Now, as part of the Physical Screening Process, let’s have them open wide!

Are their oral tissues inflamed? Do they have bad breath? High incidence of caries? All may indicate mouth breathing and an obstructed airway.

Does the patient have an underdeveloped high vaulted palate? Since the roof of the palate is the floor of the nose, a high vaulted palate is an indication of a diminished nasal airway. Asking “why" leads to your next observation.

Is the patient tongue tied?  If their tongue cannot go to its natural position during swallowing, this will lead to the maxilla staying narrow and high vaulted.  

A physical screening exam shouldn’t take more than five minutes and begins the moment your patient walks in the door from the waiting room towards the operatory. Here are a few key factors to look for:

What do you observe as they are walking in? For example, is their head tilted back with their mouth open? This posture is often observed in someone who cannot nasal breathe.

TO RECAP FROM THE LAST POST, incorporating the New Airway Imperative into your practice plan begins with asking the question: “Am I providing my patients – ALL my patients – with the best opportunity for continued and optimum airway health.”

Once educated in the essentials of sleep and airway, the actual patient process involves the assessment and incorporation of the following into your standard operational practices:

1) Screening 

2) Making the Diagnosis 

3) Discussion of Treatment Options and Team Coordination

4) Completing a Thorough Exam

5) Appliance Selection and Delivery

              6) Follow up

Dentists, orthodontists, and cosmetic dentists are human just like everyone else. Most see hundreds of patients a year. The vast majority of patients are routine, but every once in a while you get a difficult case or find that you aren’t sure of the best way to treat a specific case.

It never hurts to get a second opinion or to bounce ideas off someone who has kept up with the latest technological changes in dental materials, digital impression systems, CAD/CAM technology, dental implants, and other dental techniques.  

At Space Maintainers Laboratories, we offer secure and convenient diagnostic assistance and consultation.  

As discussed in the previous blog, the issuance of a recent ADA policy statement (The Role of Dentistry in the Treatment of Sleep Related Breathing Disorders) has necessitated the expansion of our current scope when it comes to the practice of what we commonly know as “sleep dentistry.” Our priority – as detailed in the policy – is an airway-focused imperative.

Understanding sleep and airway health management today means understanding that things have changed. Initially our goal as “sleep dentists” was to provide appliance therapy and palliative care that would prove equal to or better than CPAP.

Acknowledging that both work, but neither constitutes a cure, we must move toward a new paradigm…one that embraces early screening, and early treatment in the express interest of ensuring a healthy airway, a healthy jaw joint, excellent facial aesthetics, and an occlusion that supports these goals.

So often in the dental world one size does not fit all. Every patient’s teeth, jaws, and mouth are different, which is why you as a dentist rely on custom-made, custom-fit oral appliances.

Recommendations for a dental appliance, like a special retainer, could be thought of as expensive by patients. That would be true if you, as a dentist had to employ, train, and manage a whole lab of technicians in your office.

Fortunately, now you can get customized dental appliances to from a quality dental lab.

We have been treating patients with sleep/breathing disorders since the 1980’s. The modality? Sleep appliances which have managed these disorders with varying levels of success. The not-so-good news is that in pursuit of a better smile and improved facial symmetry and the quick or relatively quick fix, we have at times given little to no consideration to comprehensive overall airway health.

We can’t do that anymore. We now are mandated to improve, restore, or create a patient’s airway…to promote and actuate optimal airway health to the best of our ability. We need to step up. Educate ourselves, advance our skills and fulfill this freshly delineated function.

In 2017, the ADA House of Delegates approved a policy statement addressing The Role of Dentistry in the Treatment of Sleep Related Breathing Disorders 

"The passage of the sleep-related breathing disorders policy statement is the culmination of several years of work on this issue through the combined efforts of the Council on Dental Practice and the Council on Scientific Affairs," said Dr. Craig Ratner, chair of the ADA Council on Dental Practice, adding "…The end result is a comprehensive policy that can help dentists on the front lines help their patients with these potentially life-threatening disorders. Proper recognition and treatment can help prolong the health and lives of our patients."

Every dentist knows that next to getting an injection, the procedure that patients hate the most is having impressions done. The goop, the gagging, the anxiety…Ugh!

Good News! We now have the technology to eliminate this procedure. So, if you’re still taking traditional impressions, you might want to consider investing in a chairside scanner. Chairside scanners do require an upfront cost, but besides creating happier patients, they can dramatically cut down on time required to take an impression.

They can also save you the cost of impression materials, while allowing you to better assess preparations and margins -- which of course means you’ll get a better result more consistently. Finally, a chairside scanner allows you to automatically upload your scans to your dental lab of choice --  and that means faster and more accurate results.

Airway Health

Intraoral Habits: Options for Early Treatment Intervention
 

Early treatment intervention is essential when the dentist observes the formation (or imminent adoption) of an intraoral habit. Habits can cause skeletal open bites, Class II malocclusions and major airway issues.

Arch length loss has already occurred when you see an erupting six-year molar caught under the distal edge of a primary second molar. Leaving it untreated will block the normal eruption of the second bicuspid, diminish the child’s arch length and possibly affect the space needed for the tongue to rest normally.

The ELASTIC HALTERMAN APPLIANCE      

The Elastic Halterman Appliance is an easy way to quickly regain lost arch length and return a tipped molar to its ideal position.

A mushroom-shaped button is bonded to the erupting molar’s occlusal surface. A band with a hook that extends distal to the molar is cemented to the primary second molar. Chain elastic is used between the hook and the button to provide the required force.