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by Courtney Wager, R.D.H.
Before becoming a hygienist, I brought my, then, seven year old daughter to a well known orthodontic practice. I heard the owner speak while in hygiene school, and I was very impressed by what I had heard, so I decided to bring my daughter there.
After her initial consult, it was recommended that she wear an appliance, known as a palatal expander, of which I was very familiar with, having worn one myself as a child. The idea is to expand the arches to the left and right in order to create a proper alignment of the arches so that permanent teeth have room to erupt in a natural position.
She wore this for approximately six months, and then after it was removed, it was recommended that she be monitored until it was time to place orthodontic brackets.
Shortly thereafter I completed hygiene school and came to work for Drs. Ronkin and Shwartzman at Dream Smile Dental. A few months ago when Erin turned 12, I received a reminder card from Erin’s orthodontist that it’s time for a check. I brought her in where they took a number of x-rays including a cephalometric film (ceph),which is commonly used as a diagnostic tool prior to orthodontic treatment.
The orthodontist recommended that Erin have brackets placed, with no additional appliances, and estimated that she will wear these for approximately 18 months. Knowing that Dr. Ronkin is the ortho expert in our office, the very next day I showed him the recommended treatment plan, with the ceph taken at the other office. Dr. Ronkin recommended I bring her in for a consultation.
At Erin’s first visit with Dr Ronkin, to my surprise, he took ANOTHER ceph. Dr. Ronkin explained to me that the reason for this was that the ceph that Erin’s orthodontist had taken, did not include an image of her airway. After taking it, it was noted that Erin’s airway at age 12 was 4mm wide – but it should be between 11-12mm. I was SHOCKED, for a few reasons.
First, I was terrified, as I realized that if her airway is three times smaller than it should be, does this mean she’s getting three times less oxygen to her body than she should be? Second, I was so grateful that I work where I do and that the doctors are educated in Neuromuscular Dentistry – as opposed to just “straightening teeth”. Had I not worked where I do, I would have had no idea, I would have done standard orthodontia. As a result, Erin very likely could have developed Sleep Apnea as she got older which means there would not be enough oxygen getting to the cells in her body.
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Upon review of the new ceph, Dr. Ronkin recommended a palatal expander prior to placing braces because Erin’s upper jaw still needed to be expanded further more. The result of her upper arch being too narrow is a locked lower arch forcing the lower jaw back. This prevents proper development of the lower jaw and forces the tongue back. What does it do when the tongue goes back? Blocks the airway.
You can see why I was so terrified when I realized what was going on. If the airway is obstructed, sleep apnea will likely follow – sleep apnea is a serious disease which can lead to heart attacks, strokes, as well as a number of other health conditions.
I don’t think poorly of Erin’s orthodontist – I actually think he gave her the best care that he knew of. The fact is that most dental professionals aren’t trained in Neuromuscular Dentistry – they aren’t thinking of the impact that teeth have on the airway, or the temporomandibular joint (TMJ). They don’t link the bite to migraines, and neck pain. I thought I was doing my daughter the best service by bringing her to an incredibly successful orthodontist – what if I hadn’t brought her to DSD?
Erin has now been wearing the palatal expander for 5 weeks – and I’ve been taking pictures as we go along. In the before pictures, you can see how the lower front teeth appear restricted by the upper front teeth – there is no space for them to grow.
Check out six weeks later – look how much space there is! I’m so excited to see where she will be after 4-5 months of wearing this and how much opportunity there will be for the lower teeth to grow along with the uppers! I’m so excited to imagine how the tongue will no longer be restricting the airway as she grows into adulthood!
“We’re very honored to provide the best dental care using neuromuscular dentistry. We appreciate being able to help patients like Erin prolong their life as well as prevent heart and respiratory disease. We look forward to publishing the result of Erin’s treatment in the next DSD Newsletter”. –Diana Shwartzman
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