Severe Bruxism/ Neuromuscular Dentistry/ Dental Sleep Medicine/ TrigeminoCardiac Reflex and SPG Blocks are all connected and part of the same system

Dr. Shapira TMJ 0 Comments

What is the common underlying link of all of these.  The Trigeminal Nerve and the Autonomic nerves of thee Sphenopalatine Ganglion.
Self-Administered SPG Blocks can improve many autonomic issues in patients.
This is the connection of TMJ disorders to problems with the gut.
The connection of Aiirway collapse secondary to dental issues has been well established.
Bruxism is far more than a habit it is part of a medical group of disordrs.
. 2018 Aug; 4(8): 329–331.
Published online 2018 May 18. doi:  [10.1016/j.hrcr.2017.06.013]
PMCID: PMC6092563
PMID: 30112280

Grinding to a halt: Stimulation of the trigeminal cardiac reflex from severe bruxism

Key Teaching Points

  • • The autonomic nervous system has an intricate relationship with the heart; severe vagal stimulation can produce bradycardia and asystole.
  • • The trigeminal cardiac reflex is a powerful brain stem reflex that can be associated with a sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, or gastric hypermotility.
  • • Bruxism, which is reported in 8% of the population, can stimulate the trigeminal cardiac reflex and lead to profound vagal effects on the heart.

Introduction

The trigeminal cardiac reflex (TCR) is a unique, powerful, and well-established neurocardiogenic reflex that is a result of stimulation along the path of the fifth cranial nerve (trigeminal nerve). It can produce adverse cardiorespiratory changes including hypotension, bradycardia, and asystole, as well as gastric consequences such as hypermotility. This reflex has been reported to occur in various surgical conditions, as well as in neurosurgical interventions.

Sleep bruxism, thought to be a more intense form of rhythmic masticatory muscle activity, has a prevalence of about 8% and has been explicitly linked to the TCR.We report a case of a young woman with severe bruxism who incited her TCR, which subsequently produced profound nocturnal pauses that ultimately required dual-chamber pacemaker implantation.

Case report

A 27-year-old woman presented with palpitations and syncope. Three years prior to presentation she developed nocturnal and early morning nausea and vomiting that would often wake her from sleep. She was noted to have a long-standing history of severe bruxism with physical signs on examination of significant attrition. This had persisted despite the use of a retainer and bite block. Evaluation with Holter monitoring revealed sinus bradycardia, intermittent second-degree type II atrioventricular (AV) block, and a pause of 8.6 seconds (Figure 1). Interestingly, the rhythm strips showed simultaneous effects on both the sinus and AV node, suggesting an autonomic etiology. Of note, these rhythm disturbances were principally nocturnal in nature. While she was wearing the Holter, the husband was awake and corroborated that she was having severe episodes of bruxism. Further cardiac evaluation was unrevealing, including a normal echocardiogram, cardiac magnetic resonance imaging, sleep study, and thorough autonomic testing. With her constellation of symptoms—severe bruxism, AV nodal block with cardiac pauses (that were predominantly nocturnal), and gastrointestinal symptoms—we diagnosed her with hypervagotonia from stimulation of the powerful TCR from severe bruxism (Figure 2). Out of concern for risk of cardiac death from these pauses without a stable ventricular escape, we elected to place a dual-chamber pacemaker for bradycardic prevention.

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Holter monitoring revealed sinus bradycardia, intermittent second-degree type II atrioventricular block, and a pause of 8.6 seconds

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Illustration of the trigeminal cardiac reflex. X = motor nucleus of the vagus nerve; ∗ = Gasserian ganglion; V = trigeminal nerve.

Discussion

This case highlights the intricate and noteworthy relationship between the autonomic nervous system and the heart. Our patient developed high-grade AV block and syncope owing to significant and profound hypervagotonia. Based upon her evaluation and corroboration of these events by her husband, we deemed that her intense vagal stimulation was a consequence of her severe bruxism, which was eliciting the TCR.

The TCR (Figure 2) is a powerful brain stem reflex that can be associated with a sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, or gastric hypermotility. The proposed mechanism of this reflex is stimulation of the sensory nerve endings of the trigeminal nerve (Figure 2, cranial nerve V), which sends signals via the Gasserian ganglion (Figure 2, indicated by asterisk) to the sensory nucleus of the trigeminal nerve (Figure 2 inset). The afferent pathway then continues along the short internuncial nerve fibers in the reticular formation to connect with the efferent pathway, the motor nucleus of the vagus nerve (Figure 2, cranial nerve X). The last part of the reflex is formed by cardioinhibitory efferent fibers, which connect the motor nucleus of the vagus nerve to the myocardium.

Bruxism is a common occurrence in the population (8%) and has been associated with alterations in the autonomic nervous system and stimulation of the TCR. The mechanism behind the TCR stimulation is felt to be 2-fold. Firstly, masticatory movements (rhythmic masticatory muscle activity) and secondly, teeth contact can stimulate mechanoreceptors in the periodontal tissue. The link between bruxism, TCR, and alteration in the autonomic nervous system is important to highlight as it is well established that the autonomic nervous system plays a critical role in the pathogenesis of various cardiac arrhythmias, particularly atrial fibrillation. Although not specifically related to our patient, the fact that bruxism is so common raises the potential role it could be contributing to autonomic drivers of atrial fibrillation, and this is something that requires further research examination.

Conclusion

When evaluating patients who present with symptoms of significant hypervagotonia, it is important to consider sleep-related causes, in particular sleep bruxism and its role in the TCR.

Footnotes

Dr DeSimone is supported by an NIH T32 training grant (HL 007111).

References

1. Reding G.R., Rubright W.C., Zimmerman S.O. Incidence of bruxism. J Dent Res. 1966;45:1198–1204. [PubMed]
2. Schames S.E., Schames J., Schames M., Chagall-Gungur S.S. Sleep bruxism, an autonomic self-regulating response by triggering the trigeminal cardiac reflex. J Calif Dent Assoc. 2012;40:670–671. 674–676. [PubMed]
3. Arasho B., Sandu N., Spiriev T., Prabhakar H., Schaller B. Management of the trigeminocardiac reflex: facts and own experience. Neurol India. 2009;57:375–380. [PubMed]
4. Gastaldo E., Quatrale R., Graziani A., Eleopra R., Tugnoli V., Tola M.R., Granieri E. The excitability of the trigeminal motor system in sleep bruxism: a transcranial magnetic stimulation and brainstem reflex study. J Orofac Pain. 2006;20:145–155. [PubMed]
5. Chowdhury T., Bindu B., Singh G.P., Schaller B. Sleep disorders: is the trigemino-cardiac reflex a missing link? Front Neurol. 2017;8:63. [PubMed]
6. Sjoholm T.T., Piha S.J., Lehtinen I. Cardiovascular autonomic control is disturbed in nocturnal teethgrinders. Clin Physiol. 1995;15:349–354. [PubMed]
7. Okada Y., Kamijo Y., Okazaki K., Masuki S., Goto M., Nose H. Pressor responses to isometric biting are evoked by somatosensory receptors in periodontal tissue in humans. J Appl Physiol. 2009;107:531–539. [PubMed]

DNA® & RNA® APPLIANCES by VIVOS: EPIGENETIC ORTHODONTICS, ORTHOPEDICS AND PNEUMOPEDICS: PATIENT TESTIMONIALS: VIVOS : The Breathe New Life Advantage.

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DNA and RNA Appliance are used to Treat a wide variety of issues including TMJ disorders, Headaches, Migraines, Snoring and Sleep Apnea.  Postural disorders to impaired breathing can be related to chronic head and neck pain and spread  postural issues throughout the body.

It is vitally important for dentistry and medicine to address the development of airway issues that last a lifetime.  I primarily work with older children, adolescents and adults in my practice.  Children, even very young children receive the biggest benefit from expansion of airways.  The DNA/RNA Appliance gives an important second chance to patients who did not properly develop as children.  Adults can now be treated without orthognathic surgery, tongue reduction and other invasive procedures.

The DNA Appliances are changing the field or dental orthodontics from cosmetic shifting of teeth in available bone into the field of Epigenetic Orthopedics correcting problems that conventional orthodontics never addressed.

Orthodontics utilizing braces and brackets or plastic aligners as used by Invisalign, Smile Direct and other systems is about moving the teeth in the available bone to create a prettier smile and straighter teeth.   Phased orthodontics in children has to a small extent embraced expansion of bone to create more space to straighten the teeth.  Airway has only been minimally addressed by most of orthodontics.

There are many orthodontists who still practice “Contraction Orthodontics” also known as “Four on the Floor” or Bicuspid Extraction cases.  The thought process is the you “Amputate” the teeth to make room in the mouth for all of the remaining teeth.  This Contraction Orthodontics” makes the teeeth fit but crowds the tongue and impairs breathing.

Unfortunately, until recently the question of airway and ideal development of the jaws has not been addressed.  There have been major changes in the last few hundred years to patterns of orofacial and cranial bone growth.  These are negative epigenetic changes due to environmental issues including pollution, changes in how babies are fed and nurtured as new borns ant throughout their early lives.  This has led to a massive problem of underdeveloped maxillas, mandiibles and airways.

I became involved in the early 1980’s in managing airway in adults by treating sleep apnea and snoring.  I saw my son Billy had issues but when he was ready to start Kindergarten he was evaluated and I was told he had ADD, ADHD, could not start Kindergarten and needed to be on
Ritalin for life.  You worry about your child’s when they cannot start kindergarten and I refused the diagnosis and took Billy to Rush Medical School for a sleep study.  He had severe sleep apnea and we proceeded to have tonsils and adenoids removed and at 5 orthopedic expansion of hist maxilla.  He had a tongue and lip tie corrected as well.  He became a straight “A” student, went from 50% growth curve to 90% growth curve, slept well and mood was vastly improved.  He graduated college double major, double minor Magna Cum Laude,  His drug of choice was Oxygen not Ritalin.  I became a Visiting Assistant Professor at Rush Medical School Sleep Center in 1985 and did research into similarities in jaw position in sleep apnea patients and TMJ patients.

Breast feeding is a major factor in the development of proper facial form.  “Form follows function” is a truth in medicine and the changes in how babies are fed and nurtured has changed,  which changes their development.  These changes in growth and development  affect airway and sleep, intelligence and learning and most importantly brain development and function and can lead to learning and behavioral disorders including ADD, ADHD and ODD.  Many of these disorders are related to sleep disordered breathing including snoring, increased upper airway resistance syndrome (UARS), Respiratory effort related arousals (RERA) Hypopnea, Sleep Apnea.

The  underdevelopment of the nasal  oropharyngeal airway is the single biggest culprit and creates problems not just in infants, children and adolescents but also problems that last a lifetime.  Sleep Apnea can cause issues with insulin resistance, memory loss and dementia, they cause a 300-600% increase in heart attacks and strokes as well as motor vehicle accidents, are implicated in hypertension,  metabolic syndrome and obesity.  Ideally a narrow airway is corrected before 8 years of age and it was thought expansion was limited if not impossible in adolescents and adults.  The DNA Appliance has changed all that and expansion is possible throughout your life.

The DNA Appliance  is an FDA approved orthodontic device that can often correct all of these issues.  The RNA version of the
DNA Appliance is an FDA approved Sleep Apnea Appliance.  Both the DNA and RNA Appliance utilize Epigenetic Orthopedics to grow larger airways and offer the possibility of curing sleep disordered breathing in all forms.  The process of growing a larger airway has been called Pneumopedics by Dr David Singh who invented the DNA Appliance.

I will present several video testimonials of patients who have utilized the DNA/RNA Appliances.  The first one is a patient experiencing major improvement in nasal breathing after just a few months of treatment.  When the maxilla is expanded the roof of the mouth widens and high palates correct themselves flattening out.  The hard palate is the roof of the mouth  but that same bone is also the floor of the nose.  With epigenetic expansion the cross section of the nose dramatically increases in both height and width.  The expansion of the mouth makes more room for the tongue.

Nasal breathing increase the amount of Nitric Oxide the body produces which is the single most powerful antioxidant known.  A Nobel prize has been given for work on Nitric oxide.

Sleep Apnea is a serious medical issue for millions of Americans.  There are many treatments available to treat Sleep Apnea, the best known treatment is CPAP or Continuous Positive Airway Pressure which uses a compressor to deliver pressurized air through the nose and/or mouth through a mask.  CPAP is extremely effective when it is used by patients but only about one in four patients prescribed CPAP actually use it on a regular basis.  The 25% of patients who utilize CPAP is dwarfed in number by the 60% of patients who reject or fail CPAP completely.  Approximately 15% try to manage CPAP but do poorly.  Success is not the norm with CPAP in spite of the fact that it is extremely effective when used and is considered the “Gold Standard” of treatment.

The primary reason patients don’t use CPAP is that they “Hate CPAP”.   Oral Appliances are also extremely successful at treating Sleep Apnea and are considered a first line approach for mild to moderate sleep apnea and an alternative to CPAP for severe sleep apnea.  They are under prescribed primarily due ignorance in the medical community about effectiveness.  CPAP is a billion dollar industry that has tremendous monetary power and thee makers of CPAP machines also make much of the diagnostic instrumentation for sleep.

The website https://www.IHATECPAP.com is an excellent resource to learn more about Sleep Apnea diagnosis and treatment.  The name of the website is from patients who when asked why the wanted an oral appliance would commonly reply “I HATE CPAP!”

The following is a video of a physician describing his experience with an oral appliance to treat sleep apnea.  Many physicians choose not to utilize CPAP but rather a comfortable oral appliance.  Oral Appliances are excellent for managing Sleep Apnea but the DNA/RNA Appliances offer a “CURE”!  Patients with sleep apnea must have their sleep apnea treated but it can be managed for a lifetime without negative consequences.

The following video is a physician whose life was affected by her sleep apnea and who chose to seek a cure for her apnea rather than just a treatment.  She has not completed treatment at the time this video was made.  Prior to treatment she was living in a state of exhaustion.  The RNA Appliance is acting as both a sleep appliance and is growing her airway orthopedically.  When the DNA/RNA Appliance is used to cure sleep apnea it actually results in a 24/7 improvement in airway not just a correction during sleep.  This patient discusses oral Myofunctional Therapy which can aid in expansion and ideally should be utilized in every single orthodontic treatment.  More important pediatric dentists and physicians should learn to be aware of these developmental issues and address them as soon as possible to prevent future issues.  In retrospect, my son would have been far better off having his airway issues treated far earlier.  Brain development is changed by sleep apnea even in infants and very young children.

TMJ Disorders, Chronic Headaches and Migraines and other types of Orofacial pain are often associated with airway issues.  The National Heart Lung and Blood Institute published a report “The cardiovascular and sleep related consequences of TMJ disorders”  The NHLBI of the NIH  considers Sleep Apnea to be a TMJ disorder.  The DNA Appliance is often utilized as a second phase of treatment for patients with TMD.  The following is a patient who has lived her entire life with an underdeveloped maxilla and is using the DNA/RNA appliance to pneumopedically grow a larger airway and orthopedically grow her maxilla in order to treat her TMJ disorder.  While she is still early in treatment she feels that her TMJ disorder has been cured.  Her lower jaw (mandible) was locked in a posterior position and maxillary expansion has given it freedom to move forward and relieve abnormal pressure in the TM Joints

The next video is a patient who has lived with chronic head and neck pain for many years and initially was treated with a neuromuscular dental  orthotic and is  now utilizing the DNA Appliance to complete her treatment (Phase 2 ).  She describes a wide variety of improvements after wearing the DNA Appliance for a couple of months.  When you breathe better and correct airway issues it has positive effects throughout the entire body.

The next video is a patient who has had a lifetime of sinus issues and TMJ issues.  While here TMJ issues were dealt with her small airway would create a less stable result and relapse.  The DNA Appliance is being utilized to increase her airway and led to dramatic improvements in he sinus issues.  Listen as she discusses how improved breathing is improving all aspects of her life.

Shimshak et al published a paper in Cranio Journal in  1998 looking at medical expenses in patients with TMJ disorders and found that there was a 300% increase in medical expenses in every single field of medicine.  We now know that sleep and airway are very closely related and that the increase in medical expenses has many causes but treatment with the DNA Appliance addresses a wide spectrum of these issues.  I wrote an article for Cranio Journal in 2013.  The full ediitorial can be found at https://www.tandfonline.com/doi/pdf/10.1179/crn.2013.001?needAccess=true.  I was asked to write this editorial by Riley Lunn tthe editor of
Cranio Journal because I had been treating sleep and airway issues since 1982 long before most of medicine or dentistry ever looked at airway and sleep apnea.

TMJ Alias, The Great Imposter, Has a Co-Conspirator: Poor Sleep

The next patient is much  younger and his parents who are both Chiropractors brought him in to address airway issues that were leading to forward head posture and was affecting his posture in his entire body.  Chiropractors are very aware of how head and jaw position affect the entire body.

The DNA Appliance is giving three dimensional expansion and there is a cascade of positive outcomes that occur as airway improves.

The next video is of Lewis who is now utilizing his RNA Appliance instead of CPAP while he is growing a larger airway.  He appreciates being able to go camping with his appliance, something he could not do with CPAP.His teeeth have straightened out and he has a bigger better lower jaw.

 

The DNA and RNA Appliance utilize Epigenetic Orthodontics which is the single most exciting advancement in dentistry today.  While  it is called epigenetic orthodontics a more accurate name would be epigenetic orthopedics because it actually grows and reshapes and idealizes the bone rather than just move the teeth.  This is far different than typical orthodontics.

This  technological advances of the Vivos System allows us to comfortably create (grow) big wide healthy looking smiles even in patients with narrow arches. Patients with weak chins and poor profiles can see improvements often even early in treatment. In an ideal world every patient would naturally have developed big wide healthy arches with resultant large airways and enough room for their lower jaw to grow ideally.

One very special aspect of utilizing the DNA Appliance and Epigenetic Orthodontics is that the appliances are only worn for 14-16 hours per day.  This is very different that standard orthodontics with brackets and wire or Invisalign®.  Most of the wear can be done in your sleep, watching TV or commuting.  During the day at work or with friends you can be free of the appliance.  This is one of the special features patients love about the DNA Appliance, the convenient fit into your lifestyle.

The time when the appliances are out the teeth move to ideal position as nature and/or genes intended.

Typical orthodontics is a four-step process designed to move teeth through the bone.  The first step is FORCE that creates PRESSURE (1) that compresses the periodontal ligament and puts pressure on the bone.  The second step is INFLAMATION (2) which is associated with pain and discomfort. The third step which is RESORBTION (3)  which is breaking down the bone by osteoclasts to create space.  The fourth step is CONSOLIDATION (4) where new bone is formed.  The process is then repeated after every orthodontic visit when braces are tightened or with each new Invisalign® tray.

Epigenetic Orthodontics is very different because it is a two step process.  The forces are very light and movement is limited to 250 microns approximately every four days.  The light forces are applied and growth and movement occur without inflammation which makes the entire process practically pain free.  If there is any discomfort the adjustments are spaced out further.

Relapse is frequently a problem with orthodontics after orthodontists have used fixed braces to straighten crooked teeth.  Relapse is the teeth moving back to their original position and relapse is why orthodontists make retainers.  The reason for relapse is complex and not well understood.  The hours when the appliance is out let the teeth follow natural eruption processes with far lower risks of relapse.

According to Dr. Dave Singh the Founder of the field of pneumopedics and craniofacial epigenetics which includes epigenetic orthodontics “there is a natural way for the body to remodel the upper airway, reshape bone and move teeth into their correct positions painlessly without the use of surgery, drugs or injections.”

Professor G. Dave Singh DDSc, PhD, BDS states on his website: “However, the entire human genome has now been sequenced, and we now know that certain genes are involved in moving teeth. Teeth are naturally-designed to move, for example, tooth eruption in a normally-growing child. In addition, the teeth in some people erupt in a specific arrangement, producing a beautiful smile. Dr Singh believes that the specific arrangement of teeth is due to certain genes. In fact, a natural process called ‘temporo-spatial patterning’ is at work. This process is the blueprint or body plan that is encoded by genes. In other words, the right and left sides of the body, the top and bottom of the body as well as the front and back of the entire body is under the control of a genetic body plan, including the teeth. Sometimes, however, the plan gets disturbed, producing crooked teeth and improper orthopedics.”:

Getting Older or Getting Better™. THE CHOICE IS YOURS! Come in and find out what is possible.

The Vivos DNA Appliance allows us to grow and develop a more ideal facial structure and a healthier airway.

Dr. Shapira has long had a special interest in developmental processes because of his work with sleep apnea in children and adults. Dr Shapira also has over 38 years experience in treating difficult TMJ Disorders, Migraines, headaches and other Chronic Pain.  When these processes go are disturbed it changes how people breathe and swallow.  Young children are frequently put in expanders to expand their maxilla or upper jaw.  This is needed because of negative epigenetic changes caused by environmental allergies, food allergies or disturbed growth from insufficient breast feeding and bottle feeding.

Dr. Shapira, has taught classes to hundreds of dentists and their teams on how to treat sleep apnea with oral appliance therapy.  It is one of Dr. Shapira’s students Dr .Martha Cortes who first introduced him to Dr Singh and to this exciting new field.

Dr Shapira has studied this field extensively and in 2014 gave a lecture in Buenos Aires,  Argentina on the “Common Developmental Pathways of TMJ Disorders and Sleep Apnea.”  These pathways are an example of negative environmental effects on development that can be reversed in adults who were not expanded as children.  Prior to the DNA Appliance only extensive orthognathic surgery was available to widen or move bone.

Faces are different and each and every one of us is unique.  Our appearance and physiology is determined by our DNA or genes.  Genes determine our physiology and everything else about us.  This is a description of Genetics

What many people are not aware of is that the environment and other factors can change how our genes express themselves.  These types of changes are called Epigenetic changes.

Each person has a unique Genotype, these are the genes we inherited from our parents that when combined created a unique and special person.  Identical  twins  actually share a identical DNA .

The Phenotype is how are Genes are expressed, the effects of the environment on us.  These are the epigenetic changes that can be positive or negative in nature.  This can be the difference between a big wide smile that shows all the teeth

What makes the DNA Appliance special is that it uses the patient’s own genes to modify and change not just the position of the teeth but the size, shape and position of the bone that holds the teeth as well as Pneumopedically change the size and shape of the airway.  This 3-D spatial reconfiguring of the teeth and bone can make amazing changes not just in the teeth but in the face as well.  The changes the DNA Appliance stimulates mimic the natural developmental process that occur in an ideal world.  Biomimetic is the term used to describe what the DNA Appliance accomplishes, it mimics through biologic means what an ideal environment would have developed.

Oral appliances are frequently worn as a comfortable alternative to CPAP to manage snoring and obstructive sleep apnea.  These appliances often protrude the lower jaw and are needed for life.  Pneumopedics® is a term coined by Dr Singh to describe non-surgical upper airway remodeling is a different approach because instead of merely repositioning the lower jaw during sleep it gently allows allows the body to gently and gradually orthopedically increase the size of the upper jaw and increase the nasal airway.  This has been shown in some clinical cases to create a cure for sleep apnea and snoring.  The FDA-registered Daytime-Nighttime Appliance® system (or DNA appliance®) is worn during the evening and night for a total of 14-16 hours/day

Patients who are CPAP intolerant can utilize the FDA-cleared, patented mandibular Repositioning-Nighttime Appliance® (or mRNA appliance®) which works to maintain an open airway in the fashion of sleep apnea oral while gently re-developing the upper airway and moving the mandible or lower jaw and the teeth into a more natural position.

The DNA appliance® and mRNA appliance® protocols can effectively address TMD issues and headaches in both adults and children.  Dr Shapira is a leader in the use of the DNA Appliance to finish phase two treatment in TMD patients.

Dr Shapira is Awarded Diplomate Status By American Board of Sleep and Breathing and is Diplomate of American Board of Dental Sleep Medicine.

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Treatment of Sleep Apnea with oral appliances is an excellent alternative to CPAP for mild to moderate sleep apnea and an alternative for severe sleep apnea when patient do no tolerate or want CPAP.

Since 1982 Dr Shapira has been a leader in the field of Dental Sleep Medicine.  He sees patients in Highland Park and Gurnee Il.

HIGHLAND PARK, ILLINOIS  3500 Western Ave, Suite 101 60035     847-533-8313      www.ThinkBetterLife.com

GURNEE, ILLINOIS   310 S Greenleaf   60031       847-623-5530     www.DelanyDentalCare.com

Dr Shapira has added Diplomate Status by the American Board of Sleep and Breathing to his long history of being in the forefront of Dental Sleep Medicine.  He first became involved in Dental Sleep Medicine and the treatment of Sleep Disorders in 1982.  In 1985 Dr Shapira began research evaluating jaw position  as a visiting Assistant Professor at Rush Medical School in Chicago.

The Sleep Disorder Dental Society (SDDS) was the first organization dedicated to the science and practice of Dental Sleep Medicine and attended the first meeting in 1992 in Phoenix.  Dr Shapira was one of only 20 dentists at that meeting and the only dentist serving as an Assistant Professor of a medical School.  He was later credentialed by the SDDS.  The Sleep Disorder Dental Society became the American Academy of Dental Sleep Medicine and the American Board of Dental Sleep Medicine was formed and Dr Shapira was awarded Diplomate status.

He was also a founding member of DOSA or the Dental Organization of Sleep Apnea dentists.  He taught courses to hundreds of physicians and dentists and lectured on the subject as the American Academy of Anti-Aging Medicine.  One lecture from 1998 became a chapter in a medical textbook on Anti-Aging Medicine.

Dr Shapira was honored but being chosen to write the Guest Editorial when CRANIO: or the Journal of Cranio Mandibular Practice changed its name to the Journal of Craniomandibular and SLEEP Practice due to his influence in the growth of this  important medical  field that brings together the practice of Slkeep Medicine, Cardiology, Pulmonary Medicine and Dentistry

Dr Shapira is now a leader in the field of Epigenetic Orthodontics/ orthopedics and the use of the mRNA version of the DNA Appliance to offer possible permanent cures of Sleep Apnea through growth of the airway in a process called pneumopedics.

Dr Shapira practices in Gurnee at Delany Dental Care   847-623-5530

and in Highland Park  847-533-8313

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Sinus Headache, Sinusitis, Sinus Pain and TMJ Disorders

Dr. Shapira Blog, Chicago, Highland Park, Lake Bluff, Lake Forest, Libertyville, TMJ, Uncategorized 0 Comments

Chronic Sinus Headache and other Sinus Pains are closely related to TMJ Disorders. The connections between these problems is multifacted.

The Trigeminal Nerve also called the Dentist’s Nerve is the underlying common source of all of these problems.

Dentists are the experts on the Trigeminal Nerrve Disorders and in particular neuromuscular dentists who optimize eliminating noxious input to the trigeminal system. The term “TMJ: The Great Imposter” was coinded because patients with TMJ disorders frequently report symptoms not specifically related to the joints.

Dentists who practice TMD and Neuromuscular Dentistry are well versed in Myofascial Pain and Dysfunction or MPD as it relates to upper body, head neck and facial pain referred from active myofascial trigger points.

The Sphenopalatine Ganglion (SPG), the largest parasympathetic ganglion in the head is on the maxillary division of the trigeminal nerve. I have taught hundreds of neuromuscular dentists both from the USA and from across the world how to utilize SPG Blocks as part of Neuromuscular Treatment.

The Sphenopalatine Ganglion also contains Sympathetic fibers of superior cervical change responsible for “Fight or Flight” reflex and when not controlled create a wide variety of stress, pain and emotional issues.

The Myomonitor utilized by Neuromuscular Dentistry effectively neuromodulates the sympathetic and parasympathetic autonnomic input from the Trigeminal Nervous System.

The majority of sinus pain and sinus headache are NOT primary issues or infections within the sinuses. Antibiotics may actually create new sinus issues related to fungal infections.

Sinus pain and Headaches can be relieved with SPG Blocks very quickly.

Long term sinus improvements are related to function and structure.  The following is a video of a patient who has experienced a cure of her lifetime sinus issues with DNA Appliance.  Neuromuscular Dentistry treated her TMJ disorders and the DNA is used for long term stabilization and to increase the size of her airway.

There are over 150 additional videos on treatment of TMJ Disorders, Headaches, Migraines, MPD, Fibromyalgia, Sinus pain, Sleep Apnea and snoring mat this link:  https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos

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The Sphenopalatine Ganglion Block for Relief of Facial Pain from the Nasal Mucosa.

Dr. Shapira Chicago, Highland Park, TMJ, Uncategorized 0 Comments

This new article in Cranio (abstract below) discusses use of SPG Blocks in treating Facial Pain of Nasal Origin. I teach patients to self administer these block for many types of headache and facial pain.

This specific case was due to a nasal contact headache where the nasal turbinate is touching the septum.

Another approach is to grow the underdeveloped maxilla to open up airway, decrease sinus pain and infections while improving breathing.

This video is a patient who has used SPG Blocks in the past but is now making permanent changes in her nasal airway to improve health including TMJ disorder with the DNA Appliance and Epigenetic orthopedics/ orthodontics.

Cranio. 2018 Jun 8:1-3. doi: 10.1080/08869634.2018.1475859. [Epub ahead of print] Efficacy of sphenopalatine ganglion block in nasal mucosal headache presenting as facial pain.
Lee SH1, Kim Y1, Lim TY1.
Author information
Abstract
Background When intranasal contact points are the cause of headache and facial pain, opinions regarding whether to remove intranasal contact points when they are believed to be the cause of headache and facial pain are divided. Clinical Presentation A 46-year-old woman visited the authors’ pain clinic with complaints of right nasal pain accompanied by frontotemporal headache. She first met an Otorhinolaryngologist and a neurologist. Based on nasal endoscopy and pain pattern, they presumed that her pain was a nasal mucosal headache rather than migraine. A mild septal deviation to the right side with bony spur near the inferior turbinate was observed. The use of medication provided very insufficient relief. However, the sphenopalatine ganglion (SPG) block provided excellent pain relief, and the effect lasted for six months. Conclusion Considering the mechanism of pain in intranasal contact point headache, (SPG) block is a potentially effective therapeutic tool.

KEYWORDS:
Sphenopalatine ganglion block; facial pain; nasal mucosal headache; trigeminal afferent nerves…

Chicago Airway Treatment: DNA Appliance and mRNA Appliance

Dr. Shapira Advanced Light Wifre Functional Orthodontics, Always tired cause by lack of sleep, Blog, Breathing Sleeping Problems, Epigenetic orthodontics, Lack of Sleep, Orthodontic Treatment of Sleep Disorders, Other Health Problems cause by lack of sleep, Physiologic Dentistry, Sleep, Sleep Apnea, Sleep Apnea and Sleep Disorders, Sleep Apnea Effects & Symptoms, Snoring Devices, TMJ, TMJ Orthodontics, Uncategorized 0 Comments

 

Epigenetic Orthodontics is the single most exciting advancement in dentistry today. The DNA Appliance is the work horse of Epigenetic Orthodontics and was developed by Dr David Singh based on NIH research. While we call it epigenetic orthodontics a more accurate name would be epigenetic orthopedics because it actually grows and reshapes and idealizes the bone rather than just move the teeth. This process has been called Biomimetics or Biomimcry because it duplicates many natural developmental processes.

This Biomimetic technology allows us to comfortably create big wide healthy looking smiles even in patients with narrow arches. In an ideal world every patient would naturally have developed big wide healthy arches with resultant large airways and enough room for their lower jaw to grow ideally.

One very special aspect of utilizing the DNA Appliance and Epigenetic Orthodontics is that the appliances are only worn for 12-16 hours per day. This is very different that standard orthodontics with brackets and wire or Invisalign®. Most of the wear can be done in your sleep, watching TV or commuting. During the day at work or with friends you can be free of the appliance. This is one of the special features patients love about the DNA Appliance, the convenient fit into your lifestyle.

The time when the appliances are out the teeth move to ideal position as nature and/or genes intended. This allows self correction of the bite.

Typical orthodontics is a four-step process designed to move teeth through the bone. The first step is FORCE that creates PRESSURE (1) that compresses the periodontal ligament and puts pressure on the bone. The second step is INFLAMATION (2) which is associated with pain and discomfort. The third step which is RESORBTION (3) which is breaking down the bone by osteoclasts to create space. The fourth step is CONSOLIDATION (4) where new bone is formed. The process is then repeated after every orthodontic visit when braces are tightened or with each new Invisalign® tray.

” My longtime acupuncturist recommended Dr. Ira Shapira as an expert on Sleep Apnea when I shared with her my frustrations with my CPAP. Less than three months later, (and a sleep study to prove it), I am cured of my moderate condition of sleep apnea. Dr. Shapira created an oral appliance that is easy to sleep with and maintain. I am so relieved, feeling much better, significantly fewer headaches and more energy I would recommend Dr. Shapira to anyone. His knowledge of dentistry goes well beyond the norm. Anyone that suffers from TMJ and or sleep disorders should have a consult.”
” I could actually breathe and sleep better with the DNA Appliance. My school grades improved nd I no longer felt like I was drowning from lack of air when palying basketball. “
” The DNA Appliance Changed my life and saved my career. “

HEAR MORE VIDEO TESTIMONIALS:

https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg

Read Judith’s story about experiences with DNA Appliances below.

Epigenetic Orthodontics is very different it is a two step process. The forces are very light and movement is limited to 250 microns approximately every four days. The light forces are applied and growth and movement occur without inflammation which makes the entire process practically pain free. If there is any discomfort the adjustments are spaced out further.

The E-Cligner system is similar to Invisalign but utilizes three thicknesses of trays and allows patients a gentler process of clear aligner treatment.

The Alf Appliance is also available which can combine orthodontics and orthopedics with a less intrusive appliance that stimulates normal tongue reflexes. It can be an excellent appliance in continuing treatments.

RELAPSE PREVENTION AND THE DNA APPLIANCE

INCREASE AIRWAY IS ESSENTIAL TO PREVENTING ORTHODONTIC RELAPSE. PNEUOPEDICS, GROWING A BETTER AIRWAY

Relapse is frequently a problem with orthodontics after orthodontists have used fixed braces to straighten crooked teeth. Relapse is the teeth moving back to their original position and relapse is why orthodontists make retainers. The reason for relapse is complex and not well understood. The hours when the appliance is out let the teeth follow natural eruption processes with far lower risks of relapse.

According to Dr. Dave Singh the Founder of the field of pneumopedics and craniofacial epigenetics which includes epigenetic orthodontics “there is a natural way for the body to remodel the upper airway, reshape bone and move teeth into their correct positions painlessly without the use of surgery, drugs or injections.”

Professor G. Dave Singh DDSc, PhD, BDS states on his website: “However, the entire human genome has now been sequenced, and we now know that certain genes are involved in moving teeth. Teeth are naturally-designed to move, for example, tooth eruption in a normally-growing child. In addition, the teeth in some people erupt in a specific arrangement, producing a beautiful smile. Dr Singh believes that the specific arrangement of teeth is due to certain genes. In fact, a natural process called ‘temporo-spatial patterning’ is at work. This process is the blueprint or body plan that is encoded by genes. In other words, the right and left sides of the body, the top and bottom of the body as well as the front and back of the entire body is under the control of a genetic body plan, including the teeth. Sometimes, however, the plan gets disturbed, producing crooked teeth and improper orthopedics.”

Dr. Shapira has long had a special interest in developmental processes because of his work with sleep apnea in children and adults. Dr Shapira also has over 30 years experience in treating difficult TMJ Disorders, Migraines, headaches and other Chronic Pain. When these processes go are disturbed it changes how people breathe and swallow. Young children are frequently put in expanders to expand their maxilla or upper jaw. This is needed because of negative epigenetic changes caused by environmental allergies, food allergies or disturbed growth from insufficient breast feeding and bottle feeding.

Oral Myofunctional Therapy can help retrain children who were not breastfed to properly utilize their tongue muscles, facial muscles and pharyngeal muscles to return to normal patters of breathing and swallowing. Dr Shapira was an Invited dignitary at the first international meeting of the AAMS, Academy of Applied Myofunctional Sciences in Los Angeles and the March 2017 AAMS meeting in Chicago both of which he attended with his wife Anna.

Both Dr Shapira and Anna were trained as Oral Myofunctional Therapists by Joyce Moeller and the AMOT, Academy of Oral Myofunctional Therapy. Dr Shapira’s office is the only office in the midwest utilizing DNA Appiances in conjuntion with Physiologic Dentistry and oral myofunctional therapy.

Dr. Shapira, has taught classes to hundreds of dentists and their teams on how to treat sleep apnea with oral appliance therapy. It is one of Dr. Shapira’s students Dr .Martha Cortes who first introduced him to Dr Singh and to this exciting new field.

Dr Shapira has studied this field extensively and in 2014 gave a lecture in Buenos Aires, Argentina on the “Common Developmental Pathways of TMJ Disorders and Sleep Apnea.” These pathways are an example of negative environmental effects on development that can be reversed in adults who were not expanded as children. Prior to the DNA Appliance only extensive orthognathic surgery was available to widen or move bone.

Faces are different and each and every one of us is unique. Our appearance and physiology is determined by our DNA or genes. Genes determine our physiology and everything else about us. This is a description of Genetics

What many people are not aware of is that the environment and other factors can change how our genes express themselves. These types of changes are called Epigenetic changes.

Each person has a unique Genotype, these are the genes we inherited from our parents that when combined created a unique and special person. Identical twins actually share a identical DNA .

The Phenotype is how are Genes are expressed, the effects of the environment on us. These are the epigenetic changes that can be positive or negative in nature. This can be the difference between a big wide smile that shows all the teeth

What makes the DNA Appliance special is that it uses the patient’s own genes to modify and change not just the position of the teeth but the size, shape and position of the bone that holds the teeth as well as Pneumopedically change the size and shape of the airway. This 3-D spatial reconfiguring of the teeth and bone can make amazing changes not just in the teeth but in the face as well. The changes the DNA Appliance stimulates mimic the natural developmental process that occur in an ideal world. Biomimetic is the term used to describe what the DNA Appliance accomplishes, it mimics through biologic means what an ideal environment would have developed.

Oral appliances are frequently worn as a comfortable alternative to CPAP to manage snoring and obstructive sleep apnea. These appliances often protrude the lower jaw and are needed for life. Pneumopedics® is a term coined by Dr Singh to describe non-surgical upper airway remodeling is a different approach because instead of merely repositioning the lower jaw during sleep it gently allows allows the body to gently and gradually orthopedically increase the size of the upper jaw and increase the nasal airway. This has been shown in some clinical cases to create a cure for sleep apnea and snoring. The FDA-registered Daytime-Nighttime Appliance® system (or DNA appliance®) is worn during the evening and night for a total of 12-14 hours/day

Patients who are CPAP intolerant can utilize the FDA-cleared, patented mandibular Repositioning-Nighttime Appliance® (or mRNA appliance®) which works to maintain an open airway in the fashion of sleep apnea oral while gently re-developing the upper airway and moving the mandible or lower jaw and the teeth into a more natural position.

The DNA appliance® and mRNA appliance® protocols can effectively address TMD issues and headaches in both adults and children.

The following is a patient’s experiences with the DNA Appliance and Epigenetic Orthodontics.

My DNA Appliance Experience – Getting Started – By Judith Joy

My DNA appliance began with a visualization. My teeth were collapsing inward. So, I visualized how to correct this…appliances that fit over the teeth, were removable and gentle, and helped to erect the teeth.

A week later, I went to see Dr. Shapira, my dentist. He mentioned that he was doing this new thing, a DNA appliance. Based on my past history, he didn’t know if it would work, but since braces hadn’t (as they were forceful and I don’t like anything that’s forceful), maybe this would, because it was gentle. “No guarantees,” he said. But what he showed me was EXACTLY what I’d visualized, so I knew it would work.

This article is the first in a series of my experiences with my DNA appliance. After molds were taken, pictures snapped to record progress, and the appliance was made, I put it in. It wasn’t too bad…a little tight, but not that uncomfortable. Dr. Shapira showed me how to adjust it. Cool. I could adjust it on my own. I’d only need to come into the office every four to six weeks.

And I could wear it eight to sixteen hours a day, but they didn’t have to be in a row. I wear it while sleeping and a little bit during the day while doing activities that don’t require talking. My family makes fun of my trying to talk with it in, but we all laugh about it.

Dr. Shapira warned me that I’d drool a lot at the beginning. But I knew I wouldn’t because I was used to having an appliance in my mouth 24/7. And I didn’t drool. Although swallowing while wearing the DNA appliance takes a little practice. (The previous appliance was a placeholder between the braces, which didn’t work, and until something new could be invented, as I knew it would be. I just didn’t think it would take 25 years.)

At the beginning of the week, the appliance was tight when I put it in. (I’m saying “it” even though there is an appliance over the upper teeth and a separate appliance over the lower teeth.) However, after a few minutes any tightness disappeared. I have noticed that at the beginning of the week, it feels tighter and by the end of the week, it goes on more easily. I did get my cheek caught in the appliance a few times. Ouch. But I figured it out eventually.

To keep track of my hours, I made a chart of every half hour in a day. Then I put seven days on a piece of paper. It was easy to keep track of the hours the appliance was in my mouth by using a highlighter to mark the hours I actually wore it.

I’ll keep you up to date on the improvements as they happen. I know this will work. I just have the knowing feeling.

The first month passed quickly and the improvements began immediately. After a few nights, I realized that I wasn’t waking up with headaches. This is HUGE. Twenty-seven years ago, Dr. Shapira assured me that moving the jaw would eliminate many of my headaches…or at least the ones that were caused by stress from the jaw’s structure and muscles. I knew he was right.

But my teeth weren’t cooperating at that time.

I’ve noticed other improvements also after only a month. There is more room in my mouth for my tongue. My posture is better. My scoliosis seems to be self-correcting (according to my massage therapist). My face is looking smoother and younger. And I’m happier because I’m not in as much pain. An added bonus is that my sex life is getting better because I feel great.

On the downside, there is some discomfort. The muscles in my jaw were tender and my right ear hurt a bit. But two visits to the acupuncturist eased this. My cranial bones (the plates in my head) are shifting and causing some pressure. My low back aches and interferes with my sleep a bit. The chiropractor has been able to help with the cranial and low back. Also, if I sleep with a 12-inch square pillow against my stomach, it keeps my hips positioned in such a way that it eases my back, because I don’t twist them while I sleep.

My nutrition-supplement-energy doctor has noted that I need more manganese and calcium and some organs are a little bit stressed. I’m also dehydrated. Dr. Shapira says the dehydration is because the nasal passages are opening and more air is going through.

After the first month, I’d have to say, that the DNA appliance is a great success. But then I knew it would be. I’ll keep you up to date with my progress.

Judith has had long term relief with physiologic dentistry but we are both hoping that Epigenetic Orthodontics is the final piece of her puzzle.

Dr Shapira’s Notes: Judith had previously attempted orthodontics with an Orthodontist and standard techniques, it was a total failure. Calcium and Magnesium supplements may be a good routine because we are growing bone which requires calcium and the muscles need magnesium to relax. Dehydration is common for many oral appliances and the best recipe for success is to drink lots and lots of water.

When Judith describes “a great success” it is really meaningful because she is very aware of treatment effects and sensitive to any problems, even when minimal.

MY DNA APPLIANCE EXPERIENCE – 2nd MONTH – By Judith Joy

I can breath in both nostrils! This is amazing. I don’t know what I’ll do with all this oxygen. But seriously, I can now breath in both sides of my nose. Dr. Shapira says this is only the beginning and it will get even better.

As an added bonus, I don’t seem to have hay fever this spring. At first, I wondered if it was because I gave up eating grains and legumes about six weeks before starting the DNA appliance. Knowing that my sister also gave up grains, I asked her how her allergies were. “Worse than ever,” she replied. “Give me the name of your dentist.” My theory is that the air passages are bigger, so they aren’t getting clogged up as before. I may be right or I may be wrong.

I’ve also started exercising more and longer. Before, my muscles would tire (probably lack of oxygen) and I’d get a headache. Now, I can exercise easier and the rest of the day is even better because I feel so good.

On a negative front, twice this month I noticed that the lower appliance pressed into the inside gums of the lower teeth in a few spots. I talked myself into “it will be fine.” By the third day, I said, “never mind” and contacted Dr. Shapira and three hours later he adjusted the appliance. He said he’d been expecting this. But he didn’t tell me ahead of time. (I know that if you say the negative, the patient may “make the problem come true” when in fact, he doesn’t need to do so.) But still, now I know to ask about a problem earlier.

One thing that did help the pressure point pain was that I dabbed it with my boyfriend’s burn cream. Yes, my boyfriend is an inventor and had made and patented a burn cream two years before he was severely burned (1st, 2nd, and 3rd degree burns from the waist up). Luckily he had the cream and only has one small area that wasn’t covered as well with the burn cream. (There isn’t any remnant of the formerly, burned skin.)

One final “negative” is that my L5 vertebra got tweaked so my lower back and left groin hurt. Two trips to the chiropractor seems to have solved this (along with applying Biofreeze and Traumeel). Dr. Shapira says this could be because as the jaw adjusts, the spine moves and unwinds old patterns, which causes the muscles around the spine to move.

Some hints to help you:
Hint one: Dr. Shapira suggested easing the muscle pain by looking at hip height and adjusting the height to make it even. He measured my hip level (by looking at it and putting his hands on my hip bones). One was lower than the other. I added a little bit of a paper towel under the heel of the leg with the lower hip. I walked down the hall. He re-measured. We added more paper towel. I walked down the hall again. He re-measured. We took out the second paper towel. I repeated the walk down the hall. He was looking for the hip level to be consistent at the beginning and end of the walking. Since we just did this today, I’m not sure if this will work, but I’m willing to give it a try. (There is also a way to do this with a plumb line in a mirror, but I don’t know this one.)

Hint two: I’ve noticed that when I sit at my desk and use my laptop computer, my head is a bit forward and down. This causes my teeth to clench and I feel tense overall. However, when I remember to wear the appliances while I write, I’m more relaxed, my posture is even better and my neck doesn’t get as tired.

Hint three: Don’t eat or drink with the appliances in your mouth. (Except for water.) The reasoning is that it’s not necessary AND the food or drinks will stain the appliances. Also, be sure to brush the appliances after every use. This removes the bacteria that is transferred from your mouth to the appliances when they are worn.

Hint four: Finally, slow is the way to go. If you adjust the appliances too fast, the teeth may become unstable. (Yikes. I just learned this one today.) A possible indication of moving too fast is that the teeth may become sensitive to hot or cold.
So, how do you know when to adjust the appliances? I use a muscle testing method and listen to what my body is telling me. I also pay attention to my intuition. I ask my body if the appliances should be adjusted. Then I pay attention to how I feel. If they are ready to be adjusted, I feel open and expansive in my chest. If this doesn’t feel right, my chest will feel as if it’s closing and is constricted.

Of course, you can also adjust it when it feels looser and easier to put on. Move from tight to loose, adjust. It will be tight again. Wait for the loose feeling, before adjusting (probably a week later assuming you are wearing the appliances 10 – 16 hours a day).

The more you wear the appliances, the more the jaws/arches (or whatever is actually moving) will be used to the new position. You won’t have to start over each time you insert them.
I hope this helps you. I’ll keep you informed of my progress. But, so far, I love the results.

Dr Shapira’s Notes, The Second Month. The term Pneumopedics was coined by Dr Singh, the inventor of Epigenetic orthodontic and it refers to growing a larger airway. This improves every aspect of a patients life. Diseases like Fibromyalgia are associated with UARS or Upper Airway Resistance Syndrome. Correcting the size of the airway will help improve Sleep and Health for patients with Fibromyalgia. The changes that take place in posture have to do with the “Righting Reflex”. This work was by Sherrington, a neurologist who received a Nobel Prize. As your posture corrects the body needs to “catch up”. Forward head posture and the resultant strain on the muscles of the spine will gradually begin to correct.

My DNA Appliance Experience: 3rd Month – By Judith Joy

(This is one of my patients experience with the DNA Appliance. This is a long standing TMJ patient who had poor results with standard orthodontics but life changing results with DNA Appliance and Epigenetic orthodontics and orthopedics. Dr Ira L Shapira )

I’ve been experimenting with how many hours in the day I need to wear the DNA appliances. (Translation: While I finished writing my book, and I forgot to put them in during the day.) But I did find something very interesting. If I only wear them at night, then they fit tighter for longer. This means that I can’t adjust them every week and the whole process will take longer. It’s also frustrating because the forward momentum (progress) is slower. I’m only shooting myself in the foot by not wearing them more each day.

This brings me to the second way I’m hindering my progress. I’m thirsty. It seems that since having the DNA appliance, I’m constantly thirsty. (No, it’s not anything worse.) Up until now, I’ve continued to drink my brewed iced tea and gotten more thirsty. (Duh! By the way, soda and alcohol causes dehydration also.)

So, that got me to thinking…what does dehydration do to the body? This is how I understand it. Dehydration is when the body is requesting more water. If the body doesn’t have enough water from the outside (drinking), it will recruit water from the inside and keep what it already has. This translates to gunking up the waste management system within the body. Water will be reused from the urine and bowels. Therefore, the body will pee less and the bowels will become harder and thus it will be more difficult to push out.

This is bad enough, as it’s uncomfortable, but there are additional side effects of the body holding onto the water. If the body doesn’t eliminate the waste, then the toxins in the waste stay in the body longer and can be reabsorbed. This slows down the lymph and immune systems. One outcome is that the toxins have to come out somewhere, so the skin breaks out.

Also, the body is trying harder and harder to eliminate the toxins. So when an outside “bug” visits (the body is exposed to someone who is sick), the body is more likely to catch the bug because it’s busy fighting the internal battle with the old toxins and doesn’t have enough “power” to fight the new battle (the bug). End result…the body gets sick. And you know how that turns out.

So, for goodness sake, drink water. You will need more water than normal while you are using the DNA appliance. But why feel gross while you are going through the process when the solution is so simple. Drink lots of water.

One last comment. My back doesn’t hurt per se, but the pain radiates down my hips and legs. The only time it bothers me is on long walks or when I lie down. Needless to say, sleep is elusive some nights. Still going to the chiropractor and acupuncturist for comfort. It’s getting better. But since back stuff started about a month into the DNA use and there wasn’t any trauma, I’m going with the story that it’s my body adjusting to the unwinding of my spine. How cool is that?

And how can it be even better? How can it benefit me?

Dr Shapira’s Notes, Judith came in and was hitting first on the right side for a few weeks. She had a bite adjusted to her physiologic position but was hitting hard on a ceramic restoration from another dentist. It was easy to readjust her her bite and I expect her hip will quickly resolve.

I THINK IT IS IMPORTANT TO NOTE THAT WHILE WE MOVE THINGS TO A MORE IDEAL PHENOTYPIC EXPRESSION OF THE PATIENTS OWN GENETICS WITH THE DNA APPLIANCE THAT THE RESTORATIONS WERE PLACED TO FIT THE EXISTING PATHOLOGY. I DO NOT EXPECT TO NEED TO ADJUST THE NATURAL TEETH BUT THE RESTORATIONS WERE NOT PART OF A PATIENTS GENETIC SYSTEM.

Judith has seen a huge amount of growth in her maxilla. Dr Singh recommends 16 hours a day but we are seeing significant reults with patients wearing them 10-12 hours / day. Longer will create faster movement. Hydration is always important as is nutrition. The body can grow and remodel bone and sutures but the process is energy fueled.

MY DNA APPLIANCE EXPERIENCE: 4TH MONTH – By Judith Joy

Good news! My hip felt better after Dr. Shapira made the adjustments to my bite. Who would ever have thought that my jaw played such a big role in my hips? I’m just glad that we found a solution.

Another great thing for this month is that my teeth are moving. They are straightening and as they do so there is more space between the teeth. For the moment, this translates into food getting stuck between the teeth. But my goal was for the teeth to “pop back up” and that is what they are doing.

A little floss and a water pic solves the minor problem with the food.
And I’ve noticed that the lines between the front teeth (both upper and lower) are lining up as the bite widens. I’ve always wondered why the lines didn’t match up before. My bite was off. Imagine that! (Sarcasm.)

On the down side, the muscles in my neck are tighter and I’ve had more headaches this month. Although I think the cause is from something emotional (since I’m doing a lot of emotional inner work). But I’m mentioning it just because I’m recording everything that may have a possible connection.

Overall, it’s been a great month. There is progress and my teeth are “popping back up.” It’s all good.

Dr Shapira’s notes: The connection to the hips and the bite is a very important point. When treating patients we are always treating the whole body and not just the individual parts. Dr Sherrington won a Nobel prize for his work on the righting reflex. This encompasses Ascending and Descending problems.

The hips affecting the bite is an example of an Ascending problem, the bite affecting the hips would be an example of a descending problem. The field of Cranio-Sacral medicine is intimately connected to these Ascending and Descending pathways and it is crucial that they be considered in every patient.

MY DNA APPLIANCE EXPERIENCE…FIFTH AND SIXTH MONTHS

The last time I was at Dr. Shapira’s, he was surprised at how my teeth have moved so easily. He even indicated that we are nearing the end of the treatment…after only six months. Wow! That was fast. Dr. Shapira had told me that it would take one and a half to two years.

So what did I learn these past two months? To begin with, don’t forget to put the appliances in at night. You see, I forgot one night. (I was on vacation and out of my routine.) The next night, they were very tight.

The next thing I learned was that all of the little “screws” in the appliances don’t have to be moved every time. Dr. Shapira told me which ones to adjust based on how my mouth was adjusting (a good reason for the monthly checkups).

Then, I again needed a reminder that dehydration doesn’t feel good. I need to drink more water to alleviate some of my headaches. The reason I bring it up is that my mouth seems to get much dryer with the appliances in than normal.

Finally, the more I wear the appliances, the better they work. Surprise. Surprise. Wearing them only at night works, but it’s slow going. Wearing them during the day also speeds up the process.

The one thing I didn’t realize was that when the movement is over, I’ll have to wear the appliances (in a fixed position) for longer. It makes sense. I just hadn’t thought of it. But overall, it’s not a bad deal.

All in all, it’s been a good six months so far. I’m excited about the possibility of moving to the next phase.

Months 7-12 with DNA Appliance http://sleepandhealth.com/node/646

Dr Shapira is currently utilizing Epigenetic Orthodontics at Gurnee (Delany Dental Care) office for Sleep Apnea, TMJ and headache patients……847-623-5530

http://www.delanydentalcare.com

Dr Shapira have a second office in Highland Park. This office is geared toward the treatment of TMJ Disorders (TMD), Sleep Apnea and Snoring, and Epigenetic Orthodontics.

MY DNA APPLIANCE EXPERIENCE… SEVEN, EIGHT, NINE, TEN, ELEVEN AND TWELVE MONTHS

By Judith Joy

Read the first 6 months @ http://sleepandhealth.com/node/636

As you can see from the title, I haven’t written this blog for a few months. It’s just that nothing much new has been happening. My mouth is progressing nicely with steady progress. After my next appointment I’ll be done…or at least that’s what I think is happening.

I have learned a few additional things to share with you.
First, I noticed that a tooth was loose and had some wiggle to it. I decided that since I was seeing Dr. Shapira the next week, to not adjust the appliance and just stay the course until I saw him. Dr. Shapira said that I could have untightened it. But it’s all good. My teeth are all solid again.

It seems that when the jaw was done expanding, the appliance didn’t fit all the way down and pushed on the teeth. Another reason the appliance may push on the teeth is because it isn’t fitting correctly. This is definitely something to watch out for.

Second, as the teeth have become less crowded, I’ve noticed that there are stain spots between the teeth. This is probably because the hygienist couldn’t get between the teeth when she did the cleanings. So as you can imagine, I’m looking forward to my next cleaning.

And talking about cleaning, we are also doing a teeth whitening at the last appointment. I’m excited to lose some of the staining from all the iced tea that I drink. Someone once told me that if I drink things through a straw, then the offending drink won’t stain my teeth. I don’t know if it’s true, but it’s worth a try.

Next, I was shocked to learn that I’d still have to wear some type of appliance after the treatment was done. It’s silly that I’m shocked by this, as I know that retainers follow braces, but it still shocked me. At least, I’m told that the new appliance won’t be as bulky. YEAH!
Finally, I learned that by doing this DNA appliance, I actually look younger. Dr. Shapira had told me this would happen, but the information went in one ear and out the other. And as usual, when a change is gradual we don’t always see the progress. So, I’m excited for to compare the before and after pictures.

But back to the age “regression”…Dr. Shapira recently showed me a series of pictures of a woman without teeth who put in different sized dentures. As sizes of the dentures changed, her face became less sunken and the wrinkles “ironed” out.

Dr. Shapira explained that the same thing is happening to my mouth by expanding the arches and bone growing in the micro tears as this happens.

I know this sounds weird, but in the past, I’d attended a lecture about bone growth and this is exactly what happens. In the lecture, the bones were shown as purposely broken and then microfibers grew between the bones to connect them again. It was like each side of the broken bone was searching for the other.

With the DNA appliance, expanding the appliance creates what I imagine to be micro tears in the bone and then more bone grows into the space. The end result is that the arches are widened, the teeth have more room to grow straight, and my face is filled out.

All in all, I’d say that this experience was successful. The gentle vibrations of the DNA appliance were very tolerable and actually created positive change in my mouth. Remember, I started because the teeth were falling inward. Now they have room to “breath.” Gentle is certainly the way to go.

What to do with bite changes from SomnoDent Appliance from Somnomed?

Dr. Shapira Blog, Breathing problems can cause TMJ, Breathing Sleeping Problems, Clicking & Popping, Epigenetic orthodontics, Sleep, Sleep Apnea Treatment, Sleep Disorder Diagnosis, Sleep Disorder Treatment, Sleep Problems, Snoring Devices, TMJ, Uncategorized 2 Comments

Julie’s Question:
I have obstructive sleep apnea and I wear a Somnomed (SomnoDent)  appliance at night. As a result, my bottom teeth and top teeth are meeting on top of each other and the bottom teeth are off to the side. I would to be able to straighten my bite and wear the sleep appliance at night. Is this possible? Please let me know if you have additional questions. I have consulted a prosthodontist who told me he needs to confer with my dentist and sleep appliance doctor. But they are busy and I want to know if my situation is something I must accept.

Dr Shapira’s Response:
Dear Julie

There are many ways to “make you whole” and possibly offer long term cure to sleep apnea. A side effect of wearing a Somnomed Appliance or other sleep appliance is bite changes. These are usually mild but can be more severe. These are discussed at the start of treatment. The bite changes can be favorable or unfavorable. The are he result of the jaw healing to a position with a better airway.

I have been utilizing sleep appliances since 1982 and bite changes are common. Ideally aggressive morning exercise prevents most changes but after they occur they are hard to reverse. I have followed some patients for approximately 30 years and many never have issues.

Sometimes the bite changes can be reversed if you use CPAP instead of an oral appliance to treat your sleep apnea. The changes actually are healing of the retro-discal ligaments of the TMJoints and muscles. They improve your daytime and night-time breathing, posture and actually make your face look younger and healthier but when everything is healed your bite looks wrong.

I teach all my patients how to prevent changes before giving them an appliance. I often have patients who want permanent orthopedic change and this is accomplished with a plan rather than as an accident.

The changes you see in essence explain why you originally had seep apnea. It is possible to orthodontically or prosthetically correct the bite but my preferred method is the RNA version of the DNA Appliance that orthopedically grows your maxilla to a proper size. Additional work may be required to finish case after the DNA Appliance.

I frequently see long distance patients with difficult problems and the DNA Appliance lends itself to long distance treatment.

The beauty of the DNA Appliance is that it has been shown in clinical studies to cure sleep apnea in some patients. Long term prospective studies are underway.

The first video is a physician who is using DNA Appliance to grow larger airway.

This patient is a young girl whose DNA Appliance is growing a larger airway after orthodontics constricted her airway

This is a month by month explanation of a long term patient utilizing DNA Appliance.

http://sleepandhealth.websiteexpert.ca/category/blog-keywords/highland-park-epigenetic-orthodontics/

It is also possible to do a full mouth reconstruction to a physiologic position.

Julie’s response:
I currently wear the Summoned sleep appliance which I believe the only appliance my doctor makes. I would like to continue to wear this appliance because it helps my OSA without tearing up the inside of my mouth. I would like to correct my bite as my jaw pops and it is difficult to chew. Is my situation futile or can I do the bite correction and keep my current appliance?

Dr Shapira’s response:
Dear Julie,
I see many patients who we treat for both TMJ and bite issues who also wear sleep appliances. I will usually make a daytime orthotic to treat the jaw issues that is worn when the sleep appliance is out.

Treatment is usually divided into phases, the first phase is a diagnostic that can be adjusted over time during initial treatment. A second phase of long term stabilization is then done. This can be done with long term removable orthotic that would allow you to use your current Somnomed (SomnoDent) appliance.

If you choose prosthetic or orthodontic correction you would need a new SomnoDent Appliance after the work was completed.  The appliance can be adapted as you go thru treatment to maintain your treatment of obstructive sleep apnea.

There are other options for long time stabilization but they would require replacement of Somnomed appliance as well.

Dr Shapira…

TMJ and Lyme Disease: Many Symptoms Overlap

Dr. Shapira Always tired cause by lack of sleep, Blog, Breathing problems can cause TMJ, Causes of TMJ, Chronic Daily Headache, Clicking & Popping, Depression and Chronic Pain, Headaches and Migraines, Lake Bluff, Libertyville, Sleep, TMJ, TMJ Treatment, Treatment of TMJ 0 Comments

There are many signs and symptoms that are similar in Lyme disease to patients with TMJ and Sleep disorders.  Frequently both of these conditions are overlaid.  Treatment of musculoskeletal issues will not correct or cure Lyme disease but will improve the quality of patients lives.   The following videos are of a patients suffering from both Lyme disease and TMJ.

Patients who have been diagnosed with Lyme disease often develop symptoms that are not treated for the other issues that could improve their quality of life.  The Sphenopalatine Ganglion Block is not specific for treating Lyme or TMJ but can give remarkable symptom relief to many patients.  SPG blocks work on the Autonomic nervous system.

According to the CDC later signs of Lyme disease include:

  • Severe headaches and neck stiffness
  • CHRONIC HEADACHES AND NECK PAIN ARE ONE OF THE MOST COMMON SYMPTOMS IN TMJ, NEUROMUSCULAR AND POSTURAL PATIENTS
  • Additional EM rashes on other areas of the body
  • Arthritis with severe joint pain and swelling, particularly the knees and other large joints.
  • Facial or Bell’s palsy (loss of muscle tone or droop on one or both sides of the face)
  • THIS IS LESS COMMON BUT ALSO SEEN IN TMD AND FACIAL PAIN PATIENTS
  • Intermittent pain in tendons, muscles, joints, and bones
  • THIS IS SIMILAR TO MYOFASCIAL PAIN AND DYSFUNCTION THAT IS PART OF ALMOST ALL PATIENTS WITH CHRONIC JAW ISSUES.
  • Heart palpitations or an irregular heart beat (Lyme carditis)
  • Episodes of dizziness or shortness of breath
  • OFTEN RELATED TO CHRONIC STRESS FROM LIVING IN PAIN, DIZZINESS IS COMMON COMPLAINT IN TMD PATIENTS
  • Inflammation of the brain and spinal cord
  • Nerve pain  FREQUENTLY SEE REFERRED PAIN AND ENTRAPMENT PAIN
  • Shooting pains, numbness, or tingling in the hands or feet
  • PAIN IN ARMS SHOULDERS INTO FINGERS IS FREQUENTLY ASSOCIATED WITH OTH TMJ DISORDERS AND SNORING AND SLEEP APNEA PATIENTS FROM SCALENE MUSCLE ENTRAPMENTS
  • Problems with short-term memory

https://www.youtube.com/watch?v=Po1F1pO0ock
https://www.youtube.com/watch?v=ciKuRdmb5PI

January 2018 update video

Krista broke her appliance and locked and after the lock was reduced (took some time) she has made a decision to move to phase two treatment after 10 years of appliance wear.  One week prior to this video she had bonded composites placed on 6 teeth to stabilize her bite without an appliance and an upper and lower DNA Appliance was placed.  She begins the video with the appliance in her mouth, removes it and continues her story.  She does not wear DNA Appliance at work or while eating but does wear it 16 hours daily to finalize TMD treatment.

Maxillary Hypoplasia: A Cosmetic Problem With Postural Physiologic Implications Including Sleep Apnea

Dr. Shapira Blog, Breathing problems can cause TMJ, Sleep, TMJ 0 Comments

Question from Jeff:

I was told I have maxillary hypoplasia. I cannot show any teeth when i smile. I don’t want to re-arrange my face and have it go numb. Pls tell me of all other options

Dr Shapira Reply:

Dear Jeff.
There are numerous methods to address your  cosmetic problem.  The first is to do nothing as you can function for a lifetime with maxillary hypoplasia.  There are some common medical concerns related to maxillary hypoplasia .  There is usually a nasopharyngeal airway restriction associated with Max Hypo.  During the day this can lead to forward head posture and over time lead to other problems including back pain, neck pain and numbness of the hands and arms.  This same airway restriction can lead to sleep  apnea and snoring at night.  RERAs or UARS are a milder form of apnea and all can lead to heart problems, endocrine problems increased weight, cognition problems etc.
Cosmetic approaches can vary based on examination and is based on several factors.  As you know maxilary advancement carries a risk and is a major surgical procedure.  It is possible to do a Rapid maxillary expansion and anteriorization with a surgical assist which is a much less invasive procedure and movement is done orthopdically.
The DNA Appliance utilizes Epigenetic Orthopedics to grow bone and AIRWAY orthopedically and pneumopedically.  There are limits to intraoral movement but 
use of headgear (reverse pull) can be incorporated.  I am in Illinois and do many DNA and RNA cases but if the condition is extreme Dr Martha Cortes in NYC is probably the premiere DNA practitioner in the world and I have sent he patients who commute to NY for treatment.
There is no reason that you can’t use an overlat denture on your maxilla to give and excellent look without actually correcting the problem.  Snap in Smile treatment can give you an instant makeover for minimal cost.   Depending on the degree of hypoplasia and the costs you want to incur it is possible to do a reconstruction with veneers, onlays and crowns to build the teeth out to a full smile.  There will be increased thickness and a tendency to have some food retention after eating, usually a minor problem but some patients find it annoying.
In my practice I offer cosmetic only solutions but my preference is to achieve ideal airway and physiology as an integral component of cosmetic reconstruction. A large portion of my patients have been treated for sleep disorders, TMJ disorders, chronic neck,back or head pain and the cosmetics are used as a finishing technique.  Most patients get the best cosmetic results when they are built on a platform of health.
The use of Physiologic Dentistry and the diagnostic aids they provide are essential in finding the best position regardless of the type of treatment decided on.