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Snoring and sleep apnoea

Children & Adults

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Sleep is something we spend a third of our lives doing as it plays a critical role in our overall health. Sleep is a complex process of restoration and renewal for the body, it balances out our central nervous system, hormonal system and immune systems as well as processing experiences and consolidating memories. Most health institutes recommend 7-9hrs of sleep for adults which allows us to get through 4-5 sleep cycles during the night. Newborns require 16-18hrs, primary school 10-12hrs and teenagers 9hrs of sleep. Sleep has multiple stages including lighter phases N1 and N2, deep sleep N3 and rapid eye movement (REM) sleep where dreaming occurs. For an adult to get quality sleep and wake up refreshed requires 20% in N3 and 20-25% in REM sleep. Children require more time in N3 and up to 50% of the night in REM sleep in order to preserve memories and consolidate what they learn and maintain appropriate neurological connections.

Sleep deprivation may result in feeling tired or drowsy during the day in which caffeine or stimulants cannot help overcome, falling asleep within 5 minutes of laying down, micro sleeps which may cause accidents, poor hand eye coordination, slow reaction times and magnify the effects of alcohol.

Sleep disordered breathing is a general term for breathing difficulties occurring during sleep and includes conditions such as snoring, obstructive or central or mixed sleep apnoea and upper airway resistance syndrome. As many as 80% of people with sleep disordered breathing do not know they have it.

Watch this Channel 7 report to see how oral appliance therapy can help treat sleep apnoea: https://www.facebook.com/7NEWSsydney/videos/2165422146815240?s=100001576115065&v=e&sfns=mo

Children

Children are not meant to snore or grind their teeth! Common signs and symptoms of children with sleep disordered breathing include snoring, sleep talking, sleep walking, night terrors, restless sleep, teeth grinding causing worn down teeth (bruxism), reflux, swallowing problems, mouth breathing, dark circles under the eyes, chronic allergies, difficulties with concentration, behavioural problems (e.g. ADHD), bed wetting, daytime sleepiness, feeling tired in the morning, performing poorly at school, headaches, ear infections, hearing problems, crooked teeth and much more…

Children consequences of untreated sleep disordered breathing include high blood pressure, lung problems, obesity, abnormally slow growth and development due to not producing enough growth hormones, behaviour and learning difficulties such as ADHD, social problems such as siblings or friends not wanting to share a room with them at sleepovers or camps, craniofacial malformation, lower IQ due to the death of brain cells, small jaws with crooked and crowded teeth.

Here is an informative video put together by a parent for the American Academy of Physiological Medicine and Dentistry that tells the story of her son’s journey and incredible treatment outcome (you may need some tissues for this one) https://www.youtube.com/watch?v=Sk5qsmRyVcE

Adults

Common signs and symptoms of adults with sleep disordered breathing include snoring, gasping for air or choking in sleep, teeth grinding, insomnia, restless sleep, night sweats, weight gain, restless legs, nocturia, daytime sleepiness, feeling tired in the morning, easily fatigued, daytime naps, irritability, poor memory and concentration, confusion, mood and personality changes (e.g. depression and anxiety), headaches, sexual dysfunction and much more…

Adult Consequences – Adult consequences of untreated sleep disordered breathing include high blood pressure, heart failure, heart attack, heart rhythm disturbances, atherosclerotic heart disease, high cholesterol, difficulty losing weight, stroke, cognitive impairment (memory loss), insulin resistance and diabetes, gastroesophageal reflux disease (GERD), hormonal imbalances, head and neck pain, macular degeneration, glaucoma, depression, Alzheimer’s, sudden death and much more…Snoring may also cause relationship problems due to partners not being able to sleep in the same bed. Sleep issues greatly affect quality of life and can take away years if not decades off your life expectancy!

Diagnosis

Sleep apnoea can be evaluated by subjective methods such as Epworth Sleepiness Scale and Berlin Questionnaire. Areas of possible airway collapse can be found via 3D cone beam computerized tomography (CBCT) scans and physical examinations. An ENT would examine the nasal septum, turbinates, adenoids and nasopharynx. A dentist would examine the jaws, palate, tongue, tonsils, uvula, pharyngeal walls and neck circumference.

The primary objective test for sleep apnoea is polysomnography (PSG), also referred to as a sleep study which measures physical and physiological parameters during sleep. Sleep studies can be done in a hospital, sleep clinic or home setting. It typically includes EEG, EOG, EMG, oral and nasal airflow, chest and abdominal movement, oximetry, audio recording of loudness of snoring and some have video monitoring. Once all the data is collected from the sleep study a diagnosis can be made by a sleep physician.

Treatment

In children, enlarged tonsils and adenoids are a common cause for sleep disordered breathing. Therefore referral to a paediatric ENT is required as surgical removal of the tonsils and adenoids is considered the first line of treatment if the symptoms are significant and the tonsils and adenoids are enlarged. In situations where children have persistent sleep disordered breathing after ENT surgery, a post-operative sleep study may be necessary after surgical intervention especially in children with increased risk factors such as obesity, craniofacial anomalies or neuromuscular problems.

This video shows the difference ENT surgery can make for a child’s sleep quality  https://www.youtube.com/watch?v=3UpoNXgilbI

In adults, continuous positive airway pressure (CPAP) therapy is often considered the gold standard for patients with severe sleep apnoea. However for patients with mild to moderate sleep apnoea, a carefully constructed adjustable oral appliance (oral appliance therapy) which optimises the airway and supports the jaw can be a successful alternative. Patients often find the CPAP machine noisy or uncomfortable resulting in poor compliance over time which has led them to prefer oral appliance therapy. Having said that, neither CPAP nor oral appliance therapy will work effectively if there is nasal obstruction. Hence Dr Lin uses 3D cone beam computerized tomography (CBCT) scans to find where the narrowest part of the airway is and if there is nasal obstruction will refer to a sleep ENT to correct it. In severe cases more aggressive forms of surgery may be needed such as palate surgery (UPPP), tongue reduction or advancement, jaw advancement, tracheostomy and bariatric surgery. Additional forms of treatment may include behavioural therapy, myofunctional therapy, weight loss, medications, sleep hygiene, nutrition and supplementation.

Head, Neck and TMJ pain

Many people suffer from chronic headaches that can be so severe it prevents them from carrying out everyday activities

Approximately 90% of headaches occur from muscle tension. The primary cause of tension headaches is teeth clenching or grinding especially nocturnal bruxism. The muscles used for chewing and grinding are synergistic to the neck muscles hence the pain connection. In most cases a dental orthotic to alter the position of the lower jaw and bite may be enough to alleviate the pain. However the root cause of grinding is often an airway, sleep or bite problem which may also need to be addressed to achieve a better outcome.

The temporomandibular joint (TMJ) connects the lower jaw to the skull right below the ear. We use it every time we bite, chew, swallow, speak and create facial expressions which makes it one of the most highly used joints in the body. Symptoms of TMJ dysfunction include limited jaw opening, limited range of motion, unable to open or close (locked jaw), clicking, popping, crepitus, painful to chew food, difficulty swallowing, swelling, ringing in the ears, dizziness, vertigo, clenching or grinding, head and neck pain. Sleep issues such as bruxism plays a big role in TMJ pain as well as incorrect bite, trauma and arthritis. Bruxism causes continual hammering of the TMJ resulting in sore muscles and inflammation of the joint and damage to the disc. Headaches have been found in two thirds of people with nocturnal bruxism and their muscles may use up to five times more force. Incorrect bite is often a result of improper jaw development as a child which can cause the jaws and TMJ to be asymmetrical. Traumas such as a hit to the jaw or impact in an accident can damage the disc and even break the jaw bone. Like other joints of the body, the TMJ is prone to having arthritic changes. This can be associated with autoimmune conditions such as rheumatoid arthritis or bruxism speeding up the process of degeneration of the joint.

Diagnosis

Not all head and neck pain comes from the TMJ and not all TMJ dysfunction results in head and neck pain. Hence a comprehensive examination which includes a thorough history, cranial exam (3D CBCT scan), postural exam, oral exam, jaw exam, occlusal analysis, muscle palpations and neurological exam and more may be required. If a sleeping disorder is suspected then a sleep study will be performed as it may contribute to your head, neck and TMJ pain.

Treatment

The primary treatment option will be achieving your ideal bite with orthotics therapy which includes day and night time splints. If the CBCT reveals nasal obstruction then a referral to ENT may be needed. In addition, a range of adjunctive therapies may be used to help alleviate the pain which includes, dry needling, botox, trigger point injections, laser and autologous blood concentrates (stem cells/concentrated growth factors). The splints are custom designed to maximise jaw function and breathing and decompression to allow your jaw joint to heal (just like a fractured bone is plastered). Patients can experience relief after only a few days but treatment time can be up to 12 months as pain can be experienced as the TMJ remodels.

You do not have to live with the pain and debilitation of head, neck and TMJ pain however symptoms can return if post treatment management instructions are not followed.

Dentofacial Orthopaedics

Early intervention & working with growth achieves the best result

Teeth grow into the space available to them so if there is overcrowding or bite issues the fault is with the development of the jaws. Therefore it is important to align the jaws correctly and ensure that their development is optimum, in order to give the permanent teeth the best chance to erupt into their correct positions. Dentofacial orthopaedics is guiding the growth and development of the jaws in order to obtain the best facial appearance and smile. This typically involves growth guidance, expansion and functional (jaw positioning) appliances custom made to fit the patients’ jaws. In some cases myofunctional exercises are required to correct bad habits that affect jaw development. The aim is to develop the jaws to ideal size and position whilst creating enough room for all adult teeth and maximizing the genetic growth potential. This will have positive effects on the teeth, posture, speech, airway, swallowing, tongue position, profile, head, neck and TMJ. On average by age 9 around 80% of natural jaw growth has occurred and by age 12 all natural jaw growth is complete. This does not mean orthopaedics cannot be done after age 12 but treatment is always easier and faster when we are working with natural growth. The ideal age to start orthopaedics is different for every child as it depends on severity, growth and teeth development. Research carried out on over 7000 children revealed that more than 70% of children requiring orthodontic treatment have an underlying misalignment of their jaws and a derangement in the jaw joint relationship hence orthopaedics needs to be done first.

Appliances are tailor made to fit perfectly in your mouth by taking moulds or 3D scan then constructed by a dental technician within Australia

Before

  • Daily head, neck & TMJ Pain

  • Flat profile exaggerates nose

  • Flat facial structures

  • Poor breathing & sleep

  • Embarrassed to smile

After

  • Pain all gone

  • Fuller profile looks naturally younger

  • More prominent cheekbones & jawline

  • Breathing & sleep quality improved

  • Smiling happily with confidence

Orthodontics

Orthodontics is the field of dentistry that involves correcting bites and straightening of teeth

The traditional approach to orthodontics has been to wait until all adult teeth have come through then sacrifice healthy teeth to create room to align the remaining teeth. This method may result in future complications such as breathing and sleep issues, head neck and TMJ pain and worsening of the facial appearance and profile by flattening the face. For more information including twin case studies, blog posts and educational videos please visit https://www.damagedfaces.com/.

Dr Robert Lin’s health focused philosophy is to provide dentofacial orthopaedics first not only for the jaws but also the other health benefits it provides whilst doing everything he can to avoid extraction of healthy adult teeth. However in extreme cases such as abnormally large teeth and abnormally sized jaws then extractions and/or surgery may be inevitable.

Orthodontics typically involves braces (clear, ceramic, metal), lingual braces or clear aligners (Invisalign or Clear Correct). All braces types can usually achieve the same end result however differ in treatment time, price, strength, size, comfort and aesthetics. Clear aligners can also be used to move teeth and is hygienic because it can be removed to clean teeth. The disadvantages of clear aligners are the clinician has less control, limitations of certain movements hence it cannot treat all cases, totally dependent on compliance, may be longer treatment time and more expensive.

Some adults may choose to undergo orthodontics purely for cosmetic reasons to straighten the front teeth to improve their smile and self-esteem which can be achieved in as little as 3 months. The choice is yours, Dr Robert Lin is happy to give his expert advice on what orthodontic option is best for you and tailor the treatment based on your desires and needs in order to achieve the best possible outcome you can smile about.

Orthodontic materials and equipment are ordered direct from USA for the highest quality to ensure the best possible result.

GENERAL DENTISTRY

Preventative Care, regular check-up & cleans, fillings and more

Despite being an expert in all the areas mentioned previously, Dr Robert Lin still practices all other fields of general dentistry such as emergency treatment, endodontics (root canals), prosthodontics (dentures, veneers, crown and bridge), periodontics (gum treatment), oral surgery (extractions and wisdom teeth), restorative (tooth coloured fillings), cosmetics, whitening, nitrous sedation (happy gas), tongue and lip ties, dental implants, paediatrics, preventative dentistry and much more!

All in one treatment

Sleep, Pain, Orthopaedics & Orthodontics

If you suffer from a combination or all the previously mentioned problems, Dr Robert Lin is one of very few dentists in Australia that is capable of treating you from the symptoms all the way down to the root causes with the help of his team of trusted health professionals. Dr Lin suffered from all these problems growing up which required 4 years of extensive treatment to correct. Every health professional in Dr Lin’s team has treated him personally justifying the statement “Robert treats his patients the same away he would treat his own family and friends.” Here is a video that summarizes how all these health issues are related to one other like a domino effect, starting from breathing to orthopaedics to orthodontics to head, neck and TMJ pain. https://www.youtube.com/watch?v=PVxlL_lMces

Book a consultation with Dr Robert Lin