Our approach to treatment is about protecting or correcting the cranio-facial profile, and is demonstrated by the following excerpts from the BSSCMD’s publication “The Integrated Approach to Malocclusion, Sleep Disordered Breathing and TMD”.
(Details can be found under "The Book' heading).
The Integrated Approach to Malocclusion, Sleep Disordered Breathing (SDB), and Temporomandibular Disorders (TMD) is a comprehensive perspective that considers the interplay between these conditions:
Malocclusion:
- Malocclusion refers to misalignment of the teeth or improper positioning of the upper and lower jaws.
- It can impact facial profile and aesthetics, function, breathing, and overall oral health.
- An integrated approach recognises that malocclusion may be associated with other underlying factors.
Sleep Disordered Breathing (SDB):
- SDB encompasses various breathing disturbances during sleep, including snoring, obstructive sleep apnea (OSA), and upper airway resistance syndrome.
- Factors contributing to SDB include airway obstruction, tongue position, and craniofacial anatomy, including malocclusion.
- Addressing and preventing SDB is crucial for overall health and quality of life.
Temporomandibular Disorders (TMD):
- TMD involves dysfunction of the temporomandibular joint (TMJ) and associated structures.
- Symptoms include jaw pain, jaw joint noises, headaches, facial discomfort, and limited jaw movement.
- The integrated approach recognizes the relationship between cranial, TMD, malocclusion, and SDB.
Key Considerations:
- Treatment should be individualised, considering the patient’s age and specific needs.
- Early intervention (6 - 10) is preferred whenever feasible.
- Collaboration among dental, medical, and other healthcare professionals is often essential for effective management.
WE TREAT THE WHOLE FACE, NOT JUST THE WHITE BITS,
AS SHOWN IN THE FOLLOWING EXCERPTS FROM THE BOOK:
Chapter 4: TM DISORDERS AND HEADACHES
by Patrick Grossmann BDS
An area of medicine and dentistry which is all too often overlooked is the association between TMD and head, neck and facial pain. The reasons for this are unclear but I am of the opinion that too little attention is given to this subject atundergraduate level, and moreover there is no formal postgraduate training pathway in the UK for those interested in pursuing a dedicated course in orofacial pain. The TM joint connects the mandible with the cranium and dysfunction of this articulation can result in a myriad of seemingly unrelated symptoms which straddle the disciplines of medicine, neurology, medicine, physical medicine, dentistry and even psychiatry. It is thereforenot surprising that TMD cannot be pigeon–holed into any category, either dental/medical or surgical. For that reason, it is not uncommon for patients with TMD to consult numerous healthcare professionals, oftenten or more, only to be told they just have to ‘learn to live with it’ for the rest of their life.
Chapter 3: SIMPLIFYING TEMPOROMANDIBULAR DISORDERS
By Dr Noel Stimson LDS MCGDent.
Clicking is the articular disc slipping anteriorly off and back onto the condyle on opening and/or closing. The important feature here is the earlier the click occurs in the opening cycle (and the later in the closing cycle) the younger the problem is and the easier it is to treat. If the click occurs very late in opening and early in closing, you have a chronic condition (the posterior ligament is much more stretched) that is more difficult and costly to treat (Fig 1).
Some patients will tell you that their clicking joint suddenly stopped and it would be easy to assume that the problem had solved itself. CAUTION! If you then measure their ROM you will most probably find it is about 36mm, which tells you they have one or perhaps two completely dislocated discs that can no longer ‘click’ back onto their condyles and the joint’s opening translation is obstructed. This is the Closed Lock condition.
The important thing is to look at the two other major signs - ROM, and lateral excursion, deviation or deflection. Symptoms are a very helpful guide to what is going on, but can be misleading; they do not always occur when or where you expect them. I have seen patients in serious pain at the earliest stage and some with no pain at all over several years of actual dysfunction. Some have no pain OR dysfunction. I have a patient whose discs have vanished completely according to the MRI with no pain and an ROM of 53mm!! It can be very confusing.
Chapter 9: CRANIAL STRAINS AND MALOCCLUSION: A RATIONALE FOR A NEW DIAGNOSTIC AND TREATMENT APPROACH
(Peer reviewed and first published by the International Journal of
Orthodontics, Vol. 16 #2, Summer 2005, and in Cranio UK Summer 2007)
by Dr Gavin A James MDS FDS and Dr Dennis Strokon DDS
In a previous article we described the external features that characterize the cranial and facial structures of the cranial strains known as hyperflexion and hyper-extension. To understand how these strains develop we have to examine the anatomical relations underlying all cranial patterns. Each strain represents a variation on a theme. By studying the features in common, it is possible to account for the facial and dental consequences of these variations.
Chapter 8: PREVENTIVE SLEEP DENTISTRY – A CALL TO ACTION Barry D. Raphael DMD
The etiology of breathing disorders during sleep:
The practitioner of thirty years ago might have viewed obstructive sleep apnea as a disease of old, overweight men. But the intervening years have taught us that young, athletic women are not immune to the condition. We have learned that while weight and age add to the susceptibility to obstructive sleep disorders, they are not the root causes. Difficulty breathing at night comes from resistance to airflow, and many circumstances can make breathing difficult. Efforts to pinpoint the source of resistance are critical for determining the proper remediation.
Chapter 10: OSTEOPATHY AND OCCLUSION by Dr Caroline Penn DO(Hons), MSc(Ost), FSCCO, PHI Osteopath and HANDLE Practitioner
First published in Cranio UK Summer 2016 issue)
Why are dentists so bothered about the lips and the tongue? Put simply, the way the powerful muscles of the lips, cheeks and tongue work ultimately determines the development and shape of the dental arches, the face and to a large extent how we look. The teeth are simply passengers between these forces so if muscle action provides appropriate osseous growth stimulation then the teeth position will to a very large extent, look after itself. Patients who habitually breathe through their mouth or do not close their mouths respond poorly to orthodontics and the tendency to relapse is high, even when they wear retainers for life.
Chapter 13: USING THE MYOBRACE SYSTEM by Dr Doug Rider BDS (Wits) – Registered Myobrace provider
The following cases demonstrate what astonishing changes can be accomplished using Myofunctional Therapy (MFT) in a relatively short period of time. The crucial element, though, is patient co-operation. Parents consider Myofunctional Therapy because they don’t want their child to go through what they went through – extractions and braces and then still have crooked teeth when they are older – because they didn’t wear their retainers.
I enjoy the surprise on parents’ faces when we tell them that the first thing we get children to do, when we correct crooked teeth without braces or extractions, is to get their child to breathe correctly.
EPILOGUE
by Dr Noel Stimson LDS MCGDent
Patients and fellow professionals frequently ask, “what is the difference between integrative orthodontic treatment and other kinds of orthodontic treatment?”
The answer is straight forward – integrative treatment implies that behind malocclusion, there may be other common conditions such as TMD, breathing and swallowing dysfunctions, cranial imbalances, etc., which, if not addressed appropriately, may mean that the primary dental disorder (malocclusion) may not be effectively dealt with in terms of long-term stability. ‘Conventional’ treatment, on the other hand, appears to be concerned only with the mechanistic correction of crooked teeth, most commonly nowadays with extractions and fixed wire appliances only.
‘Integrated’ also explains why 30% of our members are osteopaths, chiropractors, physiotherapists, and myofunctional therapists.