GAP Australasian-Dentist-Mar Apr 2019

Category 56 AustrAlAsiAn Dentist Tr Only using Orofacia Treatment period = 10 months No braces No teeth extracted No orthodontic plates Only using Orofacial Myology and Oral Myofunctional Only B oth malocclusion and sleep disordered breathing are often treated symptomatically, with little regard for aetiology. symptomatic treatments of malocclusion include fixed braces, or aligners to physically move teeth into a new position. While mandibular advancement splints (MAs), and continuous positive airway pressure (CPAP) masks are often used for sleep disordered breathing to mechanically hold the airway open. Both of these ‘solutions’ have potential negative effects when used long term and have their own inherent challenges when used on paediatric patients. For example the CPAP mask may inhibit maxillary growth, or cause maxillary retrusion by putting a backwards pressure onto the maxillary complex. A tipping of the palatal plane and flaring of maxillary incisors have all been reported as risks (1). Furthermore, the root causes of both conditions are often not addressed with such treatments. this paradigm of symptomatic care exists despite wide acceptance that narrow, under-developed dental arches, and retrognathic jaws are in a part of the aetiological landscape of sleep apnoea (due to the narrow airway space which forms from such dentofacial morphology (2-7). so rather than simply addressing both malocclusion and paediatric sleep disorders as distinct individual problems, we ought to be correcting the dental arch and mandibular position as early as possible – in order to assist with healthy sleep in the growing child. Moreover, a focus on correcting a major root cause of malocclusion – soft tissue dysfunction (aberrant swallowing patterns, dysfunctional oral postures and non-ideal breathing patterns) would appear to be the logical thing to do. Correction of root causes is indeed a missing link in the current standard of care for treatment of both paediatric malocclusion and paediatric sleep disordered breathing. this missing link is Orofacial Myofunctional therapy which is often delivered alongside myofunctional orthodontic treatments and has been shown to assist in the correction of both malocclusion and sleep disordered breathing through correction of oral and peri-oral soft tissue dysfunction. it is indeed well documented that soft tissue dysfunction can result in malocclusion (8-12). it has also been shown that correction of malocclusion with expansion of the dental arches can reduce the severity and prevalence of sleep disordered breathing (13). Furthermore, correction of soft tissue dysfunction alone has similar effects (14-19). Given that both malocclusion and soft tissue dysfunction are a large part of the aetiological landscape of sleep disordered breathing, treatment of both must be considered as early as possible in life, if the next generation of children are to grow up having had the benefits of sound sleep during major stages of cognitive developemnt. effective treatment of both malocclusion and soft tissue dysfunction is delivered through Orofacial Myofunctional Orthodontics. One system being taught currently is the Myofocus system. this mode of care involves use of a number of well known appliances and arch development techniques, combined with Orofacial Myofunctional therapy and a team approach to care, involving practitioners normally considered outside of the ‘dental sphere’ (ear nose and throat specialists, speech pathologists, nutritionists, chiropractors and osteopaths are often included during treatment). in addition, dental professionals delivering this type of care have an understanding of the importance of positive psychology and have learned how to incorporate this into their practices in order to achieve greater compliance from patients. Compliance has long been the Achille’s Heel of such forms of early interceptive treatments. However, successful practitioners have learned how to facilitate better compliance. the result is a far more predictable mode of treatment than once thought. interestingly, there may be hidden health benefits beyond the obvious ones of better jaw growth, improved sleep, and a new way to build goodwill in dental practices. there are many often overlooked co-morbidities which exist alongside paediatric malocclusion and paediatric sleep disordered breathing. these include speech disorders – with anterior open bites, over-jet and maxillary spacing making phonation challenging (19), as well as anxiety and depression – with bullying being more prevalent in children with certain facial aesthetics linked to malocclusion (21- 22). Furthermore, postural instability (23) and cranial strains (24) are also linked to malocclusion. Paediatric malocclusion is indeed a co-morbidity and is linked with many early childhood challenges. these are challenges which must not be overlooked if the paediatric patient is to obtain optimum outcomes for sleep, speech, posture, the cranial system, and emotional wellness. u References available – email: gapmag zines@optusnet.com. u Malocclusion and paediatric sleep disorders … the hidden benefits of treating both lInICal By Dr Dan Hanson, BDs. Myofocus co-founder. Dr Dan Hanson