Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 51

Presentation Summary

disorders, with 75% of sleep disorder cases going
undiagnosed. Only during deep sleep are growth
hormones and parathormones released. Deep
sleep helps the body mobilize its defenses
against illness. It is sleep that restores the body.
REM sleep provides the fullest benefits. Therefore, if one's sleep is interrupted, that individual
will not get the maximum effect of a sound
sleep. Anytime there is a compromise in the sleep
pattern, it will affect the health and wellbeing of
the individual.
Evaluate the Airway
Orthodontists are encouraged to screen patients
for sleep disorders, but cannot diagnose them.
Orthodontists can perform a risk assessment and
then refer patients who are at risk. According to
an article in the New York Times, sleep apnea can
interrupt more than just sleep in children; it can
impact their growth. Normal development may
be negatively impacted. Lack of sleep in children
often is reflected through hyperactivity which
could lead to a misdiagnosis of AttentionDeficit/Hyperactivity Disorder (AD/HD). The risk
assessments for children and adults are different;
they are both calibrated tools with known sensitivity and specificity. Orthodontists should take
advantage of these tools to identify at-risk adults
and children and make the proper referrals.
According to a study by Dr. Palomo et al., 7.3% of
teenage patients who presented for orthodontic
screening were at high risk for sleep disorders.
This high percentage suggests that orthodontists should screen their patients carefully for
sleep disorders. Also, airway obstruction can lead
to malocclusions via a vertical growth pattern.
This has been documented and confirmed since
the late 1800s: All the more reasons for orthodontist to be able to evaluate the airway.
Imaging can be used to evaluate the airway. Traditionally, the 2-D cephalogram has been used to
achieve this, but it was not immune to image
distortion. 3-D imaging provides even better
evaluation of the airway, and orthodontists
should take advantage of it.
Winter 2017  PCSO Bulletin

Doctors

Acoustic reflection is a technology that was
developed during WWII. It can be used to evaluate airway problems. CBCT and acoustic rhinometry and pharyngometry can be used to obtain
the airway volume and the areas of maximum
constriction to better evaluate airway problems.
Using commercially available software, both
the airway volume and area of maximum constriction can be evaluated. Think of two balloons
with the same volume: if you distort one, it will
still have the same volume as the other balloon.
Therefore, total volume is less important than
the area of maximum constriction, since it does
not tell the whole story. The area of maximum
constriction should be evaluated from both
frontal and lateral in order to get an accurate
picture.
A study compared a group of 35 children with
expanders (RME) and braces to another group of
children who had only braces, in order to evaluate
the effects of the expander. The airway was the
same in both groups, but at the end of the study,
the group with RMEs had a significant increase in
airway volume in the nasopharynx area. Because
the study had a control group, the researchers
were able to eliminate the effects of just growth
and focus on the effects of the RME on airway
volume. No change occurred in the oropharynx
airway, so it is important to assess where the
obstruction is located prior to expanding or
deciding on the course of action.
Another study showed significant differences in
airway volume in Class I, Class II, and Class III
patients. That is why airway volume evaluation
plays a big role in treatment modality. Positional
devices, along with continuous positive airway
position (CPAP), are the standard of care for sleep
apnea, although compliance is low. Many oral
appliances are FDA-approved for sleep apnea
cases, as they open the vertical and position the
mandible forward. Orthodontists need to obtain
continued on page 53

51



Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2017

No label
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - No label
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 2
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 3
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 4
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 5
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 6
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 7
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 8
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 9
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 10
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 11
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 12
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 13
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 14
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 15
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 16
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 17
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 18
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 19
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 20
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 21
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 22
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 23
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 24
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 25
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 26
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 27
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 28
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 29
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 30
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 31
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 32
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 33
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 34
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 35
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 36
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 37
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 38
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 39
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 40
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 41
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 42
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 43
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 44
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 45
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 46
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 47
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 48
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 49
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 50
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 51
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 52
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 53
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 54
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 55
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 56
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 57
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 58
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 59
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 60
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 61
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 62
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 63
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 64
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 65
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 66
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 67
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 68
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 69
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 70
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 71
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 72
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 73
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 74
Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 75
https://www.nxtbook.com/allen/pcso/bulletin_summer2023
https://www.nxtbook.com/allen/pcso/95-2
https://www.nxtbook.com/allen/pcso/95-1
https://www.nxtbook.com/allen/pcso/94-4
http://www.brightcopy.net/allen/pcso/94-03
http://www.brightcopy.net/allen/pcso/94-02
http://www.brightcopy.net/allen/pcso/93-3
http://www.brightcopy.net/allen/pcso/93-2
http://www.brightcopy.net/allen/pcso/93-1
http://www.brightcopy.net/allen/pcso/92-3
http://www.brightcopy.net/allen/pcso/92-2
http://www.brightcopy.net/allen/pcso/92-1
http://www.brightcopy.net/allen/pcso/91-4
http://www.brightcopy.net/allen/pcso/91-3
http://www.brightcopy.net/allen/pcso/91-2
http://www.brightcopy.net/allen/pcso/91-1
http://www.brightcopy.net/allen/pcso/90-04
http://www.brightcopy.net/allen/pcso/90-3
http://www.brightcopy.net/allen/pcso/90-2
http://www.brightcopy.net/allen/pcso/90-1
http://www.brightcopy.net/allen/pcso/83-4
http://www.brightcopy.net/allen/pcso/89-3
http://www.brightcopy.net/allen/pcso/89-2
http://www.brightcopy.net/allen/pcso/89-1
http://www.brightcopy.net/allen/pcso/88-4
http://www.brightcopy.net/allen/pcso/88-3
http://www.brightcopy.net/allen/pcso/88-2
http://www.brightcopy.net/allen/pcso/88-1
http://www.brightcopy.net/allen/pcso/87-4
https://www.nxtbook.com/allen/pcso/87-03
https://www.nxtbook.com/allen/pcso/87-2
https://www.nxtbook.com/allen/pcso/87-1
https://www.nxtbook.com/allen/pcso/86-4
https://www.nxtbook.com/allen/pcso/86-3
https://www.nxtbook.com/allen/pcso/86-2
https://www.nxtbook.com/allen/pcso/86-1
https://www.nxtbook.com/allen/pcso/85-4
https://www.nxtbook.com/allen/pcso/85-3
https://www.nxtbook.com/allen/pcso/85-2
https://www.nxtbook.com/allen/pcso/85-1
https://www.nxtbook.com/allen/pcso/preview-program-2013
https://www.nxtbook.com/allen/pcso/84-4
https://www.nxtbook.com/allen/pcso/84-2
https://www.nxtbookmedia.com