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“The ideal treatment is to give her the smile she wants while also giving her the airway she needs.” - Dr. Danner

A young mom came to see me because she hated her smile. She was embarrassed to smile. And she often covered her mouth when laughing. She was tired of it and wanted to make a change.

Before her appointment, she had sent me a picture to analyze. And I could immediately see from the picture that she had a few front teeth out of place and a pretty narrow smile overall. Once she arrived for her appointment, I was able to take a closer look.

Her front tooth jetted out and it bothered her

Her right front tooth was sticking way out. Which made her left front tooth look like it was more out of place than it actually was. And because that right front tooth was sticking far out, it looked abnormally white and big. That single right front tooth was the one that really bothered her.

She asked me if the treatment to fix that one tooth would be a simple orthodontic change. And my answer was, yes and no. 

It wouldn’t fix the real problem

I told her, yes, we can easily change that one tooth. We can move it a little, remove some enamel and straighten up your front teeth, but here’s the issue. You would still have a very narrow / compact smile. And that’s a problem. So the main question was, why do you have such a narrow smile in the first place?

Get Evaluated

It's important to have signs and symptoms of a potential sleep breathing disorder evaluated by a knowledgeable healthcare professional.

Her tongue couldn't go where it belonged

At that point, I said, let's take a look in your mouth to get the rest of the story. When she opened her mouth, I could see that her tongue was completely covering her bottom molars. That’s not normal. Your tongue needs enough space to rest between your teeth. Her space was very limited and too restricted.

With the dental mirror, I moved her tongue to show her the back molars. Molar teeth have these little pointy cusps on their top surface. When comparing the left molars to the right molars, those top cusps should be pretty flat and parallel. That wasn’t the case for her. Everything was tipped in quite a bit, hence the narrow smile and limited space.

She seemed to like what I was saying so far, but wanted more information.

Your top and bottom teeth work together

We next looked at her lower front teeth. One of the lower front teeth was awkwardly resting behind the top tooth that was bothering her.

I explained to her that top teeth and bottom teeth have to work together. If something is out of location in one arch, it's going to cause a problem on the opposing arch. I told her again that we could fix her smile in the front, but maintaining it might be difficult if there’s an underlying problem causing your smile to look the way it looks.

Her tongue was choking her

She looked at me in a strange way, “What do you mean?” I said, well, your tongue is fighting for space because things are so constricted. It has to go someplace when you close your teeth together. It must be going into the airway because that's the only other place it could go.

And if your airway gets blocked or restricted, then breathing becomes difficult. This might not be noticeable during the day, but at night, your body could be struggling to get oxygen. And this struggle can cause havoc in so many ways, including maintaining a proper bite.

Get Evaluated

It's important to have signs and symptoms of a potential sleep breathing disorder evaluated by a knowledgeable healthcare professional.

Let’s tackle the underlying problem

So we can fix your smile, but if we instead focus on the big picture and connect the dots to an underlying problem, we can do two things at the same time. We can fix the initial problem you came in with while also enhancing your overall life by opening up your airway.

It’s tough to measure fatigue

This then led to questions about fatigue. She noted being a little tired, but chalked it up to being a new mom. But unfortunately, it’s often difficult to get an accurate report or measurement of fatigue. Some people don’t even realize they are experiencing fatigue at all. While others may tend to exaggerate their symptoms.

How likely are you to fall asleep when…

To help get a better grasp of fatigue levels, I like to use a questionnaire called The Epworth Sleepiness Scale (ESS). This questionnaire asks your likelihood of falling asleep on a scale from 0 to 3 in specific situations (e.g. movie theater). This tool gives me a much better estimate of fatigue when compared to self reporting.

My most interesting Epworth score

I recently saw a male patient with a very high Epworth score. His spouse was totally shocked by his score. She had no idea that her husband was that tired and pushing that hard everyday. It was something they never discussed.

His physician was surprised too. It was something that was never brought up during any exam. He was eventually diagnosed with a sleep disorder called obstructive sleep apnea (OSA).

The road was pointing to an airway problem

Based on what I was seeing so far, I suspected this young mom had an airway issue. So I explained to her the next step would be to get some diagnostics. Diagnostics that we would typically do for orthodontics too.

The 3-D x-ray shows us a lot

We start with x-rays which includes a 3-D x-ray that shows us all the teeth, the roof of the mouth, the tongue, and the airway. And yes, it turned out. She did have a very small airway that was being obstructed by her tongue.

The 3-D x-ray also allows us to see the sinuses. Oftentimes sinuses are very limited in capacity when the tongue pushes for space during growth and development. This can result in a very high and narrow palate which then leads to airway restrictions.

The 3-D x-ray also allows us to see the temporomandibular joints (TMJ). These are the jaw joints you can feel near your ears when you open and close your mouth. When certain anatomical restrictions exist, your TMJ will often forcibly remodel itself to accommodate those restrictions. This remodeling process can cause pressure that may lead to ear problems (e.g. ringing, aches, wax buildup, etc.).

These are common ear problems that rarely get discussed with dentists, or even physicians. And it’s even more rare to connect them to an underlying airway problem.

To top off the initial assessment, we also scan the patient’s teeth into the computer and make some models (computer and print). These models allow us to take needed measurements.

We need a sleep study

When the initial exam, Epworth questionnaire, x-rays, and models are complete, we move on to the next step—a sleep study. The sleep study can be completed at home or in a lab. The lab version requires an overnight stay. The sleep study results gives us a full picture of what’s happening during non-wake hours, and when applicable, will include a sleep disorder diagnosis (e.g. obstructive sleep apnea).

A non-invasive, non-surgical treatment has arrived

The best treatment option for this young mom will be a Vivos oral appliance. From day one, this appliance will hold her lower jaw slightly forward to open up her airway while she sleeps. This will immediately improve the quality of her sleep, but unlike most oral sleep appliances, it will do much more than that.

At the same time, the Vivos oral appliance will also expand her upper and lower jaw. It will create the space that her tongue needs. It will upright her molars that are now very tilted. And it will create the space needed for her front teeth.

When it’s all said and done, the ideal treatment for this young mom is to give her the smile she wants while giving her the airway she needs.

She had a light bulb moment

She was surprised at what she was hearing all along the way, but I’m happy to say that she was smiling the whole time! It was all new information for her, but she soaked it all in. She describes the experience as a light bulb moment.

She came in to fix one tooth, but walked away with much more. She discovered that the treatment of an underlying problem will not only fix her smile properly, but it will also

Sleep disorders affect everything

It’s well known that sleep disorders like sleep apnea are connected to many health problems like high blood pressure, unexplained weight gain, diabetes, strokes, and so on. So hopefully, we were able to prevent that from occurring with this young mom.

Come see us

Are you looking for a great smile? Do you have crooked teeth? Are you embarrassed to smile? If so, come see us. We can talk virtually or in person.

Crowns, veneers or standard orthodontic treatment may be all you need, but…

Why have the teeth shifted over time? What’s really causing this? Do you have an underlying problem that’s lurking beneath the surface? Let us help you connect the dots. Let’s do it once and do it right.

Get Evaluated

It's important to have signs and symptoms of a potential sleep breathing disorder evaluated by a knowledgeable healthcare professional.

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