I frequently discuss Dental Sleep Medicine in terms of treatment, this letter is more concerned with preventing procedures that cause snoring, sleep apnea, headaches, migraines and TMJ disorders
IT IS A Reply to Real Self Letter:
Expansion vs Contraction Orthodontics
Orthodontics vs Orthopedics
I am putting on my blog a letter to a patient from the Real Self Website
The link has photos.
I got braces about 5 weeks ago and the orthodontist said I needed my 4 bicuspids removed. Was it the right decision?
I already have them removed but did I even need to? I am now regretting my decision from reading that it causes TMJ and ages your face and changes your face profile. Later on in life it will affect my face and just age my face I'm very sad now and don't know what to do please help did I make a good decision or not?
Dr Shapira’s Answer:
Extraction of Bicuspids: Good or bad idea?
Expansion vs Contraction Orthodontics
The best time to ask that question is prior to removing the teeth. There are different schools of thought about your question.
I would have suggested looking into Epigenetic Orthopedics/ Orthodontics before committing to any treatment.
I personally believe there is a significant risk of increased headaches, migraines ,TMJ disorders, snoring and sleep apnea as a result of contraction orthodontics which includes some headgear cases which retract the maxilla and in four bicuspid extraction cases that are sometimes referred to as "Four on the Floor" or "Suck Back" orthodontics. The cosmetic and health benefits of Orthopedics vs Orthodontics only, are immense!
Orthopedics creates a full wide smile that most patients prefer.
I am giving you my personal opinion as a doctor who treats TMJ disorders, headaches, migraines and sleep apnea. I first commented on this in a letter to the editor of the ADA Journal in 2004. I stated, at that time in a response to an article on evidenced based medicine that covered this exact topic.
I had hate mail from from doctors who believe in amputating (extracting) premolars a practice I term Contraction Orthodontics.
I received an enormous amount of calls by doctors who thoroughly believe in Expansion Orthodontics. They consider the idea of amputating teeth ludicrous and dangerous. The debate in dentistry has not yet reached a conclusion. it is definitively a very hot topic!
I reiterated this in an editorial in Cranio Journal in 2007.
Cranio, 2007 Apr;25(2):77-8.
The National Heart, Lung, and Blood Institute considers the cardiac and sleep consequences of temporomandibular disorders.
I also discussed this issue in my guest editorial celebrating the Journal of Cranio-Mandibular Practice adding Sleep to its name, now the Journal of Craniomandibular and Sleep Practice.
Volume 31, Issue 1 (January 2013), pp. 1-2
TMJ Alias, The Great Imposter, Has a Co-Conspirator: Poor SleepIra L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
20 years ago I did not believe it was possible to orthopedically grow adults without surgery. I was dead wrong!
My personal opinion NOW is that there is almost never a reason to amputate teeth for orthodontics anymore due to new technology in growing jaws orthopedically.
YOU DON'T KNOW, WHAT YOU DON'T KNOW! I believe this statement sums up my feelings about doctors who continue to amputate body parts unnecessarily. Many doctors do not understand that they are they are treating Epigenetic Problems but think they are treating Genetic problems.
Dr Robert S Corruccini's book (published 1999) "How Anthropology Informs The Orthodontic Diagnosis Of Malocclusion's Causes" clearly show how almost 100% of typical orthodontics are due to epigenetic changes that have taken place in the last 400 years. This book should be required reading not just for orthodontic students but for the educators in orthodontics.
Dr David Signh created a new concept in treating failure of normal development of the maxilla (upper jaw). It was based on his work at the NIH. It is possible to grow the maxilla orthopedically and the airway pneumopedically. Pneumopedically is a term coined by Dr David Signh who created the DNA Appliance to describe growing larger airways. I personally feel that amputation of teeth to rearrange remaining teeth in limited bone will continue (unfortunately in my mind) for many years.
This does not mean you personally will have problems. It is also possible to see a dentist who does not create problems in spite of extractions. I would probably look for a doctor who does not do extractions and get a second opinion. This doctor probably has a very different mind set.
I have lectured on the Developmental aspects of TMJ disorders, Migraines, Sleep Apnea, Gerd, ADD, ADHD in Argentina and in the US. A lecture I gave at the Academy of Anti-Aging Medicine A4M meeting to two thousand physicians has been made into a chapter in a textbook on anti-aging medicine.
I recommend the all children be evaluated for airway as young as possible especially if there is snoring. The best time to address these problems is as young as possible. These problems are widespread and common and can create a lifetime of problems.
I will be posting this answer on my websites, ThinkBetterLife.com, IHateHeadaches.org, IHateCPAP.com, DelanyDentalCare.com websites.
Each of my websites has additional material on this subject.
Ira L Shapira DDS
Chair, American Alliance of TMD Organization
Diplomate, American Board of Dental Sleep Medicine
Diplomat, American Academy of Pain Management
Regent & Fellow, International College of CranioMandibular Orthopedics
Former Assistant Professor Rush Medical School Sleep Center
Lifetime member American Dental Association
American Academy of CranioFacial Pain
American Academy of Sleep Medicine
American Academy of Dental Sleep Medicine
Charter member Dental Organization for Sleep Apnea (DOSA)
Founding Credentialed member Sleep Disorder Dental Society (Became American Academy of Dental Sleep Medicine)
American Equilibration Society