AIRWAY CENTRIC DENTISTRY

The airway governs our ability to breathe and to achieve a restful, oxygenated, restorative night’s sleep, as well as to perform optimally during the day. Any temporomandibular joint or occlusal philosophy must address airway patency while managing pain and dysfunction, identifying contributing factors and alleviating the perpetuating factors. The teeth are the last piece of the Airway Centric paradigm. The airway is the first, then joint and muscle and, lastly, the occlusion.

(Gelb, 2014)

The above quote is taken from a paper written by Dr Michael Gelb, the son of Dr Harold Gelb, who was instrumental in pioneering the wider approach to identifying the symptoms and the treatment of jaw joint disorders (TMJ disorder).1

In fact, the above paper constitutes the first reference by the World Dental Federation (FDI) in their 2018 policy statement.2

This statement promoted the early identification of Sleep-Related Breathing Disorders (SRBD) and urged dentists to take steps in preventing late onset forms.

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TMJBDS® originates in childhood and usually from mouth breathing.



BREATHING & SLEEP DISORDERS - IN CHILDHOOD

The prevention of late onset forms as outlined by the FDI2 begins with screening and detection in early childhood.


Sleep-Related Breathing Disorders (also known as Breathing and Disordered Sleep) in children can arise from a variety of causes but most commonly emerge from chronic mouth breathing.


When a child breathes through the mouth, the tongue will descend from the roof of the mouth and the lower jaw will swing down and back, taking the tongue with it. The incorrect posture of the tongue and function of the oral muscles lead to poor growth and development of the jaws, with a narrow upper jaw and crowded teeth.4


As the whole craniofacial complex fails to develop forwards, the progressive narrowing of the airway from the base of the tongue causes the head to posture forward to open the upper airway.

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Incorrect tongue position restricts
development of the maxilla causing crowding.

Modern research has shown potential compensations throughout the rest of the spine,5 which can lead to alterations in posture and often children with these issues will develop a forward head posture.6 Coupled with the aforementioned effects on the body, Breathing and Disordered Sleep (BDS) has been consistently linked to snoring, decreased cognitive development, behavioural issues and ADHD in children.3 The medical profession also warns that the latter stages of BDS can lead to life threatening consequences if left untreated.3 In essence, this is a breathing problem which manifests itself into sleep and Temporomandibular Joint (TMJ) disorders that vary in severity.1

BREATHING & SLEEP DISORDERS - IN ADULTHOOD

As with most habits and patterns that are formed in childhood, they are retained into adult life as long as the causes of the issue remain unaddressed. In adulthood, the problem is much more difficult to address as the patient is no longer growing and the contributing factors that were formed in childhood become established.

BDS in adults includes mouth breathing and snoring and is linked to a variety of issues ranging from daytime fatigue all the way to motor vehicle accidents and serious cardiovascular issues.7


Chronic BDS can progress to Obstructive Sleep Apnoea (OSA) which is a life-threatening illness with serious consequences for the sufferer.8

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Tongue and mandible obstruct airway.


CAUSES OF TMJ DYSFUNCTION

Mouth breathing, poor growth of the jaws and incorrect myofunctional habits can cause a reverse swallow as an adaptation.9 This means the patient swallows using their lower lip, which causes their lower jaw to push back every time the lip muscle activates.


As a result, the head of the mandibular condyle is driven upwards and backwards multiple times per hour, traumatising the joint.


Mouth breathing, poor myofunctional habits and other associated issues, all occurring over a period of time, can manifest in adult life as TMJ dysfunction.


This highlights the importance of treating breathing dysfunction simultaneous to the treatment of the TMJ, and preferably in childhood, before it fully manifests itself in an adult.

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The causes of malocclusion, TMJ and sleep disorders are primarily mouth breathing and incorrect myofunctional habits. All treatment must be directed at these two parameters.

(Dr. Chris Farrell, 1989)

TREATING THE CAUSES

Once the link between the two issues of BDS and TMJ are recognised, it is only logical to proceed to a treatment protocol that is all encompassing of the interplay of issues that are occurring and acknowledges that a multidisciplinary approach is needed. As awareness and diagnosis of BDS continues to rise, health professionals are rapidly realising the importance of early treatment.10 Current approaches like continuous positive airway pressure (CPAP), or mandibular advancement devices (MADs), are only effective in managing the symptoms of BDS and should not be considered as a cure. In some instances, these approaches have shown poor acceptability from patients and negative side effects intra-orally, as well as on the craniofacial complex, further complicating the issue.11 Other invasive surgical treatments have also been known to produce incomplete resolution and relapse of symptoms12 if efforts are not made to restore normal function. Hence why treatment methodologies should always be aimed at restoring correct natural function,13 rather than managing the symptoms as they appear.

Furthermore, the widespread nature and rise of BDS, as well as the demand for effective TMJ treatment, means focus must now be shifted to an approach that practitioners can easily implement. A global solution for a global problem. For the past three decades, Myofunctional Research Co. (MRC) has pioneered an all-encompassing treatment approach that addresses BDS in children and has treated adult TMJ issues with consideration of the airway. With pioneering protocols and innovative appliances, treatment methodologies exist for practitioners worldwide to implement and provide a greatly needed service for their patients in conjunction with an approach that utilises allied health professionals.

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Establishing Nasal Breathing
the primary goal of Myosa® TMJBDS® treatment.



THE MYOSA® SYSTEM

The Myosa® System incorporates breathing retraining, myofunctional training, mandibular advancement and TMJ decompression into one simple, easy to use appliance.



The Myosa® appliances will open the airway and regulate breathing through the mouth, whilst simultaneously correcting the associated myofunctional causes of upper airway collapse.


Patients may seek treatment for snoring, and it is important to educate the patient that snoring is a symptom of BDS, rather than the problem.


The Myosa® system treats more than just the symptoms of the problem by correcting the aetiological factors which cause TMJBDS®.


REFERENCES:
1. Gelb ML. J Calif Dent Assoc. 2014;42(8):551-62.
2. World Dental Federation (FDI). Dentistry and Sleep-Related Breathing Disorders. (2018,     November 12).
3. Kim KB. Am J Orthod Dentofacial Orthop. 2015;148(5):740-7.
4. Buschang, P. H. Seminars in Orthodontics. 2013;19(4), 212-226.
5. Saccucci M, Tettamanti L, Mummolo S, Polimeni A, Festa F, Tecco S. 2011;6:15.
6. Solow B, Sonnesen L. Eur J Orthod. 1998;20(6):685-93.
7. Somers VK, J Am Coll Cardiol. 2008;52(8):686-717.
8. Marshall NS, Sleep. 2008;31(8):1079-85.
9. Proffit WR. Angle Orthod. 1978;48(3):175-86.
10. Vlahandonis A, Walter LM, Horne RS. Sleep Med Rev. 2013;17(1):75-85
11. Almeida FR, Henrich N, Marra C, et al. Sleep Breath. 2013;17(2):659-66.
12. Bhattacharjee R, Kheirandish-gozal L, Spruyt K, et al. Am J Respir Crit Care Med.       2010;182(5):676-83.
13. Guilleminault C, Sullivan SS. Pediatr Neonatol Biol 2014;1(1): 001.

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Myosa® S1 Mouldable
Controls breathing and opens airway. TMJBDS® treatment.