Airway Orthodontics

At Yarmosky Pediatric Dentistry, for over 38 years we have excelled at straightening teeth with exceptional results. Our specialized training in Pediatric Orthodontics and Childhood Growth & Development makes us especially suited to care for your child. But fixing crooked teeth is just the tip of the iceberg, and in addition to a healthy smile, we strive to create healthy kids for life. At Yarmosky Pediatric Dentistry, our 21st century orthodontic treatment offers so much more for your child than just “straight teeth.” Our approach is informed, holistic and integrative, taking the concept that THE CHILD THAT IS ATTACHED TO THE TEETH into full consideration.

A healthy airway is the foundation for optimal health at any age and is the foundation for our orthodontic treatment goals:

• A Well-Balanced Esthetic Face
• Healthy Jaw Joints
• A Beautiful Smile That Lasts a Lifetime
• A Healthier Airway

At Yarmosky Pediatric Dentistry, our 21st Century Orthodontic Philosophy is to address and treat the underlying cause, not just the symptoms. We now know from extensive research that any initial signs of crooked or crowded teeth or incorrect bite positions mean that the jaws are not growing properly. Crooked teeth are only ONE of the many symptoms that signal a poor growth and development pattern. The underlying causes can be improper oral habits such as breathing through your mouth instead of your nose and developing an incorrect swallowing pattern.

The upper jaw grows properly when you breathe through your nose and your tongue positions naturally in and on the roof of your mouth– this is known as the “correct tongue resting position” (imagine an image of a car parked in a garage.) The properly positioned tongue is the actual physical scaffolding for a full wide upper jaw and straight teeth to develop around. When breathing out of your mouth, your tongue automatically drops down and hangs low; as a result, the top jaw narrows and the arch “collapses.” When this happens, the teeth have less room and space available in the dental arch and become crowded in order to try to fit (imagine the walls of the parking garage “cave in” and as a result, the same size car cannot fit inside.)

Because many of the bones of the face are connected to each other, when one bone is out of balance or not growing correctly, it can have a domino effect on the other bones and structures of the face. For example, the roof of the mouth (palate) is also the floor of the nose; they are, in fact, the same bone. So, harmful, but common behaviors like mouth-breathing, not only lead to narrow and collapsed palates and crowded teeth but also directly affect the space, size, and shape of the nasal cavity. This leads to constricted and narrow nasal cavities which make breathing through your nose even more difficult. This compromised airway effects everything from daytime cognitive performance to nighttime sleep quality because the body cannot properly oxygenate the organs.

In a properly “tongue- supported upper jaw,” the upper teeth are always on the outside or overlapping the lower teeth. Therefore, if a narrow upper jaw develops as previously described, it traps the lower jaw from growing (Again, think of the lower jaw as a car trying to move forward into a garage with narrow, constricted wall—it can’t move forward.) If the lower jaw, or mandible is trapped or blocked from achieving its natural forward growth, this constricts the wind pipe behind it. You can now understand how a healthy airway is the foundation of ideal orthodontic treatment results and why addressing all the CAUSES, not just addressing the teeth is important to your child’s smile AND general health.

In addition to understanding mouth-breathing as an underlying cause, another harmful oral habit that must be addressed while in orthodontic treatment, is an acquired incorrect swallowing pattern, termed a “REVERSE SWALLOW.” An indication that a Reverse Swallow exists is when you observe the lips “purse” together and tense inward while the chin muscle or “ball of the chin” strains or clenches and becomes “dimpled” in appearance during a swallow of food or drink. You may even notice a slight “head bob” during the last part of a swallow. When this swallowing pattern happens repeatedly, about 2000 times per day, the muscles of the lips and chin put so much “inward” force on the upper and the lower teeth, that the teeth get “pushed backwards” and become crowded. In addition to the teeth being affected, this repeated “backward” muscle force inhibits or “holds back” the proper “forward” growth of the jaws and therefore leads to a constricted and compromised airway space and size.

MYOFUNCTIONAL ORTHODONTICS
Helps correct unhealthy and detrimental behaviors, patterns and habits (the underlying causes). In turn, your child’s teeth, jaws and upper airway develop correctly, the healthy way; THE WAY NATURE INTENDED US TO GROW.

SLEEP DISORDERED BREATHING

• In Order To Live, We Need To Breathe And To Sleep
• Much research in the field of sleep medicine and obstructive sleep apnea (OSA) has concluded that a compromised airway can result in poor sleep. Pediatric SLEEP DISORDERED BREATHING develops from mouth breathing during the day and puts them at a much greater risk to develop not only OSA in the future but also many behavioral, emotional and cognitive issues in the present. Research shows a direct link between children that mouth breathe during the day and then suffer from sleep-disordered breathing at night are often misdiagnosed as having ADD and ADHD symptoms, experience increased anxiety, problems in school with focus or behavior, nighttime tooth grinding, bedwetting, snoring, long face appearance with weak chins, dark circles under the eyes and more.
• Myofunctional Orthodontics help address and correct bad habits and oral problems that cause mouth-breathing and help redirect poor airway growth early in life, during these important and formative years when children need all the help they can get.
• A healthy airway allows your child to breath better, to sleep better and to function better. Orthodontics gives your child “straight teeth;” MYOFUNCTIONAL ORTHODONTICS can give your child a BETTER QUALITY OF LIFE as well.
• The philosophy of Airway Orthodontics is to respect and protect the airway’s health during the orthodontic treatment process. Straightening the teeth is, of course, a large part of orthodontic treatment, but it is important to remember that the teeth are attached to a child and your child’s health is just as important, if not more.

The MyoBrace® system utilizes a series of both removable oral appliances, called “TRAINERS” and “MYOFUNCTIONAL TRAINING EXERCISES” to help your child grow healthy, breathe easily and sleep better by dealing with the underlying issues that can cause “crooked teeth” and “narrow palates” in the first place – as a result your child ends up with not only a beautiful smile, but a healthier airway.

The goals of MyoBrace® Treatment are:

1. Proper Resting Tongue Position on The Roof of The Mouth – “Tongue on the Spot”
2. Lips Together at Rest
3. Breathe Through the Nose
4. No Movement of the Lips or Face Muscles When Swallowing

Airway Orthodontics does not represent a specific “system” per say. Based on your child’s age, desires, health concerns, and specific dental malocclusion or growth issue, our approach can be a combination of traditional orthodontics (bands and brackets) with Myofunctional Orthodontics using a system which originated in Australia and is used all over the world called MyoBrace®. The MyoBrace® system can also stand alone and provide comprehensive Airway Orthodontic treatment WITHOUT BRACES. Each child and situation will be unique, but within all our categories of treatment ideas and options, we will have one that uniquely fits your child  to achieve the best orthodontic and overall health results.

4 General Treatment Phases based on your child’s age and dental development:

• Trainer Series (~Ages 2-4)
• Pre-Ortho Phase (~Ages 4-7)
• Growth Phase (~Ages 6-12)
• Post Growth Phase (~Over Age 10)

The proper treatment for your child is determined by their specific malocclusion, tooth development and the age of the child. The ideal time for orthodontic treatment to effect proper growth is between ages 2 and 10 in our Trainer, Pre-Ortho and Growth Ortho Phases. Myofunctional Orthodontics can also be utilized at any age in conjunction with traditional orthodontic treatment to obtain better results and help insure stability after braces have been removed.

Trainer Series I (~Ages 2-4):
Trainer Series II :
The Infant Trainer allows your child to exercise their natural impulse to chew, to correctly use and exercise the jaw muscles, to learn to breathe through their nose, to establish proper tongue position, and to swallow properly. You cannot go wrong in starting your child out with this easy to wear appliance as it establishes the cornerstone of good facial development and healthy airway growth. This is also an excellent “binky-swap” appliance. Many young kids trade their pacifiers in for the “big kid version” and are able to kick the habit AND undo the improper growth that was started.

Pre-Ortho Phase (~ages 4-7):
Starting during primary dentition, (just baby teeth) or early mixed dentition (permanent teeth just starting to erupt) the Pre-Ortho Phase uses the MyoBrace® to create a balanced soft tissue oral environment that fosters the ideal facial and jaw growth to naturally straighten teeth. Starting your child at this age and phase will give you the best results in the least invasive manner and does not require “braces” or other “metal” appliances in the mouth. It is a 3-stage/3 appliance process that requires wearing a MyoBrace® trainer appliance DAILY for 1-2 hours during the day and while sleeping, as well as participating in a variety of fun and short MyoBrace® Myofunctional Activities.

Growth Phase (~ages 6-12):
During the mixed dentition in our Growth Phase orthodontic treatment, we use the MyoBrace® System palatal expansion, or bands and brackets (braces) or a combination of MyoBrace®, expansion, and braces. As with all treatments, creating a balanced soft tissue oral environment that fosters the ideal facial and jaw growth as we straighten the teeth will assist the development of the remaining permanent teeth as well as to foster healthy airway growth.

Post growth phase (~over age 10):
In the permanent dentition, (the permanent teeth are all in) our Post Growth phase orthodontic treatment uses traditional braces together with the MyoBrace® system, if needed, to achieve our goals of a well-balanced esthetic face, healthy jaw joints, a beautiful long-term smile and a healthy airway. These in turn create the proper balanced soft tissue oral environment (between the muscles of the tongue, lips, and checks) which will keep the teeth straight.

1

Well Balanced Esthetic Faces

With proper nasal breathing and tongue position the upper jaw naturally develops forward and wide, allowing room for straight teeth, and even more importantly, allowing for the lower jaw to assume a forward and balanced position.

We routinely expand the upper jaws in orthodontic treatment, advance lower jaws and create the proper structural balance for each individual child which results in ideal function and facial esthetics. We don’t dictate how your child should look. We just achieve the ideal balance and the esthetics follow naturally from there. Establishing the proper nasal breathing and swallowing patterns will ensure the well balanced and esthetic face will last a lifetime.

2

Healthy Jaw Joints

If the lower jaw is retruded into the base of the skull it can lead to headaches, backaches, earaches, poor posture and so on. This condition is called Temporal Mandibular Joint dysfunction, commonly known as TMJ. As we explained above, by expanding the upper jaw, our orthodontic treatment gives the lower jaw freedom of movement and freedom of growth and thus predisposes health of the jaw joints. If the lower jaw is not allowed the freedom to grow forward, the jaw joint, its nerves and blood vessels, physically get compressed, squeezed and damage to the delicate cartilage disk as well as the boney condyle occurs. Clicking, pain and restricted opening are common symptoms. If a child has developed TMJ symptoms already we can re-posture the lower jaw to alleviate those symptoms and protect the jaw joint.

3

Beautiful Smile that Lasts a Lifetime

Many factors contribute to a beautiful smile. We strive for a wide smile with the proper lip line (teeth with a hint of gum) and a natural smile arch (upper front teeth mimic the arch of the lower lip). By guiding the teeth into a balanced functional occlusion, making sure there is enough room in the upper palate to “house” the tongue to act as a scaffold and by establishing proper nasal breathing and swallowing habits we help assure that your child’s beautiful smile can last a lifetime. We cannot however, always overcome inevitable forces of aging or habits we do not work to change.

Myofunctional training and use of a MyoBrace® trainer appliance after “traditional” orthodontics is completed and the braces come-off, is recommended and is the best way to guard against relapse after treatment. For some, this commitment isn’t something that appeals to them at the time of bracket removal,  they just want their braces off, and we can certainly understand that. This is why long-term retention is often needed to ensure that your child’s smile will be a gift that keeps on giving. Following active orthodontic treatment, we will offer either Myofunctional Training with a MyoBrace® trainer or customized “clear” retainers for nighttime wear, provided at no additional fee.