At My Rivertown Dentist, our comprehensive approach to care evaluates more than just teeth. In addition to the typical examinations of teeth and gums, we also evaluate jaw structure, jaw joints, facial balance, and airway.
Orthodontic evaluation of our patients is rooted in this same approach.
The Science – Airway Influences on Growth
In 2017, the American Dental Association (ADA) published recommendations that dentists screen for airway disorders.1 This recommendation came about to help bridge the gap in untreated chronic airway disease. Who better to assess possible airway problems than a doctor trained in looking at the oral cavity – one of the two gateways to breathing? With her advanced training with children, Dr. Ashley Lee is just that person.
The brain needs a certain amount of oxygen to thrive. When getting less than what is needed, the brain signals changes in the body to compensate. In growing children, this results in changes in jaw formation, posture, and possibly even behavior.
The changes can be instrumental in identifying airway issues early. Because the airway runs behind the upper and lower jaws on its way from the nose and mouth to the lungs, Underdevelopment of the jaws is now recognized as one of the primary reasons for airway issues such as sleep-disordered breathing (SDB) and obstructive sleep apnea (OSA).2, 3
Our Growing Children
For proper jaw and airway development, the following things need to occur:
- Quiet breathing that is through the nose both day and night
- Lips remaining gently together with relaxed facial muscles
- Tongue resting flat against the roof of the mouth, except when talking or eating
- Swallowing without excessive facial or head movement.
In young kids (birth to age 7), an open airway is a top priority for the brain. If a child is unable to do these things, their body will develop a compensation (a change in posture while standing, sitting, or sleeping) that may negatively impact their growth. The consequences usually will follow the child into adulthood.
1ADA airway doc
2Facial Contour Features Measured on CT Reflects Upper Airway Morphology in Patients With OSA Zishanbai Zhang, MD,*† Dance Sun, MD,*† Yajie Jia, MD,*† Nanxi Fei, PhD,‡ Yanru Li, MD, PhD,*† and Demin Han, MD, PhD*
3The role of craniofacial maldevelopment in the modern OSA epidemic: a scoping review Jason L. Yu, MD1,2; Akshay Tangutur, MS ; Eric Thuler, MD, PhD, MBA; Marianna Evans, DMD; Raj C. Dedhia, MD, MSCR
Signs of Dysfunctional Growth or Development
4Determinants of Sleep-Disordered Breathing During the Mixed Dentition: Development of a Functional Airway Evaluation Screening Tool (FAIREST-6)
James S. Oh, DDS • Soroush Zaghi, MD • Cynthia Peterson• Clarice S. Law, DMD, MS• Daniela Silva, DDS, MS • Audrey J. Yoon, DDS, MS
Interceptive Orthodontics – Game Changer
A growing amount of research shows that changing the trajectory of jaw growth can positively influence all the symptoms listed above. 5 This can be done by what is called interceptive (also known as phase 1) orthodontics.
In the past, phase 1 orthodontics was reserved for kids showing up with a dental crossbite (when the lower teeth are positioned outside of the upper teeth).
3D technology now allows our team at My Rivertown Dentist to assess the jaws in more than one dimension. We can evaluate skeletal crossbites (not just dental), airway volume, and jaw joints. Using this technology, your Madison dentist can better plan the interception of current problems and the prevention of possible future ones.
Advantages of Airway Orthodontics
Prevention – Some patterns that are present in adults who struggle with specific chronic health issues may be preventable by altering facial growth patterns in childhood. Since we understand that specific growth trajectories make patients more susceptible to some health conditions, Dr. Ashley Lee believes it is our responsibility to give patients the treatment options that encourage growth and proper function.
Health – When a patient presents with symptoms, Dr. Ashley Lee strives to discover the underlying cause. This is not always a tooth problem, and many times it is connected to overall health. The mouth is the window to the body. If skeletal or functional problems are contributing to a patient’s symptoms, we seek solutions. Interceptive orthodontics is one tool that assists our Madison office in growth and development.
Collaboration – While we provide interceptive orthodontics to assist a child in achieving their growth potential, many of our patients will also work with our team of partnering professionals to maximize their health outcome. Our collaborative team helps treat tongue posterior, airway, proper breathing patterns, sleep-disordered breathing or apnea, body and neck posture, and of course, balanced, healthy, and attractive smiles.
Orthodontic Options for Patients in Madison
Screenings start right away! Along with the American Academy of Pediatrics, we recommend that children have their first visit to the dentist by age 1. The team at My Rivertown Dentist has advanced training that allows us to more effectively screen for current and potential issues related to jaw growth and airway development. Catching early habits and monitoring growth patterns gives us the chance to positively impact growth and development.
Magical age of 7! The American Association of Orthodontists recommends your child’s first orthodontic screening take place no later than age 7. The upper jaw is mainly done with passive growth after this age. If we are able to identify the need for intervention early, treatment options are typically less complex.
Treatment options and decisions for our young patients are based on symptoms, patient maturity, and parent preferences.
5A roadmap of craniofacial growth modification for children with sleep-disordered breathing: a multidisciplinary proposal Audrey Yoon*, David Gozal, Clete Kushida, , Rafael Pelayo , Stanley Liu , Jasmine Faldu and Christine Hong
Health-First Orthodontic Options
For our smallest patients, we often encourage the use of this passive device to encourage ideal development. Myo Munchee is a small chewing device made of soft, medical-grade silicone. With just 10 minutes of daily chewing exercise, children (and adults) can improve the tone and function of the muscles of the lips, face, and jaws. The Munchee also encourages lip closure, correct resting tongue placement & swallow pattern, and promotes nasal breathing. Training muscles from an early age encourages proper jaw development. Click here for more info.
Palate expanders are used when the upper jaw is too narrow to align properly with the lower jaw, or when the narrowness of the upper jaw is causing problems with breathing and eating. Expansion with this simple appliance is only possible while the child is growing and is completed before the palate fuses during puberty. Gentle pressure from the expander on the upper molars is all it takes to encourage the palate to expand at this age.
Benefits of Palatal Expanders:
- Widens the Jaw to make more room for teeth
- Helps alleviate airway obstruction
- Correction of crossbite
- Prevents tooth impaction
Traditional metal braces attach to the front of the tooth. The metal braces we use are small and comfortable. The wire is held in place with either brace-matching silver ties or any color of the rainbow! Many of our younger patients (and some of our adults!) enjoy choosing colors to make their own patterns, changing them for holidays, favorite colors, or school colors. Traditional braces treat crooked, misaligned teeth and can be used alone or in conjunction with appliances that influence growth or better airway health.
At our office in Madison, clear aligners are the most well-known braces alternative. Utilizing clear, removable aligning trays rather than braces, you can correct your smile without anyone knowing you are in treatment. And since they are removable, you don’t need to alter your diet or how you brush and floss.
TADs, or temporary anchorage devices, are used often to hold certain teeth in place while providing anchorage to move others. TADs also assist in advanced movements that may otherwise require surgery, such as closing an open bite. They anchor into the gums and can easily be placed and removed in the office with only a local anesthetic, and can reduce treatment time.
What if You Are Done Growing?!
Even for our Teens and Adults, expansion may be recommended for a more ideal correction of your bite, an alternative to jaw surgery, or to improve your airway! Click here to learn more about My Rivertown’s Inspired Orthodontics for Adults