Our Blog

“My child, Cody has always slept with his mouth open and snored. I remember sitting in his room watching him struggle to get a good night sleep because he couldn’t breathe properly. He started his treatment with Dr. Sebastian in October of 2013. Within months, I saw a change! Even during the day, I would notice he was keeping his mouth closed to breathe and by the time his treatment was finished, he had completely stopped snoring!! It has been amazing to see such a simple appliance make such a huge difference in the life of my child!! Thank you Dr. Sebastian for your dedication to each child you treat.”

As you can see from this testimonial, the importance of early treatment is imperative. Utilizing this technology, we are convinced that orthodontics must be more than just about a healthy bite.  We continue to use our sleep questionnaire and visual examination of the soft tissue skeletal appearance, ability to breathe through nose and tonsil size. We have also begun a tracking system that will allow us to better follow the progress of our Phase I patients who are experiencing any airway problems.

80% of symptomatic airway children go un-diagnosed, so the problem is not going to just “go away” on its own. Dentists and orthodontist should be at the forefront of this effort because we are the ones seeing these children on a regular basis and it fits into areas in which we are intimately involved. Our goal is to help the next generation “breathe a little easier”.

As always, we appreciate your continued support and trust in our office. If I can answer any questions you may have, please do not hesitate to contact our office.

Orthodontics - April 30, 2014 - Vol. 28 - No. 5

After clinical crown lengthening, endodontic therapy, and prosthodontic treatment, teeth have a survival rate of 96% at 5 years and 83% at 10 years.

Article Reviewed: Long-Term Survival Rate of Teeth Receiving Multidisciplinary Endodontic, Periodontal and Prosthodontic Treatments. Moghaddam AS, Radafshar G, et al: J Oral Rehabil; 2014;41 (March): 236-242.

Background: With larger numbers of adult patients now seeking orthodontic treatment, orthodontists are frequently involved in interdisciplinary treatment planning regarding compromised teeth.

Objective: To evaluate the long-term survival rate of teeth undergoing endodontic, periodontic, and prosthodontic treatment.

Design: Retrospective study.

Participants/Methods: 87 patients (81% female; age range, 21 to 70 years) who underwent crown lengthening, endodontic treatment, and prosthodontic work on at least 1 tooth between 1996 and 2009 at the Guilan University of Medical Sciences were included. A total of 245 teeth were treated. Teeth with furcation involvement, considerable mobility prior to crown lengthening, or a crown-to-root (C/R) ratio <1 were excluded. All crown lengthening procedures were done by a single periodontist whose records were used to select the sample. Patients were recalled for a clinical and radiographic exam to record bleeding points index (BPI), position of the restorative margin relative to the gingival margin, pocket depth, mobility, C/R ratio, and reasons for any lost teeth. Teeth with severe caries requiring addition crown lengthening, extensive periodontal lesions, pocket depths >7 mm, or severe furcation involvement were deemed hopeless.

Results: 18 teeth (13 maxillary, 5 mandibular were lost or deemed hopeless during the recall exam. The survival rate was 98% for 3 years, 96% for 5 years, 83% for 10 years, and an estimated 52% for 13 years (using the Kaplan-Meier estimator). Survival rate was not influenced by patient sex, history of smoking, or the presence of a post. Teeth that had survived >10 years showed increased pocket depths and C/R ratios. When examining factors to predict failure, the major determinates were found to be C/R ratio and the position of the crown margin relative to the gingival margin.

Conclusions: The survival rate of teeth receiving complex prosthodontic, endodontic, and periodontic treatment was 83% at 10 years.

Reviewer's Comments: The authors highlight the fact that these survival rates reflect good interdisciplinary treatment planning, and did not attempt complex treatment if the tooth was overly compromised. It also was unclear what the response rate was for patients being recalled, which could alter the strength of these findings.(Reviewer–Brent E. Larson, DDS, MS).

© 2014, Oakstone Publishing, LLC

Orthodontics - April 30, 2014 - Vol. 28 - No. 5

The discontinuation of excessive gum chewing can effectively eliminate chronic headaches in some adolescents.

Article Reviewed: The Influence of Excessive Chewing Gum Use on Headache Frequency and Severity Among Adolescents. Watemberg N, Matar M et al: Pediatr Neurol; 2014;50 (January): 69-72.

Background: It is not uncommon for adolescents to suffer from chronic migraine or tension headaches. Is there something that we might be able to do to help them?

Objective: To assess the impact of excessive gum chewing on headache occurrence among children and adolescents.

Participants: 30 subjects who reported chronic headaches and excessive gum chewing.

Methods: The sample was divided into 4 groups based on the amount of gum chewing per day. Group 1 was up to 1 hour; group 2, 1 to 3 hours; group 3, 3 to 6 hours; and group 4 >6 hours per day. All of the patients were asked to stop gum chewing for 1 month. At that point, their symptoms were evaluated and they were asked to renew their gum chewing habit exactly as it was before discontinuation; a second interview was carried out 2 to 4 weeks later.

Results: Following the discontinuation of gum chewing, 19 of the 30 patients reported complete resolution of headaches and 7 described some improvement in headache frequency and intensity. No improvement occurred in 4 patients. The duration of the headache symptoms before stopping gum chewing did not play a role in the clinical response because some children who reported full or significant improvement had suffered from chronic headache for up to 6 years. All 20 of the patients who reported either complete or partial headache relief reported relapse of their headaches within days to a week of resuming gum chewing. Ten of the 30 patients in this study reported chronic symptoms related to the temporomandibular joint, and these symptoms also improved upon gum chewing discontinuation.

Conclusions: The discontinuation of excessive gum chewing can effectively eliminate chronic headaches in some adolescents.

Reviewer's Comments: This is a clean-cut and impressive study that provides an opportunity to provide a significant service to our patients. Imagine being able to help a patient who has suffered from chronic headaches for 6 years to eliminate these symptoms by simply discontinuing gum chewing.(Reviewer–John S. Casko, DDS, MS, PhD).

© 2014, Oakstone Publishing, LLC

Orthodontics - April 30, 2014 - Vol. 28 - No. 5

The likelihood of having tinnitus was 8 times higher in individuals with temporomandibular disorder (TMD) symptoms than it was in those without TMD symptoms.

Article Reviewed: Is There a Link Between Tinnitus and Temporomandibular Disorders? Buergers R, Kleinjung T, et al: J Prosthet Dent; 2014;111 (March): 222-227.

Background: Patients who have temporomandibular joint and masticatory muscle disorders (TMD) also are reported to frequently have tinnitus. Reports range from 2% to 59% of TMD patients also having tinnitus. Are TMD and tinnitus related?

Objective: To investigate if there is an association between tinnitus and TMD, and to examine if therapy for TMD has an effect on tinnitus symptoms.

Design/Methods: This was a prospective clinical study in which the prevalence of TMD and tinnitus was investigated in 951 consecutively referred prosthetic patients with a mean age of 54 years. Thirty patients with both TMD and tinnitus were the test sample examined in the study. A baseline examination was performed on each symptomatic patient by one experienced dentist. The examination consisted of a functional analysis of the masticatory system, an evaluation of the temporomandibular joint and associated musculature, and a tinnitus questionnaire. Each patient received dental functional therapy, which consisted of physiotherapy and intra-oral splints. The patients were evaluated at 3 to 5 months to determine the effects of functional therapy on the TMD and tinnitus symptoms.

Results: 8.6% of the 951 subjects were diagnosed with TMD and 7.2% were diagnosed with tinnitus. In total, 3.2% had both TMD and tinnitus simultaneously. The likelihood of having tinnitus was 8 times higher in individuals with TMD symptoms than in those without TMD symptoms. Eight patients had unilateral TMD symptoms and unilateral tinnitus; all were on the same side. Stomatognathic TMD therapy improved tinnitus symptoms in 44% of the test subjects.

Conclusions: This trial showed a significant correlation between tinnitus and TMD. Dental functional TMD therapy may have a positive effect on subjects with simultaneous symptoms of both TMD and tinnitus.

Reviewer's Comments: Previous studies and this report appear to support a connection between tinnitus and TMD. With an incidence of tinnitus that is 8 times higher in patients with TMD symptoms, perhaps a question about tinnitus in addition to TMD would be appropriate in our patient health history forms. A significant placebo treatment effect has been reported in TMD and tinnitus patients, and I agree with the authors that it would be interesting to assess the TMD/tinnitus treatment effects with a longer-term randomized trial including controls.(Reviewer–John S. Kanyusik, DDS, MSD).

© 2014, Oakstone Publishing, LLC