Research and Articles
Oral appliances — past, present, and future
Orthodontic Practice US (Volume 9 Number 4) | June 2018
by Dr. Steven R. Olmos and Matt Rago review oral appliances and their characteristics
Oral appliances designed for relief of facial pain and jaw dysfunction, sleep breathing disorders, and orthodontics have been utilized for many years with little change in materials until recently. This article will review indications/limitations of existing designs/materials, and how computer-aided manufacturing allows for better and healthier alternatives.
There is always a reason for patients’ symptoms. Chronic face, jaw, head, and neck pain are all interrelated and are highly comorbid with sleep breathing disorders.1 Malocclusion, skeletal development deficiencies, and teeth crowding are symptoms of a functional breathing disorder. 2-7 Oral appliances are used for each indication.
Research and Articles
Improving quality of life and faces nonsurgically
Orthodontic Practice US (Volume 8 Number 3) | March 2017
by Steven Olmos, DDS, DABCP, DABCDSM, DABDSM, DAAPM, FAAOP, FAACP, FICCMO, FADI, FIAO
A case study featuring a young patient is presented as an example of the airwaycentered philosophy that essentially is defined as a mandibular relationship that produces the optimal orthopedic function of the temporomandibular (TM) joints and prevents or reduces airway collapse (oropharyngeal) in the unconscious state (sleep).
Research and Articles
Airway Centered Dentistry: (The A, B, C’s of Treatment for Chronic Face Pain/OSA and Closing Anterior Openbite Without Ortho)
Oral Health | May 2017
by Steven Olmos, DDS, DABCP, DABCDSM, DABDSM, DAAPM, FAAOP, FAACP, FICCMO, FADI, FIAO
Bullet points
- Definition-orthopedic/functional breathing
- Comorbidity of orthopedic and facial pain and breathing
- Answers to our questions
- Method or technique-paradigm shift
- Integrating myofunctional techniques
This article defines “Airway Centered Dentistry”, explains the mechanism of chronic face/jaw pain and dysfunction, reviews the technique and triage systems that have been successful in the standardized approach currently utilized in 45 TMJ and Sleep Therapy Centres in seven countries.
Treating chronic pain is a lot like emergency medicine. There is a triage process where structural (orthopedic/dental), metabolic, breathing (functional and obstructive apnea), infectious, and genetic mechanisms are evaluated. When patients are unconscious in the ER the airway, breathing and circulation are evaluated. In the treatment of chronic head pain, we do the same.
Research and Articles
Chasing Pain
Diagnosing and Treating Trigeminal Neuralgia in General Dentistry
As dentists, we know quite a bit about tooth and gum pain, but when it comes to chronic facial pain and neuropathic pain, our dental school education leaves us unprepared. The objective of this article is to explain the differences between men and women with chronic orofacial pain and the relationship to proper functional breathing.
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Research and Articles
Headache and jaw locking comorbidity with daytime sleepiness
Orthodontic Practice US American Journal of Dentistry, Vol. 29, No.3 | June, 2016
Purpose: To investigate the relationship between craniofacial pain symptoms (painful conditions present in the cranium and face, including jaw joint-related pathology and primary headache conditions) and daytime sleepiness, determined by the Epworth sleepiness scales (ESS), to correlate the comorbidity as well as potential predictive factors.
Research and Articles
Pediatric severe apnea/obesity/TMD/headache — Class III
Orthodontic Practice US (Volume 7 Number 3) | May 2016
The purpose of this case study is to demonstrate the relationship between obstructive sleep apnea (OSA), obesity, TMD, and headache in the pediatric population. It is possible to resolve OSA in children whereas we most often only manage it in the adult population. This demonstrates the need to identify the clinical signs and screen for sleep-breathing disorder symptoms in children and adolescents.
Research and Articles
3D orthopedic development for pediatric Obstructive Sleep Apnea (OSA)
Orthodontic Practice US (Volume 7 Number 2) | March 31, 2016
This article seeks to evaluate the 3D volumetric changes that are necessary to treat pediatric Obstructive Sleep Apnea (OSA). Adult static therapies are not indicated for children. Children require dynamic therapies to encourage and correct skeletal development to improve sleep-breathing disorders. Formulas for arch width expansion are currently based on dental space and skeletal calculations and are not applicable nor are they validated in the treatment of pediatric OSA. Treating children with OSA requires a new formula of skeletal development for both maxilla and mandible based on correction of the immediate medical problem evaluated by overnight sleep testing called polysomnography (PSG) (attended) or home sleep testing (HST) (unattended).
Research and Articles
Optimal Dental Therapy for OSA
September 2015 | Dentalcetoday.com
Optimal is a very different than acceptable, especially if you are the patient. This case study will highlight the need for a structural assessment of the 4 points of the airway prior to treatment utilizing CBCT (i-CAT). In additional, this case report will demonstrate how successful resolution of sever apnea with an oral appliance on a patient for whom continuous positive airway pressure (CPAP) had little effect on excessive fatigue until the nasal airway was addressed.
Research and Articles
CBCT in the evaluation of airway — minimizing orthodontic relapse
Orthodontic Practice US | April 1, 2015
Dr. Steven Olmos Discusses the Four Points of Breathing Obstruction
For those of us who treat obstructive sleep apnea (OSA) or those who have tried but run into problems that make you want to throw up your hands, think about the four points of breathing obstruction. Each patient has a different set of obstructions, so decisions on how to choose between the hundreds of appliances to treat breathing disorders are based upon multiple points of obstruction. The best treatment may be combination therapy (hybrid): oral appliance therapy, nasal positive pressure, and nasal surgery. The optimal result is one in which the four points of obstruction are best managed. Triage of options is dependent on a good clinical exam of the tongue and its posture and cone beam computed tomography (CBCT).
Research and Articles
Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015
Journal of Clinical Sleep Medicine | 2015
An American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine Clinical Practice Guideline
Kannan Ramar, MBBS, MD1; Leslie C. Dort, DDS2; Sheri G. Katz, DDS3; Christopher J. Lettieri, MD4; Christopher G. Harrod, MS5; Sherene M. Thomas, PhD5; Ronald D. Chervin, MD6
Introduction
Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientific literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring.
Methods
The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations.
