Archive for the ‘Snoring’ Category

Guest Article: Growing Better Airways with Biobloc Orthotropics

Tuesday, July 16th, 2013

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By Dr Mike Cary

Our airway health is related to how our face grows.  Facial growth and symmetry is influenced by genetics and tongue position.  In fact, how the tongue sits in the mouth has more impact than genetics when it comes to facial growth and symmetry. 

Favorable growth is associated with horizontal facial growth while unfavorable is associated with vertical growth.  Excess vertical growth results in elongation of the face, dental crowding, narrow palate, recessed chins, increase in airway restrictions and other conditions.  This occurs when the tongue is not resting against the roof of the mouth when the mouth is at rest (when we are not eating, drinking or speaking).  Good rest oral posture is when the tongue rests against the roof of the mouth, lips together, teeth lightly together and breathing through the nose.  Poor rest oral posture is when any of these are missing allowing the upper jaw to grow more vertically.  We find favorable facial growth is associated with good rest oral posture and horizontal growth.

Airway restrictions or obstructive sleep apnea in children have many of the same signs as poor rest oral posture such as narrow jaws, crowded teeth and mouth breathing.  Many times enlarged tonsils seem to be the cause of airway restrictions and unfavorable growth.  The first line of defense is to remove enlarged tonsils and adenoids to help children breath better.  However, this treatment alone does not improve rest oral posture, allowing unfavorable facial growth to continue.  Studies have shown over time, tonsil and adenoid removal alone helps a small percent of children with breathing disorders.

Biobloc Orthotropics® helps the face grow to its genetic potential by eliminating growth restrictions caused by poor rest oral posture.  Vertical growth is minimized and both jaws are developed in a forward and horizontal direction.  When the face grows more horizontal, the nasopharynx and oropharynx size increases as the base of the tongue comes forward with the face.  As the tongue comes forward it moves out of the airway space allowing more airflow from the nose to the lungs.  A 2007 study demonstrated Biobloc Orthotropics® can improve airway volume by 30%.  Currently Biobloc Orthotropics® is the only known method to increase the size of the airway with growth guidance.

Biobloc Orthotropics® utilizes a series of retainers to sequentially develop forward growth of the upper and lower jaw.  When compared to conventional orthodontic approach, orthotropics minimizes restrictive forces on the upper jaw when used properly allowing both jaws to grow forward.  You can see in figure 1 how the face and lips are fuller and the lower jaw is no longer recessed.

Figure 1

Figure 1

The oral appliances are comfortable to wear and are not visible making it desirable for the patient.  As the jaws develop forward, the tongue is lifted out of the airway to improve airflow (figure 2).

Figure 2

Figure 2

Biobloc Orthotropics® works best in children between age 5 and 8, when upper jaw growth is the greatest.  Treatment time can vary depending on the child, age and severity of the condition.  Treatment goal is to improve rest oral posture, increase favorable horizontal growth and improve airway volume.  Biobloc Orthotropics® can help improve facial and airway growth using conservative oral appliances.  To learn more, visit biobloc.org or Dr. Mike Cary to see if your child could benefit from orthotropics.

Dr Mike Cary is a general dentist in Sherwood, Oregon working with Oregon Sleep Associates to help children develop better airways utilizing Biobloc Orthotropics®.  Contact him at www.drmikecary.com or 503-925-9992.

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Exercise Lowers Apnea Levels and Benefits Sleep

Thursday, March 14th, 2013

Exercising

The obesity epidemic sweeping our nation has dramatic effects on health. Exercising is not only a key component in losing weight, but it may also affect the severity of Obstructive Sleep Apnea and help you sleep at night.

Researchers enrolled forty-three sedentary and overweight adults aged 18-55 years with at least moderate untreated OSA in a 12-week study to evaluate the efficacy of exercise as a treatment for sleep apnea. The participants were divided into two groups: One met 4 times per week and performed 150 minutes per week of moderate-intensity aerobic activity, followed by resistance training twice a week. The other group was the control and met twice weekly to perform low-intensity exercises designed to increase whole-body flexibility. Both groups underwent sleep studies before and after the exercise trial to determine severity of apnea. The results of the trial, published in the journal SLEEP, showed that the group that exercised weekly experienced a moderate reduction in their Apnea-Hypopnea Index (AHI), the measurement of the average number of breathing events per hour of sleep. The group that was limited to stretching did not experience this reduction.

Interestingly, the exercise group members did not experience any weight loss as a result of the exercise, suggesting the benefit of a reduced AHI was not in relation to losing weight. The researchers point out that further studies need to be done on this subject but speculate that “possible mechanisms of improvement in OSA following exercise training include a general strengthening and fatigue resistance of the ventilatory and upper airway dilator muscles, attenuation of respiratory instability from reduced sleep fragmentation, decreased nasal resistance, and prevention of lower-extremity fluid accumulation.”

Exercise is not a replacement for effective treatment such as CPAP or an oral appliance but a regular exercise program may help reduce your apnea severity.

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Oral Appliance Therapy for Sleep Apnea

Tuesday, August 28th, 2012

For over twenty years Positive Airway Pressure therapy has been the gold standard treatment for Obstructive Sleep Apnea. Although modern CPAP machines are comfortable, quiet and compact, what is the solution for those who cannot or will not use the therapy? Luckily, there are alternative treatments.

One of the most common CPAP alternatives for sleep disordered breathing is called a mandibular repositioning appliance (MRA), or oral appliance. These devices resemble orthodontic retainers and work by repositioning the lower jaw forward during sleep, thereby anchoring obstructive tissue out of the airway and preventing apneas. The devices usually have some sort of adjustment screw or tensioner that allows for minute advancements. A health professional preforms these advancements over time until the breathing is corrected. The devices have been shown to be effective in treating some forms of sleep disordered breathing such as snoring and mild to moderate apnea. Patients with severe sleep apnea might see a reduction in intensity of their apneas, but the problem is likely to remain. For this reason, an MRA is not recommended for severe sleep apnea.

You may have seen the commercials on television for so-called “boil and bite” mouth guards that help to treat snoring. These devices are generally not beneficial. To be truly effective, oral appliance therapy must be custom fit to each patient and a qualified dentist must supervise the advancement of the device. Advancing the jaw too far forward too quickly can lead to complications including temporomandibular joint (TMJ) pain.

It is also very important that there be an objective measurement of the treatment’s efficacy after initiation. Patients may subjectively feel some relief after using an oral appliance, yet they can still have significant sleep disruptions. An overnight sleep study should be performed to confirm or refute the efficacy of the oral device.

When correctly fit and titrated, oral appliances may provide a convenient way of treating mild sleep disordered breathing. They can be also be used in conjunction with PAP therapy to allow for reduced pressures. Oregon Sleep Associates has longstanding relationships with several dental providers in the area who specialize in oral appliance therapy. If you are interested in an alternative to CPAP or are seeking treatment for the first time, contact our sleep specialists for more information at 503-288-5201.

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