often starts with myofunctional disorders at a young age when the child breathes through the mouth constantly with the mouth open and the tongue drops to the floor of the mouth during rest. During swallowing, they often develop abnormal swallowing patterns, with the tongue pushing forward against the lower front teeth and hyperactive circumoral muscle activities in the lips and cheeks. Thumb sucking, using a pacifier to an older age in a child, and tongue-tie can aggravate the disorders. Children with severe, chronic allergies, asthma, oversized adenoids and tonsils, large nasal polyps, deviated septum, and nasal trauma can make the kids develop chronic mouth breathing.
Upper airway OSA is unique to humans because it is not found in other animals. Our airway is much more complicated than theirs because we have developed a complex vocal cord in our larynx. Pharynx is essential for breathing, swallowing and speaking. Unlike other animals, our pharyngeal airway extends from the nasal septum to the epiglottis, is long, soft and collapsible. The pharynx has relatively little bony or rigid support. The airway largely depends on the activity of the pharyngeal muscles to maintain airway opening. During sleep, no muscle tone keeps it open, and that airway section can collapse, compounded by the possibility of the tongue falling into the airway, blocking air movement. In this modern era, our foods are much more refined (from mashed-up baby puree to processed TV food) that require minimum chewing exercise for our masticatory system of the jaws and muscles, causing underdevelopment of the jaw bone and muscle mass. The small jaw then infringes on the throat size and increases airway resistance. The weak muscles are not strong enough to provide the necessary tonicity around the airway to support and widen the airway behind the mouth.
The undeveloped jaws, weak muscles of the tongues, lips and faces have a cause-and-effect of myofunctional disorders. Patients with myofunctional disorders often have their resting tongue positioned on the floor of the mouth. The tongue is a unique organ. The tongue base is attached to the bone while moving freely. It has 16 muscles, changes shape but not volume (hydrostatic properties), and is essential to complex and quick movements for speech and swallowing abnormal swallowing patterns. With the tongue on the floor of the mouth, the lower jaw habitually drops down slightly and compensatory functions lead to abnormal swallowing mechanisms, affecting craniofacial morphology. The opened mouth produces higher force from the cheek muscles that causes the narrowing of the palatal arches and the size of the nasal passages above the palates (they share the palatal bone). They often have other comorbidities like temporomandibular conditions, orofacial myofascial pain, poor postures, kyphosis, and uneven shoulders, neck and shoulder pain.
When mouth breathing is the norm, the nasal passage tends to have more inflammation, resulting in more nasal congestion. The compensatory reaction is to lean the head slightly forward, together with the shoulders, to keep the airway open. In Orofacial, the patient develops long and narrow faces, teeth crowding, malocclusion, crossbites, open bites, small jaws, difficulty swallowing, and speech impairments. Suppose the myofunctional disorder is not treated earlier on in children. In that case, the signs that those conditions can express are snoring, teeth grinding, daytime sleepiness, difficulty focusing, attention-deficit/hyperactivity disorder (ADHD), and depression.
Eventually, OSA will develop in their adulthood if untreated. Symptoms like nocturia, obesity, daytime sleepiness, snoring, teeth clenching and morning headaches are common. In female patients, additional illnesses like pregnancy diabetes, preeclampsia, and polycystic ovarian syndrome are associated with OSA.
Myofunctional therapy, through active exercises, can improve functions related to the tongue at rest and in motion and its impact on craniofacial morphology and the ensuing orthodontic and occlusal stability.
Our goals of myofunctional therapy are to:
- Eliminate or minimize oral habits
- Normalize breathing through the nose (after allergy/ENT clearance)
- Develop a lip seal and toned lips
- Chew and swallow correctly
- Attain a palatal tongue rest position: anterior and posterior
- Work to activate and elevate the back of the tongue
- Tone the pharyngeal muscles
- Work on functional posture training
When myofunctional therapy and lingual frenectomy, if needed, are provided to a child with abnormal oral functions and craniofacial morphology, it can reverse the craniosomatic abnormalities and allow the normal development of breathing, swallowing, and speaking.
For adults, myofunctional therapy has been examined and proven clinically for over a century. It could serve as an adjunct to other OSA treatments. Several systematic reviews confirm that it reduces snoring, the apnea-hypopnea-index and OSA severity, oxygen desaturation, and daytime sleepiness. It also can stabilize the orthodontic and occlusal stability.
Dentists are uniquely positioned to recognize, screen, and possibly treat OSA and dysfunctional disorders as early as 2 to 3 years old because we see our dental patients regularly and spend much longer than their family doctors when we see them.
At Affinity Dental Care, we are knowledgeable in OSA and myofunctional disorders. We screen patients routinely and refer them to a sleep physician or an ENT specialist for proper assessment and diagnosis. We also provide early interceptive myofunctional therapy and oral appliance treatments, if appropriate, to our patients.