At our Dental office, Orthodontist follows etiology oriented approach. 

-Etiology Oriented Approach

• Atypical swallowing

Atypical swallowing is a myofunctional problem consisting of an altered tongue position during the act of swallowing. High incidence in population, multifactorial etiology and the recurring connection with the presence of malocclusions made it a topic of strong interest and discussion in science. 

Our orthodontist evaluate two questions: 1) what kind of connection is there between atypical swallowing and malocclusion; 

                                                                            2) what kind of therapy should be used to solve it. 

Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults

Obstructive sleep apnea (OSA) is a common disorder affecting at least 2% to 4% of the adult population and is increasingly recognized by the public. The signs, symptoms and consequences of OSA are a direct result of the derangements that occur due to repetitive collapse of the upper airway: sleep fragmentation, hypoxemia, hypercapnia, marked swings in intrathoracic pressure, and increased sympathetic activity. Clinically, OSA is defined by the occurrence of daytime sleepiness, loud snoring, witnessed breathing interruptions, or awakenings due to gasping or choking in the presence of at least 5 obstructive respiratory events (apneas, hypopneas or respiratory effort related arousals) per hour of sleep. The presence of 15 or more obstructive respiratory events per hour of sleep in the absence of sleep related symptoms is also sufficient for the diagnosis of OSA due to the greater association of this severity of obstruction with important consequences such as increased cardiovascular disease risk. The Practice Parameters of the American Academy of Sleep Medicine (AASM) present evidence-based recommendations for several aspects of the diagnosis and management of OSA. 

Patients at High Risk for OSA Who Should Be Evaluated for OSA Symptoms

•  Obesity (BMI > 35) 

• Type 2 diabetes 

• Congestive heart failure 

• Atrial fibrillation 

• Pulmonary hypertension 

• High-risk driving populations 

• Stroke

• Treatment refractory hypertension 

• Nocturnal dysrhythmias 

Questions about OSA that Should Be Included in Routine Health Maintenance Evaluations 

• Is the patient obese? 

• Does the patient snore? 

• Is the patient retrognathic? 

• Does the patient complain of daytime sleepiness? 

• Does the patient have hypertension? 

OSA Symptoms that Should Be Evaluated during a Comprehensive Sleep Evaluation 

• Witnessed 

• apneas 

• Snoring ,Gasping/choking at night 

• Sleep fragmentation/maintenance  insomnia 

• Nonrefreshing sleep 

• Total sleep amount 

• Excessive sleepiness not explained by other factors 

• Sleep fragmentation/maintenance  insomnia 

• Nocturia 

• Morning headaches 

• Memory loss 

• Decreased concentration 

• Decreased libido Irritability 

Components of Patient Education Programs 

• Severity of disease 

• Pathophysiology of OSA Explanation of natural course of disease and associated disorders 

• Risk factor identification, 

• explanation of exacerbating factors, and risk factor modification, 

• Genetic counseling when indicated Treatment options 

• What to expect from treatment 

• Outline the patient’s role in treatment, 

• address their concerns, and set goals 

• Consequences of untreated disease 

• Drowsy driving/sleepiness counseling 

• Patient quality assessment and other feedback regarding evaluation 

General OSA Outcomes Assessment 

• Resolution of sleepiness 

• OSA specific quality of life measures 

• Patient and spousal satisfaction 

• Adherence to therapy 

• Avoidance of factors worsening disease 

• Obtaining an adequate amount of sleep 

• Practicing proper sleep hygiene 

• Weight loss for overweight/obese patients