special | REPORT

Spot the children with a sleep disorder

Myofunctional appliance treatment:

Sleep dentistry for the 21st century
By Chris Farrell, BDS (Syd)

D
uring the last decade, the medical caused by relaxation and poor muscle tone around
profession has become much the throat and jaws, there are many underlying
more aware of Sleep Disordered causes of SDB. The most common of these are
Breathing (SDB) acting as a chronic mouth breathing, poor diet, obesity and
major contributor to a range of poor development of the jaws. Additionally, ortho-
health problems. In addition dontics with extractions may exacerbate breathing
to having a negative impact on issues by restricting tongue space.
mood, energy levels, ability to
regulate stress, behavioural problems and emo- Treating sleep disordered breathing
tional well-being, severe sleep disorders, such as
obstructive sleep apnoea (OSA), have been associ-
ated with the causes of life shortening events such
as heart disease or stroke.
T raditionally, treatment for Sleep Disordered
Breathing, particularly Obstructive Sleep
Apnoea (OSA), has been the domain of the medical
SDB characteristically occurs when the flow of profession involving the use of the Australian devel-
air through the nose or mouth is obstructed during oped Continuous Positive Air Pressure (CPAP)
sleep. While this airflow obstruction is typically device. However, the inconvenience caused by

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myOSA® appliances reposition the

mandible which opens the airway
and regulates breathing.

In the USA, where the problem has SDB in children has also been recognised
“Increasingly, it has become been extensively researched by the med- as causing widespread health, devel-
ical profession, estimates suggest that opmental and behavioural problems,
apparent that the causes of SDB
as many as “50-70 million people in the including difficulty concentrating at
begin to develop during early United States are chronic sufferers from school. Additionally, as well as being det-
childhood. If these causes are sleep disorders, who have impaired health rimental to the development of the face,
left unchecked, a child’s SDB can and daily functioning issues as a result of jaws and teeth, if left untreated, paediatric
these disorders.”1 Furthermore, Center on SDB can lead to significant and serious
result in a variety of disorders, Sleep Disorders Research concludes “The health problems causing poor quality of
ranging from enlarged tonsils and societal economic impact of sleep disor- life later in adulthood.
adenoids to learning difficulties ders is estimated at $16 billion annually Stanford University Sleep Medicine
for health care expenses and $50 billion Division has focussed on the causes of
and behavioural problems....”
annually regarding lost productivity.”2 SDB and has found a high prevalence of
SDB in young children. In fact, according
the bulky CPAP machine and discomfort Early childhood intervention to the division “Obstructive sleep apnoea
from the mask that must be worn has often (OSA) has become increasingly rec-
discouraged patients from continuing with
treatment. The research shows now that
there is more than 50% non-compliance
I ncreasingly, it has become apparent
that the causes of SDB begin to develop
during early childhood. If these causes are
ognised as a notable health concern in
children given its consequences on behav-
iour, function and quality of life.”4
of patients on CPAP and its variants. As left unchecked, a child’s SDB can result in a Furthermore, “the importance of early
a result, treatment with oral appliances variety of disorders, ranging from enlarged recognition and treatment in children is
are now considered to be the most con- tonsils and adenoids to learning difficul- paramount to maximizing resolution of
venient way to alleviate SDB. So, almost ties and behavioural problems. In fact, symptoms and potential avoidance of OSA
by default, the dental profession has had “more recent concern for upper-airway syndrome during adulthood.”5 Addition-
a new field of sleep medicine thrust upon patency would seem to demand scrutiny ally, the “elimination of oral breathing,
it with little scientific basis for treating much earlier. The age of 5 years has been i.e., restoration of nasal breathing during
SDB using Mandibular Advancement suggested, but even by then the face has wake and sleep, may be the only valid
Devices (MADs). achieved most of its adult proportion.”3 ‘finishing line’ in paediatric SDB.”6

May/June 2015 Australasian Dental Practice 85

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Emerging role for

dentists in treating SDB MRC myOSA® Range

T his raises the issue of where the gen-

eral dentist or dental specialist can
find protocols for the treatment of SDB?
I have been recognised as being critical
of the current orthodontic practice taking
too mechanical an approach to a biological
myOSA® for Juniors

The potential demand from the medical problem and this view is now supported
myOSA® for Kids
profession as well as the general public in dental literature. In fact, according to
will undoubtedly increase pressure on the an article written by Dr James Ackerman myOSA® for Adults
entire dental profession to become more and published in the American Journal of
proficient in sleep dentistry and to cater for Orthodontics and Dentofacial Orthope- myOSA® for Snorers
this, there are comprehensive courses now dics “it is fair to say that orthodontics has
becoming accessible to the profession. been more technology driven than biolog- myOSA® for Bruxing
Traditionally, adult treatment of SDB, ically or scientifically based.”7
mild OSA and snoring has focused myOSA® for TMJ
on Mandibular Advancement Devices Mechanical vs Biological
(MADs). While there have been numerous
design variations and whilst these can be
effective, there seems little concern about
the potential harm their long-term use
T he overly mechanical approach of
using MADs in sleep dentistry is
cause for concern for two main reasons. Treatment of SDB in children, which
exposes patients to. The design of these Firstly, there is the derangement of the typically involves referral to an ENT for
MADs is based primarily on orthopaedic occlusion with retraction of the maxilla a tonsillectomy, is another area where an
appliances, used extensively by ortho- making the airway more compromised overly mechanical approach is used in an
dontists, particularly in Europe, during and secondly, this approach can cause attempt to alleviate a biological problem.
the last 50 years. Major players in the exacerbation of TMJ problems and ini- Research shows this approach is suc-
sleep medicine industry, such as CPAP tiate damage and remodelling of the TMJ cessful less than 50% of the time and
leader Resmed, have also now become capsule. Added to this, research shows recurrence of SDB issues routinely takes
involved in Dental MAD appliances. This a close association between SDB and place. Furthermore, SDB and poor crani-
is a strong indication that it is essential bruxing and typically these MADs are ofacial growth in children are intimately
for dental professionals to better educate rigid, thus allowing little if any scope associated and malocclusion is an all too
themselves regarding treatment of SDB. for bruxers. obvious result.

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The connection between SDB, poor Disordered Breathing and TMJ disor- more regarding how to begin inte-
craniofacial growth and malocclusion was ders with a myofunctional instead of a grating myOSA® into your practice visit
highlighted in a study published in the mechanical approach. Rather than just myoresearch.com/courses.
Japanese Journal of Clinical Dentistry for focus on alleviating the symptoms of
Children. According to the research, the SDB, the myOSA® appliance range aims to References
mouth breathing habit, which is a major treat the upper airway and neuromuscular
1. National Center on Sleep Disorder Research (2003).
cause of SDB, has a negative impact on dysfunction, which can cause SDB. 2. Center on Sleep Disorders Research (2005).
the “morphology of the jaws and dental The myOSA® appliance range functions 3. Robert R. Rogers (2006) Sleep Breathing and
arches in growing children. The mor- by posturing the lower jaw forward, cor- Orthodontics: Orthodontic Products Online.
phology of the jaws and dental arches recting tongue position and opening the 4. Sleep Medicine 2013.
5. Sleep Medicine 2013.
then begins to control function, perpetu-
6. Sleep Medicine 2013.
ating a downward or negative spiral.”8 7. James L. Ackerman - Am J Orthod Dentofacial
Furthermore, the literature is increasingly Orthop 2015;147:290-2.
quoting myofunctional therapy as a vital 8. Japanese Journal of Clinical Dentistry for Children
missing link in the treatment of paediatric April 2009 (Vol.14 No.4).
9. Guilleminault C Et al. Critical role of myofascial
as well as adult SDB. In fact, there is an reeducation in pediatric sleep-disordered breathing.
“abundance of literature on the benefits Sleep Med (2013).
of myofunctional treatment on growth and
orthodontic development.”9 About the author
During the 1990s, I was a founder of the
Myofunctional Research Co. (MRC) as a Dr Chris Farrell graduated from Sydney
vehicle for developing a range of functional University in 1971 having gained a com-
intraoral appliances designed to address prehensive knowledge of traditional
myofunctional problems in growing chil- orthodontic treatment using the BEGG
dren and thereby resolve orthodontic technique. As a result of his clinical expe-
problems. Today, our signature product, rience, he became interested in TMJ/TMD
the highly successful Myobrace® System, disorder and after further research, dis-
is sold globally and all told, we have sold bite, which opens the airway and regulates covered the etiology of malocclusion and
several million appliances. These appli- breathing. While the causes of SDB are TMJ disorder was myofunctional, which
ances, which include a range for treating varied and can differ between individuals, contradicted the established view of his
TMJ Disorder and bruxing, are equally the myOSA® range includes sleep appli- profession. Dr Farrell founded Myofunc-
well-suited to treatment of both paediatric ances for a wide spectrum of patients. tional Research Co. (MRC) in 1989 with
and adult SDB. Hence, a different philos- The range includes appliances to suit SDB the intent to develop a myofunctional
ophy and protocol, which does away with patients from as young as two-years-old orthodontic system targeted at treating
the complexities of the current MADs, is through to adults as well as specialty the upper airway and neuromuscular
already present. appliances targeted at TMJ disorder and dysfunction causing malocclusion. Dr
This new approach to treating SDB has tooth grinding. Farrell’s Myobrace® and Trainer treat-
taken shape as the myOSA® System, which The myOSA ® myofunctional sleep ment systems have proven extremely
is a functional range of intra-oral appli- system can be easily implemented effective at providing early, preventive
ances designed to provide the medical into any dental or medical practice to pre-orthodontic treatment and are now
and dental professions with an effective satisfy patient demand for effective used by dental professionals in more than
means of diagnosing and treating Sleep sleep treatment solutions. To learn 100 countries.

88 Australasian Dental Practice May/June 2015