We just started using a new sleep appliance called MicroO2 with great success. This appliance seems to be much more comfortable than the Somnomed appliance. We have stopped significant snoring and improved oxygenation almost immediately, even in very severe cases. The appliance also does not constrict the tongue space- a common problem with other sleep appliances. When we call our patients after a few days of wear they are amazed with the results. We use a neuromuscular bite as the starting point for the appliance. This allows a much more comfortable jaw position. There is a greater than 70% overlap between TMD and sleep apnea so by combining neuromuscular dentistry techniques into the design of the appliance makes sense. We begin to treat both problems at the same time and find this to be integral to success. I will post some pictures and some sleep studies showing how the appliance works.
Boulder Dentist Serving Denver, Ft. Collins & Nearby Areas in Colorado
Dr. Adler of Adler Cosmetic & Family Dentistry believes that education is a continuous pursuit of knowledge and a constant refining of ones skills. He has tried to live this belief by continuing his education at the Las Vegas Institute (LVI) in Las Vegas, Nevada. Dr. Adler has already attained a fellowship from LVI but continues to take courses to expand his knowledge of different aspects of dentistry and to be able to offer the best and most complete care to his patients.
This week, Dr. Adler is returning to LVI to complete the third session of Neuromuscular Functional Orthodontics. This course will bring together all the information that Dr. Adler learned in the first two sessions and will focus on the key components in finishing treatment. During Session 3 of Neuromuscular Functional Orthodontics, Dr. Adler will be instructed on a number of issues including the reason some cases fail and how to avoid common mistakes, easy-to-understand case presentation, treatment sequences specifically as it relates to more complex cases, and age related treatment options. The emphasis of the course will be finishing to the correct functional treatment.
Neuromuscular Orthodontics focuses not only on making the patient’s smile look great by straightening the teeth but also makes sure that the patient’s bite is correct. Many functional issues that patients may have including problems with their TMJ can be corrected using neuromuscular orthodontics. It can also be used to help guide the development of younger children while they are doing orthodontics to help them avoid bite problems as adults. It combines the function of moving the teeth through orthodontics and finding and maintaining the correct bite through neuromuscular principals. It is an exciting aspect of dentistry that opens many new treatment options to patients.
For more information on Neuromuscular Orthodontics or to set up a free consultation to decide if Neuromuscular Orthodontics is right for you, please call us at 303-449-1119 or check us out on the web at www.AdlerDentistry.com
Many orthodontists have had the discouraging experience of completing dental treatment, with what appeared to be good results, only to discover that the case had relapsed because the patient had a tongue thrust swallowing pattern. If the tongue is allowed to continue its pushing action against the teeth, it will continue to push the teeth forward and reverse the orthodontic work. The force of the tongue against the teeth is an important factor in contributing to malformation (“bad bites”).
Tongue thrusting is the habit of thrusting the tongue forward against the teeth or in between while swallowing. It is normal for infants to thrust their tongues between their gums but by the age of 6, normal swallowing patterns should be developed. A normal swallowing pattern involves squeezing the tongue against the roof of the mouth instead of pushing it forward against the teeth. For tongue thrusters, the constant pressure of the tongue pressing up against the teeth during each swallow and even at rest causes a number of different problems and will force the teeth out of alignment.
There are several different types of tongue thrust and resultant orthodontic problems:
• Anterior open bite – the most common and typical type of tongue thrust. In this case, the front lips do not close and the child often has his mouth open with the tongue protruding beyond the lips. In general, it has been noted that a large tongue usually accompanies this type of tongue thrust.
• Anterior thrust – upper incisors are extremely protruded and the lower incisors are pulled in by the lower lip. This particular type of thrust is most generally accompanied by a strong mentalis (muscle of the chin).
• Unilateral thrust – the bite is characteristically open on either side.
• Bilateral thrust – the anterior bite is closed; however the posterior teeth from the first bicuspid to the back molars may be open on both sides. This is the most difficult thrust to correct.
• Bilateral anterior open bite – the only teeth that touch are the molars with the bite completely open on both sides including the anterior teeth. Once again a large tongue is also noted.
• Closed bite thrust – typically shows a double protrusion meaning that both the upper and lower teeth are flared out and spread apart.
When a tongue thrust exists, the upper arch collapses from improper lateral development usually provided from a normal posturing tongue. A patient with a tongue thrust often has difficulties with speech, especially the “S” and “Z” sounds. The patient is often a mouth breather, and when at rest, rests with their mouth open with a forward tongue position. Tongue thrusters will often make a funny face when swallowing or appear to be frowning. Most tongue thrusters are unable to “Click” with their tongues.
In order for orthodontics to be successful, tongue thrusting habits have to be re-trained into normal swallowing patterns prior to the completion of treatment. Dr. Adler prefers to use a Fixed Myo-Functional Tongue Trainer also known as Myo-Functional Bead. The Myo-Fuctional Bead is used to train the tongue to swallow in a correct pattern. The patient is instructed to spin the bead with the posterior aspect of the tongue. This exercise teaches the tongue to squeeze against the roof of the mouth instead of pushing forward against the teeth. There are many designs for a Myo-Functional Bead. Ideally, the bead is placed posteriorly, between the 1st molars. A Myo-Functional Bead can be placed on numerous appliances both fixed and removable, and can be added to prefabricated appliances.
It is important to recognize tongue thrusting during early development so that the behavior can be retrained and cause less damage to the bite and speech patterns. Dr. Adler is available for complimentary consultations regarding tongue thrusting and orthodontics. Please call the office at 303-449-1119 to schedule.
Recently, Dr. Adler, Heather and I (Kim) went to the Las Vegas Institute (LVI) in Las Vegas, Nevada for continuing education and training. We were only there for four days but were able to gain a surprising amount of valuable information in that short amount of time. The continuing education and training was focused on Orthodontics in Conjunction with Neuromuscular Dentistry. Having worked with Dr. Adler for several years now, I was comfortable with the information regarding the neuromuscular aspect but how it related to Orthodontics was a new twist. It was fascinating to understand how orthodontics could be used to not only straighten teeth (as it has traditionally been used) but also to correct the bite and even prevent future TMJ issues if treatment is started early enough.
Orthodontics is very hands on for the assistants. The majority of appointments are spent almost entirely with the assistant. This is great for the assistant because we get the chance to spend time with our patients regularly and really develop a good working relationship with them. Because orthodontics is very hands on, LVI had the assistants practicing their skills at placing brackets, bands, wires and ligatures in addition to other exercises. This was great because it allowed us to apply the techniques and tools that we had already learned about in lectures. The lectures went over a wide range of information from placement of brackets and appliances to types of materials and instruments to use. The assistants also got a chance to sit in with the doctors during some of their lectures so we could better understand the reasoning behind some of the doctor’s treatment decisions. Orthodontics is an exciting new aspect of Dr. Adler’s practice that the entire team is ready be involved in.
Dr. Adler continues to expand his abilities and his teams’ skills so that he can offer the best treatment available to his patients. Orthodontics has a wide variety of cases where is can be an extremely beneficial and valuable tool in Dr. Adler’s arsenal of skills and techniques. Dr. Adler’s strives to be on the cutting edge of new dental technologies and techniques and believes that continuing education for himself and his staff is an important way to achieve this goal.