This document discusses the connections between breathing disorders like sleep apnea and asthma and their impacts on facial development and dental health. It suggests that medicine and dentistry should be in conversation to address these issues. Early intervention is important to guide proper facial growth and establish nasal breathing. Removing obstacles to nasal breathing like tonsils/adenoids and using palatal expansion or orthotropic techniques can help. Establishing proper tongue posture is also key to supporting development.

1. Should Medicine and Dentistry be in
conversation?

2. Photos from this book
by a Pediatric Allergist

3. Allergic Shiners due to Allergic Rhinitis

4. Open mouth posture leading to dental
distortions;V-shaped, high vaulted palates.

5. Open mouth/ Facial tension

6. Bruxism (tooth grinding) may be classified as a major sleep disorder.
Univ. of Miami School of Medicine ( pediatric allergy division) has ascertained a
three-fold incidence of bruxism in allergic vs. nonallergic children. Over 50% of the
children studied have previously had numerous attacks of secretory otitis media.
Bruxism opens the orifice and normalizes pressure on both sides of the eardrum.
During the daytime, talking and yawning accomplish this equalization.
Allergic Edema of
Mucosal Membrane
Blockage of Eustachian Tube
from Allergic Edema

7. MOUTH BREATHING AND ASTHMA
We speculate that asthmatics may have an
increased tendency to switch to oral breathing, a
factor that may contribute to the pathogenesis of
their asthma.
Chest. 1999 Dec;116(6):1646-52. Route of breathing
in patients with asthma. Kairaitis K, Garlick SR,
Wheatley JR, Amis TC
http://chestjournal.chestpubs.org/content/
116/6/1646.full
http://www.ncbi.nlm.nih.gov/pubmed/10593789

10. Announced 10/15/2014 -Mike Napoli to have
jaw surgery for Obstructive Sleep Apnea

11. IDS%ARE%SLEE
HEY%ARE%MOUTH%BRE
AFFECT%THEIR%FACIAL%
It Can Cause Poor Facial Development,
Compromised Airway, Exacerbate Asthma
Symptoms As Well As Crooked & Crowded
Teeth!

12. • 1980 - 7 million with
asthma
• 2013 - 26 million
with asthma
• 2013 - 30 million
adults with moderate
sleep apnea
• 1965 - a French
physician and his
colleagues studied sleep
issues
Parallels in breathing disorders
Randall Brown,MD
Univ. of Mich.
Am J Respir Crit Care MedVol 165

13. Latest research begins to connect the dots between breathing
disorders...
“Association Between Asthma and Risk of Developing Obstructive Sleep
Apnea”
...Asthma patients faced an almost 40% greater risk for sleep apnea
than asthma-free participants.
JAMA. 2015, January,The Wisconsin Sleep Cohort Study

14. Are we doomed to be a society of Darth
Vaders?

15. I think there has to be a better answer...

16. This dental arch has a long way to grow to develop as it was intended.
Neanderthal Man 100,000 yrs. ago Homo Sapiens 35,000 yrs. ago

17. Comparing nasal volume with different palate shapes. Imagine the red box is
the nose...
Remember:The roof of the mouth is the floor of the nose/ with expansion of the palate
you get more air and better breathing.

18. The story of this gentleman
that goes with the high palate
in the previous slide...
- tonsils removed age 3
- severe allergies all his life
- crowded teeth leading to
removal of 4 permanent teeth
and braces
- prostate cancer age 49
- worsening heart disease
- restless legs
- many fractured teeth and
crowns
Spinning instructor at the
Mac- physically fit; no sleep
issues identified prior to sleep
testing
AHI- 53

19. N.S. 8 y/o
Medical history: was significant for allergies, anxiety, disruptive behavior
disorder, developmental delay, bed wetting, snoring bruxing , sleep
walking, and restless sleep. He was diagnosed with Obstructive Sleep
Apnea and an AHI of 11. Following the sleep study he was referred for
removal of tonsils and adenoids. His symptoms improved and his AHI
came down to 4, but he was noted to snore and still have episodes
when he stopped breathing. He was referred for maxillary expansion
and orthotropic treatment.
Dental history: gummy smile, narrow arch, deep bite, crowding and flat
profile- showing maxillary and mandibular retrusion.

20. irway
reathing
irculation
Remembering CPR, we need to circulate oxygen to the
brain, or we can be brain dead in 4 minutes.
FOOD WATER AIR

21. The tongue is the only skeletal muscle with an origin
and without an insertion.The palate is the point of
insertion.

23. SLEEPING%WITH%THEIR%MOUTHS%OPEN.%%NASAL%BREATHING%IS%OBSTRUCTED.%
TH%BREATHERS.%%THE%TONGUE%IS%IN%THE%FLOOR%OF%THE%MOUTH%.%%THIS%WILL%
FACIAL%DEVELOPMENT%AND%THE%POSITION%OF%THEIR%DEVELOPING%TEETH
THESE%KIDS%ARE%NOSE%BR
CLOSED.%%THEIR%TONGU
NORMAL%GRO
WTH%O
TEETH%AND%BEAUT
How early do problems start? Do you see problems in
the faces of the children on the left?

25. What makes us suspect an
airway issue in a child?
1. Recognize the signs ....

26. Look for strains or
contractions in the
facial features.

27. Shiners or darkness
under the eyes.

28. Neck Extension
Crowded Teeth

29. Listen to your patient for
symptoms
▷ snores
▷ difficulty breathing during
sleep
▷ stops breathing during
sleep
▷ teeth grinding
▷ sleep walking
▷wets bed
Rapid maxillary expansion in the treatment of nocturnal enuresis-
Timms In the ten cases examined in this study, nocturnal enuresis
ceased IN EVERY CASE within a few months of maxillary
expansion.

30. Symptoms associated with Sleep
Apnea in Adults
▷ Asthma
▷ Allergies
▷ GERD
▷ Heart Disease; Hypertension
▷ Depression
▷Stroke
▷Diabetes
▷ADHD
▷Restless Leg Syndrome

31. Sleep Health Questionnaire
Current Sleep Symptoms
Symptom Y N Symptom Y N
Difficulty breathing during sleep Morning headaches
Stops breathing during sleep Learning issues
Snores Resists going to bed
Restless sleep Teeth grinding
Sweating during sleep Wets the bed
Daytime sleepiness Gets out of bed at night
Nightmares Trouble getting up in the morning
Sleepwalking Falls asleep in school
Sleeptalking Naps after school
Screaming during sleep Behavioral issues – ADD/ADHD
Kicks legs during sleep/uncomfortable
feeling in legs
Reports feeling unable to move when
falling asleep
Name: Birthday:
What allergies does your child have?
Drugs: Environmental:
Does your child have asthma? Y N
What diagnosed health conditions does your child have?
What surgeries has your child had?
Physician’s name: Phone:

32. 2. Remove obstacles preventing
tongue to palate posture

33. What can you do???
Eliminate activities that interfere with the tongue
to palate posture.
Release tongue-
ties as soon as
possible
Avoid pacifier
use
Discourage
thumb-sucking in
infancy

34. The infant must use muscles from the beginning
to nurse. Continue that use of muscles in
transitional food choices...
Avoid pureed foods
Give foods in natural form ( with
handles) the baby can grip
∅

35. Transition to a normal cup by way of an inverted sippy
cup to allow a normal swallow to occur.
∅ www.maddak.com

36. WHAT CANYOU DO?
Book geared to teach nasal breathing
via the Buteyko Method

37. I think Dentistry can contribute
meaningfully and non-surgically to the
solutions...

38. Karen O’Rourke DDS
Transforming Smiles...
Transforming Lives...
We like to start treatment as early as...
years old!

39. Karen O’Rourke DDS
Transforming Smiles...
Transforming Lives...
Treating abnormal growth at older ages is far more difficult and less
likely to succeed than effective growth guidance in the young child.
Research compiled by Robert Ricketts DDS
A t P u b e r t y
T h e F a c e I s
o f A d u l t
P r o p o r t i o n
Too Late
A t A g e 5
T h e F a c e I s
o f A d u l t
P r o p o r t i o n
Louisa
A t A g e 8
T h e F a c e I s
o f A d u l t
P r o p o r t i o n
Louisa

41. Patient with OSA…High Indicator
line…Retrusive profile
Ideal Indicator line
Normal profile

42. Biobloc Orthotropics®

43. Orthotropics- Greek for Growth Guidance

45. Adult Manifestation of Downward Growth

46. Expansion Phase
Better oxygenation 10 months later

47. • Facial Changes/ Relaxed Musculature

49. BEFORE
11/24/10
AFTER
3/16/2011
Before- lower teeth were outside upper teeth
Interceptive Treatment - age 4 1/2 : 4 months treatment

50. Biobloc Orthotropic Treatment
Before AfterGrow the jaw forward
and allow the lips to
come together
comfortably

51. Karen O’Rourke DDS
Transforming Smiles...
Transforming Lives...
What are the potential pitfalls
of Orthodontics?

52. Tale of two boys
in my practice

53. Traditional Orthodontics

54. Biobloc Orthotropics

56. What did I ask of you?
•Recognize the problem
•Remove obstacles to nasal breathing -
tonsils and adenoids and/or palatal
expansion - a great non-surgical option
•Remove obstacles for tongue to palate
posture, like pacifiers, thumbs
•Consider Orthotropics and early treatment;
avoiding extraction of permanent teeth
correcting Form
•Consider Buteyko Breathing, correcting
Function

57. What’s so Great About
Breathing Through My
Nose?
• Nasal Breathing is
critical to proper oral /
facial development and
asthma management

58. Nasal Breathing
Leading Researcher in Pediatric Sleep Apnea
Christian Guilleminault, MD, recently stated “
Elimination of oral breathing, i.e. restoration of
nasal breathing during wake and sleep, may be
the only valid end point when treating
Obstructive Sleep Apnea.
09/06/2014

59. Healthy Living Magazine 2015 - Is this the
current state of children’s dental health?

60. I hope that I have helped you to look at your patients in
a new light, and that together we can accomplish more
than either of us could alone...