mean? Furthermore, I am a dentist, what does that have to do with me and my practice?
My focus after dental school graduation from the Medical University of South Carolina was to learn all I could about full restorative dentistry. I wanted to make beautiful smiles and restore damaged, broken teeth back to optimal health and beauty. Little did I realize was the damage to these beautiful, God-given pearls, was from acid erosion and grinding and clenching, a result of small airways and mouth breathing. I had always been taught that grinding and clenching of the teeth was because of an “interference” in the bite. If we removed the interference, balanced the bite, and had patients wear an oral appliance, they would not damage the newly restored teeth. The tmjs, the joints on either side of your face that allow for opening and closing the mouth, would be in a healthy, happy place with no stress and the patient would be cured.
On my search to train with the best dental institutes in the world, I was introduced to sleep dentistry. It truly rocked my world! Dentists were learning beside ENT’s, pedodontists, pediatricians, orthodontists, and myofunctional therapists. It was truly an interdisciplinary team that was going to have to be implemented back home. It was like drinking from a fire hose. My head was spinning, how was I going to explain all of this to my staff and patients, and at the same time treat them for the dental issues they had come in for?
As I was learning about this at the prestigious Dawson Academy, they were offering take home sleep studies to the attendees.. My husband, who is not a dentist, but in the medical field, happened to be with me. We both took the sleep study. The study was measuring how many times we held our breath for 10 seconds or more, heart rates, arousals, and desaturations in oxygen. These studies have to be read by a physician. There are two forms of sleep study: 1) in a hospital sleep lab; 2) and take home. They both are read by a physician and are very accurate. Now with Covid and hospitals being full, I am wondering how that is affecting the hospital sleep labs. I have not done research on that, but it would be interesting to know.
Our results were read by a physician in the cloud, and it turns out that I had mild apnea and my husband had severe. Neither one of us even snored! I had always considered myself a great sleeper. For the last 6 years prior to getting the sleep study, I had taken a half of an Unisom for sleep. I had become accustomed to taking it during my pregnancy with my second child. It turns out that I was sleeping with my mouth open and having 13 apneic events per hour. That means I was holding my breath or shallow breathing for 10 seconds or longer. Why? I am not overweight or unhealthy, so I thought. I did have preeclampsia with both of my pregnancies. That is a condition in which your body’s blood pressure rises to dangerous levels, and your organs start to shut down. The swelling that occurs is horrendous. I was unrecognizable in 3 days because my body was unable to filter and excrete toxins.
Nobody could explain preeclampsia. My doctors said it was a complication of pregnancy, but nobody knew the cause. When I was a child, I would faint. They could not figure out the cause of that either. My insulin levels were checked several times to determine if it were due to hypoglycemia that I was fainting. The results were inconclusive, but I am sure there was too much sugar in my diet.
The last health condition was a tightness in my chest from time to time. I would describe it as the feeling of a tube sock in my throat. I had been blessed with a very busy dental practice, a beautiful family, friends and pets! Stress could be expected, I reasoned. The fix for that, as always, a prescription. Xanax was my drug of choice, which combined with Unisom can really give you the illusion of a good nights sleep! Wrong!
As I started to explore this silent killer in the night, I realized that the one thing that had never been looked at by anyone in the medical field, not even dentists, was my airway. Nobody had ever suggested that I could be breathing wrong and that I was deprived of oxygen at night, maybe the daytime too. I can’t throw stones because I was in the medical field myself, a pharmacist and a dentist, and I had not known this information to treat my patients with as well.
So, how are dentists contributing to this phenomenon? As it turns out, the size of the airway is related to jaw size. In other words, we evolutionized into a population that does not have room for their teeth and tongues. In the prehistoric days, we had a jaw size that could accommodate 32 teeth. That is all of our adult teeth, including wisdom teeth, with room behind that. In over 20 years of dentistry, it was rare that I saw anyone have that kind of set up! We used our teeth to grind and mince meat in our chewing. As our Westernized culture and diet evolved, we began eating processed foods that didn’t require that kind of mastication. The result was these smaller jaw sizes and mouth breathing.
The other thing that was happening was the smaller upper jaw (palate) didn’t allow for the tongue to fit up into it. When the tongue cannot get up into the palate, mouth breathing is the only choice. The mouth drops and the oxygen that goes over the soft tissue increases in size. This means that the tongue gets larger, as do the tonsils and adenoids. All of the excess in soft tissue, impinge on the airway, making it hard for oxygen to be delivered to the tissues to do the work of the body. If you think about it, how long can you live without oxygen? We put so much emphasis what we eat and drink, and for me, for 43 years, have never considered I could be in an oxygen deficit at night that was causing stress on my body. Sleeping should be the one time we are at peace and operating in the parasympathetic nervous system, not the sympathetic. However, some of us are literally fighting to stay alive in our sleep.
We spoke a little about jaw size and sleep breathing disorder and how the two are related. Because of jaw size, when we lie down at night and the muscles relax, the lower jaw naturally wants to hinge open. When it makes that one move, it can decrease the size of the airway by up to 50% or more. Factor in that mechanical motion and the soft tissue size that I spoke of earlier, this is what causes the labored, obstructed breathing. There is no physical way I can keep my mouth from hinging open, because I have this jaw size. Most of the world has it. Remember I said rarely do I see a patient with room for wisdom teeth and room behind that? That is why mouth taping has become common for some. Mark Cuban just recently invested in a company called Somnifix that is basically a subscription based company of tape used to cover the mouth while sleeping. The general public is starting to learn the advantages of nasal breathing and the health benefits and are looking for answers. Mouth tape can reduce or
eliminate snoring in some cases, but it does not change the size of the airway.
Currently, there are 3 ways that I know of to treat apnea and upper airway restrictions: 1) CPAP (Continuous Positive Air Pressure); 2) MAD (Mandibular Advancement Devices); and 3) surgery. They all have their advantages and limitations. In this article, I am going to talk about the limitations of an oral appliance. I am also going to say that this is the route I chose to treat myself and my family, including my children, because I believe the benefits greatly outweigh the risks. Like so many, CPAP is useful for those who wear it, but compliance is huge. Most do not even want to discuss hoses and masks to go to bed. For those that use this and are compliant, it is great. I do recommend frequent sleep studies to make sure the chosen method of treatment is effective.
As for the MAD, they all work off of the same principle. They move the lower jaw forward. Because you are held in that position overnight, muscle memory kicks in. When you remove the appliance in the morning, it is recommended to chew on your back teeth immediately to reprogram the muscles so as not to experience a change in the bite. You may not be able to fit your back teeth together at first. People that have existing joint damage in the temporomandibular joints (tmjs), may experience some discomfort as their jaw has been positioned forward. For people that have not had any pre-existing conditions, such as sore jaw muscles, popping/clicking in the joints, or jaws being “stuck” open or closed, it is usually not a problem. Again, a personal choice. My recommendation on appliance therapy is give it one month. Any changes that occur in that month are reversible, but if it is uncomfortable and the patient does not see the benefit, they should try something else. The trick is to find the “right fit” for the individual and everyone is different.
For me, I want to inform the public as best I can on a subject I have learned a lot about over the years. The case studies doctors and dentists have where we have treated hundreds of thousands of patients collectively are remarkable. The health changes from getting off sleep medications such as Ambien to losing weigh to treating ADD/ADHD in children and adults is incredible. Something so simple to look at that just gets overlooked. You can’t fault health care or your medical provider. We practice what we know and what we learn about. I guarantee, if
you asked, it is rare that you would find a provider if asked that said they haven’t treated themselves and their families with one of the above methods. It’s what happened to me, and I want to extend this knowledge and treatment options to you!