Breathing disorders and orthodontics AAO 2022.
Two lectures were covered, the first by Takashi Ono which looks at the issues surrounding mouth breathing and its consequences, the second lecture was by Martin Palomo looking at OSA and busy offices, our role and how new technologies are helping.
Nasal breathing Vs mouth breathing
- Nasal Vs mouth breathing, which is better: Nose = air is humidified, pressurized and filtered than the one come through mouth.
- The tongue pressure is 10 times more with mouth breathing than nose breathing in sitting position
- Even greater in supine position.
= That means tongue pressure increases during mouth breathing especially while sleeping.
Memory and Nasal breathing
- Normal nasal breathing
- = air flow stimulates sensory nerve ending via olfactory to prefrontal cortex and hippocampus region of brain = responsible for memory function.
- Memory consolidation was better in subjects who breathe through nose Ribeiro 2016SR
- 10 papers, largest paper non-validated questionnaire and half of studies no controls. Variety of outcome measures.
- Takashi’s own study into rats showed less O2, and their opinion was this results in impairment in development
Nasal obstruction and other consequences
- Taste: Taste disturbed by breathing dysfunction, alters shape of lingual papillae Hsu 2017
- Mouth breathing group had increased threshold for sweet and sour taste
- Muscles of mastication: Decreased in cross sectional area of masseter and temporalis muscle, with increase in type 2 muscle fiber.
- Reduced muscle size and strength & decreased efficacy of masseter muscle strokes
- Shape of palate
- Altered shape of palatal shape, smaller volume Lione 2015
- Halitosis increased prevalence Motta 2011
- Actopic dermatitis Yamaguchi 2015
New technologies to manage OSA in busy orthodontic office Martin Palomo
Prevalence of sleep obstructive sleep apnoea
- 42 million adults USA
- 1 in 5 mild OSA
- 1 in15 moderate OSA
- 75% severe sleep disorder = undiagnosed
Diagnosis and the orthodontist
- Orthodontists cannot diagnose: White paper from AJODO Rolf Behrents 2019
- CAN carry out a Risk assessment= onwards
Risk assessment: Adults
- STOPBang (Questionnaire for Risk assessment): http://www.stopbang.ca/osa/screening.php
- 8 questions, yes / no and physical details
- 100% accurate for high risk apnoea patient
- University of Toronto Canada
Risk assessment: Children
- Paediatric sleep questionnaire (PSQ). Available University of Michigan
- Children who snores loudly = poor academic performance,.
- Tools for tracking whether your child is snoring or not –
- Apps Snorelab, Snoreclock
- Mobile apps that records fractions of snoring and categorizes into quite, light, loud and epic snoring – Validited = close to PSG
- Results vary with distance in which phone is kept, or microphone issues
- Wearables –
- Watches, tapes, rings, bands
- Temp control, heart rate, pulse, snoring, Sp02.
- If oxygen drops 4% it wakes you up and will regularly see that pattern.
Imaging / assessment
- Volume: CBCT required = only partial assessment
- Cross sectional area:
- Greater description.
- Example of a balloon, same volume but can distort shape, 1 has more resistance than the other even though same volume = cross sectional area more important
- Greater description.
- Area of nasal resistance
- Functional assessment
- Strength of area
- Play musical instrument – greater resistance to collapsing – for the same area
- Myotheraputics – exercises Vanessa Leto
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