Raphael Center for Integrative Orthodontics Dr. Barry Raphael. Spreecast: Better Faces Less Braces.

1. Better Faces - Less Braces
A Spreecast Webinar by
Dr. Barry Raphael
Of the
Raphael Center for Integrative
Orthodontics
November 13, 2013

2. The link between
crooked teeth, sleep and ADHD

3. Spectrum of SDB
Normal
Prevalence:
Snoring
8-10%
UARS
?
OSAS
1-3%
3

4. Anatomic Determinants of SleepDisordered Breathing Across the
Spectrum of Clinical and Nonclinical Male Subjects*
Jerome A. Dempsey, PhD; James B. Skatrud, MD; Anthony J. Jacques, BS;
Stanley J. Ewanowski, PhD; B. Tucker Woodson, MD;
Pamela R. Hanson, DDS, MS; and Brian Goodman, PhD
CHEST September 2002 vol. 122no. 3 840-851
•Apnea occurs due to craniofacial
morphology and obesity, each with
their contributions
•The single most important cephalometric
variable in predicting AHI severity was the
horizontal dimension of the
maxilla (ie, porion vertical to supradentale
[PV-A] distance).
•SDB increased five- to seven-fold
in non-obese subjects and threefold in
obese subjects

5. Airway Size Matters

6. Which is easier to breath through?

7. Which would you rather have?

8. Pharyngeal Airspace
Mouth breather
Nasal breather
Mouthbreathers have significantly
smaller airway space.
(measurements PAS-OccL, PAS-UP, airway volume, area and minimum axial area)

9. Nighttime symptoms of SDB in kids
•Abnormal sleeping position
•Bruxism
•Chronic, heavy snoring
•Delayed sleep onset
•Difficulty breathing
•Difficulty waking up in AM
•Drooling
•Enuresis
•Frequent awakenings
•Insomnia
•Mouth breathing
•Nocturnal migraine
•Nocturnal sweating
•Periodic Limb movement
•Restless sleep
•Sleep talking
•Sleep terror
•Sleep walking
•Witnessed apnea

10. Daytime symptoms of SDB in kids
•Morning headache
•Mouthbreathing
•Morning thirst
•Excessive fatigue
•Abnormal shyness,
withdrawn, and
depressive
presentation
•Behavioral problems
•ADHD pattern
•Aggressiveness
•Irritability
•Poor concentration
•Learning difficulties
•Memory impairment
•Poor academic
performance

11. Sleep Monitor
SQI = 7.3
SQI = .41

12. Airway
Problems
• Open Mouth habit
• Mouth breathing
• Snoring
• Apnea/Hypopnea
• Flexed Head
• Gasping for Air
• Stridor
• Bruxism
• Restless Sleep
• Bed wetting
• Tired and cranky

13. In the News, March 2012