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Posts for: November, 2013

CaughtEarlyCross-BitescanbeCorrectedWithPalatalExpanders

There’s more to orthodontics than simply moving teeth. Especially with children and adolescents, we also want to guide the development of the entire facial structure to solve certain types of malocclusions (poor bites).

One such concern involves the upper jaw and palate (roof of the mouth), known collectively as the maxilla. In some individuals, the maxilla is narrower than normal. This causes the upper teeth to fit abnormally inside the lower teeth when occluding or “biting down” and is known as a cross-bite. A cross-bite may restrict the amount of space for your teeth to erupt (appear in the mouth) in proper alignment. It can be so severe the individual may have to shift the jaw to one side to completely bite down.

If a cross-bite is caught early, there’s a non-surgical treatment to widen the maxilla and help prevent upper teeth misalignment. But there’s a limited time window of opportunity: this is because the maxilla is actually formed by two bones with a seam that runs down the middle of the palate. The two bones will eventually fuse, usually at the beginning of puberty; until then there’s a slight separation.

Before the bones fuse, we can use a palatal expander to widen this seam and encourage permanent bone growth in the resulting gap. The expander is made of two metal halves joined in the middle by a small screw device that fits between the teeth. You or your child turns the screw a very small amount once or twice a day with a special key and the action pushes the maxilla outward on either side: the slight tension created stimulates bone growth. Over time, the new bone will have added width to the maxilla and eliminated the cross-bite.

While it’s possible to correct this after the maxilla fuses, it will require surgery to separate the bones. The palatal expander helps us correct the problem in the most non-invasive way possible, but it must be done before puberty. Discovering this type of malocclusion early is one of many reasons why regular dental visits should be an important part of your child’s healthcare.

If you would like more information on palatal extenders, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Palatal Expanders.”


By John G. Fisher, DMD
November 12, 2013
Category: Oral Health
ShaquilleONealsSlamDunkAgainstSleepApnea

You may think snoring is a minor problem, but it can be a lot more than that. Just ask hoops star Shaquille O'Neal, whose rambunctious snoring bothered his girlfriend enough for her to suspect a health problem. Her observations eventually led to Shaq's diagnosis of moderate Obstructive Sleep Apnea (OSA), which occurs when the soft tissue structures at the back of a person's throat, including the tongue, partially close off the upper airway and prevent air from moving into the lungs during sleep. Sometimes airflow can be blocked completely for 10 or more seconds.

When air flow is reduced, blood oxygen levels drop. This leads to brief waking episodes known as “micro-arousals,” which can happen sometimes more than 50 times an hour. The sleeper might not even be aware of this, even while gasping for air. Micro-arousals prevent the person from ever reaching deep, restful sleep.

Besides suffering from excessive daytime sleepiness, studies show sleep apnea patients are at higher risks of heart attacks, congestive heart failure, high blood pressure, brain damage and strokes. People with sleep apnea also have a higher incidence of work and driving-related accidents.

OSA can be treated in a few different ways. On the advice of his doctor, Shaq opted for a Continuous Positive Airway Pressure (CPAP) machine, which generates pressurized air delivered through a face mask worn while sleeping. The force of the pressurized air opens the airway (windpipe) in the same way as blowing into a balloon does.

For people with milder OSA, or who find they can't tolerate wearing a mask during sleep, an oral appliance supplied by a dental professional might be the answer. Oral appliances are worn in the mouth and are designed to gently reposition the jaw and move the tongue forward away from the back of the throat. Success rates of 80% or more have been reported using oral appliances, depending on the severity of the OSA.

If you would like more information on sleep apnea, please contact us or schedule an appointment for a consultation. You can learn more about sleep apnea by reading the Dear Doctor magazine article “Snoring & Sleep Apnea.” Dear Doctor also has more on “Sleep Disorders & Dentistry.”