MRC Myobrace Beginner Course 2014 Part 1

transcript

The Myobrace System-As a Hammer for a House-

Sat-Sun, January 18-19, 2014

dr. barry raphaelthe raphael center for integrative education

www.alignmine.comdrbarry@alignmine.com

Myofunctional Research Company presents:

Sunday, January 19, 14

The Myobrace System-A hammer for a house-

Sat-Sun, January 18-19, 2014

dr. barry raphaelthe raphael center for integrative education

www.alignmine.comdrbarry@alignmine.com

Day 1 AMSunday, January 19, 14

Can you hear me?

Let’s turn off ringers...

If all you have is a hammer...

In the news, March 2012

The House that

ADHD/Breastfeeding/Malocclusion/dental trauma/SDB

Understanding the relationships between breastfeeding, malocclusion, ADHD, sleep-disordered breathing and traumatic dental injuries.

Sabuncuoglu O., Med Hypotheses. 2013 Jan 7. pii: S0306-9877(12)00566-X. doi: 10.1016/j.mehy.2012.12.017. [Epub ahead of print]

RO since1983 (30 years...yikes)

Bucknell University 1974University of Pennsylvania 1978

(Three Years in General Practice)Fairleigh-Dickenson University 1983

Jim McNamara

Functional OrthodonticsFunctional Orthodontics

Myofunctional Research Co.

Spring, 2009 MRC meeting, Chicago > Terry

September, 2009 MRC conference, Coral Gables, Fl.

Myofunctional Orthodontics

Chris Farrell

John Flutter

German Ramierez

Damien O’Brien

Myofunctional Research Co.Rancho Cucamonga

2008-2012Sunday, January 19, 14

Oral Myology

Oral Myology Basic CourseJoy MoellerNYC 2011LA 2012

Oral Myology: Levels 2, 3Kim BenkertClifton 2012

Habit CessationShari GreenClifton, 2013

Biobloc Orthotropics

BBO Mini-residencyBill Hang

Agora Hills2012-13

BBO IntensiveDrs. John and Mike

MewLSFO2013

Breathing and Sleep

Buteyko MentorshipThe Breathing Center

Woodstock2010

Breathing Well ProgrammeJohn Flutter

2010 Ortho-Postural TrainingRoger Price

Sleep DentistryMichael Gelb, et.al

NYU2012,2013

Cranial Osteopathy

Advanced Dento-cranial OrthopedicsBob Walker

ALF, The Team ApproachJim Bronson

Cranial AcademySoon

Teaching

Mt. Sinai Pedo ResidencyAli Attaie

2010-2012

Montefiore Ortho ResidencyTony Maganzini

2009-PresentSunday, January 19, 14

Handicap2007 = 172013 = 23

It’s about the Airway

“It’s all about Barry And

The World of Mouthbreathing”

BTW….I lost 30lbs

Honorarium and Travel Expenses for MRC

No vested interest in Myofunctional Research Co.

Chris told me to tell my truth.

Director, raphael center for integrative education

Disclosure

Represented today?

Medical

Sleep Medicine

Schedule

Reading Assignment?

1. The Perfect House: an overview of Myofunctional Orthodontics.1. Airway and Breathing Dysfunction2. Soft Tissue Dysfunction3. Chronic Diseases of Lifestyle4. Malocclusion and Retractive Orthodontics

2. Airway Focused Orthodontics1.Diagnostics2.Prevention3.Undoing the Damage4.Establishing Good Habits

1.The Myobrace System1. Appliance Types2.Clinical Protocols3.Patient Education and Motivation4.Follow-ups and troubleshooting

5.Interdisciplinary Treatment3....

The Myobrace System-A hammer for a house-

The Myobrace SystemDay 2

1.Case presentations and demonstrations1.Case Results2.Patient Assessment3.Myobrace delivery

2.Starting your first case1.Case selection checklist2.Materials check list3.Health History forms4.Patient flow check list5.Ordering Myobrace appliances

3.Course Review: Q&A4.What comes next

Paper clips….

1. Level 1 Screening2. Facial Measurement Routine3. Treatment Goals4. Demo: Myobrace Delivery5. Starting your first case6. What comes next?

Feedback

I agree I like

I disagree I have a problem

I have a question

The Perfect House

Shelter from the

HVACComfortable Environment

Family Living Together

Decor and Activity

“The Roof is Leaking”

“The A/C is broken. I

can’t sleep.”

“Mommy, Lisa’s hogging bathroom!”

“This place is a mess!”

Chronic Diseases of

Lifestyle

Airway and Breathing

Inefficiency

Soft Tissue Dysfunction

Malocclusion and

Orthodontics

Airway-centricPathology

The Perfect House

Chronic Diseases of

Lifestyle

Malocclusion and

Orthodontics

DysfunctionSunday, January 19, 14

Snoring 8-10%

NormalPrevalence:

OSAS 1-3%

UARS ?

Spectrum of SDB

Anatomic Determinants of SleepDisordered Breathing Across the Spectrum of Clinical and Nonclinical Male Subjects*

•Apnea occurs due to craniofacial morphology and obesity, each with their contributions

•The single most important cephalometric variable in predicting AHI severity was the horizontal dimension of the maxilla (ie, porion vertical to supradentale [PV-A] distance).

•SDB increased five- to seven-fold in non-obese subjects and threefold in obese subjects

CHEST September 2002 vol. 122no. 3 840-851

Jerome A. Dempsey, PhD; James B. Skatrud, MD; Anthony J. Jacques, BS;Stanley J. Ewanowski, PhD; B. Tucker Woodson, MD;

Pamela R. Hanson, DDS, MS; and Brian Goodman, PhD

Anatomic Determinants of SleepDisordered Breathing Across the Spectrum of Clinical and Nonclinical Male Subjects*

•It is the maxilla that determines the effective horizontal dimension of the pharynx, and in particular the upper pharynx.

•A constricted maxilla places the upper pharynx (pharyngeal isthmus) at increased risk of collapse with loss of muscle tone.

•differences in morphology explain susceptibility to AHI from weight gain

OSA Risk Factors

• 134 Japanese Males• PSG and various measures• Risk Factors for Increase AHI (Apnea-Hypopnea Index)

• Age• BMI• Position of Hyoid Bone• Size of Airway (and resistance to flow)• Neck Circumference

Analysis of anatomical and functional determinants of obstructive sleep apnea.

Aihara K, et. al ,Sleep Breath. 2012 Jun;16(2):473-81. Epub 2011 May 15.

Which is easier to breathe through?

Which would you trust most?

Which would you rather have?

Narrow Airway Dynamics

• Narrow, irregular airway > •> increased shear forces >•> negative pressure pulls on soft tissue >•> tissue pulling and trauma (snoring) >•> impairment of mechanoreceptors >•> uncoordinated diaphragm and upper airway muscle contraction >• >DISORDERED BREATHING

Powell N, Guilleminault C. “Abnormal pharyngeal airflow in obstructive sleep apnea using computational fluid dynamics: Feasibility study.” Proceeding of the 9th World Congress on Sleep Apnea (Seoul, Korea) 2009

Morphology and SDB in children

“Abnormal craniofacial morphology, but not excess body fat, is associated with an increased risk of having SDB in6–8-year-old children.”

Ikävalko, et.al.,Eur J Pediatr (2012) 171:1747–1752

•491 Finnish children 6–8 years of age• studied: BMI, occlusion, sleep survey• Looked for: Frequent snoring, apeas, open-mouth posture

Risk Factor Incidence

Obesity 0

Tonsilar Hypertrophy 3.7x

Crossbite 3.3x

Convex Facial Profile 2.6x

“A simple model of necessary clinicalexaminations (i.e. facial profile, dental occlusion and tonsils) is recommended to recognize children with an increased risk ofSDB.”

Associations between sleep-disordered breathing symptoms

and facial and dental morphometry, assessed with screening examinations

Hyunh, et.al., AJODO, 2011, 140:762-70

SDB associated with: Swollen Tonsils and AdenoidsLong and narrow face

AllergiesFrequent Colds and Infections

Habitual Mouth Breathing

Dolicofacial shapeHigh mandibular plane angle

Narrow palateSevere crowding

Of the 600 orthodontic patients...

•16% had long facial form

•86% had convex profiles (mandible set back from maxilla)

•Over 50% had daytime mouth open posture

“In this large, population-based, longitudinal study, early-life SDB symptoms had strong, persistent statistical effects on subsequent behavior in childhood.

Findings suggest that SDB symptoms may require attention as early as the first year of life.”

Sleep-Disordered Breathing in a Population-BasedCohort: Behavioral Outcomes at 4 and 7 Years

Karen Bonuck, PhD,a Katherine Freeman, DrPH,bRonald D. Chervin, MD, MS,c and Linzhi Xu, PhDa

PEDIATRICS Volume 129, Number 4, April 2012

“The 2 clusters with peak symptoms before 18 months that resolve thereafter still predicted 40% to 50% increased odds of behavior problems at 7 years.”

Sleep-Disordered Breathing in a Population-BasedCohort: Behavioral Outcomes at 4 and 7 Years

“...early childhood SDB effects may only become apparent years later.”

Nighttime symptoms of SDB in kids

•Abnormal sleeping position•Bruxism•Chronic, heavy snoring•Delayed sleep onset•Difficulty breathing•Difficulty waking up in AM•Drooling•Enuresis•Frequent awakenings•Insomnia•Bed Dread

•Mouth breathing•Nocturnal migraine•Nocturnal sweating•Periodic Limb movement•Restless sleep•Sleep talking•Sleep terror•Sleep walking•Witnessed apnea

Daytime symptoms of SDB in kids

•Morning headache•Mouthbreathing•Morning thirst•Excessive fatigue•Abnormal shyness, withdrawn, and depressive presentation

•Behavioral problems

•ADHD pattern•Aggressiveness•Irritability•Poor concentration•Learning difficulties•Memory impairment•Poor academic performance

Childhood Obstructive Sleep Apnea Associates with Neuropsychological Deficits

and Neuronal Brain Injury

•Childhood OSA is associated with •Deficits of IQ •Deficit of executive function •Possible neuronal injury in the hippocampus and frontal cortex.

•“...untreated childhood OSA could permanently alter a developing child’s cognitive potential.”

Ann C. Halbower, et.al, PLoS Medicine,August 2006 | Volume 3 | Issue 8 | e301

Caroline Rambaud & Christian GuilleminaultEuropean Journal of Pediatrics

DOI 10.1007/s00431-012-1727-3Pub Online: April 11, 2012

Death, nasomaxillary complex, and sleep in young children

Abrupt sleep associated death in seven children with good pre-mortem history

Findings in all 7 cases

•chronic indicators of abnormal sleep

•enlargement of upper airway soft tissues

•a narrow, small nasomaxillary complex, with or without mandibular retroposition

“all children present a visuallyrecognizable abnormal high and

narrow hard palate”

Maxillary DysplasiaIs a major factor in

Sleep Disordered Breathing

Maxillary RetrusionMidface Deficiency

Maxillary HyperdivergencyLong Face Syndrome

Adenoid FaciesBimaxillary Retrusion

What causes it?

The Perfect House

Chronic Diseases of

Lifestyle

Dysfunction

Malocclusion and

Orthodontics

“….there is much circumstantial evidence that jaws and faces do not grow to the same size that they used to…”

Daniel E. Lieberman

The “Modern” Maxilla

The Gothic Arch The Roman Arch

Chris Farrell

Soft Tissue Dysfunction is THE etiology in

Maxillary DysplasiaAnd Malocclusion

How do you build an arch?

The Roman Arch

No scaffold?

When the tongue rests in the roof of the mouth the teeth erupt around the tongue forming a normally shaped and sized jaw.

The tongue is the scaffold for the upper jaw

Those children who breathe through the mouth or have the lips apart at rest will not have the

tongue in the roof of the mouth.

All of these children will have an underdeveloped upper jaw.

It will not be big enough for all of the teeth and when the adult teeth erupt they will be crooked.

Egil Peter Harvold

•Norwegian Orthodontist

•Cleft Palate

•Professor

•Brought Functional Treatment to N.A.

•1981 Primate experiments

• Blocked nasal passage

• Skeletal malocclusion resulted1912-1992

Block the nose> posture changes and teeth get crooked

Plugged Nose changes Posture

Posture changes Teeth

Lowered mandibular posture, tongue protrusion, and open bite

Open mouth posture retained for 1 year after nose reopened. Facial features retained

John Mew

•“Orthotropics”

•“Maxillary undergrowth is such a constant feature of modern malocclusion” - AJODO,1979

•Normal growth of maxilla > Down and Forward

•Dysfunctional growth > Down and Narrow

•Biobloc Therapy to reestablish Forward component

John Mew, 1981

“Because the genetic control of skeletal growth is not precise,

the articulation of the teeth and jaws depends upon additional guidance

from oral posture.”

The Tropic Premise

John Mew

“ If the tongue at rest is against the palate with the lips lightly sealed and

the teeth in or near contact, there will be ideal facial and dental

development.”“Something RARE in industrialized

societies…”

The Tropic Premise

If the tongue is chronically held away from the palate……the maxilla collapses in all three dimensions.

SOFT TISSUE DYSFUNCTION

With Chronic Open Mouth Posture

Comparison of Unsupported vs Supported Growth

SOFT TISSUE DYSFUNCTION

With Chronic Open Mouth Posture

Comparison of Unsupported vs Supported Growth

11y male vs Bolton norm

Male 8-3y

Male 10yo

11-7yF

Everyday in my practice...

Bolton Standards15yo

The Maxilla is Down and Back

The Mandible is Retrognathic

Nasal Cartilage Collapse

Insufficient Facial Support

Bi-maxillary Retrusion

Pharyngeal AirspaceThree-dimensional assessment of pharyngeal airway

in nasal- and mouth-breathing children

Alves, M, et.al., Int J Ped ORL 75 (2011) 1195–1199

Cone Beam and Airway analysis toolSunday, January 19, 14

•Exam for Mouthbreathing•the habitual posture of the lips (apart, even slightly)•size and shape of the nostrils•control reflex of the Alar Nasalis •Glatzel mirror test•Rhinoscopy•Adenoid hypertrophy

25 Mouth breathers, 25 Nasal breathers, Avg 8-9 y/o

Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children

Pharyngeal Airspace

Mouthbreathers have significantly smaller airway space.

(measurements PAS-OccL, PAS-UP, airway volume, area and minimum axial area)

Mouth breather Nasal breather

Open Mouth Posture is the most common

and significant Soft Tissue Dysfunction

In children today.

The Perfect House

Chronic Diseases of

Lifestyle

Dysfunction

Malocclusion and

Orthodontics

Weston Price

Nutrition and Physical DegenerationWeston A. Price, DDS, 1939

Price-Pottenger Nutrition Foundationwww.ppnf.org

1870-1948

Weston Price

•Dentist in Cleveland, OH•Traveled worldwide•“primitives” on their traditional diets

•freedom from decay, •stalwart bodies, •resistance to disease •fine characters •beautiful, straight teeth.

•Malocclusion is a product of the diet of industrialized societies

1870-1948

Kevin Boyd

Peter Gluckman

Neese and Williams

Scott Gilbert

Clark Spencer Larsen

Darwinian Dentistry Are we developing the wayour genes meant us to be?

Obesity

Hypertension

Cardiovascular Disease

Type 2 Diabetes

Fatty Liver Disease

Some Cancers

Osteoporosis

Depression

The Results of the MismatchBetween Genes and the Environment

Chronic Non-Communicable Diseases of CivilizationWestern Lifestyle Diseases

Metabolic Syndrome

Asthma

Autism

Asperger’s

Alzheimers

ADD/ADHD

Chronic Back Pain

Caries

Malocclusion

Sleep Apnea

There was a time...

5,000 years agoWhen caries and malocclusion

were rare!

The Missing Piece in Orthodontics Today...

Its not justGrowth and Development

ItsGrowth, Development and

AdaptationSunday, January 19, 14

If Malocclusion is caused byGrowth and Development...

Genotype Phenotype

Total Growth

If Malocclusion is caused byGrowth and Development and

Adaptation...

Genotype Phenotype

Total Growth

An example of “adaptation”

What do you notice about these boys?

An example of adaptation

What do you notice about these boys?

One of them has crooked teeth.Sunday, January 19, 14

3 August 2003 3 August 2003

RHYS - 10Y 11MHow did these teeth get this way?

Different genes than his brother?Sunday, January 19, 14

1 March 2007 1 March 2007

RHYS - 14Y 5M Four years later, after successful MFO

(Treatment by Dr. Chris Farrell)

RHYS - 16 AUGUST 2007 KYLE - 16 AUGUST 2007

TRAINER BWS MYOBRACE MINIMAL SWA

RHYS & KYLE - 13Y 8MDid genetics make the teeth crooked?

Did genetics make the teeth straight again?Sunday, January 19, 14

The Perfect House

Chronic Diseases of

Lifestyle

Dysfunction

Malocclusion and

Orthodontics

Edward H. Angle

•1898 Treatment of malocclusion of the teeth and fractures of the maxillae

•KNOWN for:•The Angle Classification•The Edgewise bracket and rectangular wire•Non-extraction orthodontics: “The Angle School”•Organizing the Specialty of orthodontics

•”... more often than is recognized, the peculiarities of lip function may have been the cause of forcing the teeth into the malpositions they occupy”.

1855-1930

From “Malocclusion” 1907

Crozat Appliance

Light intermittent forces can affect skeletal growth

•Based on the work of •George Crozat 1894 - 1966

•Albert Weibrecht• Arch development in harmony with natural growth and muscles•Light wire removable appliances

Crozat Philosophy

•Preserve the natural dentition and

•Develop the bony structures

•Assist the natural shape of the face and jaws to develop to their full biologic potential. •Overall health and well being of the patient

The Extraction Wars

Edward Angle vs Calvin Case

Witzig vs McNamara

NewConn 2009 Extraction vs Non-extraction Debate

1855-1930

5-10% extraction rateV. Kokich

F. Bogdan

Passive-Self Ligation

• “…benefits of minimizing friction and binding…”

• The “Functional Effect” - light wire in large slot allows muscles to guide the movements

• “to match each phase of treatment with the natural force systems of normal growth and development…”

• “…higher level of care is about "face-driven ortho…”

The Damon System

Non-extraction

Light-wire, Low-force

aaccnjpa@gmail.com

Blocked out #26

18 Months

26 Months

Finding room for all the teeth is not a problem if you start early enough and try to mimic what

nature intended

Protractive vs. Retractive Orthodontics

Bimaxillary Dysplasia

Should treatment be based on the Angle Classification?

Bimax retrusion

Successful dental result

Failed Profile Result

Bimax retrusion

Successful dental result

Failed Profile Result

Treatment

What is the appropriate treatment for a Collapsed Maxilla?

Treatment

Headgear?

Treatment

Class II Elastics? Sunday, January 19, 14

Treatment

Mandibular Advancment Appliance?(Herbst, Twin Block,MARA with reciprocal anchorage)

Treatment

Extractions ?

Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of

Class I bimaxillary protrusion

Qingzhu Wanga; Peizeng Jiab; Nina K. Andersonc; Lin Wangd; Jiuxiang Line

Angle Orthodontist, Vol 00, No 0, 0000 (pre-publication 2012)

“the dimension of the velopharynx, glossopharynx, and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolars…” “Any factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon {the pharynx}.”

“the more the incisors were retracted, the more the pharyngeal airway was reduced.”

Backed into a corner...

Retraction OrthodonticsSunday, January 19, 14

If Retraction Mechanics has the potential to

hinder the airway, how much retraction is OK?

Is it OK if I tie your tie just a little too

tight, son?

If snoring is likely to lead to obstruction someday,

how much snoring is “normal” for a child?

The Perfect House

Chronic Diseases of

Lifestyle

Dysfunction

Malocclusion and

Orthodontics

Airway-centricOrthodontics

John Mew

“If it were possible to improve faces to the disadvantage of the teeth, where would our duty lie?” -AJODO, 1979

Esthetics?Proper

Breathing?

Orthodontic treatment in children to prevent sleep-disordered breathing in adulthood

“Consequently the most important missing diagnosis is the airway.

Nevertheless, breathing is the most important action for human beings to live; we forgot the airway to make

a diagnosis of the orthodontic patients.”

10.1007/s11325-005-0028-8Review

Makoto Kikuchi

Comparison case

Older sister: Extract two upper premolars. Airway 14 to 10mmYounger sister: Non-extraction. Airway from 14-17mm

Comparison case

The result of the treatment looks almost the same from the appearance; however, there were big

differences between the sisters inside the face that was the most important structure for human beings:

the size of the airway.Sunday, January 19, 14

Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of

Class I bimaxillary protrusion

Qingzhu Wanga; Peizeng Jiab; Nina K. Andersonc; Lin Wangd; Jiuxiang Line

Angle Orthodontist, Vol 00, No 0, 0000 (pre-publication 2012)

“the dimension of the velopharynx, glossopharynx, and hypopharynx were decreased after maximal retraction of anterior teeth with extraction of four premolars…” “Any factors that can influence the posture and position of tongue and soft palate may displace them backward andencroach upon {the pharynx}.”

“the more the incisors were retracted, the more the pharyngeal airway was reduced.”

Setback at your Peril

Bilateral SSRO: “the pharyngeal airway was constricted significantly at the oropharyngeal and hypopharyngeal levels at both the short-term and the long-term follow-ups”

Lefort I plus SSRO: “bimaxillary surgery rather than only mandibular setback surgery is preferable to correct a Class III deformity to prevent narrowing of the pharyngeal airway space

American Journal of Orthodontics & Dentofacial OrthopedicsVolume 131, Issue 3 , Pages 372-377, March 2007

Effects of bimaxillary surgery and mandibular setback surgery on pharyngeal airway measurements in patients with Class III skeletal deformities

• Fengshan Chen, Kazuto Terada, Yongmei Hua, Isao Saito

J Oral Maxillofac Surg. 2011 Nov;69(11):e395-400. Epub 2011 Jul 27

Effect of mono- and bimaxillary advancement on pharyngeal airway volume: cone-beam computed

tomography evaluation.

Hernández-Alfaro F, Guijarro-Martínez R, Mareque-Bueno J.

•A statistically significant increase in the pharyngeal airway volume occurred systematically. •The average percentage of increase was:• 69.8% with MMA• 78.3% with Mandibular Advancement • 37.7% with Maxillary Advancement

Effects of Maxillary Protraction and Fixed Appliance Therapy on the Pharyngeal Airway

•25 x 11 year olds•Reverse Pull HG, 350 g, 14h/d for 6 months• Follow-up 4 years post-treatment• 2D analysis only (cephs)

Emine Kaygısız et.al., Angel Orthodontist, Volume 79, Issue 4 (July 2009)

“...the maxilla continued to grow forward after treatment, which was maintained in the long-term observation.”

“improved the nasopharyngeal and oropharyngeal airway dimensions initially, …. was maintained at long-term follow-up.”

Mandibular Advancement

Sleep Breath (2012) 16:971–976

“Orthodontic therapy should beencouraged in pediatric OSAS,

and an early approach maypermanently modify nasal breathing and respiration, thereby preventing obstruction of the upper airway.”

Yesss!!!

Orthodontics in the 21st Century

ConventionalOrthodontics

AirwayOrthodontics

GeneticTooth-Focused

Esthetics PrimaryTreating Symptoms

Airway Ignorant

AdaptationMuscle-Focused

Esthetics SecondaryTreating CausesAirway Concious

A Pathology Cycle

Declining Health

FunctionMouthBreathing and

Low Tongue

FormLong FaceFunction Weak MMuscles

FormNarrow Palate

Function Deviate Swallow

FormSwollen T&A

Crooked TeethForm

Breaking The Cycle

Declining Health

Low Tongue

FormNarrow Palate

FunctionSwallowing with Active

Facial MusclesCrooked

TeethForm

FormSwollen T&A

Conventional Orthodontics

Backed into a corner...

Prevention is not mechanical!

Breaking The Cycle

Declining Health

Low Tongue

FormNarrow Palate

FunctionSwallowing with Active

Facial MusclesCrooked

TeethForm

FormSwollen T&A

Airway-Centric Orthodontist

Ortho and Ped OSAChad M. Ruoff & Christian Guilleminault

Sleep Breath, 2011, pub online, May 11

“Although dentists and orthodontia recognize the importance of evaluating and treating OSA, they have yet to realize how well-positioned they are for the prevention of sleep-disordered breathing (SDB).”

Ortho and Ped OSAChad M. Ruoff & Christian Guilleminault

Sleep Breath, 2011, pub online, May 11

The “environment plays an important role in the development of SDB. Therefore, manipulation of environmental factors may decrease the development of OSA. There is a need to better define these environmental factors and predict those at risk for the development of OSA so that orthodontists and dentists can both treat and prevent OSA.”

Roger Price’ Toothberg

Airway-Related Craniofacial Dysfunctions

• Chronic Naso-pharyngeal Obstruction• Tongue form aberrations (Frenum and tongue-tie)• Open Mouth Rest Posture • Myofunctional disorders (Swallowing, chewing,etc.)• Chronic Hyperventilation and Hypocapnia• Breathing Disordered Sleep (OSA, UARS, snoring)• Bruxism and parafunctions• TMD and facial pain components• Cranial and postural issues• Malocclusion

Open Mouth Posture

•Early Feeding and Nutrition

•Allergies, Asthma, URT infections

•Posture

•Airway, Breathing, and Sleep Disorders

•Soft Tissue Dysfunctions (Tongue Thrust, Open Mouth)

Instead of crooked teeth being The Problem,They are just a SYMPTOM of something larger

Big-Picture Issuesrelated to

(Mal)Occlusion

If the Cause is in the muscles,then treatment must be, too.

Airway-Centered OrthodonticsAnd

Muscle-Centered OrthodonticsVs.

Tooth-Centered Orthodontics

The Perfect House

Chronic Diseases of

Lifestyle

Dysfunction

Malocclusion and

Orthodontics

Environmental Holistic

Medicine

Sleep and Breathing Dentistry

Myofunctional Ortho-Postural

Training

Myofunctional Orthodontics

MRC Myobrace Beginner Course 2014 Part 1

Health & Medicine