The Seattle Protocol – Tom’s Story

By: Dr. Elizabeth Eggert

How Did This Start?

Tom’s journey began in 2014 when he came to us as a new patient looking to improve his oral health and the appearance of his teeth. During his comprehensive exam, Dr. Elizabeth found the main areas of concern to be the excessive wear, erosion and fracturing of Tom’s teeth. Dr. Elizabeth recommended Tom go through the records process (you can learn more about the records process here) and based on the information gathered during that process, she recommended a full-mouth reconstruction to address his uneven bite and rebuild his broken teeth. Throughout the process of reconstruction, it became clear that the amount of force in Tom’s bite was putting too much pressure on even his temporary crowns, which resulted in the temporaries cracking or falling out on more than one occasion. Dr. Elizabeth was concerned that even after completing the full mouth reconstruction, Tom would have underlying issues. Given Tom’s other symptoms, including difficulty breathing through his nose, dry mouth and use of a CPAP machine, Dr. Elizabeth recommended Tom complete the Seattle Protocol to help address his airway patency.

Tom Before

What Was Involved?

The Seattle Protocol is a six-step process that helps patients with symptoms of sleep-disordered breathing and other conditions determine whether a compromised airway is contributing to their ailments. Each step builds upon the last, but patients don’t necessarily need to complete the entire process as the purpose of the protocol is to determine the phase that provides the best relief of symptoms. You can learn more about the Seattle Protocol and each of the steps here. Throughout the process, Tom noticed improvements in his symptoms such as dry mouth, decreased clenching and grinding, and less waking throughout the night.

What Have Tom’s Results Been?

After completing five of the six steps of the Seattle Protocol, Dr. Elizabeth fabricated a sleep appliance for Tom to continue to improve his airway patency, reduce his bruxism and help him sleep better. Tom has now been using his sleep appliance for over a month and says the results so far have been great! He’s noticed less clenching and jaw pain and experienced an overall improvement in his sleep. Tom said that going through the Seattle Protocol helped him better understand the connection between his sleep and airway issues and he appreciates Dr. Elizabeth’s thorough explanation and care throughout each stage.

Tom After

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What is the Seattle Protocol and How Does it Help Pinpoint Airway Obstructions?

By: Dr. Elizabeth Eggert

When a patient with symptoms of airway issues first comes into our office, we often recommend the Seattle Protocol. This six-step method helps us identify where the issue lies by pinpointing which jaw positioning alleviates our patient’s symptoms. This allows us to create a custom night appliance for our patient that opens up their airway and curbs any inflammation or damage to the teeth, jaws or soft tissue. It also helps ward off serious systemic issues like high blood pressure, stroke or heart attack.

Before you embark on the Seattle Protocol, we may suggest an at-home sleep quality screening device or a sleep study so we solidify our starting point.

Seattle Protocol Step 1: Nose Breathing and Mouth Taping

The first step in the Seattle Protocol is to gently train your body to breathe through your nose, not your mouth. Breathing through your mouth during sleep can lead to snoring and a dry mouth. The Seattle Protocol encourages nose breathing by adding a strip of paper tape vertically across the center of your lips. The light adhesive of the tape keeps your lips together but is easy and painless to remove.

Step 2: Temporary Splint for Lower Jaw and Mouth Taping

Once you’ve adjusted to the mouth taping, the second step of the protocol adds a temporary splint for your lower jaw while you sleep. Adding this splint increases the vertical dimension of your jaw and allows more airway space.

Step 3: Temporary Splint for Lower Jaw with Lower Jaw Pulled Forward and Mouth Taping

If adding the lower splint only isn’t giving you the restful sleep you deserve, we move onto the next stage of the protocol. In this step, we add an element that pulls your lower jaw forward. This realigns your jaw and increases your airway space not only vertically, but horizontally as well. This also can give your tongue more of the space it requires.

Step 4: Temporary Splint for Lower and Upper Jaw with Mouth Taping

With all steps of the Seattle Protocol, if you aren’t getting relief from the previous step, we move on. In this step, we remove the forward jaw posturing component and add a splint for your upper jaw. You then go to sleep with splints on your upper and lower teeth and your jaw is free to move. This stage allows for additional vertical height, opening up your airway, but without restricting the jaw muscles into any one strict position.

Step 5: Temporary Splint for Lower and Upper Jaw with Lower Jaw Pulled Forward and Mouth Taping

If you need to continue in the protocol, step five again adds a horizontal component by linking the upper and lower splints together and moving the lower jaw forward. The intent, as always, is to continue to open your airway more and more.

Step 6: Temporary Splint for Lower and Upper Jaw with Lower Jaw Progressively Pulled Forward and Mouth Taping

If you still aren’t getting that good night’s sleep, we move to the final stage of the Seattle Protocol. In this stage, we keep moving your lower jaw forward, incrementally, until you feel well-rested.

In summary, after the initial two weeks of nasal breathing therapy and sleeping for 2-3 nights with each temporary night guard, once you experience relief of symptoms, we stop the protocol. This helps us identify which splint appliance/positioning alleviates the airway obstruction and allows us to fabricate your custom night appliance.

The further you progress through the steps in the protocol, the more severe your obstruction. If you progress into steps 4, 5 or 6, we may discuss the possibility of oral surgery to help you achieve optimal results.

If you’re concerned that you or your loved ones are dealing with sleep-disordered breathing, schedule an appointment with Dr. Elizabeth or Dr. Jeff by calling our office at 651.482.8412. Both Dr. Elizabeth and Dr. Jeff have the knowledge and experience to walk you through the Seattle Protocol and the best next steps.

Your healthy future starts today.

 

Confused by the Process? Learn How Sleep Apnea is Diagnosed

By Dr. Elizabeth Eggert

Do you deal with snoring, gasping for air in your sleep, a dry mouth, headache in the morning or daytime fatigue? Sleep apnea could be the culprit. It’s important to begin by making an appointment with Dr. Elizabeth or Dr. Jeff as well as with your primary care physician. Sleep apnea can be life-threatening and should always be carefully investigated.

The first time we see you for sleep apnea symptoms, we will perform an assessment for signs of structural abnormalities or any physical issues that could be contributing to airway obstruction. This could include an enlarged tongue or tonsils, a small jaw or a large neck.

If your primary care doctor is concerned that sleep apnea is an issue for you, they will refer you to a sleep specialist. A board-certified sleep specialist will evaluate you by performing an overnight sleep study. This will give them more insight into the severity of the situation and help them determine the best course of treatment.

There are two different types of sleep studies your sleep specialist may recommend: a polysomnogram test or a home sleep apnea test.

Polysomnogram test:

A polysomnogram test is a sleep study, performed in a sleep lab, that helps diagnose sleep-related conditions.

During your night at the sleep lab, you will be hooked up to equipment that will monitor your heart, lungs and breathing patterns, brain, general movement and oxygen levels while you sleep. In some cases, your sleep specialist will let you sleep all night long. If your physician detects signs of sleep apnea, they will more than likely wake you up in the night and hook you up to continuous positive airway pressure, or CPAP. A CPAP machine has a mask that covers the nose and/or mouth, that is connected to a tube and the base of the machine and that delivers continuous air pressure all night long, allowing the airway to remain open.

When your sleep specialist tests the CPAP machine on you, they will watch how it improves your airway obstruction and will calibrate it for your specific needs.

Home sleep apnea test:

In some cases, your sleep specialist will give you an at-home sleep apnea test kit that monitors and tests breathing patterns and sleep disturbances. This can be a good solution for individuals who find the polysomnogram test cost-prohibitive or difficult to coordinate. However, if sleep apnea is suspected from the results of your home test, your doctor may still recommend a visit to the sleep lab for further testing.

After you receive your results from your sleep specialist, if they indicate the presence of sleep apnea, we recommend you contact our office to set up another appointment. At this appointment, Dr. Elizabeth or Dr. Jeff will walk you through our records process.

During this comprehensive analysis, they will determine if a sleep apnea appliance would help alleviate your symptoms of sleep apnea. If they decide it would be helpful, Dr. Elizabeth or Dr. Jeff will confer with your general practitioner, sleep physician and lab to design a sleep apnea appliance, custom fit for you, that supports your jaw in the position that best improves your airway, often a forward position.

We may also recommend that you adjust your sleeping positioning or we may refer you to an orthodontist for another consultation if we believe that braces or other orthodontic treatment could help better keep your airway open.

If you’re experiencing sleep apnea symptoms, reach out to us at 651.482.8412 to make an appointment with Dr. Elizabeth or Dr. Jeff. They will perform a thorough assessment and collaborate with your other physician(s) to find the best treatment plan for you.

Sleep Apnea and Oral Health Share A Few Primary Connections

By: Dr. Elizabeth Eggert

Obstructive sleep apnea (OSA) is a condition that must be taken seriously. Obstructive sleep apnea is an airway blockage that occurs when, during sleep, muscles in the back of the throat relax and/or the tongue and surrounding tissues migrate back into the throat, obstructing the airway.

Not only can sleep apnea cause fatigue, headaches and memory loss but it can also lead to even more serious health issues such as hypertension, heart failure and stroke.

Many people don’t understand what causes sleep apnea and how it affects oral health. We’re going to take a few minutes to unpack some of these connections.

Risk factors for sleep apnea

When you come in for an appointment, we look for signs or symptoms that could be considered “red flags” for airway conditions, including sleep apnea. Dr. Elizabeth or Dr. Jeff perform an assessment to see if you have any of the following risk factors among many others:

  • Over 40 years of age
  • Obesity
  • Large tongue or tonsils
  • A large neck
  • A small jaw

If we think you might be dealing with an airway issue like sleep apnea, we’ll ask you if your loved ones complain that you snore or gasp for air when you sleep. We’ll ask you if you deal with insomnia or daytime drowsiness. Do you wake up with a headache or a dry mouth? Do you have nasal or sinus problems?

We will also look for signs of TMD, bruxism or dry mouth, all of which can be connected to OSA.

TMD goes hand in hand with sleep apnea

Did you know that, in 52% of obstructive sleep apnea cases, a person also struggles with temporomandibular disorder or TMD?

TMD occurs when the temporomandibular joint (TMJ) doesn’t function properly. When the joint is irritated, chewing and talking can be mildly to moderately painful.

So why do sleep apnea and TMD often occur together? When a person is deprived of oxygen during sleep, their body will compensate in unconscious ways. In many cases, their jaw muscles clench and release or grind the jaw around to gain more airway space. When sleep apnea is left untreated, this jaw motion becomes habitual and can cause TMD or even deterioration of the jaw joint itself.

Bruxism goes hand in hand with sleep apnea

Bruxism is another condition that is often present alongside obstructive sleep apnea. Often intertwined with TMD, bruxism describes a condition caused by the clenching or grinding of teeth. It occurs unconsciously during sleep and can be another way a person’s body compensates for an airway obstruction.

Symptoms of bruxism include broken, cracked, chipped or worn teeth. Because the clenching and grinding of teeth cause tension in a person’s head, jaw and muscle discomfort are commonly present.

Of the 31% of adults who deal with bruxism, at least 25% of them also battle OSA.

Sleep apnea leads to mouth breathing

As we already stated, sleep apnea is an airway obstruction often caused by soft tissues that move towards the back of the mouth during sleep. In addition to clenching and contracting your jaw muscles in response, a person will typically also mouth breathe in an attempt to get more oxygen.

Mouth breathing leads to snoring but it also leads to other, more serious oral consequences.

Saliva plays an important role in rinsing food and harmful bacteria out of our mouths. When a person breathes through their mouth, it becomes dry and becomes a haven for food particles and bacteria. Without this natural “rinsing” function, plaque easily grows under the gumline and can cause tooth decay, gingivitis and in extreme cases, periodontal disease.

If you’re experiencing symptoms of sleep apnea or related conditions, Dr. Elizabeth or Dr. Jeff would love to see you in our office. They can evaluate your situation, determine which factors are present and, if they see evidence of sleep apnea, refer you to your primary doctor who may refer you to an ENT or sleep specialist. Then Dr. Elizabeth or Dr. Jeff will partner with these specialists to determine the best courses of action to help alleviate sleep apnea and any peripheral issues and restore your health. Schedule your appointment by calling our office at 651.482.8412!

5 Ways Mouth Breathing Can Affect Your Teeth and Oral Health 

By: Dr. Elizabeth Eggert

According to the 2015 “About Last Night” survey, mouth breathing affects 71% of Americans. But just because it’s common, doesn’t mean it’s not something to be concerned about. Let’s take a look at the symptoms of mouth breathing and its effect on oral health. 

Common indicators of mouth breathing

Do you or your loved one snore? Snoring is one of the most obvious signs of mouth breathing. Additional red flags include:

  • Dry mouth and lips in the morning
  • Chronic bad breath (halitosis)
  • Crowding of teeth
  • Frequent colds
  • Frequent sinus or ear infections

But the effects of mouth breathing don’t end with these bothersome symptoms. 

Mouth breathing negatively impacts the teeth

  • Mouth breathing can cause teeth to wear down.

Although there are several reasons for worn teeth, when nighttime breathing is obstructed by the tongue or throat tissues, our bodies enact a defense mechanism—we clench our teeth in an attempt to open up our airways. This clenching, also known as bruxing, causes teeth to wear down over time. 

  • Mouth breathing can cause tooth decay.

When we mouth breathe, our mouths dry out. This means that the saliva that helps us wash harmful bacteria out of our mouths during the daytime hours isn’t bountiful enough to do its job while we’re sleeping, leading to a buildup of bacteria that erodes our teeth. 

Add this to the fact that a dry mouth can’t maintain proper PH levels and becomes increasingly acidic which also contributes to tooth erosion and decay. 

  • Mouth breathing can create an “open bite.”

An open bite occurs when the tongue is thrust into the front teeth in order to open up an obstructed airway. Over time, the upper front teeth push forward far enough that they no longer contact the edges of the lower front teeth. 

Mouth breathing negatively impacts the tongue and gums  

  • Mouth breathing can cause gum disease.

Not only does a dry mouth wreak havoc on teeth but it also causes problems with the gum tissue. When saliva isn’t present to do its job washing the mouth of harmful bacteria, this bacteria can build up along and under the gum tissue, leading to gingivitis. Left untreated, gingivitis can cause gum disease and result in a host of issues throughout the body. 

  • Mouth breathing can cause a scalloped tongue.

When the tongue puts forward pressure on the front teeth, it can develop a semi-permanent imprint of the teeth, resulting in a scalloped appearance.

In some cases, a child’s jaws don’t develop properly and there isn’t enough room in their mouth for their tongue. Not only can this lead to a scalloped tongue but it can result in an elongated facial structure. 

At Eggert Family Dentistry, we have experience diagnosing and treating mouth breathing. Dr. Elizabeth and Dr. Jeff apply their knowledge and experience to find the right interventions to restore and protect your oral health. If you’re concerned that you or your loved one is dealing with the harmful effects of mouth breathing, give us a call at 651.482.8412 to learn how we can help!

Sleep Apnea: Signs to Watch For

By: Dr. Elizabeth Eggert

At Eggert Family Dentistry, we know that sleep apnea is no laughing matter. It can go undetected for years and has serious side effects. Take a few minutes to consider the warning signs, when to discuss signs with us or your doctor and some effective treatment options to consider.

What is obstructive sleep apnea?

Obstructive sleep apnea is an intermittent blocking of the airway during sleep. This often occurs when the muscles in the back of the throat relax too much, causing soft tissue to collapse into the airway and resulting in partial or complete blockage.

When obstructive sleep apnea occurs, breathing can be restricted for 10+ seconds, decreasing oxygen to your brain and causing a buildup of carbon dioxide. This cycle of airway blockage can repeat many times a night, leading to fitful sleep and many serious side effects. Side effects include glaucoma, increased blood pressure, heart disease and unfortunately, even death.

What signs should I watch for that may indicate sleep apnea?

You or your loved one may be battling sleep apnea if the following signs are present:

  • Loud snoring
  • Night sweats
  • Extreme daytime fatigue
  • Gasping or choking upon awakening
  • Dry mouth or sore throat upon awakening
  • Reduced daytime concentration
  • Mood swings and irritability

The symptoms of pediatric sleep apnea can be very different from sleep apnea symptoms in adults. Learn more here.

When to see your dentist or doctor

If you’re experiencing any signs of sleep apnea, it’s important to make an appointment with Dr. Elizabeth Eggert or Dr. Jeff Eggert and with your primary doctor. While there can be other causes behind some of these signs, obstructive sleep apnea is a common and serious condition. If, upon evaluation, we think you might be struggling with sleep apnea, you may find success with one of these treatment options: CPAP or Oral Appliance Therapy.

CPAP: A mask that covers the nose and/or mouth, connected to a tube and machine, that delivers continuous air pressure all night long, allowing the airway to remain open.

Oral Appliance Therapy: A custom-fit mouthguard that keeps the airway open by supporting the jaw in a forward position. This is something that Dr. Elizabeth and Dr. Jeff can fit you for in our office.

To learn more about obstructive sleep apnea, check out our Sleep Apnea FAQ’s.

You’re in good hands at Eggert Family Dentistry! If you are concerned that you or a loved one may be struggling with sleep apnea, schedule an evaluation with us at 651.482.8412.

Reasons We Might Refer You to or Collaborate with an ENT

By: Dr. Elizabeth Eggert

There are certain situations at Eggert Family Dentistry when we need to collaborate with other physicians to provide the best possible care for our patients. Especially as we have worked to integrate more airway into our practice, many of you have been asked to seek out care with a board-certified ENT for a more integrated approach to dentistry.

In this article, we will provide information about how certain medical conditions may be linked to your airway and therefore situations where it may be best to collaborate with an ENT. We will also launch into more specific information about some of these conditions below.

  • Sleep – if you have trouble snoring, falling asleep, staying asleep, trouble with restless sleep, you wake up feeling unrefreshed, or issues with nighttime urination, these can all be linked to airway issues.
  • Other Health Conditions – ADHD, allergies, anxiety, birth defects, cardiovascular disease, chronic head and neck pain, chronic pain, daytime fatigue, depression, digestive issues, emotional problems, frequent colds, sinus problems, sore throats, or tonsillitis, grinding or clenching of teeth, headaches, high blood pressure, jaw locking, large tonsils or adenoids, memory loss, mouth breathing, neck aches, obesity, pain or clicking in jaw joint, previous orthodontics, PTSD, speech problems, sucking habits, tonsillectomy, adenoidectomy, or type II diabetes can all be linked to airway issues.
  • Dental Observations – there are many dental conditions that can be linked to poor airway flow as well such as crowded teeth, deep overbite, forward head position, head tilted back, mouth breathing, narrow dental arches, recessive lower jaw, scalloped tongue, tongue thrust, tongue tie or tooth wear.

Snoring and sleep apnea

Sleep apnea is a serious condition that can lead to several other serious medical conditions. In cases where our patient is struggling with sleep apnea, Dr. Elizabeth or Dr. Jeff can often link what they see with the teeth, jaw, and muscles (like the tongue) to aid in determining the cause. Does our patient have inadequate space for the tongue based on the size of the jaw? Is the root of their condition the size or shape of their soft palate? How does the alignment of the teeth play in? Once this is determined, the best course of treatment is pursued. It is often helpful both during the diagnostic phase as well as during the treatment phase to collaborate with an ENT. This allows us to look at the situation from all facets and choose the best course of treatment.

Beyond sleep apnea itself, there are other sleep disordered breathing diagnoses or simply disordered breathing at all times, that can be detrimental to overall health. ENTs or other medical professionals can often help us navigate through treatment options.

Enlarged tonsils and adenoids

Enlarged tonsils and adenoids in children can cause facial and jaw deformities as a child grows. When Dr. Elizabeth or Dr. Jeff notice enlarged tonsils or adenoids and determine that the enlargement is not simply due to a virus, we will often refer our patient to an ENT for a consult.

Sinus problems

If a patient comes into our office with jaw pain, Dr. Elizabeth or Dr. Jeff evaluate many things, including the patient’s teeth and jaw. Because sinus problems can be a contributing factor to teeth and jaw discomfort, if their examination is inconclusive, Dr. Elizabeth or Dr. Jeff will refer our patient to an ENT for further evaluation.

In some cases, mucus can build up in the sinus cavity, causing sinusitis and leading to halitosis (bad breath). If halitosis is present (often in combination with jaw discomfort), this is another situation where Dr. Elizabeth or Dr. Jeff will most likely refer our patient to an ENT.

TMJ disorder

Another common cause of jaw pain is a disorder of the temporomandibular joint (TMJ). At Eggert Family Dentistry, we most commonly treat TMD by providing our patient with a splint or night guard. In severe cases, full-mouth reconstruction may be necessary. However, if we are unable to make a dental determination for the jaw pain, we can refer our patient to an ENT for a CT scan or an MRI to rule out bone and joint issues.

At Eggert Family Dentistry, we go above and beyond to make sure each one of our patients receives superior care. This often means referring our patient to or collaborating with a board-certified ENT for further investigation. If you’d like to schedule an appointment with us, give us a call at 651.482.8412!

 

Sleep Apnea FAQ’s

By: Dr. Elizabeth Eggert

1. What is the sleep cycle and why is it important?

Sleep is a recurring state characterized by relatively inhibited sensory activity and a reduction of muscle activity from nearly all voluntary muscles as well as reduced interactions with a person’s surroundings. Sleep is characterized by two distinct states: non-REM sleep and REM sleep. These alternate in 90 to 110-minute cycles with each cycle lasting between 5-15 minutes. A normal sleep pattern consists of 4-5 sleep cycles throughout the night. The first sleep cycles contain short REM sleep and long periods of deep sleep but as the night goes on, REM sleep lengthens and deep sleep decreases. Sleep has been determined to be biologically necessary for life due to the healing and repair that occurs.

2. What is sleep apnea?

Obstructive sleep apnea is an airway blockage. This occurs when, during sleep, muscles in the back of the throat relax and/or the tongue and surrounding tissues migrate back into the throat, obstructing the airway.

3. How do I know if I suffer from sleep apnea?

Although more common in men, OSA can occur in women too. The risk of OSA is increased for people with excess body weight, a narrow airway or a misaligned jaw. Snoring, choking while sleeping, excessive daytime sleepiness, waking and gasping, poor memory, irritability and morning headaches are all signs of OSA. If you suspect you’re experiencing these symptoms, schedule an appointment with Dr. Elizabeth or Dr. Jeff to discuss them. If you’d like more information, check out one of our recent posts here!

4. What happens if OSA is left untreated?

Treating OSA is imperative to your safety as well as your health. When left untreated, OSA can cause excessive daytime fatigue, morning headaches and memory loss. In addition, studies suggest that untreated OSA increases your risk of numerous health issues such as hypertension, congestive heart failure, atrial fibrillation, coronary artery disease, stroke and type 2 diabetes.

5. What are my treatment options for OSA?

  • Breathing devices (like CPAP)
  • Adjusting your sleeping habits/positions
  • Dental sleep apnea and snoring appliances
  • Orthodontic treatment
  • Surgery

*Prior to selecting any form of treatment, patients should undergo an initial evaluation by a board-certified sleep specialist practicing in a center accredited by the American Academy of Sleep Medicine.

6. What’s the difference between snoring and OSA?

Snoring is the sound that occurs during sleep when the soft palatal tissue in the upper airway vibrates as you breathe.

In the case of OSA, a person’s airway repetitively becomes obstructed during sleep and they intermittently stop breathing. This obstruction happens when the throat muscles relax and close off the airway.

7. What is an oral appliance?

An oral appliance is a custom-fit oral appliance that supports the jaw in a forward position to help maintain an open airway.

8. What is the difference between Continuous Positive Airway Pressure (CPAP) Therapy and Oral Appliance Therapy?

CPAP Therapy involves wearing a mask that covers the nose and/or mouth and is connected to a tube that allows air pressure to keep the airway open during sleep.

Oral Appliance Therapy involves wearing a custom-fit oral appliance nightly to keep the airway from collapsing. These oral appliances are useful in correcting mild to moderate cases of obstructive sleep apnea and are effective in improving airflow. The devices typically cover the upper and lower teeth and reposition the lower jaw in an advanced position.

Both CPAP therapy and Oral Appliance Therapy have proven successful for the treatment of sleep apnea and can result in improved sleep patterns and reduced snoring frequency and loudness.

9. Is there a link between TMJ Disorder and Sleep Apnea?

Yes. Since the temporomandibular joint is so close to the sinuses and airways, TMJ disorder (or TMD) can affect breathing. A misaligned TMJ can cause improper tongue positioning, resulting in a blocked airway during sleep. A recent study of people with TMJ disorder found 75 percent of participants experienced sleep-disordered breathing (SDB). Learn more in one of our previous posts!

10. What will treatment do for me?

Treatment will decrease your risk of OSA-related disease and help you get better sleep…the effects of which cannot be underestimated! From increased productivity during your waking hours to garnering more enjoyment from your daily life and experiencing more fulfillment in your relationships, quality sleep is foundational.

 

If you are having trouble sleeping and would like to speak with a dental professional at Eggert Family Dentistry, we would love to connect with you! Give us a call at 651.482.8412 or connect with us online.

Corrective Jaw Surgery – My Journey to a Better Life

By: Christine Norgaard

They said it would be transformational. I admit that I was skeptical. They said my bite didn’t align. I couldn’t see it – my teeth looked straight. They said it would improve my breathing and sleep and possibly reduce my chronic sinus and ear infection problems. That’s when I started to pay attention. “They” are a talented and compassionate trio of dental professionals: Dr. Elizabeth Eggert is my primary dentist and started me on this journey, Dr. Brian DeVoe is my orthodontist, and Dr. Karl Andreasen is the oral surgeon. Together, they developed a comprehensive treatment plan. Now that I’m three years past the surgery, I can attest that it did greatly improve my overall health. Here’s my story.

Background and treatment plan

While I thought my teeth were straight, what I didn’t realize was how misaligned the top teeth were to the bottom teeth. When my teeth were closed (the bite), the top teeth completely covered the bottom front teeth. I had had teeth breaking which resulted in quite a few crowns over the years. When I saw photos of the inside of my mouth, I couldn’t believe the excessive wear that had occurred on those crowns because of my misaligned bite. From the photos, I could also see the extent of the wear on my other teeth.

With the teeth breaking down, Dr. Elizabeth told me that more teeth would likely break and result in more crowns if I didn’t make an adjustment to my bite. Because Dr. Elizabeth is also my daughter, she’s also aware of many other health issues I’ve had all my life, most of which were getting worse over the last 15 years. I’ve had allergies all my life which triggers asthma. The asthma was getting worse though, and I had a chronic cough from all the irritation. I was taking a lot of medications for allergies and asthma, but not getting much relief. Each breath felt like sandpaper inside my head and lungs. I had three or four horrible sinus or ear infections each year. My primary care physician even said he never sees adults with the severity of infections I had. He treated the infections but they kept coming back. They were typically limited to the right side of my head. There were times the congestion was so severe in my head that a shower sounded like rain falling on a tin roof. I always had pressure on my right side. I sought help from ENT specialists who simply said “you have a Eustachian tube dysfunction.” There were no solutions. I even had to quit the church choir after singing with that group for 20 years because I just didn’t have the breath support.

Other medical conditions I had, which I now know are NOT normal, include the fact that I have never been a good sleeper – everything would wake me up. I have mild hypertension and started taking a low dose drug for that. I had worsening acid reflux and while I was on a medication for stomach acid suppression, it became less effective and I’d additionally need five or more Tums a day to feel comfortable.

One day in 2014, one of my crowns popped off. Dr. Elizabeth told me I didn’t have many other options, I had to look into how I could correct my bite if I wanted my teeth to stop breaking down. So, I started with Dr. DeVoe who, shortly after, included Dr. Andreasen in the discussion. In reviewing the models of my bite and both 2D and 3D x-rays, they showed me how things were actually constructed in my mouth and my head. The 3-D x-ray showed the compression of my airway and the right side Eustachian tube. The airway was the size of a straw and Dr. Andreasen said that it should be more like the size of a nickel. He wanted me to have a sleep study to determine whether or not I had sleep apnea. I did – it turns out that I had severe sleep apnea and was apparently waking up over 30 times each hour. The sleep study doctor I saw said he was surprised I hadn’t experienced even worse health issues. He also told me that with the surgery Dr. Andreasen would recommend, there was a great success rate in ‘fixing’ the sleep apnea problems.

The x-rays also showed that my top jaw and teeth were canted or sloped down from the right side of my face to the left. That surprised me because it wasn’t visually apparent to me. Putting it all together and with the possibility of fewer ear and sinus infections, I decided I would opt for the corrective jaw surgery. They told me that the whole process would likely take 18-24 months including the orthodontics pre and post-surgery.

Orthodontic treatment

A week before my 60th birthday, I got my braces. Dr. DeVoe and his staff couldn’t have been better or more supportive. They told me what to expect. They were patient when a bracket would fall off (usually because I’d eaten something I shouldn’t have). I felt a little awkward starting braces in my 60’s but there were some visits where I was one of the younger patients in his office. Dr. DeVoe has a great eye for details. He gave me excellent explanations of what was happening in my mouth and answered all my questions. At one point, when the surgery was about a month away, it felt like nothing was aligned in my mouth. He said that was normal and that after the surgery, it would all be better and feel more natural. He was right. I had braces for nine months before the surgery and another eight months after the surgery for final ‘tweaking’ and to allow my jaws to heal.

I did alter my diet after I got the braces (and again after the surgery). I pretty much stopped snacking. It was generally a decision about whether or not eating something was worth all the extra effort to clean around my braces. It was amazing because my stomach issues got dramatically better. I no longer needed Tums. My primary care physician cut the prescription for my acid reflux drug in half. I felt better. I lost a total of 45 pounds from the day I got braces, through the surgery, to the date I had the braces removed. An unexpected, but wonderful side benefit.

The surgery

Formally, it is called a LeFort I osteotomy and bilateral sagittal split ramus osteotomy of the mandible. It is more simply called corrective jaw surgery. There are many medical reasons to consider this surgery. For me, both the upper jaw and lower jaw were moved forward. My upper jaw was also leveled to correct the cant from left to right. I had one small stitch on each side on the outside of my face which quickly healed and left no mark. There are a series of plates and screws now in my jaw bones. All of the surgical work was done on the inside of my mouth so there are no visible signs or scars.

The surgery was done at St. John’s Hospital in Maplewood under general anesthesia. I was hardly in the hospital 24 hours. I saw Dr. Andreasen several times over the first couple weeks. I felt exhausted for the first three days. There was discomfort – but I was able to tolerate it by taking four Advil every four hours. Within two weeks, I was taking only one Advil every 4-6 hours. I did some ice packs, but had very little swelling and not much bruising or discoloration. I remember how good a warm wash cloth felt on my face. On the fifth day, I inhaled through my nose, and couldn’t believe it! I had such a deep breath that I actually got dizzy. I had no idea that was what breathing could be like! It was easy – there was no feeling of sandpaper down my bronchial tubes!

The information brochure that Dr. Andreasen gave me was great and very helpful. It also laid out possible complications. It explains that the nerves are exposed during surgery and tingling or numbness may occur. As I healed, I experienced some of that, especially in the area under my nose and around my upper front teeth. It took a while for the feeling to come back. After three years, the area feels ‘different’ but not in an irritating way. For the first year after surgery, I found that I couldn’t tolerate the vibrations from my SonicCare toothbrush. It was too intense. Now though, no problem.

For the first few weeks, I ate a liquid or very soft food diet. No chewing. My jaw wasn’t wired shut though, it was stabilized by orthodontic rubber bands. Dr. Elizabeth gave me a recipe book of smoothies and smooth soups. This helped with nutrition and getting adequate protein. It was so exciting after a couple months to start adding back other soft foods like a muffin, scrambled eggs, or salmon that I could easily swallow without chewing. Four months after surgery, I could drink out of a straw again. It sounds like such a little thing, but it also meant that my muscles were coming back to normal.

I took just under two weeks off of work. Cost? I am lucky to have great dental and medical insurance. The surgery and hospitalization were covered under my medical plan. Other than standard co-pays and deductibles, I paid little out of pocket.

Three years post-surgery

 

Was it worth it? Absolutely! It’s hard to say what the biggest benefit was. The original intent was to fix my bite. That was easily met. The doctors are all pleased with the results. I have a lovely smile! You can see my bottom teeth now. Flossing is also easy with perfectly spaced teeth. I wear my retainer every night. I keep telling people that I had no idea breathing could be so easy. I have even been able to go back to my church choir. I can also tolerate the incense at church for the first time in my life. I can enjoy my fireplace and have campfires with the grandkids. My lungs no longer feel irritated. I haven’t had a sinus or ear infection in three years! While I still have some medications (my allergies didn’t go away), all of the dosages have been significantly decreased. All my allergy triggers are still there, but because my airway is larger, I have a greater tolerance before major irritation begins. My blood pressure is lower and controlled. I sleep through the night. This is something I had never known was normal, or even possible, before surgery. Everything they said has been true. I feel great. I thank Dr. Elizabeth, Dr. DeVoe, and Dr. Andreasen for their care and expertise. It has been transformational and I’m grateful for what this has done for me, my health, AND MY LIFE!

The Link Between Airway and Dental Issues

By: Dr. Elizabeth Eggert

At Eggert Family Dentistry, we recognize the importance of a thorough dental evaluation. When you or your child come in for an exam, we don’t just attend to your teeth and gums. We make it our business to examine your muscles, jaw, and airway as well. We want to ensure that your tongue is functioning properly, that you have a broad upper arch, are able to breathe easily through your nose, and are swallowing correctly.

Why are we so thorough?

Many people don’t realize that they’re struggling with airway issues because the bulk of the symptoms manifest themselves while we’re asleep. Also, the body is so good at adapting, sometimes what someone knows as “their normal” is necessarily the most “healthy normal.” Luckily, Dr. Elizabeth and Dr. Jeff understand the connection between a variety of dental problems and how they may be linked to airway issues. For example, all of these dental problems that we check for during a regular dental examination can be linked to airway issues:

  • Bruxism
  • Functional tooth wear and fracture
  • TMD/myofascial pain
  • Malocclusion
  • Erosion
  • Periodontal disease
  • Caries
  • Abfractions (severe gum tissue recession)
  • Impacted teeth
  • Orthodontic or orthognathic relapse

The intersection of dental issues and airway: A couple examples

Nocturnal bruxism, or teeth grinding, is not uncommon in children and some doctors will tell parents it “normal.” We now understand that often tooth grinding, especially in children at night, often occurs because of a restricted airway. In fact, the connection between bruxism and sleep-disordered breathing (SDB) is so strong that bruxism is now acknowledged as a clinical marker for SDB and children with this disorder should consider a sleep screening.

Upper Airway Resistance Syndrome (UARS) is another type of sleep disordered breathing. Unlike sleep apnea, patients with UARS typically don’t completely stop breathing, however, the resistance of air through the airway causes multiple micro-arousals throughout the night. This often creates fatigue because the body is never able to reach the deeper and reparative stages of sleep. UARS also causes more stress hormones to be released into the body as a mechanism to help the body maintain and airway. These extra stress hormones often lead to an increase of inflammatory markers and can be linked to inflammatory diseases like hypertension, diabetes, TMD, cancer, among others.

Fortunately, a thorough dental examination can help detect a wide variety of dental problems that may be caused by or contributing to airway issues and/or sleep disordered breathing. Our dental exams go above and beyond simply looking for cavities and help you achieve and maintain optimal wellness.

Want to learn more?

If you’re interested in the connection between dental problems and airway issues, we highly recommend these books:

Sleep Interrupted by Steven Park, MD
No More Allergies, Asthma or Sinus Infections by Dr. Lori Jones
Close Your Mouth by Patrick McKeown
The Oxygen Advantage by Patrick McKeown

If you are concerned that dental issues are causing airway issues for you or your child, contact Eggert Family Dentistry or give us a call at 651.482.8412!