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Your Quality Of Life

what do we mean?

Good quality of life is composed of many things, which are different for everybody. However, we can probably all agree that we want to be pain-free, headache-free, and specifically we want to be able to chew and enjoy our food without pain or discomfort. Eating leafy, crunchy and fibrous foods is necessary for good nutrition and it adds pleasure to the eating experience, however poorly functioning joints and muscles can get in the way of that. 

Living with chronic pain and/or headaches with no solution in sight can have a huge impact on ones quality of life and on relationships with family and friends. Pharmaceuticals such as pain medications can offer relief, but they often do not address the root problem. 

We all require high quality sleep to feel rested and rejuvenated. Unfortunately, many of us rarely get the necessary amount of sleep we need. In addition to length of sleep, it is important that the time we sleep is of good quality. There are many sleep disorders that can impact one’s quality of sleep. We work together with family physicians and sleep specialists to establish a proper diagnosis and the best therapy for each situation. Having a well-developed airway is crucial to be able to oxygenate our bodies adequately while we sleep. If the body needs to overexert itself to take a breath, this will lead to frequent arousals during sleep and reduced oxygen intake. As dentists, we spend a lot of time working in people’s mouths. This gives us a unique perspective to understand how the anatomy and physiology of the mouth and surrounding structures can affect the airway.

Modern life “Syndrome” – What is it? Why Now?

Modern Life “syndrome” can be seen as the effect modernization and parting from nature has on the way we live our lives today. In relation to craniofacial development, it is a well-known fact that over the last 10,000 years human skulls and jaws have undergone a general reduction in size, however over the last 400 years this reduction has escalated dramatically. We now see narrow and high palates (roof of the mouth), smaller lower jaws with retruded joints (TMJ), tooth crowding, wisdom tooth impaction, deviated nasal septum, restricted nasal breathing as a new “norm”. All of the above have one thing in common, all resulted from a person having a small mouth. Although there is great deal of controversy with regard to what are the causes for all these conditions, this nonetheless raises the question – what is normal vs. common and is there anything that can be done? 

We are seeing trends that we cannot ignore, however much more research needs to be done to understand the complexity of how the “small mouth” phenomena happens and why some people are affected more than others.  

Below are just some of the factors that have been attributed towards the trend of developing into a population of “smaller mouths”. This information is composed of only short summaries and are not intended to explain the full complexity of oral development:

Mixed gene pools across continents

Lack of prolonged breastfeeding

Use of pacifiers, bottles, sippy cups and straws in early developing years

Oral Habits

Tongue tie

Lip tie

Soft diet

Allergies/Food sensitivities

Enlarged tonsils and adenoids

Is it a coincidence that all of the following are
becoming increasingly more prevalent among our friends and family:

  • Braces to have straight teeth
  • Wisdom tooth extraction
  • Clenching and grinding
  • TMJ problems
  • Chronic headaches and migraines
  • Neck and back pain (never-ending chiropractic adjustments)
  • Diagnosis of ADHD in kids
  • Snoring sleep apnea

All of the above can be linked to having a small mouth. Although some are more obvious than others, it is important to understand that everything is interrelated and we must provide treatment that accounts for that. For example, more evidence is being found to suggest that sleep-disordered breathing (SDB) and obstructive sleep apnea (OSA) in kids is often misdiagnosed as ADHD since the behavior of ADHD and a sleep/oxygen deprived child are often indistinguishable. A child that breathes through the mouth and has underdeveloped jaws, may end-up with lack of room for the tongue. This ultimately forces the tongue into the airway, predisposing the child to snore and SDB/OSA, which can significantly affect their neurological development and overall growth. 

The body will sacrifice proper function and posture to get air in, which leads us to forward head posture (FHP). FHP is a silent epidemic, as we see it in people everywhere we go. Sometimes we attribute it to a desk job or just bad habits, which are valid reasons. However very frequently it’s due to poor airway and the body’s need to posture the head more forward to open the airway. FHP leads to neck, back pain and headaches. While we try to address these issues with massage and chiropractic adjustments, the actual source of the problem is a compromised airway due to limited tongue space.

When we talk about TMJ, Headaches and Airway we must consider them part of the same root problem that come with various degrees of severity and variability. FORM follows FUNCTION and eventually vice versa where poor FORM leads to continued poor FUNCTION. As a result of this strong link among them, comprehensive treatment options would need to include a solution to addressing the root cause. Treatment may vary from person to person, based on the problem at hand and how comprehensive the patient wants to take it. In some cases dental appliances are used to keep the problem from getting worse or maintaining it, or more comprehensive approach that involves orthodontics/orthopedic and/or restorative work.

    TMJ and MYOFASCIAL PAIN DISORDERS

    TMJ is the most complex joint in our body, suspended in the air and only held in place by muscles and ligaments. This joint is directly associated with the most complex nerve in our body, which is called the trigeminal nerve. This makes treating this area, as you’d imagine, quite complicated, thus a comprehensive approach is necessary to be able to understand the root of the problem. 

    Temporomandibular joint disorder (TMJD), is commonly associated with symptoms including, but not limited to: headaches, facial pain, jaw pain, sore/chipped/broken/worn teeth, clicking or popping in the jaw, and limited jaw movement.

    Migraines and Headaches

    Many people who suffer from chronic headaches are not aware that TMJ Disorder may be the cause. When the jaw joints are out of alignment due to poor fit of the teeth, this leads to an unbalanced bite (“bad bite”) where the jaw muscled are under a constant strain. The longer that strain remains uncorrected, muscles start to form “knots” or otherwise called trigger points which can lead to headaches.

    TMJ headaches can be very painful. As a result of their severity and frequency, TMJ headaches can sometimes be misdiagnosed as migraines.

    SLEEP DISORDERS

    Having a sleep disorder can have a serious  impact on your health and your overall quality of life. Sleep deprivation can result in poor performance at work, put you at risk for accidents, and affect your mood and how you feel around your family and friends. 

    Repeated oxygen deprivation and brain arousals during sleep can have significant general health consequences, putting the body into high stress mode when in fact it should be recovering from day-to-day stresses. The only way to find out if you have Sleep Apnea or any other sleep disorders, is to undergo a sleep test. If a physician or a dentist suspects that there may be an underlying sleep disorder, he or she would refer you to a sleep clinic and have you tested under supervision of a sleep specialist.

    Common sleep disorders that may be diagnosed at the sleep clinic are:

    1. Insomnia: inability to fall asleep
    2. Narcolepsy: uncontrolled sudden onset of sleep
    3. Restless Leg syndrome: constant urge to move your leg during sleep
    4. Benign snoring: mild form of airway obstruction that likely has no impact on overall health, other then possibly disturbing one’s partner’s sleep
    5. Upper Airway Resistance Syndrome (UARS): increased breathing effort needed to get past the resistance in the upper airway. Due to the need for increased respiratory effort, the brain has to arouse itself from deeper stages of sleep. This interrupts the proper sleep cycle and interferes with brain’s efforts to repair and restore itself. UARS can lead to Sleep Apnea if remains unmanaged
    6. Sleep Apnea: involves apneas (pause in breathing) and hypopneas (reduction in breathing), where breathing repeatedly stops for 10 seconds or more
      • Central: is where the brain doesn’t send proper signals to the muscles that control your breathing during sleep
      • Obstructive: involves an obstruction in the upper airway that prevents one to take a breath during sleep
      • Mixed: both central and obstructive apneas are involved

    Although, the cause of upper airway resistance syndrome and obstructive sleep apnea (OSA) is multifactorial, the factors that may be present are generally additive. This means that if we can address one of the factors, we may be able to either reduce the severity of the condition or possibly eliminate it.

     

    What are the factors involved?

    1. Life-Style Factors

    • Excess weight – did you know your tongue can also gain weight?
    • Large neck circumference
    • Alcohol and sedative use
    • Smoking (inflammation and fluid retention in airway)

    2. Developmental Factors

    • Narrowed airways
      • Limited tongue space
      • Poor tongue function
      • Retruded jaw position
      • Enlarged tonsils and adenoids
    • Nasal congestion/obstruction
      • Deviated septum
      • Enlarged nasal turbinates

    3. Hereditary/Genetic Factors

    • Gender (more common in men)
    • Age
    • Family history

    We have the capability to have an impact in two categories, life-style and the developmental factors. What do both of these categories have in common? The answer is lack of physical  space in the airway.

    Obstructive Sleep Apnea is a very dangerous condition that can shorten one’s life and predispose them to various chronic lifetime conditions that reduce quality of life. Below are just some of the possible risks involved with unmanaged or untreated OSA.

    • High Blood Pressure (Hypertension)
      • 35% of OSA patients have hypertension
      • 30% of hypertensive patients who have OSA are undiagnosed
      • OSA is the most common condition associated with resistant hypertension (64%) – Pedrosa et al.
    • Risk of Heart Attack
      • 70% of men hospitalized after heart attack have OSA – Konecny et al.
    • Risk of Stroke

    Nearly 60% of patients who had a stroke have OSA – Y. Kaneko et al.

    What is the treatment of OSA or UARS?

    Two valid approaches exist in treatment and management of sleep apnea. One involves reducing the obstruction itself and the other is done to by-pass the existing obstruction. Sometimes both approaches and often multiple modalities are necessary to completely eliminate OSA.  Below is a summary of the more common therapies available.

    Are you suspecting you may have Obstructive Sleep Apnea or you think someone you know may have OSA? Click on the following link to fill out Sleep Disorder Questionnaire

    Reducing the obstruction

    • Life-style changes
      • weight loss (exercise/diet)
      • smoking cessation
      • limiting alcohol use
    • Myofunctional Therapy
    • Dental Orthopedics and Orthodontics
    • Laser therapy
    • Surgery 

    By-passing the obstruction

    • CPAP (considered the Gold Standard to OSA management today)
    • Oral Appliances maintaining forward jaw position
    • Positional therapy – sleeping propped up on the pillow; or sleeping on the side

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