TMD and Comprehensive Dentistry in the Digital Theater

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Опубликовано:

21 мар 2023

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Комментарии : 4

@that.sleep.dentist 5 месяцев назад

Hi James, I’m just seeing your reply now, many months later, and appreciate what you’re doing for your patients!

@MrTurbojet93 Год назад

Awesome video Dr. Klim. I am a D2 and really looking forward to the rest of the series.

@that.sleep.dentist Год назад

Hi Doc, You're brilliant. However there's a key component missing here, and that is airway. Bruxism has been strongly linked to airway issues and there are plenty of published studies on the subject. Clenching and grinding release tension on the muscle that helps us swallow (name forgotten at the moment). Relaxing that muscle opens the airway diameter. When a patient has attrition ONLY on the anterior teeth, that is due to sliding the mandible forward to clench and grind, which brings the tongue forward, just like with an MAD appliance. The severe lower anterior crowding in the case of the gentleman at the end of your video is due to insufficient development of the maxilla, forcing lowers to crowd together so his mandible will fit (in other cases the mandible escapes the maxilla and positions itself into a class III, so the incisors don't have to crowd their way in -- a more common compensation among Asian populations). Sleep apnea is also highly correlated with hypertension, which this gentleman has. By giving him that orthotic and opening his vertical, you've provided more vertical tongue space. That, along with the anterior positioning, brings the back of his tongue out of his airway. This will reduce severity of any breathing issues and hence his blood pressure goes down. He's probably getting more deep, restorative sleep too, which improves health in many ways. Also, since jaw position affects daytime breathing as well, then naturally he misses his orthotic during the day. Finally, you can see the acid erosion damage on his molars. There is a high correlation between apnea and/or upper airway resistance syndrome, and acid reflux. So start looking at the airway volume on those CBCT's and also at the cervical spine. Neck curvature or lack thereof also affects jaw posture. A straight or "military neck" that has lost it's lordotic curve, also forces the mandible to sit in a more retruded position. I could go on and on but this is a dimension you can add to your practice that will improve lives even more than you're already improving them!

@KlimDDS Год назад

Hi Carolyn. Thank you for your excellent descriptions of cranial development and the impact of airways on occlusion. Yes, I understand; I have had sleep apnea issues since high school; even being a skinny guy, I had limited pharyngeal space. With early premolar extractions and round wire mechanics in the early '70s, I have underdeveloped maxillary bones and an entrapped lower mandible to the cranial base. I have gone through multiple sleep studies through the years and have been managed with a c-pap and lower jaw advancing appliances. I am doing well now. With close attention to diet and weight management, I am sleeping well with optimized sleep most of the time. I use the Oura to nightly monitor my sleep patterns. The Oura is an amazing tool. Yes, though I did not mention it in this video, the case with acid erosion has been on a c-pap for years when we first observed minimal airways on a CBCT. In addition, he has had other health issues contributing to acid erosion. He has taken a holistic path and is doing well today. This has been a 10+ year journey. Interestingly enough, he has worn a nighttime appliance for years and did not signal chronic bruxing when analyzing his EMGs. Lack of airways and sleep disturbance issues is one of the spokes in the wheel of those with bruxing, and I am pleased the profession is paying more attention to airway issues. My first exposure to airways training was Dr. James Garry (USC) 25 years ago, who, along with Dr. Ricketts historically, introduced airway thinking into our profession. I have also observed skeletal triggers with tomograms and Cephs before using CBCT technology. Those with underdeveloped maxillary development and lower mandible entrapment are often prone to limiting pharyngeal space. Though Dr. Shimbashi may not have fully understood this during his studies, he did observe the positive effects of those with optimal maxillary and mandibular developments. Now that the profession understands how to deal with deeper bites, many of our clients can gain relief from sleep disturbance issues by releasing the lower mandible from the cranial base. Dr. Javier Vasquez ( www.dentalxp.com/xperts/jvasquez ) has taken biofunctional occlusion to a new level of outstanding as related to sleep disturbances and biofunctional physiologic jaw posturing and occlusion. Thanks for your input. I do address airways, sleep disturbances, and skeletal balance in other videos. This posted video is part of my online teaching curriculum that deals with the digital workflow steps I use to capture skeletal balance. Most of these cases do have sleep disturbance issues, and some do not. However, the skeletal diagnostics and workflow remain the same in my hands when restoring a worn dentition, as conveyed in this overview video. All the best.