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%1 and has been explicitly linked to the TCR.2We 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.
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.
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.3
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.2, 4, 5, 6 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.7 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.
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 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.
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
Sleep Apnea is a dangerous disorder with multiple medical problems associated with untreated Sleep Apnea.
There are many methods used to treat sleep apnea. The standard medical treatment is CPAP or versions of CPAP called BiPAP and APAP.
CPAP in any of it’s forms is very effective. Unfortunately, CPAP fails the majority of patients due to non-compliance, or minimal compliance.
25% of patients use their CPAP and love it but 75% of patients fail to properly treat their sleep apnea due to not using it or using it for too short a period of time.
CPAP Alternatives include comfortable oral appliances to treat sleep apnea. There are currently over 120 different appliances available. They are considered a first line treatment for mild to moderate sleep apnea and a second line approach for severe sleep apnea when patients refuse CPAP or cannot tolerate CPAP. See the patient Oral Appliance Testimonials at the end of this post.
Oral Appliances are also used by patients who like their CPAP but do not take it with them when they travel. Severe apnea puts patients at risk for heart attacks and strokes , especially in the early morning. Traveling without CPAP can be dangerous. Patients who only wear their CPAP for an hour or two at night are also at high risk for heart attacks and strokes.
Colin Sullivan who invented CPAP uses an oral appliance. I have many physicians as patients who also prefer an oral appliance to CPAP.
Some patients are not good candidates for Oral Appliances due to severity. In most cases these patients are obese to morbidly obese. They are often good candidates for combination therapy which tuilized an oral appliance and CPAP. Some oral appliances are designed to increase the comfort of the nasal CPAP.
Combination therapy can also be an oral appliance and a night time positioner to keep patients off their back where sleep apnea is usually more severe.
Oral appliance therapy is NOT indicated for patients with primarily Central Sleep Apnea but mays ill be used to increase comfort of the masks.
CPAP is life saving technology for people with obstructive sleep apnea. Unfortunately, the majority of patients do not tolerate CPAP and often go untreated. Dental Sleep Medicine offers a comfortable, safe and effective alternative to CPAP. Dr Shapira is a pioneer in the use of oral appliances to treat CPAP with over 30 years experience.
Ira Shapira has been utilizing physiologic dentistry for over 30 years to treat TMJ disorders, headaches, migraines and sinus pain. Dr. Shapira is a dentist whose philosophy of care leads to more than just a pretty smile. Cosmetic dentistry is one of his specialties, but more and more his practice has come to focus on the tremendous health benefits that can come from a smile that blends form and function. The founder of IHateCPAP.com, a nationwide network of dentists dedicated to educating patients about the dangers of sleep apnea and the treatment options available, he says, “I often joke that I was a quack for 25 years when I was one of the few dentists in the world treating sleep apnea and I woke one day to find I was the expert.
His interest in sleep apnea treatment began with his son’s treatment for the condition. “I was told my 5 year old son had ADHD could not start kindergarten and needed to be on Ritalin for life. I said I don’t think so. He had a sleep study and had severe apnea which was treated with tonsilectomy and orthodontic. Turns out his drug of choice was OXYGEN not Ritalin. He graduated magna cum Laude double major, double minr. All he needed was good sleep!” Following this experience he became a visiting Asst Profesor at Rush Medical School’s Sleep Disorder Center where he did research on jaw position and sleep apnea in the 1980’s long before most ohysicians or dentists even knew what sleep apnea was. He felt that people needed to learn about sleep apnea, and he decided there should be more treatment options available. This intensely personal origin to his interest in sleep apnea is responsible for his treatment attitude: “I like to think of my patients as though they were members of my family. I want them to have the quality of care they can appreciate and that I would expect for myself or my family.”
The same spirit has inspired him to found iHATEheadaches.com, a website that can help people get in touch with local physiologic dentists who can resolve the most common form of headaches: tension headaches. These headaches are related to TMJ disorders and to Myofascial Pain and Dysfunction (MPD)…
Suffering from sleep problems like snoring and trouble breathing?
Are you having problems sleeping and keep waking up at night suddenly, as well as snoring loudly? You could have something called sleep apnea. Sleep apnea is surprisingly common right across America. It can occur at any age and to either gender, but it is more common amongst older males. Many patients have sleep apnea, sometimes severe but do not fit the typical pattern.
It is quite simply the narrowing or blockage of the airway while you are asleep. This means at times there is a restriction in the amount of oxygen you take into the lungs. The outcome of this could be trouble breathing and snoring. Patients who have sleep apnea usually have a smaller airway when awake as well and are predisposed to apnea when their muscles are relaxed. Patients with forward head posture or recessive chins are at greater risk for sleep apnea.
Quite a lot of research has gone into finding out what causes sleep apnea. Some of the causes are listed below:
Large tongues relative to the size of the mouth.
Sleeping on your back (supine)
What these tend to do is relax the muscles in your airway so much that it might become difficult for you to breathe. A dental solution may be available, in the form of some oral appliances which can help to let you get more sleep, but you may need to tackle lifestyle changes too.
A treatment that fits in the palm of your hand
An oral appliance can help with sleep apnea treatment, but does not cure the problem. It can help to relieve the symptoms and there are many available for you to choose from.
Thornton Adjustable Positioner (TAP)
This is a comfortable, adjustable mouthpiece, which helps to make sure your airway is kept open so that you can maintain correct breathing. The device pushes your lower jaw forward into such a position that the airway remains open. Better breathing takes place with less snoring so you and your partner can get a decent night’s sleep.
The MAS – Dorsal Fin Device, made by SomnoMed
This is a custom-made oral appliance, which is made up of upper and lower dental plates with a specially designed fin-coupling piece allowing the mouth to open and close normally. This device helps to adjust your jaw level. This improves the comfort level and effectiveness of your treatment, as the jaw is only moved as far as is necessary to reduce sleep apnea and alleviate snoring so that you can sleep better.
Herbst Telescopic Appliance
This appliance may be effective if you are a chronic snorer and also have moderate to mild obstructive sleep apnea. This adjustable appliance should allow you to move your jaw both laterally and vertically, eliminating the necessity to disengage it. It is fitted onto your teeth with clasps, but friction helps to hold it in place too. If it is first positioned in the wrong place it can be removed and repositioned using shims to ensure a sufficient supply of oxygen reaches your lungs.
In some cases, we may recommend dental treatments such as orthodontics or a mouth reconstruction (with veneers, implants, and other treatments) to help treat your sleep problems
Could one of these work for you?
If after reading this you think there is a solution to relieve your sleep apnea symptoms, then you may need to have a thorough examination to determine what is the root cause of your sleep disorder. We may be able to help you breathe better and help reduce sleep disorder symptoms by fitting a suitable orthotic device.
Trouble breathing while asleep? It could be sleep apnea
Snoring is the most common warning sign of sleep apnea.
Do you find it difficult to breathe when you sleep or find yourself snoring far too often? You could be suffering from something called sleep apnea. Many patients are
Many patients are unaware of their sleep apnea, even when it is very severe or life-threatening and concerned family or friends inform them of the problems. If you have loud disruptive snoring there is an excellent chance it is a warning sign. Listen to the warning before it’s too late!
Sleep apnea is a sleep disorder which occurs when breathing stops and starts repeatedly. You could have sleep apnea if you know you snore loudly and you still feel tired right through the day even if you thought you had enough sleep. Sleep apnea can happen when your throat muscles relax at the wrong time or when your brain fails to send the correct signals to the muscles that are responsible for controlling breathing.
These are some of the common sleep apnea symptoms:
Sleepy all day
Short lapses in breathing while asleep
Sleep a lot but still tired
Suddenly waking up accompanied by a shortness of breath or heart palpitations
High Blood Pressure or Hypertension
Waking up with a dry mouth or a sore throat
Headache, especially morning headache
Insomnia, waking during the night and not being able to return to sleep.
Motor Vehicle Accidents or near misses
What are some of the most common sleep apnea causes?
Apnea comes from the Greek meaning “want of breath”
The most common type of sleep apnea is called obstructive sleep apnea (OSA). This is when the muscles in the back of your throat relax and block your air flow. This is actually an active process, when we breathe in we create a vacuum that sucks our airway shut, usually at the base of the tongue.When this happens, not enough oxygen gets into your blood. Your body reacts very quickly and you normally find yourself waking up suddenly with a choking or snorting noise. It tends to happen time and again through the night, so you just can’t get enough sleep.
Sleep Apnea is the most severe form of sleep disordered breathing and is a total blockage of the airway. Hypopnea is an incomplete blockage of the airway that still causes oxygen to drop significantly but may just have snoring with total stoppage of breathing. Upper airway resistance syndrome (UARS), also called Respiratory Related Arousals (RERA) is a partial blockage of the airway and is usually found in younger healthier and thinner individuals, especially women. It can cause all the same symptoms as Sleep Apnea and is one of the major cause of Fibromyalgia.
People with certain characteristics are more likely to experience sleep apnea. For instance, if you are overweight, a male or a smoker you are more likely to get sleep apnea. There are other physical reasons for sleep apnea, too. You might be more likely to get sleep apnea if you have a thick neck, a receding chin or enlarged adenoids or tonsils. Some allergies can cause sleep apnea too. Many of the patients do not fit this clinical picture but still experience sleep apnea. This is due to the configuration of their upper and lower jaws and tongue.
The National Heart, Lung and Blood Institute of the NIH published a report on “The cardiovascular and sleep related consequences of Temporomandibular Disorders”. They have recognized that the same underlying mechanisms are involved in snoring, sleep apnea and TMJ disorders.
There are ways to relieve sleep apnea and it may be surprising to learn that dental solutions could help. You don’t have to suffer needlessly as these days there are devices available which have been shown to be very beneficial for sleep apnea sufferers.
Some of the most commonly used devices used by dentists look a bit like a sports mouth guard. They gently and comfortably move the lower jaw forwards and downwards and help to keep your airways open. These are called Mandibular Advancement Devices (MAD) and there are over 100 types available.
One of these devices is the TAP 1 appliance that is one the most effective devices available. It consists of an upper and lower appliance connected with a hook and a bar. There is a handle that is turned to advance the lower jaw. This handle acts as a volume control for your bed partner. who can turn off your snoring and increase your airway. The Somnodent appliance by Somnomed is one of the most comfortable appliances available.
A second device that may be used is a tongue retainer. This is a splint which holds the tongue in the right position and works to ensure the airway is kept open. Overall, dental solutions not only improve oral and dental health for sleep apnea sufferers, but improve sleep patterns and reduce snoring, too.
Could your medical solution be a Dental Appliance right for you? Start living a better life now.
If you think you suffer from sleep apnea and have tried ways of relieving it without much success, then it may be time to consider a dental solution to this dangerous medical problem.
We will need to examine your mouth and throat properly and may be able to give useful recommendations about what can be done to help you relieve your symptoms. Oral appliances are a first line treatment for mild to moderate sleep apnea. CPAP is still considered the first choice for severe sleep apnea but oral appliances are considered an alternative to CPAP for patients desiring a more comfortable treatment or for patients who cannot tolerate CPAP.