Clinical Spotlight

Breathing Dysfunction and Head Posture

by Theodore R Belfor, DDS, and Michal Niedzielski, PT, PRC Much attention has been given to blue light’s deleterious effects on sleep. Screen time’s negative impact isn’t limited to blue light though. Today’s over-reliance on cell phones, tablets, and computers contributes to a forward head posture which can affect breathing. Additionally, forward head posture should be viewed as an occupational hazard for dentists while treating patients. What is FHP? Forward head posture (FHP) is defined as​ forward translation of the …

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An Evaluation of Oral Appliance Therapy Device Volumes: Is Size as Advertised?

by Jerry Hu, DDS, D.ABDSM, D.ASBA, D.ACSDD, and Len Liptak, MBA During an Oral Appliance Therapy (OAT) consultation, many Dental Sleep Medicine practitioners provide patients with the buffet option. The patient is seated in the consultation room, and they are met with an array of different devices in varying colors, shapes, and sizes. Like the people in the buffet line, they don’t always make the choices that are best for them. In this situation, the wrong choice can be costly. …

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Obstructive Sleep Apnea and Dental Implants: Sleep Before You Drill

by John H. Tucker, DMD, DICOI, DABDSM, and Dennis R. Bailey, DDS, FAAOP, DABDSM Many patients are presenting for management of their sleep breathing disorder (SBD) that have had restorative procedures utilizing dental implants with subsequent prosthetic rehabilitation. There are specific and special concerns that require consideration, both in the pre-treatment phase and when planning treatment utilizing a mandibular repositioning oral appliance. Obstructive sleep apnea (OSA) is a disorder characterized by repetitive collapse of the upper airway during sleep, with …

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Increasing airway volume with a removable orthodontic dental appliance: a multi-case report

by Theodore R. Belfor, DDS, Michael Philcock, and Scott Simonetti, DDS Introduction The American Association of Orthodontists White Paper: Obstructive Sleep Apnea and Orthodontics states, under the term “Etiology,” “Obstructive Sleep Apnea occurs as a function of increased collapsibility of the upper airway. The pharyngeal critical closing pressure (Pcrit) is the pressure at which the upper airway collapses. This collapsibility is influenced further by impaired neuromuscular tone.”1 Comparing the size and shape of the pharyngeal airway for Obstructive Sleep Apnea …

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COVID-19: A Paradigm Shift for the Treatment for Sleep Related Breathing Disorders

by Keith Thornton, DDS The COVID-19 pandemic has created a paradigm shift in the medical acceptance and patient expectation of telemedicine as a treatment pathway. The treatment of Sleep Related Breathing Disorders (SRBD) is no exception. There are three aspects of the treatment of SRBD to be taken into consideration: Options and opportunities for telemedicine Use of an immediate appliance for diagnosis, treatment, and long-term management Future potential for dentists and physicians Options and Opportunities As we turn our attention …

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The 3 Most Common Mistakes with Oral Appliance Selection

  by Jamison Spencer,  DMD, MS Almost every week I get an email from someone asking “Jamison, what’s your favorite appliance?” I get this question almost EVERY time I lecture. Sometimes, if I’m feeling particularly rude, I’ll answer their question with a question. “What is your favorite dental bur?” “Or your favorite endo file?” If this exchange occurs in person they will then look at me confused, and then answer back, “well, I guess that depends on the situation.” Right! …

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The Clinician and Patient Benefits of Midline Devices

  by Patrick Tessier, MBA Appliance selection is one of the most important decisions a clinician makes when treating a patient with Sleep Disordered Breathing (SDB). Breaking down the academic, clinical, and financial benefits of the two major advancement categories can provide clarity on the overall effectiveness of appliances. Mandibular Advancement Devices (MAD) are generally segmented into two advancement mechanism categories, midline traction (MT) and bilateral thrust (BTh). MT devices have a single point of midline adjustment in the anterior …

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