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Dr. Beckman's International Veterinary Dentistry Institute offers courses in all areas of vet dentistry. Online & Live Courses for Vets and Techs https://veterinarydentistry.net/ To request an invitation to the VDP Program: https://ivdi.org/ Complications of Extractions or Oro-Nasal Fistula (ONF) Closure After Radiation in Humans and Dogs Introduction Radiation therapy is a common treatment modality for certain cancers affecting the oral cavity in both humans and dogs. While effective for managing malignancies, radiation can lead to significant challenges in dental procedures, particularly tooth extractions and oro-nasal fistula (ONF) closures. This evaluation synthesizes literature discussing complications associated with these procedures in both species, highlighting parallels and species-specific differences. Human Literature Osteoradionecrosis (ORN) Pathophysiology: ORN is a major complication following extractions in irradiated fields. Radiation induces hypovascularity, hypocellularity, and fibrosis in the bone, reducing its ability to heal and resist infection. Incidence: Studies report ORN rates between 5% and 15% after dental extractions in irradiated patients. Risk Factors: Total radiation dose exceeding 60 Gy. Location: Mandible is more prone due to poorer vascular supply. Timing: Extractions performed within 6 months post-radiation have higher risks. Comorbidities: Diabetes, smoking, and poor oral hygiene exacerbate risks. Management: Prophylactic measures include hyperbaric oxygen therapy (HBOT). Surgical debridement or segmental resection may be necessary for severe ORN. Soft Tissue Complications Delayed Healing: Radiation-induced fibrosis and reduced vascularity lead to delayed mucosal healing. Infections: Secondary infections, such as osteomyelitis, are common due to impaired immune response and reduced tissue integrity. Dehiscence: Closure of oro-nasal fistulas is often complicated by wound dehiscence due to tension at the suture site and poor healing capacity. ONF Closure Challenges: High recurrence rates due to radiation-induced tissue fragility. Limited availability of local tissue for flap reconstruction. Surgical Options: Use of pedicled flaps, such as buccal or palatal flaps, has been successful. Free tissue transfers (e.g., radial forearm free flap) are utilized for extensive defects. Tissue engineering with growth factors or stem cells is an emerging area of interest. Pre-Surgical Preparation: Hyperbaric Oxygen Therapy (HBOT): While not universally applied, HBOT is frequently recommended before surgical interventions in patients at high risk for ORN. Protocols often involve 20-30 preoperative dives (2.0-2.5 ATA for 90-120 minutes per session) and 10 postoperative dives. Antibiotics: Broad-spectrum antibiotics may be prescribed prophylactically to reduce the risk of infection. Nutritional Optimization: Ensuring the patient's nutritional status is optimized can improve surgical outcomes. Veterinary Literature (Dogs) Osteoradionecrosis (ORN) Pathophysiology: Similar to humans, radiation in dogs leads to hypovascularity and reduced bone turnover. The mandible is the most commonly affected site. Incidence: Published reports indicate a lower incidence of ORN in dogs compared to humans, possibly due to differences in fractionation protocols and total radiation doses. Risk Factors: Total radiation dose (commonly > 50 Gy). Larger tumor burden and proximity to the bone. Management: Conservative treatment includes antibiotics and analgesics. Surgical intervention involves debridement or mandibulectomy in severe cases. Soft Tissue Complications Delayed Healing: Radiation reduces epithelial turnover and fibroblast activity, delaying healing of mucosal wounds. Fistula Formation: ONF formation is common after radiation and can be exacerbated by dental extractions, particularly in the caudal maxillary region. ONF Closure Challenges: Dogs often have limited tissue for local flap reconstruction. Radiation reduces the availability and viability of tissue for surgical manipulation. Surgical Options: Buccal mucosal advancement flaps and rotation flaps are commonly used. Palatal flaps are an alternative for larger defects. Advanced techniques, such as axial pattern flaps, have shown promise. Adjunctive Therapies: HBOT has been explored in veterinary medicine with anecdotal success, though systematic studies are limited. Comparative Analysis Common Complications Delayed Healing: Both species exhibit delayed healing due to radiation-induced vascular and cellular changes. ORN: A significant risk in humans and dogs, although reported incidences and management strategies differ. Wound Dehiscence: Tissue fragility and tension at surgical sites are common across species. Species-Specific Differences Risk Factors: Humans are more affected by lifestyle factors such as smoking and systemic conditions like diabetes. Dogs are less influenced by these factors but may have different radiation fractionation protocols affecting outcomes. Management: Free flap techniques and tissue engineering are more advanced in human medicine. Veterinary approaches often rely on local flaps and less invasive options due to cost and availability constraints. Hyperbaric Oxygen Therapy (HBOT) Protocol Human Protocol Hyperbaric oxygen therapy (HBOT) is commonly recommended presurgically for patients who have undergone radiation therapy, especially in the head and neck region, to reduce the risk of complications such as osteoradionecrosis (ORN) after oral surgery. Typical HBOT Protocol for Pre-Surgical Cases: Presurgical Sessions: Number of Sessions: Usually 20-30 sessions. Duration of Each Session: Each session typically lasts 90 minutes at a pressure of 2.0 to 2.5 atmospheres absolute (ATA). Postsurgical Sessions: Additional 10-20 sessions may be recommended following the oral surgery to further promote healing and reduce the risk of complications. Scheduling: Presurgical HBOT is ideally started at least 3-4 weeks before the planned surgery to ensure adequate time to complete the prescribed sessions. Why HBOT Helps: Increases oxygen delivery to tissues damaged by radiation. Promotes angiogenesis (growth of new blood vessels) in irradiated tissues. Enhances fibroblast function and collagen synthesis. Reduces infection risk by boosting tissue oxygen levels. Important Notes: The specific number of sessions may vary depending on individual factors, such as the extent of prior radiation damage, the site of surgery, and the overall health of the patient. Close coordination between the oral surgeon, oncologist, and a hyperbaric medicine specialist is crucial for optimizing outcomes. Veterinary Protocol The use of HBOT in dogs follows adapted protocols based on human medicine, with adjustments for size and species-specific factors. Presurgical Sessions: Number of Sessions: Typically 10-20 sessions are suggested. Duration of Each Session: Sessions last approximately 60-90 minutes at pressures of 1.5-2.0 atmospheres absolute (ATA). Postsurgical Sessions: Additional 5-10 sessions may be recommended depending on the dog's healing progress and surgical outcomes. Monitoring: Dogs should be carefully monitored for signs of oxygen toxicity or other adverse effects during HBOT. Sedation may be required for some patients. Future Directions Human Medicine: Further research into tissue engineering and stem cell therapies to improve healing. Optimization of prophylactic measures such as HBOT and pharmacologic agents. Veterinary Medicine: Development of standardized protocols for managing post-radiation complications, including recommendations for the use of hyperbaric oxygen therapy (HBOT) in veterinary medicine. Emerging guidelines suggest that HBOT can support pre-surgical preparation by improving tissue oxygenation, enhancing vascularization, and promoting healing. Typical protocols involve 10-20 sessions at 1.5-2.0 atmospheres absolute (ATA) for 60-90 minutes per session, with an additional 5-10 sessions postoperatively to ensure optimal healing. Further research is needed to validate these approaches and refine their application for specific conditions. Exploration of advanced reconstructive techniques and adjunctive therapies like HBOT in controlled studies. Cross-Species Insights: Comparative studies to assess shared pathophysiology and potential therapeutic strategies across species. Conclusion Complications following extractions or ONF closures in irradiated fields pose significant challenges in both humans and dogs. While similarities in pathophysiology exist, differences in risk factors, management, and available interventions highlight the need for species-specific approaches. Continued research, particularly in cross-species translational medicine, is essential to improve outcomes for both populations. Podcast Details Host: Dr. Brett Beckman, DVM, FAVD, DAVDC, DAAPM
Welcome to the Sterile Technique Podcast! It's the podcast about Surgical Technology. Whether you are a CST or CSFA, this podcast helps you earn CE credits and improve your surgery skills in the OR. This episode discusses the cover article of the October 2024 issue of The Surgical Technologist, which is the official journal of the Association of Surgical Technologists (AST). The article is titled, "Palatal Hybrid Surgery for Obstructive Sleep Apnea - State-of-the-Art Annotation of Uvulopalatopharyngoplasty". "Scrub in" at steriletpodcast.com and on Twitter, @SterileTPodcast (twitter.com/SterileTPodcast). This podcast is a Dybas Media production. Sound effects adapted from GarageBand and sindhu.tms at https://freesound.org/people/sindhu.tms/sounds/169065/ and licensed courtesy of https://creativecommons.org/licenses/by-nc/3.0/.
Guest: Beth Bergstrom, MS, CCC-SLP - This episode provides answers regarding Velo-Pharyngeal Incompetence (VPI) and how to diagnose a submucous cleft from other diagnoses differentially. She shares specific methods to recognize a submucous cleft as a structural issue that only improves with surgical intervention; she explains why. You'll learn treatment options that are dependent on the characteristics before and after repair.
Join me for a podcast summary looking at the effects of aligners when expansion occurs. In this podcast we will explore if bone loss occurs with expansion and why bone loss doesn't necessarily cause recession. The podcast is based on the lecture and research by Greg Huang presented at this year's AAO, and includes some more recent research on the topic PICO Population adults, 22 maxillary arches, 20 mandibular arches Intervention – expansion with aligners, average 3.7mm Control – minimal expansion, average 0.6mm Outcome – bone height and width from CBCT What was the bone loss? Maxilla · Minimal bone loss · Minimal bone height and width change Mandibular · Significant bone loss · 1.5mm height mandibular centrals · 1.4mm height premolars What movement took place of the incisors? Maxilla · Little change in bucco-lingual inclination Mandibular · Labial and buccal tipping increased What were the overall changes? Dental changes · 3-4mm of expansion · Mainly at premolars · Mainly buccal tipping, not bodily movement · Lower incisors procline Similar bone loss with aligners expansion from other studies, Zhang 2023 , Allahham 2023 Should CBCT's debate within the literature regarding voxel size of a CBCT and false negatives. Accuracy of alveolar height CBCT 2019 Yuan Li BA systematic review showed · CBCT Vs skulls/patients · Bone height 0.03mm · Bone width 0.11mm My thoughts: no difference in cbct and gold standard, however the measurements were all of large structures, not bone height or thickness of less than the voxel size Predict bone loss · Upper arch no predictors as limited changes · Lower arch, same as for fixed appliances, but the quantity was missing o Proclination o Expansion o Buccal expansion and tipping Systematic review of orthodontics 48 articles de Llano-Pérula 2023 · Proclination · Less keratinised tissue · Thin biotype · Prior recession · Crossbite · Previous recession · Age Does bone loss = gingival recession? · Not generally found from Greg's study · When significant bone loss of 3mm, far less than 3mm gingival recession Significant retraction of upper incisors and intrusion Kim 2024. Loss of Palatal bone however in retention palatal bone recovered Hypothesis · If PDL and periosteum are maintained epithelium is maintained · If the root moves back into the bone, the bone recovers – as PDL and periosteum osteogenic, and tension generated between PDL and periosteum · PDL-periosteum hypothesis – proposed by Greg Huang What I liked about Greg's lecture was that he started with declaring his conflict of interest as an academic, both the royalties he receives for his books as well as research funding, which was great to hear and a trend I hope continues. Acknowledged the hard work of the research lead, his trainee and the time-consuming process of orientating CBCT slices of 1000s of images
I have sleep apnea. I also had major jaw surgery at 15. Are they connected? If I had a Magic 8 Ball, it would likely say, “All signs point to Yes”. And so would one pioneer in holistic dentistry by the name of Dr. Claire Stagg. Through my personal journey of trauma and jaw surgery, we highlight the limitations of conventional solutions like CPAP and oral appliances, underscoring the need for a comprehensive, whole-body approach. Dr. Stagg shares invaluable insights into the interconnectedness of our body's systems, focusing on non-surgical solutions for TMJ, clenching, grinding, sleep apnea, and airway disorders. This is about building your symphony of specialists who focus on the root cause, not just the diagnosis. It's the conversation I wish my parents and I had over 35 years ago when I sat in the dentist's chair. Today, I hope it serves as a guide for anyone struggling to find answers. And for parents, let it offer a new kind of hope for your kids to leave you better informed when it comes to your dental health and overall well-being. KEY MOMENTS 00:00 Intro 00:06 Whole Body Approach to TMJ 03:50 Orthodontic Surgery Complications and Alternatives 14:31 Identifying and Addressing Airway Issues 18:20 Comprehensive Approach to Airway Disorders 20:48 Navigating Specialists for Sleep Apnea 25:38 CPAP vs Oral Appliance 26:51 Addressing Root Cause of Sleep Apnea 34:34 Understanding Palatal Expansion and Growth 42:05 Empowering Dental Health Education and Advocacy 46:33 Parent's Journey to Healing Child 48:49 Rapid Fire Game 49:49 Dr. Stagg's closing thoughts 51:29 Hilary's closing thoughts/Wellness Resources and Support Availability Grab a copy of Dr. Stagg's book, “Smile: It's All Connected" Hardcover: https://amzn.to/3XLYm9X (Amazon) Share storytime about proper dental health with her children's book "Captain IFBI" https://amzn.to/4cipP7l (Amazon) Get the Daily Dental Protocol Checklist. https://lp.constantcontactpages.com/sl/Y4V5mXB CONNECT WITH DR STAGG https://healthconnectionsdentistry.com/ https://www.instagram.com/SmileProDentist https://www.facebook.com/SmileProDentist HEALING IN YOUR HANDS. HAVENING WITH HILARY https://www.hilaryrusso.com/havening CONNECT WITH HILARY https://www.hilaryrusso.com/podcast https://www.instagram.com/hilaryrusso https://www.facebook.com/HIListicallySpeaking/ https://www.facebook.com/groups/hugitoutcollective/ https://x.com/hilaryrusso https://www.tiktok.com/@hilisticallyspeaking Music by Lipbone Redding https://lipbone.com/ FULL TRANSCRIPT ALSO ON PODCAST WEBSITE 00:06 - Dr. Claire Stagg (Guest) Think about all the systems that are shut down because you can't breathe right? The oral appliance isn't going to fix it. The CPAP is definitely not going to fix it, because what's going to happen is the body is going to acclimatize or get used to that level of band-aiding and then it's like okay, you know what it is. The little Dutch boy with his finger came to mind with a dam. So you put one finger here and then you put one finger here, and then you put one finger here and you put one finger, and then you're not gonna have enough fingers or toes, and then the dam's gonna break. And it's exactly the same concept. 00:40 - Hilary Russo (Host) Okay, my friends, One of the reasons I went into the work that I do is it was an effort to heal my own trauma and, as a result of that, from having TMJ my whole life, from having jaw surgery when I was a teenager and not knowing really how to heal and not getting the right kind of support after that surgery, I wanted to know what I could do to heal later in life, because we really never stop healing, right? You hear me talk about that all the time and it's really how Havening came into my life. It was the first time I was ever Havened was on the trauma from my surgery years later. But what we're learning is that it's all connected. Everything from head to toe. It's all connected. Everything from head to toe, it's all connected. 01:32 So when I was introduced to Dr Claire Stagg, a holistic dentist who believes in the whole body approach thank you so much I knew that her story and her method would resonate with so many others, because I've had these conversations with so many Dr Stagg about TMJ, jaw issues, clenching, grinding, stress and the problems that happen after the breathing, the sleep apnea, and it's such a common problem. So when you came into my space, when I was introduced to you by a client who you introduced me to, I knew that you were the right person to talk about this, to share the journey, to share possibilities, and I am so grateful that you are here. 02:12 - Dr. Claire Stagg (Guest) Well, thank you, thank you, and I think it would be good to, if it's okay with you, to answer your questions and your journey, because I think you went through the whole gamut of from the start out the gate to the journey itself. So the first thing I'd like to add is that surgery is a massive undertaking and, unfortunately, one of the things because you and I have talked before this is that, without stepping on too many toes and being politically correct, it would be wise to figure out why orthognathic surgery is being done. A lot of times people are having their jaws move forward without understanding how the whole concepts work, and a lot of times some things can be done, so a lot and some can be done non-surgically. You just don't know what. You don't know until you know it. So surgery is a end-all, be-all concept and if you have a broken bone, it's a good time to put things together. 03:20 But the head, the cranium, all these things keep moving all the time. I have a skull here with sutures. I mean this is just the top part, if you will, this is the front. The head you can tell Fred moves a lot too with me. Then this is the part that I work with and this is what I tell everybody, this is what I do right this part and right this part, and then this part. All right, but not as crooked. But what happened is you had your surgery to go ahead and to fix something that might have been fixable without it actually having to have the surgery. So here we go. I'm trying to put it all together for you and showing us us on YouTube. 04:04 - Hilary Russo (Host) We are on YouTube in case anybody wants to watch the video rather than just listen. It is on YouTube. 04:10 - Dr. Claire Stagg (Guest) Right. So what I'm trying to say basically is that if you approach and saying that you need jaw surgery, please educate yourself more before you go down that rabbit hole, because it makes us a lot harder for us who are coming in behind to work on, to have arch expansion or arch development or airway issues to resolve them, if we're trying to move bone when you have screws tying them in. That's all I'm trying to say. So I interjected very early on. I'm sorry, but that's where I think. If you start off the gate that way and I think, unfortunately your issues, if I may say so, continued and stemmed from the actual surgery. They were trying to do one thing, but you ended up with a lot of other things. So that's where we have to weigh the pros and the cons, right. 04:59 - Hilary Russo (Host) Absolutely. 04:59 - Dr. Claire Stagg (Guest) Very delicate. 05:00 - Hilary Russo (Host) Yeah, and it's something that you know. Back in the 80s, when this surgery was done, I was 15 years old. What was known about it? It was pretty much a younger surgery. The surgery itself was hours, the healing process was eight to 10 weeks with a jaw wired shut, and just you know. If this is triggering to anyone, I just want to preface that we're going to go there, that this surgery was not a minor surgery that you're doing in a dental office. I had a doctor that dealt with the face, I had an orthodontist, I had a dentist. It was like this team. And even after the surgery, a year later, I had follow-up surgery and I told myself. I said this has got to be it Like there can't be more than this because it was very traumatic. And this has got to be it Like this, there can't be more than this, because it was very traumatic. And the years following, because I was still growing, there was movement still happening, obviously, right. 05:55 - Dr. Claire Stagg (Guest) So, and at 15, you're not finished growing. And that's the other thing to girls and boys grow differently. Girls can grow, still continue growing, sometimes up to 18, sometimes maybe even 21. Boys start later, but they can continue growing. I have a friend of my former husband who was continuing to grow tall at 29 plus. So everybody's different, but 15 is very young to do that. 06:19 - Hilary Russo (Host) It was young. It was a decision I had to make. 06:21 - Dr. Claire Stagg (Guest) We could start a column of pros and cons there, Hihillary, of things that could go really really well and things that we might want to wait because they might cause problems later on, right? 06:32 - Hilary Russo (Host) But this is also something that you have a lot of younger patients and I know that there are moms and dads out there that listen that this might not be for them, specifically someone who's in my age range, but perhaps their child has breathing issues or they are dealing with. You know, I had the malocclusion, I had a protruded lower jaw and it was causing a lot of lockjaw and pain and discomfort and to go to that extreme after braces. I imagine that's not the approach this day and age, because there's more science, there's been more development, so it's also to give parents an understanding of information that they're getting about holistic dentistry and other possibilities before taking that approach with their children even. 07:19 - Dr. Claire Stagg (Guest) All right, so let's go ahead about and talk. Interject also because you had four premolars extracted correct? 07:27 - Hilary Russo (Host) Yes, I think you're talking about the wisdom teeth. No, no, no, oh no. 07:32 - Dr. Claire Stagg (Guest) The 18 year old molar right. We, in theory, have 32 teeth, all right. Unfortunately, and I'm just so we're. We're going to talk about all the not to do things all right, to put it in quotes for air, quotes for those who are listening there are a lot of things that and I'm not bashing orthodontists, please don't get me wrong, I'm not. I do orthodontics too, so that's not the issue. There's different ways of doing things all right. That's not the issue. There's different ways of doing things All right. One of them and if you, if you read or you know of Western Price, western Price talked about nutrition, about airway, of growing, of growing arches. All right, your head, your neck. So basically we're back to this again All right. 08:21 And unfortunately, what happens is that when you have the jaw joint like this, all right, this is this is, think of it this way, like this, and then like that, when you translate, okay, what happens? A lot of times? You end up with a jaw disorder or joint disorder if this whole part, this maxilla, this part, is not developed enough and it sounds to me like what you had was an underdeveloped upper arch right. So, unfortunately, a lot of times, people say, oh, this one, they think that this is the normal one. And then this is too far forward, the lower jaw is too far forward, and that's why you end up having all these issues. Let's go ahead and let's take teeth out and bring the jaw back. Well, you've just created a joint problem, a TM joint, temporal mandibular joint problem, because now you shove the joint back, the jaw back. So now you see the cascade of events and this is what I was trying to say the cascade of events, of all the not to do so. First of all, figure out why you need surgery, what has happened, and then all the not to do so. You can't compound a problem with another, causing causative problem that will create another set of problems. 09:48 So the first thing that you want to do is you want to be able to develop the arches and figure out which one truly is underdeveloped, because nine times out of ten, it's not necessary that the lower jaw is too far forward. Most of the time it's because the upper arch is not developed enough. And so, in order to balance them, conventional orthodontics go ahead and say let's take teeth out to make more room. Well, there's just so much. Think of a garage. This is my favorite analogy that I use. All right, think of a garage and let's say you have a 20 by 20 by 24, four walls that are 20 feet long, right? So it's a square, okay. And you say you're going to make more room and you decide to take four feet off in the length of each side of the garage. Will you have a bigger or a smaller? 10:45 - Hilary Russo (Host) garage. You're not going to have a lot of space for those cars, that's for sure, correct. But you have a smaller garage, right, right, and it's exactly the same thing with the mouth, all right. 10:55 - Dr. Claire Stagg (Guest) So think too, now that you have on top of that garage, you have another room, all right, which is the nose. The nose, if you will, is a hollow space, all right. But the floor of the nose is the roof of the mouth, which you've just made smaller. What are you doing to the nasal passages? It's the same exact thing. Now you've brought the jaws up and back, you've made the garage or the box smaller. You've made the nasal passages smaller. Now you've brought everything back. What's back here? It's the tube that the airway is. So you start breathing through the nose, and the tube continues from the nose down to the throat. 11:43 - Hilary Russo (Host) And again, I just want to mention to folks if folks are actually listening and they want to see what Dr Stagg is talking about, you can go ahead and find this podcast episode on youtubecom slash Hilary Russo. You'll see all the podcast episodes there to watch as well, if you want to do that. 11:58 - Dr. Claire Stagg (Guest) So, if you go ahead, when you think about it, this is a person laying down, but this is the best picture that I can have right now to where we need to breathe through our nose. A lot of people breathe through their mouths, but, no matter what, if you lay back and everything closes up, then you have OSA or obstructive sleep apnea. So, basically, what I'm trying to say is the rabbit hole started by, probably, the diagnosis of lack of airway or lack of space, and so that's where it would be important to go ahead and to determine what type of space do you want? Which space are you trying to open up? The nasal passage or the oropharyngeal passageway? An oral mouth? Pharynx is the back, where the throat is. So in your case, it sounds to me like they wanted to go ahead and to move your jaw so that you can have straight teeth, right. 12:54 - Hilary Russo (Host) That was part of it, and also I was getting a lot of pain and jaw aches. So they broke it, set it back and I don't know if I truly remember everything because I was a kid. You know you think you're getting braces, retainers, it's all to straighten your teeth. That's it, day is done, perfect teeth and you're happy. But there were more issues I was dealing with and that is where I am now, 35 years later, where the problems have become the obstructive sleep apnea movement and wondering where does one go next when you have years in between and other issues are now coming up. 13:32 - Dr. Claire Stagg (Guest) Right. So the rabbit hole you're down at the bottom of the rabbit hole, right? Okay? So we're not going to cry over spilt milk, because it is what it is, it's done. But now you're aware that there are issues that you have to deal with. Okay, so then the goal is to figure out how we can get you out of the rabbit hole by reverse engineering what has occurred. So, basically, now you're going to address your airway, you're going to address your jaw joints, you're going to address your bite and you're going to address your nasal passages both going to address your nasal passages, both upper and lower. That's the airway, all, right. So this is where you mentioned that you were talking with um sleep doctors. Okay, that's one part of the orchestra. If you will, all right, then you're going to talk with dentists. That's the other part of the team, if you will, the orchestra. 14:22 I like to say that patients are the music. You either have harmony or cac. Say that patients are the music. You either have harmony or cacophony. It's a French term. You either have chaos or you have health, right. So the whole idea now is to figure out who's going to be in charge of trying to figure out what's wrong, what happened where you are now, because we can't reverse engineer everything to. If you have screws in there, per se, all right, but the whole idea is to figure out what can we do to either see what we can ameliorate or make better and or stop from getting worse. So that's the interesting part is that's where you really need to figure out where you are now. 15:02 If you do have an airway issue, to what intensity is the airway issue an issue? Those of you who do not know anything about sleep apnea we have either a sleep test, a home sleep test, to where you can take a little apparatus. Home Dentists, we're not allowed to diagnose sleep apnea, but we can treat it with oral appliances. So mild to moderate sleep apnea we can treat with an oral appliance. Severe sleep apnea is supposed to be treated. Standard of the gold, standard of care is with a CPAP machine, which stands for continuous positive air pressure. It's like a reverse blow dryer mower back up your nose or your mouth, right. So if you consider that you have an issue, then we need to figure out what your index or your indices are. So, again, a lot of this is on my website, healthconnectionsdentistrycom, where you can read up on the sleep screenings. Again, we cannot diagnose sleep apnea, but we can treat it with an oral appliance. 16:07 Mild to moderate sleep apnea, usually at normal. Zero to five. Your indices are normal. Five to 15, it's mild sleep apnea, 15 to 30, it's moderate and over 30 is severe. Now, those are just the standard of care, the norms and the indices and who cares right. All you really need, as a patient, to know is whether I can breathe or not. Please, let me breathe or not. Let me help me breathe. So if you go ahead and you consider them, that's why you can have a home sleep test and we do home sleep test, because it helps me figure out as a dentist, because I can treat a functional breathing disorder that is in my wheelhouse. But I cannot treat sleep apnea without it being diagnosed by a physician. So if you have officially been diagnosed as you have Hilary with by a physician for sleep apnea, then that's where, too, you need to find yourself a doctor, dentist, who is versed in this type of care. So then you need to figure out where you're going to go from there. 17:18 - Hilary Russo (Host) And I think that's the thing, and I've talked to other people and I know folks are tuning into this episode of HIListically Speaking with Dr Claire Stagg. Just to remind you, we will put that information on the website. We will put everything about the healthconnectionscom dentistry. Also her book that we're going to talk about that just came out. That's doing very well. And the questions I've been hearing from some who have been in these forums are are you know if you've been diagnosed with moderate sleep apnea? Like myself, I've also been through this traumatic TMJ surgery. I'm 35 years in. I know there are little plates in my mouth from the initial surgery and I've been given a referral to see an ENT, a referral to see a pulmonologist, a referral to see a speech pathologist. But then there's the airway side and then there's go find a dentist and it can be very overwhelming, like where to go first right. 18:12 And I think that's the similar question I hear from folks. 18:15 - Dr. Claire Stagg (Guest) Where do I go first? Right, and that's where I said the orchestra, all right. So I like to think that a doctor like myself, a dentist, who sees the medical side as well as the oral dental side, we and I liken it to the conductor of the orchestra the orchestra, the parts, the wind, the pipes, the drums, the bass, the, whatever the strings, whatever, all the different parts, if you will are all the different doctors, if you will, who are doctors, if you will, who are going to partake in making music. The patient is the one who is the music, and you either are going to have that harmony where everything just falls into place and that everything works well and you're healthy, all right or you have everybody throw something at the wall and expecting something to stick right. That's putting it pump up politely. So the goal is to get the bullseye the first time if you fail to plan to plan to fail, right, right. And so the goal now is someone like myself and we we talked about this is we got to figure out where you are exactly in this point in time. It didn't really matter so much anymore now, because you've had that surgery and that changes and has changed you forever. But where are you now? What are the building blocks that we can use now to move forward? Interject here for the parents and for those who are asking yeah, but this doesn't pertain to me. Well, we can work with children With the AFT systems. 19:50 Dr Nordstrom has come up with systems to work with neonates. You can do the tie releases. You can start as from the newborns on. The whole idea is to breathe properly. Once you breathe properly, as in, you have proper tongue position and then you have proper nasal breathing, then you set yourself up for success, right. 20:10 Unfortunately, with a modern diet and with the way that things are going nowadays, unfortunately things retract a lot and you don't have that room and you end up with disorders and you went through what you went through. Okay, so if we go ahead and we have that conductor I circled back now to the music all right, if you go ahead and you have a team, somebody's got to know what the right hand's doing. Somebody has to know what the left hand's doing, but together we make sure that we're all on board with the same ultimate goal, which would be to get you to breathe again properly. What I heard you say is that you went to see an ENT and they have their own wheelhouse, they have their own tools, they have their own tests, they have their own. We got to do this. This is it, this is my way, or the highway right I? 21:01 - Hilary Russo (Host) haven't actually gone to the ENT yet. I have a referral right because I'm like I want to go the right route before somebody starts telling me oh, you need this, this and this. I did consult with one dentist who said you need a CPAP, and I'm like you don't even know what you're talking about. 21:17 - Dr. Claire Stagg (Guest) That's the weekend course. 21:20 - Hilary Russo (Host) Right, that's the oh, I heard sleep apnea. I'm not a sleep dentist, I don't even deal with this stuff, but I've heard this is the best route to go. I don't want to hear, I've heard. I want to know what is good for me, because it's bio individuality. This is what I've been through. So I'm in this place. Where do I go to the ENT first? Do I go to the pulmonologist first? Do I go to a dentist who deals with, who is specializes in airway and TMJ? You know that's and sleep apnea, which obviously falls under that. 21:52 - Dr. Claire Stagg (Guest) So one of the things you need to be aware of is the American Dental Association does not recognize these as specialties, unfortunately. I think that will change my practice. I have an emphasis in treating sleep apnea, tmj disorders, head, neck, facial pain. So that is one thing that you can be aware of. The second thing is a lot of us who do this have had many, many, many, many, many, many, many, many, many, many, many, many hours of extra training. It's just not a weekend course. 22:26 I mean, I've been doing this for nearly 20 plus years to this intensity and it's a process I keep learning. I mean, I'm still going through a residency for pediatrics right now and it's a lot that I know, but now I'm learning to fine tune and I'm going. I can deep dive a little bit more for certain things that I have been able to do, because it's same old, same old. Plus ça change, plus c'est la même chose, as we say in French. The more it changes, the more it's the same. So there's a lot of different things but, like you said, I like that bio individuality. So everybody's different but everybody's the same. It's just you can't use one cookie cutter technique, but we're all humans and that's where it's all connected. 23:10 So we're circling back to how it's all connected. And if you have somebody who understands how it's all connected, that's when they could guide the ENT to say hey, you know what? This is what I suspect I use the word very underlined, bold caps suspect. I suspect, for example, she has a nasal valve collapse. I suspect, for example, she has a deviated septum. I suspect she has sinus issues. I suspect that she has pharyngeal obstruction. Could you please verify for me? Could there be upper airway resistance syndrome? I suspect that she may be having obstructive events. You might even have central apneic events, we don't know. So that's where you get somebody who understands as a dentist. All right, cause we're the best ones, and this is what floors me and I'm just going to put something for hooah, hooah for my team, my team, all right, this is what we do all day long. We're in the mouth. We see this stuff day in, day out. 24:17 What bothers me is that they don't train dentists nowadays to read the signs of obstructive C-papnea and or airway disorders. That's going to change. That's all in the book, by the way. Every single sign you could think of is in the book. But I think that's what needs to be changed. It should be common sense that it's not drill, fill and build, it's actually determine what you see, that it's not normal. 24:43 So I would hear patients tell me entire lives they've had these tore eyes. They look like little mushrooms at the bottom of their jaws or one on the roof of their mouth, on their palate. Or my dentist told me that was normal. No normal for whom? All right, I digress. So, anyhow, what happens is if you have a team conductor, then the dentist who understands this, who is more versed in this knowledge, can go ahead and say okay, then this ENT, could you please help me accomplish X, y, z. If you have a sleep doctor, all right. You don't want to get lost in the rabbit hole of medicine, right, because that's the other thing too. You can very easily get lost in that rabbit hole, all right. 25:29 So, you want to stay with those of us, because your mouth, your head, your neck is this, is our wheelhouse. Ent is air, nose and throat. All right, sleep. They're the physicians. They're the ones that are going to. Yes, they prescribe the CPAP. Yes, they're the ones that are going to diagnose it. But at the end of the day it they're the ones they're going to diagnose it, but we're at the end of the day, it's still the dentist that's going to do the appliance for you. 25:50 one way or the other, it's going to be something in your mouth right right and I prefer to go that route it bugs me that now you have physicians who are doing oral appliances. It's like, okay, you won't let us diagnose something that we deal with, okay, yes, yes, there's the medical, the physical aspect, the insurance part, blah, blah, blah, blah, of sleep apnea. Yes, there's a lot of pathophysiology that needs to be dealt with by a physician. Get that, get that, but don't go make an oral appliance for my patient. You don't know what you're dealing with, you don't know how to make it, you don't know what position to do it and you certainly don't know how to put it into the way they breathe better, and you don't know how to check it and you don't know where you're putting that jaw joint. So, yeah, that that kind of bugs me a lot. 26:33 - Hilary Russo (Host) Sorry, I think that's part of the reason why now share. This is an open space. If you want to drop an F bomb, you can. I don't mind. 26:41 - Dr. Claire Stagg (Guest) I can say it in French, but I could say it in French. 26:49 - Hilary Russo (Host) Yes, right, you can French your way out of this. So I, my thing is and I've thought this, but from talking to you, from talking to others in the field that even though I've been given referrals, I've been holding off on filling those referrals because I'm like I think that's just a doctor telling me this is what's normal and this is how we normally protocol this. My gut tells me that it's somebody who deals with this face all the time and that moves into the next things like how do you find that sleep dentist? How do you find a dentist who is experienced or emphasizes work in that area and know that you're getting someone who's good and isn't just going to say, hey, we're going to, we'll get you fixed up with an orthodontist and now you're going to get a palate expander or now we're going to do the surgery over? Because that's a fear that I've run into as well as one that I have on my own. 27:43 - Dr. Claire Stagg (Guest) Right, I wouldn't go there yet if I were you. Okay, just stop Whenever you hear surgery again, just let's think this over, all right. So let me give you some of my feedback too. Right, there was a sleep course, all right, and I thought, okay, cool, I'll go ahead and I'll go, I'll support the symptom. Nobody's talking about causes, and that bugs me to high end. And there was a children's neurologist in a very, very prestigious hospital Boston I think it is who said yes, said yes, I mean it's all fine and good. Because they said, oh, don't worry about it, you know. And then she said no, no, no, I think she has a point. 28:34 Yes, so the thing that is that, all right, if you go ahead, you think about all the systems that are shut down because you can't breathe. Right, the order appliance isn't going to fix it, the c-pap is definitely not going to fix it, because what's going to happen is the body's going to acclimatize or get used to that level of band-aiding. And then it's like okay, you know what it is, the little dutch boy with his finger came to mind with a dab. So you put one finger here and then you put one finger here, and then you put one finger here and then you put one finger here and you put one finger and then you're not gonna have enough fingers or toes and then the dam's gonna break. And it's exactly the same concept, because if you go ahead and you the the concept of an oral appliance okay to come back again and I'm showing the picture to mount moderate c, pap. Yeah, it's called a mandibular advancement device, or MAD for short, right, okay, well, what does that do? It brings the lower jaw forward. Why? Because the tongue is attached to the front of the lower jaw. So you bring the lower jaw forward. All right, so that's the mandibular advancement device. Well, how far are you going to be able to break the jaw out of socket? Eventually? No, because if you don't address the root cause, you're going to have inflammation. 29:55 So that airway that's already restricted, be it because of diet, because of environment, because of whatever. You have large tonsils which are supposed to be there as buckets to hold whatever pathogens or whatever bugs that are in the air or that you're eating, or whatever. They're the engines that are holding the foot down, if you will, the soles, whichever. They're the ones that protect you so things don't go to your lungs, but eventually they get overwhelmed, and that's when your airway is so closed up by these massive tonsils. And then again let's take them out. Surgery to remove tonsils. All right, did that too? All right. 30:34 So I know I'm jumping everywhere right now, but I'm trying to go by the anatomy. If you'll follow, there's a process to my reasoning here. So the dentist will say say okay, let's do a manageable advancement device for mild to moderate sleep apnea, but that's not treating the root cause. All right. The sleep doctor will say you need a CPAP because it's severe sleep apnea. But that's not also treating the root cause. 31:05 Because somewhere along the line, if you don't have a nasal what we could call a patent nasal passage or passageway to get air through your nose, all right then. And or if you're doing a CPAP to push air down your mouth which you should be breathing in your mouth anyhow then you're still not getting the air, the quality of air you need. As a sidekick, just so you know, when you breathe through your nose, you actually develop nitric oxide. It's a gas, all right that you develop. You create it. As a human, we create nitric oxide in our sinuses. When you don't nose breathe, you're not getting your nitric oxide, which means that your vessels are getting hotter faster, you age faster. All right, none of that's going to happen with a CPAP and none of that's going to happen with the appliance, because three months down the road there's just so much that you could advancement that you can do. There's just so much titration with a level of pressurization with a CPAP that you can do, and eventually you're back to square one. 32:10 Okay, well then now let's do orthognathic surgery to bring your jaws forward. And then that's when you have another issue, because now you're locked in. So let's tie back that in. With the anatomy, remember I showed you, and for those of you who can't see, the skull is not fixed. There's lots and lots and lots and lots of little sutures. That's why I was saying there's dozens and dozens and dozens of bones, but they're all connected, and the cranium, the housing of the cranium, but there's lots of them underneath, all right, under the skull, all right. So what happens is all these bones actually pulse. That's called the cranial sacral rhythm. All right, that's where cranial sacral therapy would be really good. That's where you unfortunately have issues because you have screws holding your face. Your facial plates are held together, right, so we're trying to go through all the systems and the scenarios here. 33:08 An ideal person who hasn't had surgery can have all these little bones changed. Because they're not fused together. They are not fused together. They are not fused together. What did you hear me say? They're not fused together, they are not fused together. So if anybody says that you cannot expand your palate because you're over nine run, it's not true. I expanded, I've done an arch expansion on an 83 year old all right. 33:41 - Hilary Russo (Host) I actually had a conversation with a dentist who told me that women they're finding and tell me if what your thought is on this the palate of a woman actually is able to expand for much longer than we originally thought years wise like it, and maybe I'm saying this wrong, but she even had a palate expander in the top and she's in her 50s. So I'm curious, I mean, is that an approach to try? So can I guy it's a human period. Anyone can. Anyone. Okay. 34:11 - Dr. Claire Stagg (Guest) A human can have. Now I don't know if there's going to be a sex differentiation for the progression of the of the treatment. The treatment I don't know, but any human can have their arches expanded, short of having a disorder of one sort or the other, but in general you can have the arches expanding because the bones are not fused. Right, it's not here, it's here. Let's talk about why you can develop a palatal expansion and growth. All right, this is a totally misunderstood concept. All right, remember we talked about the roof of the mouth is the floor of the nose, and this is magnetic. So bear with me, that's why it was all all catawanka earlier on. So in here you have what we call the nasal passages and you have a thing called turbinates, right? So if you look at it, there's little windmills in here. So you have anterior, middle and posterior nasal passages too, and here you have what we call the sinus, the maxillary sinuses. Here you have the frontal sinuses, all right, okay. 35:14 So how arch expansion works? And this is why you do slow. Slow is good what you do. Remember this is magnetic, so it might be a little hard for me to do. You go ahead, you do a little bit. All right, you do a little bit and then you wait, then that goes ahead and creates bone. Then you do a little bit, then it creates bone, you do a little bit and it creates bone and so, slowly but surely, you've created the arch that is wider, because it happens in the middle. All right, if you go too fast, what happens is you end up having extrusion of the teeth, or the flaring of the teeth and or what we call the buckle plate perforations, which is what the orthodontist freaked out about. You're going to flare out the teeth because you're going too fast. 36:07 - Hilary Russo (Host) Well, how long does something like that take normally? What is that process? 36:11 - Dr. Claire Stagg (Guest) They do what the orthodontist usually do, what they call rapid palatal expansion. Slow is the best thing. Do a little bit grow bone. Do a little bit grow bone. Do a little bit grow bone. Do a little bit grow bone. Guess what happens, unless you have a septal spur which acts like a handcuff to hold that nasal passage, that septum tied up to another bone on the side. If you don't have a septal spur, that deviated septum just lines right down. That's what happened with me and I was in my fifties I was over 55 when I did mine. If you go ahead and you do slowly, you can expand an arch. Now there's a school out there that says let's do it in a month and then we wait six months. I'd say okay. That to me sounds so wrong and this is my humble opinion, for each time I'm giving you anything. These are my humble opinions and what I've learned and what I've read and my interpretation of everything. 37:13 Okay, of course, but if you're going to go ahead and you're going to go like zip and then wait, go ahead and you're going to go like zip and then wait, all right. The big fallacy with that is you zipped and you waited six months and that space, in theory, is supposed to grow bone. Uh-uh, it fills up with collagen. That is why, when you go too fast and kids or whom on whom, no matter what age, if you go too fast, you end up with a ton of relapse. So, slow, a little bit grow bone, a little bit grow bone, a little bit grow bone, a little bit grow bone. 37:49 - Hilary Russo (Host) Now you have success now, this is just one approach. Right, the palette expansion is just one approach okay, that's the transverse approach. 37:58 - Dr. Claire Stagg (Guest) So if you're doing this in 3d, you have to think your garage right, because you have width, you have depth and then you have length. Well, it's the same thing. This is the width. The transverse effect is the width. All right, now we have the sagittal aspect, which is from the side, so that's where two to for example, if I'm not mistaken that your issues came from, is that if you look at my profile and they said that this part of you was there, but this part of you was too far forward, so I'm going to exaggerate now, like that, right? 38:36 - Hilary Russo (Host) That's exactly what it was like, right. 38:38 - Dr. Claire Stagg (Guest) It wasn't that this was too far forward. It can be, but in reality it's that this was underdeveloped. So that's the side view, or the sagittal view. Nine times out of 10, if you have an airway issue, it's because you're overclosed, and then you need height, and that's when we can go ahead and do height. Interestingly enough, oral appliances the same one that they advocate to go ahead and do the mandible advancement devices the same thing. There's two things that they do. When they're doing a sleep appliance, what are they? Protraction vertical, but they're doing the protraction with the lower jaw only and vertical. They're putting the special amount of vertical or the height into the appliances. 39:27 - Hilary Russo (Host) Acrylic Now there's a lot of information that we're sharing with folks. I'm taking in a lot of information. I do want to mention real quick that Dr Stack has a new book that just came out, called Smile. It's all connected whole health through balance. I'm going to put a link on there in the podcast notes, rather to grab that book, because this is really something that was written for the everyday person to understand. It's not like reading a medical guide or anything like that. 39:56 You will be able to go to an upset or an issue that you might be confronted with, learn more about it because, as we were saying before, what gets measured gets managed. But also we have to be our own healthcare advocates and then find the right kind of people to support you, because obviously you can't fix the problem yourself, but you can support yourself in that. And also I know you have a children's book and that's Captain IFBI. I in that. And also I know you have a children's book and that's Captain IFBI. I love that Right encouraging good oral hygiene habits, which, by the way, that ties in with the download that you're offering as well, which is the dental protocol checklist, and I love that. We're going to put all that in the podcast notes so that folks that are tuning in or if they're watching on YouTube because you know you're showing us some fun stuff on visual they'll have the option to either listen to this anywhere we have podcasts and also on YouTube. 40:46 But, on that note, if you feel that this podcast episode with Dr Claire Staggs inspiring you anyway, touches you anyway, if you know anyone who might be confronted with any of these upsets whether it's sleep apnea, whether it is TMJ or any kind of upset that you might be dealing with, the dental side of your life, or even breathing this is something you can pass along to somebody, share it, let them have the knowledge and make a decision where they want to go next, because we definitely are sharing some really good information here and I really appreciate it. 41:18 Dr Sags, I know we're talking a lot about my upset, but I know there are other people out there that are dealing with the sleep issues, the sleep apnea, the breathing, the grinding, the bruxing, and wanting to change the holistic approach to dentistry. You're just a normal person, sweetie. I'm just like everybody else. I know I am, and it's one of the reasons why I do this show, because many of the things that I'm facing or have seen with clients is something I want to talk about so that I can make this a vessel for others to get answers or at least find something that they could take away from this and hopefully make a choice that helps them become a happy and healthy grownup, you know. 42:03 - Dr. Claire Stagg (Guest) So let's talk about the book. This book was written. It's taken me 10 years to get it out here. All right, this book was written for the average lay person. It's a conversation from one mom to all the other moms who have asked me questions. 42:21 All these years I've been practicing. I graduated in 1982. So I've been at this for a long time. I came to this country in 87. So I was not of American training per se, so I have had different training. I'm also very outside the box thinker and I like to ask why? So why do you want me to do it this way? Give me a reason why I should do it that way. 42:47 So the whole idea was to understand that, yes, why are these patients getting better? Why is there cacophony? Why is there not harmony? Why do they have all these issues all the time that they haven't had resolution for and that I have not been able to finger point. That's when I went down my training what's going on? What's going on, what's going on. 43:10 So the book's goal is to go ahead and to change the demand. Because my what? To educate the demand, if you will, because the more people are educated in this is the more they'll understand what's actually going on. It's for you to be your own advocate in your own choices. Just like Hilary at 15 did not know any better or any know what to do or not not to do, her mom or parents didn't know, because they followed their, the advice of their physicians, which is okay, don't get me wrong. You know, but why don't you find out? If you go ahead and you're playing a game of poker, wouldn't it be nice to know your hand instead of playing blind? You know what I mean. 43:58 So this, this book, has the entire deck in it. This is what I'm trying to say. It's written with you for everything, everything that Hilary and I have talked about, and I think one if you have the book, you will see anything about airway, you'll see about joints, you'll see about teeth, you'll see about muscles, you'll see about nerves, how it used to be, how it is and what the connections are structural, chemical, mechanical, functional, emotional, spiritual, because we're all one. And then in the future, where I think dentistry should and could be. But I think and I know that if we change the demand, the supply will have to change, because the more the moms and the dads and all of us understand how this is connected. They're going to have to teach doctors how to connect the dots too. So that was the goal of this book is to change the way dentistry is perceived and experienced in the world and then change the world for a healthier, better place people to be healthy so they don't have to suffer like a Hilary. 45:04 - Hilary Russo (Host) Yeah, I so needed. I wish my parents had this back in the 80s when I had this surgery, even though it was different back then. We've progressed, we've gotten better, we're more knowledgeable, we have more tools available to us and science and approaches, but it's here now and if my what is the saying? Someday your story can be somebody else's survival guide. I use that one a lot. I know that's Brene Brown. 45:26 - Dr. Claire Stagg (Guest) That's a good one, yeah. 45:27 - Hilary Russo (Host) Yeah, and I'm hoping that this next stage of my own journey is much less invasive and more productive. It's finding ways. So having conversations with doctors like yourself, people who practice more of a holistic and whole body approach and aren't really running right to surgeries and appliances and everything that might not be the best plan, you know. It's constructing the plan building the house and realizing what size garage is really going to fit and what kind of cars do you have for that garage. 46:03 - Dr. Claire Stagg (Guest) Right, because there's different appliances too, so there's different arrows in your quiver, because you want to shoot for the bullseye every time, right, and that's that's where I did all that additional training. It's like, okay, okay, so we have a joint issue. Well, well, let's deal with a joint, but then you can't disconnect the tongue and the space that the tongue holds. And then, okay, so now I do tie releases. So, and not everybody's going to practice the way that I practice this. 46:33 This is my passion, though, and you talked about your survival journey. My daughter fell and hit her chin when she was three and a half, and that's where she hit her chin, which automatically put her jaw joints up and back, got her disc displaced. So here I am searching for answers back in 2003, 2004. And that's where I ended up. So, yes, I was doing the chemical aspect, where we were mercury free, we were doing all the nutrition, everything. But then it's like, how do I fix my child, how do I get her to not be in pain too? And so that's where it's like, okay, let's do this, let's figure out how we can make this happen. And so that was my journey to go ahead and to put that together for all the other parents who would have these questions. 47:22 - Hilary Russo (Host) Yeah, and interestingly enough, here you are, a dentist, being confronted with something that you think, oh, I have the answers because I'm a dentist At least it happened to a dentist's daughter and you're looking for the approaches that are going to help her heal and live her best life the best way possible. 47:39 - Dr. Claire Stagg (Guest) So you know, it makes me laugh too. I guess I'm getting very spicy today. I like spicy, dr Staggs Very spicy. So I remember I had this 83,. He's 90-something now, but he was clearly apneic. I mean his lips were blue, all right, his he had no airway, really, really bad. And so I told, I told him you know why don't you do a sleep screening? No, no, no, my doctor blah, blah, blah. So I went ahead and I said okay, ask your doctor to go ahead and send you to lab and have a sleep test. So he goes ahead and he tells his physician that and his physician says what does she know? She's just a dentist, yeah. 48:29 - Hilary Russo (Host) Aye, aye, aye, aye, aye. I wish we could all just get along and work together. So anyhow, that's my two cents again. 48:38 - Dr. Claire Stagg (Guest) So don't read a book by its cover and look for somebody who understands how it's all connected and there's going to be more of us. There are more of us, it's just you don't know where to find them. 48:49 - Hilary Russo (Host) So what I want to do real quick in closing, I usually do a game with all of my guests, and what I've been doing is I pull you're going to have a little fun and what I've been doing is I pull you're going to have a little fun. This is what we do here. Not everything's so serious. I'm going to throw out a word, something you said today, and I want you to come back with the first word that comes to mind. Just a quick word association game. 49:08 I already want to say happy. Say happy as much as you want. But if I say the word holistic, what's the first word that comes to mind? Body, jaw, oh God, pain, palate, growth, airway, life, dentist, happy. 49:28 - Dr. Claire Stagg (Guest) Smile, beautiful Happy. 49:30 - Hilary Russo (Host) Beautiful. Love that. I love that you focus on the word happy. Just be your own healthcare advocate. You know we don't, we don't have to throw out a name. There are a number of things out there that are good and there are a number of things out there that are not so good, and you have to be your own healthcare advocate to make that choice. 49:47 - Dr. Claire Stagg (Guest) And things can work different strokes for different folks. I mean it could be the best thing, anything could be the best thing for anybody. It's just that sometimes, when you don't know any different, you wish that had you known, had I known. Had I known, had I known I wouldn't have done it this way that's kind of where I am. 50:06 - Hilary Russo (Host) I wish I knew at 15. So I'm hoping that what you shared, I know we'll have more conversations because I'm on a route where I'm going to be looking for approaches uh, because unfortunately we're not in the same area, but that doesn't mean I wouldn't hop a flight to come down to Florida, by the way, no, you still can. I can, I can, but I'm gonna. I know you have a tight schedule, a lot of people to talk to, everybody is. You're in high demand, dr Stagg, and for good reason, and I'm just so grateful to have you here. 50:35 - Dr. Claire Stagg (Guest) I am eternally grateful to you interviewers, because you have platforms that you can spread the word to the world, because you're the ones, basically, that are going to change. I'm just, I'm just flotsam on the ripple of the of the thing you know. I'm just like, hey, go this way, go this way, go this way. 50:55 - Hilary Russo (Host) We're all in it together as you said, it's all connected, we're all connected. So if we can do anything to help others, that's what we're here for and I'm just so grateful for you. Thank you so much. Thank you too. 51:06 - Dr. Claire Stagg (Guest) And thank you for having me. And so, on a one little note, I was like this is my last little saying in the book, which has lots of little life lessons. My one is that you're not a drop in the ocean, you're the entire ocean in a drop. So blessings, Hilhillary, I love you. Thank you so much. 51:24 - Hilary Russo (Host) I love you too. Thank you for being part of the ripple. 51:28 - Dr. Claire Stagg (Guest) Thank you. 51:29 - Hilary Russo (Host) I know we unpacked a lot, I know there's a lot going on here with Dr Stagg, but for good reason and we are not done. Next, I want you to grab a copy of Dr Stagg's book Smile it's all connected whole health through balance, plus her children's book that she has Captain IFBI, as well as her checklist to download for daily dental protocol. All of this is in the podcast notes and, if anything resonated with you that we shared here on the show, if you were touched, moved and inspired by our conversation, if you have more questions, dr Stagg is actually holding a Q&A online on Wednesday, july 17th, at 7 pm Eastern time. It's a really great chance to connect with her again, maybe follow up on some of the things we talked about, or if you have your own questions, and get to the root of your dental journey no pun intended with that one and you can get some more knowledge, because knowledge is power. Right, what gets measured gets managed. So be your own healthcare advocate. 52:30 First, and you know I share a lot about my havening journey, how it has been a big part of my chronic pain. My TMJ and I want to offer you the opportunity to try Havening and see if it works for you. This is a really wonderful way to overcome fears. If you have a fear of going to the dentist or the doctor or even managing chronic pain, or maybe you just wanted to self-soothe, to self-regulate, for daily self-care, it's a wonderful tool to put in your toolbox and I'd be happy to have a conversation with you and see if it's right for you. A link to connect with me is also in the podcast notes. 53:07 HIListically Speaking is edited by 2MarketMedia with music by Lipo Redding, and I know you tune in week after week because you want answers, you want to find ways to be a happy and healthy grownup, and I'm here for you and I just want you to know that those traumas that you're turning into triumphs, they're happening, they're in motion and I am proud of you. I believe in you, I love you and I will see you soon. Be well.
Ever wondered if you can reshape your palate as an adult? Prepare to challenge what you thought you knew about orthodontic treatment as we unlock the truth about adult palatal expansion and the transformative MARPE device. You'll learn about the pioneering work of Dr. Moon and the evolution of expansion appliances, and hear firsthand accounts of how cutting-edge techniques have improved outcomes dramatically. Plus, get answers to burning questions about the latest advancements and less invasive methods in orthodontics.In this eye-opening episode, we explore the MARPE procedure's potential for children under 10 dealing with craniofacial issues often stemming from habits like thumb sucking. Discover how early palate expansion can significantly impact not just dental health but also tongue placement and overall facial structure. Learn practical tips on how to measure the palate accurately and the benefits of addressing these issues early to avoid complex treatments down the line. We also dive into the role of intrusion techniques for managing high palates and gummy smiles, ensuring you have a comprehensive understanding of these vital procedures.Lastly, we tackle the complexities of orthodontic jaw surgery and the preparatory role of MARPE. From reducing the invasiveness of double jaw surgeries to addressing sleep apnea holistically, this episode provides a thorough guide to navigating these intricate treatments. You'll get insights into the costs and additional treatments associated with MARPE, along with personal experiences and professional recommendations to help you make informed decisions. Don't miss our deep dive into dental expansion options, swallowing issues, and the crucial role of myofunctional therapy and sleep studies in enhancing oral and airway health. _________________________________________________________________________________ABOUT OUR HOST: Renata Nehme RDH, BSDH, COM® has been a Registered Dental Hygienist since 2010. In 2016, when she was introduced to the world of "Myofunctional Therapy" she immediately knew that was her calling, especially when she learned that it encapsulated many of her passions- breastfeeding, the import of early childhood development, and airway health. In 2021 Renata founded Airway Circle with the intention of creating a collaborative and multidisciplinary group of like-minded health professionals who share the same passion for learning and giving in the dental health and airway space. Myo Moves - Become a Patient: www.myo-moves.com Airway Circle - Become a Member: www.airwaycircle.com
Traditional orthodontics has primarily focused on aligning teeth, often overlooking the broader impact on facial and airway development.But this is quickly changing, with more and more orthodontists embracing their rightful roles as gatekeepers for sleep-disordered breathing.In this episode, I am joined by Dr. Ilya Lipkin as we peel back the layers on why traditional orthodontic techniques are due for an update, especially when it comes to treating adult patients.Dr. Lipkin has developed groundbreaking methods for palatal expansion in adults. His approach is less invasive and more patient-friendly, aimed at improving both dental aesthetics and airway health.It's not just about straightening teeth; it's about breathing better, sleeping better, and ultimately living better.Stay tuned and learn more from this pioneer, great clinician, and innovator. Key TakeawaysIntro (00:00)Meet Dr. Ilya Lipkin (00:47)Innovative approaches to adult palatal expansion (04:03)The connection between orthodontics and airway health (07:15)Palate Expansion vs. tonsils and adenoids removal for airway health (14:09)Educating the medical community on airway orthodontics (14:53)Customizing orthodontic treatments based on patient factors (18:46)Dr. Lipkin's palatal expansion techniques and protocols (26:01)Why you should take Dr. Lipkin's course (39:56)Additional Resources - Text Dr. Ilya Lipkin: at 201-394-8162 for more information about his course----- Register for the OrthoPreneurs Summit at Sea (2024): https://opsummit2024.com/- For more information, visit: https://orthopreneurs.com/- Join our FREE Facebook group here: https://www.facebook.com/groups/OrthoPreneurs
Visit www.drstevenlin.com for this episode and moreNarrow palates occur partly due to low tongue posture.The role of the tongue during childhood development guides the growth of the adult palate.As kids' teeth develop it's the action of the tongue to seal upwards into the palate and not forward towards the teeth to allow proper dental development.Myofunctional therapy evaluation includes the assessment of the posture and function of the tongue.When children have low tongue posture, they may also have a small, narrow palate. Other factors can include aSmall, narrow dental arches increase the risk of breathing and sleep disorders. If you have a narrow palate as an adult, addressing tongue posture may help improve your risks of breathing issues.Dental practitioners all over the world are beginning to diagnose and treat issues associated with narrow palates and low tongue postures.This week I'll be joined by Dr. Yue Weng Chue, TEDx speaker and creator of the LinguaStik, a method to diagnose oral restrictions that may interfere with dental arch formation.We discuss the details of myofunctional therapy assessment and correcting tongue posture wide palatal development.
¡Sumérgete en el fascinante mundo de la química sostenible en nuestro último episodio de Cuestión de Química, en el que descubrirás cómo las resinas Palatal, desarrolladas en BASF Chile, no solo protegen superficies, ¡sino que también contribuyen al planeta sin comprometer la utilidad para nuestros clientes!
Welcome to Jaw Talk with Dr. Tiffany. In this episode, our guest is Dr. Shereen Lim, a distinguished dentist based in Perth, Australia, with extensive expertise in dental sleep medicine. Dr. Lim holds a postgraduate diploma in dental sleep medicine from the University of Western Australia and has dedicated over a decade to managing snoring and obstructive sleep apnea.Dr. Lim is a passionate advocate for promoting airway health from infancy, offering an innovative approach to minimize the development of airway-related issues. She is also the author of the insightful book, “Breathe, Sleep, Thrive: Discover How Airway Health Can Unlock Your Child's Greater Health, Learning, and Potential.” In her private practice, Dr. Lim specializes in tongue tie management from infancy to adulthood, early interceptive orthodontics, and myofunctional therapy.Join us in this engaging conversation as Dr. Lim shares her journey into airway dentistry, her insights into treating young patients, and her experience in helping individuals unlock their full potential through improved airway health. Whether you're a dental professional or simply curious about the impact of airway health, this episode promises valuable insights and expert advice.We talk about:[0:00] Intro[02:52] Journey into airway dentistry[05:18] Training and post-graduate education[07:14] Treating young patients[09:18] Comprehensive intake[10:25] Sleep screening for young children[13:41] Palatal expansion and nasal breathing[16:37] Primary first molar norms[19:12] Imaging in Dr. Lim's practice[20:37] Palate expansion relapse[23:21] Dr. Lim's team [24:38] Dr. Lim's favorite workhorse[26:53] ‘Now What' TMJ treatment scenario[32:03] Becoming an author[34:15] Advice to general dentists[35:55] What Dr. Lim is excited aboutResources mentioned:Book: https://www.drshereenlim.com.au/book/Connect with Dr. Lim here:https://www.drshereenlim.com.au/https://linktr.ee/drshereenlimConnect with Tiffany here:Courses: https://www.tmdcollective.online/https://www.tmdcollective.comhttps://www.instagram.com/tmd.collective/Patreon: https://www.patreon.com/tmdcollectiveSupport the show
We have been told most of our hygiene lives that palatal expansion is just for kids... Well on the episode today we have Renata Nehme, RDH who is very much an adult who decided to fix her malocclusion through the use of a palatal expander. It took 6 screws and vigilant turning but the results are in. Be sure to listen to how not only her maxilla changed but several other facial features! Links:You can check out Renata's work on Instagram - @myomoves or on Facebook and Instagram - @airwaycircle
We have been told most of our hygiene lives that palatal expansion is just for kids... Well on the episode today we have Renata Nehme, RDH who is very much an adult who decided to fix her malocclusion through the use of a palatal expander. It took 6 screws and vigilant turning but the results are in. Be sure to listen to how not only her maxilla changed but several other facial features! Links:You can check out Renata's work on Instagram - @myomoves or on Facebook and Instagram - @airwaycircle
Join Hallie and her adorable 5-year-old daughter, Mia, as they delve into Mia's remarkable airway journey on this week's episode of The Untethered Podcast.As early as 5 days old, Mia had a tongue and lip tie release to help with breastfeeding. She later had rapid palatal expansion which she shares on this episode. In this fun and informative episode, Hallie and Mia emphasize the significance of maintaining airway health by sleeping with a closed mouth and nasal breathing. Mia also re-learns where our tongue should be at rest! If this episode has resonated with you in some way, take a screenshot of you listening, post it to your Instagram Stories, and tag @halliebulkinIn this episode, you'll hear:Mia's Airway Journey: Spacers, Planas Tracks, Rapid Palatal Expander, and Temporary Fixed RetainerRapid Palatal Expansion to Aid in Airway Expansion in ChildrenNasal RinsingNasal Hygiene Tips for Good Airway Health explained by a 5-year-oldFor more episodes visit www.untetheredpodcast.com Hosted on Acast. See acast.com/privacy for more information.
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Zach and Kevin are joined by Dr. Brian McGue for more hot "Myths and Tips" talk! Brian's myth: The posterior palatal seal! Brian's tip: contour adjacent contacts for molar crowns and especially implant crowns (use a fine cylinder diamond) If you want to interact with us, head over to the Very Clinical Facebook Group! Join the Very Dental Facebook group using the password "Timmerman," Hornbrook," McWethy" or "Lipscomb." The Very Dental Podcast network is and will remain free to download. If you'd like to support the shows you love at Very Dental then show a little love to the people that support us! -- Crazy Dental has everything you need from cotton rolls to equipment and everything in between and the best prices you'll find anywhere! If you head over to verydentalpodcast.com/crazy and use coupon code “verydental10” you'll get another 10% off your order! Go save yourself some money and support the show all at the same time! -- The Wonderist Agency is basically a one stop shop for marketing your practice and your brand. From logo redesign to a full service marketing plan, the folks at Wonderist have you covered! Go check them out at verydentalpodcast.com/wonderist! -- Enova Illumination makes the very best in loupes and headlights, including their new ergonomic angled prism loupes! They also distribute loupe mounted cameras and even the amazing line of Zumax microscopes! If you want to help out the podcast while upping your magnification and headlight game, you need to head over to verydentalpodcast.com/enova to see their whole line of products! CAD-Ray offers the best service on a wide variety of digital scanners, printers, mills and even their very own browser based design software, Clinux! CAD-Ray has been a huge supporter of the Very Dental Podcast Network and I can tell you that you'll get no better service on everything digital dentistry than the folks from CAD-Ray. Go check them out at verydentalpodcast.com/CADRay!
Hallie answers a common question: "Can we continue orofacial myofunctional therapy ("myo") when a patient has a palatal expander?" Join Hallie to find out the answer! Do you have questions you want Hallie to address? Send her a message on Instagram @halliebulkin! Enjoy this short and sweet but info packed episode!Please click here to download the show notes.For more episodes visit www.untetheredpodcast.com Hosted on Acast. See acast.com/privacy for more information.
When the jaw is too narrow, your doctor or dental professional may suggest a palatal or maxillary expansion. This widens the jaw to make room for teeth in younger patients, to correct or improve the way the upper and lower jaws work together, and improve breathing. It can also broaden your smile.Maxillary Expansion in AdultsTwo types of palatal maxillary expansion techniques are generally used in adults: the MSE Expander non-surgical device (best for ages 17-35) and surgically-assisted maxillary expansion (SAME). MSE Expander: With the non-surgical expander, a fixed orthodontic appliance is attached to the back molars, crossing over the upper arch. It applies a gentle force to push against the teeth and expand the palate and the jaw.SAME: Because the bones are already developed in an older patient, SAME is used when appliance expanders are unable to do the job on their own, or for moderate or severe cases. In this instance, the doctors makes small cuts along the jaw to create symmetrical segments that can be broadened or adjusted over time.SAME is both safe and effective, and performed under general anesthetic. Following surgery and recovery, the treatment can take several months to a year to achieve the desired result, with incremental adjustments to expand the palate. Some minor discomfort may occur in the first few days as your body adjusts to the expansion pressure. You may even see spaces appearing between your front teeth over time as the bones separate. Once the expansion is complete, orthodontic treatments can close the gaps between your teeth. Good stability is expected in the long term, with no significant relapse.Why Would I Need Palatal Maxillary Expansion?At Airway & Sleep Group, we are most concerned with your ability to breathe and sleep properly. The palatal maxillary expansion procedure is often used to resolve issues related to obstructive sleep apnea (OSA) or temporomandibular joint dysfunction (TMD), or to open airways and the nasal cavity to improve breathing. Other reasons for its use can include modifications for crooked or crowded teeth, or a crossbite.A narrow bone structure in the face could be causing OSA or TMD. We may suggest a sleep study to study the amount of air flow during sleep, and how much carbon dioxide is in the blood. We'll also monitor for sleep interruptions and things like brain activity and heart rate. If we discover that poorly-aligned teeth or a small jaw are the cause, we may recommend a maxillary expansion to solve breathing issues.Sleep Apnea and Adult Palatal Maxillary Expansion at Airway & Sleep GroupAt Airway & Sleep Group, we help improve sleep-disordered breathing issues through a number of treatment techniques, including adult palatal maxillary expansion. If you are suffering from sleep apnea, come talk to us.Airway & Sleep Group is conveniently located in Reston, Virginia to serve patients throughout Northern Virginia and the Washington D.C. metropolitan region. Contact us to schedule an appointment at 571-244-7329, or use our convenient online form.
Is your nose stuffy all the time? Are you a chronic mouth-breather? Did you already try various methods including over-the-counter pills, sprays, or even nasal saline? Maybe some of the simple tips or hacks you found online worked, but only for a few minutes. In this video, I'll reveal 7 ways you can breathe much better through your nose for much longer periods of time and long-lasting results. For your complete guide on how to clear your stuffy nose for good, read my e-book on How to Unstuff Your Stuffy Nose: Breathe Better, Lose weight, Sleep Great. ✅ Video Chapters (download transcript PDF) 00:00 Introduction 01:13 #1. Nostril dilating devices 03:29 #2. Nasal decongestants (pills & sprays) 05:28 Why you have a deviated nasal septum 07:58 #3. Septoplasty 09:49 #4. Turbinate procedures 11:03 My take on empty nose syndrome 13:18 #5. Nasal valve/nostril surgery 18:29 #6. Rhinoplasty 18:50 #7. Palatal expansion 20:23 Why you can't sleep well even if you're breathing well through your nose ✅ Links Mentioned in Video How to Unstuff Your Stuffy Nose E-book Sleep, Interrupted: A Physician Reveals The #1 Reason Why So Many Of Us Are Sick And Tired Conservative ways to unclog your nose https://youtu.be/uEK5Ydb97js https://youtu.be/BpPLISVMb50 Generic nasal strips on Amazon Mute nasal dilators Nozovent nasal dilators AIRMAX nasal dilators Tape Your Mouth? video ✅ Dr. Park's Products and Services How you can lose weight naturally without cardio or counting calories. Dr. Park's The 90-Day Sleep Diet course Want to un-stuff your stuffy nose? Read the e-book, How to Un-stuff Your Stuffy Nose: Breathe Better, Lose Weight, Sleep Great (PDF) Your Health Transformation Workbook: Refresh, Restore, & Rejuvenate Your Life (online format) Want to have more energy, sleep better, have less pain, and enjoy living again? Reserve a Virtual Coaching session today with Dr. Park ✅ Connect with Dr. Park DoctorStevenPark.com doctorpark@doctorstevenpark.com For inquiries about interviews or presentations, please contact Dr. Park through his website at doctorstevenpark.com. ✅ Disclaimer This video is for general educational and informational purposes only. It is not to be taken as a substitute for professional medical advice, diagnosis, or treatment. Please consult with your doctor first before making any changes to your health, exercise, nutrition, or dietary regimen. Certain product links above will take you to Amazon.com. If you then go on to buy the product, Amazon will provide me with a small commission, which will not cost you anything.
Maxillary transverse deficiency is a highly prevalent malocclusion present in all age groups, from primary to permanent dentition. If not treated on time, it can aggravate and evolve to a more complex malocclusion, hindering facial growth and development. Aside from the occlusal consequences, the deficiency can bring about serious respiratory problems as well, due to the consequent nasal constriction usually associated. In growing patients, this condition can be easily handled with a conventional rapid palatal expansion. However, mature patients are frequently subjected to a more invasive procedure, the surgically-assisted rapid palatal expansion (SARPE). More recently, researches have demonstrated that it is possible to expand the maxilla in grown patients without performing osteotomies, but using microimplants anchorage instead. This novel technique is called microimplant-assisted rapid palatal expansion (MARPE).The study, made to demonstrate and discuss a MARPE technique developed by Dr. Won Moon and colleagues at University of California – Los Angeles (UCLA) concluded that the demonstrated technique could be an interesting alternative to SARPE in the majority of non-growing patients with maxillary transverse deficiency. The present patient showed important occlusal and respiratory benefits following the procedure, without requiring any surgical intervention.Read the study here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5398849/Airway and Sleep Group utilizes the principles of rapid palatal expansion to improve airway and combat sleep apnea by creating ample room for the tongue through craniofacial orthopedics. Call 571-244-7329 for more information.
James Nestor (@mrjamesnestor) has written for Outside, Scientific American, The Atlantic, Dwell, The New York Times, and many other publications. His latest book, Breath: The New Science of a Lost Art, was an instant New York Times bestseller. James has appeared on dozens of national television shows, including ABC's Nightline and CBS's Morning News, and on NPR. In this episode, we discuss: How James became fascinated with the subject of breath and breathing What James learned from studying free divers The 10-day mouth breathing experiment Why it's advantageous to breathe through your nose The difference between mouth vs. nose breathing During allergy season snoring & sleep apnea goes up Mouth breathing can affect the development of your face Breastfed babies will be less apt to snoring, sleep apnea & crooked teeth The problem with braces Palatal expansion is the new wave of orthodontics Practices to make nose breathing an unconscious habit You can change the size of your mouth Our environment impacts our breathing Overbreathing can make you more apt to have osteoporosis Why balancing carbon dioxide in your system is important What is hypoventilation training? Carbon dioxide training is an effective therapy for anxiety The benefits of mouth taping CPAPs are doing nothing to help the root cause of sleep apnea Myofunctional therapy trains people to have proper oral posture Why you should use a neti pot Hacks for better breathing Tummo is similar to the Wim Hof Method The breathing technique called the “physiological sigh” 5.5 breaths per minute Take control of your breath anytime of the day Holotropic breathing brings up subconscious thoughts Keep breathing... make it calm, light, slow and deep Show sponsors: Organifi
Palatal is the name given to sounds that come when the body of the tongue is raised against the hard palate (the middle part of the roof of the mouth). Yes From BBC presentation trainer Peter Stewart (@TweeterStewart), GET A BETTER BROADCAST, PODCAST AND VIDEO VOICE is a short, daily guide to help you become a stronger voice communicator on radio and TV, podcasts, video, voiceovers and webinars.It's the audio version of the book Peter's writing of the same name, both focusing exclusively on your vocal image on audio and video channels with two main aims:· To get you a better voice for audio and video channels.· To show you how to read out loud confidently, convincingly and conversationally.Through these under-5-minute episodes, you can build your confidence and competence with advice on breathing and reading, inflection and projection, the roles played by better scripting and better sitting, mic techniques and voice care tips... with exercises and anecdotes from a career spent in TV and radio studios.And as themes develop over the weeks (that is, they are not random topics day-by-day), this is a free, course to help you GET A BETTER BROADCAST, PODCAST AND VIDEO VOICE.Look out for more details of the book during 2021.Contacts: https://linktr.ee/Peter_Stewart Peter has been around voice and audio all his working life and has trained hundreds of broadcasters in all styles of radio from pop music stations such as Capital FM and BBC Radio 1 to Heart FM, the classical music station BBC Radio 3 and regional BBC stations. He’s trained news presenters on regional TV, the BBC News Channel and on flagship programmes such as the BBC’s Panorama. Other trainees have been music presenters, breakfast show hosts, travel news presenters and voice-over artists.He has written a number of books on audio and video presentation and production (“Essential Radio Journalism”, “JournoLists”, two editions of “Essential Radio Skills” and three editions of “Broadcast Journalism”) and has written on voice and presentation skills in the BBC’s in-house newspaper “Ariel”.Peter has presented hundreds of radio shows (you may have heard him on BBC Radio 2, BBC Radio 4, Virgin Radio or Kiss, as well as BBC regional radio) with formats as diverse as music-presentation, interview shows, ‘special’ programmes for elections and budgets, live outside broadcasts and commentaries and even the occasional sports, gardening and dedication programmes. He has read several thousand news bulletins, and hosted nearly 2,000 podcast episodes, and is a vocal image consultant advising in all aspects of voice and speech training for presenters on radio and TV, podcasts and YouTube, voiceovers and videocalls. See acast.com/privacy for privacy and opt-out information.
Keeping the upper airway open Breathing while you sleep….it's kind of a big deal. So much so that things like a CPAP exist to save lives, open the airway, and get your body the oxygen it needs to survive. But is this the best option? What happens if you have a septal deviation? Are there any measures we can take to improve airway patency while we sleep, and even train!? To better understand what our options are, we have to look at what a CPAP actually does, and we need to have our bodies be able to do in its place if it's something we want to cease using. So too with nasal breathing. What are the components needed to breathe effectively through our noses? You'll get to find all this out today in this debrief. Check out Movement Debrief Episode 144 to learn more! Watch the video here for your viewing pleasure. If you want to watch these live, add me on Instagram. t Show notes Check out Human Matrix promo video here. Here are some testimonials for the class. Want to sign up? Click on the following locations below: February 20th-21st, 2021, Atlanta, GA (Early bird ends January 31st at 11:55 pm!) April 10th-11th, 2021, Warren, OH (Early bird ends March 14th at 11:55 pm) May 29th-30th, 2021 Boston, MA (Early bird ends April 25th at 11:55 pm!) August 14th-15th, 2021, Ann Arbor, MI (Early bird ends July 18th at 11:55 pm!) September 25th-26th, 2021, Wyckoff, NJ (Early bird ends August 22nd at 11:55 pm) November 6th-7th, 2021, Charlotte, NC (Early bird ends October 3rd at 11:55 pm) Dickinson College in Carlisle PA (POSTPONED DUE TO COVID-19) [Approved for 14 Category A CEUs for athletic trainers] Montreal, Canada (POSTPONED DUE TO COVID-19) [6 CEUs approved for Athletic Therapists by CATA!] Or check out this little teaser for Human Matrix home study. Best part is if you attend the live course you'll get this bad boy for free! (Release date not known yet :( Here's a signup for my newsletter to get nearly 5 hours and 50 pages of content, access to my free breathing and body mechanics course, a free acute:chronic workload calculator, basketball conditioning program, podcasts, and weekend learning goodies. Introduction to Orofacial Myofunctional Therapy Course Review - If you want to dive into myofunctional therapy and tongue posture, this is the post for you. If you want to peep some exercises for your tongue, check out the playlist here. Orthodontic elastics - These are great cueing devices for tongue placement Nasal saline rinse - Clean your nostrils with this one. CPAP Question: My question for you has to do with the CPAP machine and why it could be bad? I know it's a steady flow of air that can affect the pressure in the ribcage, but can you explain this further? Would an APAP machine that does not have a constant flow of air be better? Or are there still risks? Watch the answer here. Answer: CPAP and APAP are devices that alter the pressure of the air you breathe in, which helps prevent the airway from collapsing while you sleep. Normally, we breathe through negative pressure. This means that as we breathe in, the diaphragm pulls downward, which creates a force that makes the airway and surrounding structures want to collapse inward. Fortunately, air getting pulled in the lungs helps maintain the shape, and life is good. But what happens if this negative pressure is so great that the airway collapses too far and you do not get adequate airflow? Well, now you aren't getting enough oxygen, which causes major problems. Like uh....death. A way to "fix" this is through positive airway pressure, which essentially has the reverse effect of negative pressure—creating expansion. Now I have a situation where I still create negative pressure from the diaphragm, but I change the pressurization of air coming into my body in a manner that allows the airway to fill. Life is good. There are three categories of devices you could go with to utilize this mechanism: Continuous (CPAP): Blows a constant stream of air in under a single set of pressure Automatic (APAP): Samples your breathing and determines what pressure you need to be at Bi-level (BiPAP): The pressure changes depending on the breath cycle. These devices are essential and life-saving for someone who has sleep apnea. This is especially true for central sleep apnea, where the brain causes the apneic events to occur. These devices can also mitigate many of the symptoms felt from sleep deprivation. So if you are someone with apnea, you most likely want to get one of these devices ASAP. In terms of which device you choose, the BiPAP will most likely make a full respiratory cycle occur more easily, but it's also more expensive. Your best bet is to coordinate with your sleep doc. Now before you read onward, let me be clear: PSA - Do not perform the following recommendations without consulting a physician first. This is not medical advice and is for entertainment purposes only. There are a few issues with using these devices as a treatment: Compliance is SUPER low. 50% of users after 1 year will stop. Several side effects can happen such as dry throat, difficulty falling asleep, etc. The device may not be fixing the problem if sleep apnea is obstructive and not central. What I mean by point number 3 is that the problem of sleep apnea has to do with the airway collapsing at some location. The machine does not fix the structural collapse but creates an artificial breathing environment; acting like a stent for your airway. Stents open up the pipe, but don't fix the underlying issue. This could be why CPAPs do NOT have cardioprotective effects. You could still have many of the following issues: Restricted nasal airway Low resting tongue posture, whcih collapses the pharyngeal wall during sleep Low soft palate posture restricted airway size Limited cervical dynamics Limited thorax dynamics All of these factors could limit your ability to breathe effectively during sleep and life. I think they need to be addressed to really "fix" the problem. [caption id="attachment_13405" align="aligncenter" width="386"] Make that airway dynamic AF, fam![/caption] Consider if you cannot adequately breathe through your nose for whatever reason. You will not get nitric oxide production needed to dilate blood vessels, which has several cardioprotective effects by reducing blood pressure and such. The key is to restore this mechanism. How would you do that? That I cannot answer, as each individual's needs will be unique. You need data, imaging, and a physical examination to make decisions. Pursuing upper airway restoration involves working under a skilled physician (Dentist, sleep doctor, ENT). Treatments could include the following: Surgeries to impact airway at any level (maxillomandibular advancement, septoplasty or other nasal surgeries, surgical palate expansion, tongue-tie release, etc) Oral appliance and airway orthodontics Myofunctional therapy and physical therapy Maximizing sleep environment Eating foods that support a healthy sleep environment Whatever you need, please consult a physician skilled in this domain, but I do think going this route is essential for improving upper airway dynamics, and subsequently sleep. If you want to check out some of the stuff I've tried, you can see them below: Maxillary expansion Tongue-tie release and septoplasty Wisdom teeth extraction Oral appliance Deviated septum Question: When dealing with a client with a deviated septum, that is a constant mouth breather. What is the best route to take with them in order for them to improve their breathing during training? Would the tongue drill help? Are there other drills? Watch the debrief here. Answer: The best route to "fix" a deviated septum would be consulting a practitioner who specializes in the upper airway. What will likely need to happen is some changes in mouth structure and position to improve the floor of the nose (aka roof of the mouth) and potentially a surgical procedure to correct the deviation pending the degree. There are likely no conservative measures that can alter a septal deviation, this is a structural issue. That said, many folks can still nasal breathe well despite this structural issue. In fact, I know someone right now who has an 80% blockage in one nostril who nasal breathes like a boss! Just like you can have osteoarthritis without pain and a high level of function, so too can you have a structural problem in your nose but still breathe well. The key is to have all the pieces in places needed to ensure a nasal breathing environment: Palatal tongue posture Ability to breathe through your nose Carbon dioxide tolerance Let's dive into each! Palatal tongue posture A palatal tongue posture is the ability to place your entire tongue on the roof of your mouth and keep it there. Notice how the tongue is right up against the roof of the mouth (photo credit: Sémhur)The ability to get into this position requires adequate mobility and knowing how to get into position. If you want some good exercises to enhance tongue mobility, check out this post and my Youtube playlist here. If you want to better improve tongue placement, utilizing orthodontic elastics on your mouth can be a big help. Basically, you can put the elastics where you can't get your tongue up to as an external cue. Focus on pressing the elastic into the roof of the mouth. [caption id="attachment_13409" align="aligncenter" width="376"] Elastic on the tongue tip. A good starting point[/caption] Ability to breathe through your nose This is as it sounds. Can you breathe through your nose while keeping a palatal tongue posture? Think breathe quietly and slowly through your nose in this position. You can also use a saline rinse through your nose to keep it open and clean. [caption id="attachment_13411" align="aligncenter" width="376"] Keep ya nose clean, fam![/caption] Carbon dioxide tolerance Mouth breathing is useful for keeping blood pH in a tight window during exercise. pH is governed by carbon dioxide, so the better you can tolerate carbon dioxide, the longer you can nasal breathe. This quality can be improved by working on a controlled pause. Here are the steps to this action: Attain palatal tongue posture Exhale a normal amount through your nose Pause and do not breathe. Hold to the point of first experiencing air hunger (where you feel the need to breathe in) Breathe in lightly through your nose, and exhale again; repeating step 3. Over time, your ability to tolerate air hunger should improve, and NO ONE will mess with you. Sum up CPAPs help keep the airway open and oxygen in your body, but improving airway dynamics and structure are key to "fixing" sleep apnea Nasal breathing requires a palatal tongue posture, regular nasal breathing, and carbon dioxide tolerance Image by https://www.myupchar.com/en
Dr. Katherine Fu discusses the movement disorder, palatal tremor
I summarise Cesare's lecture looking at Class 2 subdivision cases with treatment options classification: · Type 1: Mandibular midline deviated from facial midline, Maxillary correct: 56-62% · Type 2: Maxillary midline deviated facial midline, Mandibular correct 29% Cassidy 2014 Aetiology · Type 1 subdivision: shorter mandible on affected side: Sanders 2010 Interceptive management · RME = improved mandibular asymmetry by a mandibular rotation: Evangelista 2020: Treatment: Non extraction: 1. Asymmetric Class 2 corrector / functional appliance o Type 1 case (mandibular asymmetry) o Single sided class 2 corrector, e.g. Monoscope · Address aetiology: of a shorter mandible 2. Asymmetric distalisation with modified pendulum + TAD · Type 2 case (maxillary asymmetry) · Palatal finger spring active on the 1stmolar to distalise · Pendulum appliance with occlusal rest on U4s · TADs o Placed: buccal 5-6 o Ligation: Indirectly ligated to premolars Extraction: 3. 1 premolar extraction · Type 1 and type 2 cases · Extract on the unaffected side o Distalisation, Unilaterally activated TPA o No cant Janson 2004 4. 3 premolar extractions · Type 1 (mandibular asymmetry) · 3 units: o 2 upper units to manage class 2, o 1 unit in the lower arch on unaffected side · Outcome: Coincident CL and predicable Turpin 2005 References Distalisation of intra-oral appliances + TADs da Costa Grec, R.H., Janson, G., Branco, N.C., Moura-Grec, P.G., Patel, M.P. and Henriques, J.F.C., 2013. Intraoral distalizer effects with conventional and skeletal anchorage: a meta-analysis. American Journal of Orthodontics and Dentofacial Orthopedics, 143(5), pp.602-615. Class 2 subdivision CBCT Sanders, D.A., Rigali, P.H., Neace, W.P., Uribe, F. and Nanda, R., 2010. Skeletal and dental asymmetries in Class II subdivision malocclusions using cone-beam computed tomography. American Journal of Orthodontics and Dentofacial Orthopedics, 138(5), pp.542-e1. Class 2 subdivision classification Cassidy, S.E., Jackson, S.R., Turpin, D.L., Ramsay, D.S., Spiekerman, C. and Huang, G.J., 2014. Classification and treatment of Class II subdivision malocclusions. American Journal of Orthodontics and Dentofacial Orthopedics, 145(4), pp.443-451. Extraction of 2 units Vs 1 for class 2 subdivision Janson, G., Cruz, K.S., Woodside, D.G., Metaxas, A., de Freitas, M.R. and Henriques, J.F.C., 2004. Dentoskeletal treatment changes in Class II subdivision malocclusions in submentovertex and posteroanterior radiographs. American journal of orthodontics and dentofacial orthopedics, 126(4), pp.450-462.
Summary of studies looking at expansion of aligners using invisalign First Overall conclusions · Greater expansion anteriorly · Greater predictability of expansion anteriorly Vs posteriorly · Greater predictability of expansion buccally, unpredictable palatally Summary of webinar: Invisalign European scientific symposium part 3: Expansion Arch expansion pattern using clear aligners: a three-dimensional retrospective study in paediatric subjects with posterior crossbite. Dr. Silvia Caruso WHAT'S THE QUESTION? How effective is the Invisalign system at expansion Previous papers: not predicable but change in material to smart track since WHO DID THEY TREAT? N20 Age 6-10 Mod-severe crowding WHAT DID THEY DO? Retrospective Maxillary dentition Gingival width and buccal cusp width of teeth WHAT DID THEY FIND? Buccal expansion · C-C expansion: very predicable: 99% achieved (4mm) · 1st permanent molar-molar expansion: predicable 88% achieved (3.8mm) · Primary molar expansion: least predicable buccal and palatal Palatal expansion · Primary molar expansion: unpredictable 42% achieved (1.9mm) · 1st permanent molar-molar unpredictable 38% achieved (1.4mm) CONCLUSION · Buccal expansion predictable with invisalign · Palatal expansion predictable at C-C region, unpredictable Molar regions Summary of webinar: Invisalign European scientific symposium part 3: Expansion First maxillary expansion with aligners in growing patients. Dr. Tommaso Castroflorio & Dr. Francesco Garino WHAT WAS THE QUESTION? What expansion can be achieved with Invisalign first WHO DID THEY TREAT? N = 43 Age 8 Morphological superimposition WHAT DID THEY DO? Expansion using Invisalign protocols WHAT DID THEY FIND? · C-C expansion: Greatest: 3mm + · Primary molar expansion: 3mm · Permanent molar-molar expansion: Least: 2mm · 19% area increased · 38% volume increase CONCLUSION? 1. Expansion greater anterior, less posterior 2. Increase in volume and area
Todas las notas: https://academialatin.com/curso/gramatica-historica-espanol/consonantes-palatales/ En la séptima clase del curso de gramática histórica del español estudiaremos un aspecto clave de la evolución del consonantismo del latín a las lenguas romances en general y al castellano en particular: la aparición de las consonantes palatales. Estudiamos los orígenes de estas palatales, las grafías alfonsíes para estos nuevos sonidos y, por último, el yeísmo. Este vídeo es parte del CURSO DE GRAMÁTICA HISTÓRICA DEL ESPAÑOL. Tienes todas las clases aquí: https://academialatin.com/curso/gramatica-historica-espanol/ En este curso de gramática histórica del español estudiaremos los aspectos de la gramática histórica, o lingüística histórica, del castellano o el español, desde el latín clásico hasta nuestros días, pasando por el latín vulgar, el periodo alfonsí y el Siglo de Oro. Para ello empezaremos por la fonética y la fonología históricas (parte que suele ser el núcleo o la única parte de asignaturas de Filología Hispánica), viendo la teoría y practicando la evolución de étimos latinos al español, y seguiremos con la morfosintaxis histórica.
Todas las notas: https://academialatin.com/curso/gramatica-historica-espanol/consonantes-palatales/ En la séptima clase del curso de gramática histórica del español estudiaremos un aspecto clave de la evolución del consonantismo del latín a las lenguas romances en general y al castellano en particular: la aparición de las consonantes palatales. Estudiamos los orígenes de estas palatales, las grafías alfonsíes para estos nuevos sonidos y, por último, el yeísmo. Este vídeo es parte del CURSO DE GRAMÁTICA HISTÓRICA DEL ESPAÑOL. Tienes todas las clases aquí: https://academialatin.com/curso/gramatica-historica-espanol/ En este curso de gramática histórica del español estudiaremos los aspectos de la gramática histórica, o lingüística histórica, del castellano o el español, desde el latín clásico hasta nuestros días, pasando por el latín vulgar, el periodo alfonsí y el Siglo de Oro. Para ello empezaremos por la fonética y la fonología históricas (parte que suele ser el núcleo o la única parte de asignaturas de Filología Hispánica), viendo la teoría y practicando la evolución de étimos latinos al español, y seguiremos con la morfosintaxis histórica.
John Pollock and Wai Ting review AEW Dynamite with the Eye for an Eye main event. [REVIEW STARTS AT 00:23:31] Wednesday’s show featured Jon Moxley facing off with Santana in their Eye for an Eye revenge match, Riho defending the AEW women’s title against Nyla Rose, the debut of Jeff Cobb as Chris Jericho’s assassin, Kenny Omega & Hangman Page defend the AEW tag titles against SCU, a match is added to Revolution, MJF takes on Jungle Boy, Dustin Rhodes is a hero in Austin, Texas and Britt Baker cuts an incredible promo about teeth! NEWS OF THE DAY [00:05:21] WWE Raw rating from Monday’s show in California Additional notes for Week 1 of the XFL Westminster Dog Show boosts WWE Backstage Notes from Paul Levesque’s NXT conference call on Wednesday John Cena appearing on Friday Night SmackDown later this month Ring of Honor will hold a tournament for its women’s title beginning in April Plus, our weekly Patreon t-shirt giveaway, your feedback, comments, and questions from the POST Wrestling Forum. Photo Courtesy: AEW Rewind-A-Dynamite Theme by Jacob Chesnut Subscribe: Apple Podcasts | Android | Spotify | Google Play | Stitcher | TuneIn | Mac & PC | RSS Discuss: https://forum.postwrestling.com Support us on Patreon – The POST Wrestling Café: http://www.patreon.com/POSTwrestling T-Shirts & Hats: https://store.postwrestling.com Follow: Twitter | Facebook | Instagram | YouTube
Huge palatal access arrived and let’s see what happens.
Com este OrtoCast, você ficará por dentro de todas as dicas sobre MARPE, que em inglês é uma sigla para Miniscrew-Assisted Rapid Palatal Expander, traduzido fica expansor rápido da maxila assistida por mini-implantes. Esta série de áudios traz a experiência e prática do Dr. Sérgio Cury, onde você encontrará dicas, resoluções de problemas técnicos, curiosidades, habilidades da ortodontia e muito mais! Assine o OrtoCast no site: www.sergiocury.com.br Baixe o material: https://sergiocury.com.br/ortocast-3-marpe-mini-implant-assisted-rapid-palatal-expander/
How considerations and the management plan differ in children, teenagers and adults. A podcast between orthodontist Dr Andrew Chang and pediatric dentist Dr Diane Tay that covers the issues in detail. Dr.Andrew Chang: Diane, welcome, it's nice to have you back on our podcast. Dr. Diane Tay: Hi Andrew. Very good to chat to you again. As always. Dr.Andrew Chang: Well, what we'd like to talk to our audience of dentists today and if there is any interested parents out there as well, but mainly for dentists. The topic of supernumeraries or what we call,extra teeth types. And we were going to focus on the area of the upper front maxilla, the upper front teeth region. So maybe Diane, if you could provide our audience an outline of the different classifications or types of uninterrupted supernumeraries that we're going to talk about. Dr. Diane Tay: Yeah, absolutely Andrew, thank you. And yes, you are right for the benefit of the audiences. We know there's many different types of supernumeraries they can be in different positions, different numbers. And so just to clarify to be, particularly, you know, a really interesting topic and there's so much to say about that, but we're just going to limit it to unerupted teeth and anterior maxilla, which is something really common and has an impact. And I think can be reasonably,picked out and you know, and noticed and managed early by dentists. So as we were saying, souvenir is basically it's just a type of dental normally in the numeric form in terms of the number. So there are different types of supernumeraries and generally overall we divide them into what we call supplemental tooth or supervisor supplemental tooth is where it actually has the exact same form, the exact same function as adjacency. Dr. Diane Tay: So they pretty much don't really have any difference in anatomical differences versus supernumerary. More so where is the tooth? It's characterized by an atypical anatomic form and sometimes they can be smaller or different in the anatomy, very very briefly and a very old classification. You can classify them into the more conical shape form, you can classify them as tuberculate or supplemental form. So it's just a different sort of classification depending on the roots. Obviously there's other kinds of which I won't go into, such as composite odontomes etc. But really important to look at them and also determine the position. So it's not just what type of supernumerary it is, but the position of the supernumerary. So sometimes they can be just in a normal position they could be inverted. Dr. Diane Tay: So those ones tend to, and we'll talk about them more but inverted do generally and very rarely they don't erupt by itself. So hence sometimes the management does become different. And being aware that generally these ones will not erupt. We need to decide whether we need to remove them pending other things, which Andrew and I will discuss, just to clarify for a lot of our dentists, because we hear commonly misused terms, but strictly speaking, mesiodens is a tooth that's located between the central upper incisors. So a supernumerary say, you know, how little or to the 11. So that would not necessarily classify as a mesiodens. So it means it's actually one that's located between the upper incisors. Dr. Diane Tay: But I guess most irrelevant in classifications. While important, I guess like you and I, Andrew are very interested in the clinical management. So what are some of the signs that are important to know? And I know from my point of view, I always think the picking up, sort of knowing our, again going all where I was going back to first principles, knowing our dental development, knowing when teeth erupt, when should they exfoliate, always will help us lead to picking up these things early. And again, the earlier these things are picked up, then management always becomes, easier, less complicated. So the first thing I always think about when I'm looking at a patient is this dentition appropriate for their age? And so if you notice that there's somewhat of a delay or a failure of eruption in the permanent incisors. Dr. Diane Tay: So let's say a patient is eight years old and they've lost the lower incisors, the upper incisors, there's absolutely no mobility in the central incisors. Or even if you may see asymmetrical eruption. So, for instance, you may see the 51 has exfoliated and the 61 is still absolutely no signs of mobility, clinical mobility. I would be starting to look into reasons as to why. There is a failure of exfoliation and failure of eruption, of the permanent incisors. Also of course I know is different, but maybe there's an extra tooth in the sequence so you may notice that there may be a supplemental 52. So again, counting the teeth and charting them properly. But another thing that really, is important also if you start noticing a large gap or a diastema between the two front central incisors, often times people tend to think, Oh look there, that must be caused by a labial frenum. And that may be the case. But for me, I always will check if there is, if I'm concerned, it's just taking a very, very simple radiograph and you might find something else that may be present there. I mean, Andrew id be really happy to hear from your perspective or clinical experience of what you think or is there any other clinical signs that you might Dr.Andrew Chang: I've definitely seen your two, the two most common ones that in my experience has been the large gap, between the front central incisors where one incisor has erupted and the other incisor has not formed. So I suppose this leads to the next question is what other, you did mention a periapical, but what other diagnostic age should a dentistfirst of all use to diagnose this? Dr. Diane Tay: Yeah, that's a really good question, Andrew. From my side of things, I guess coming from a surgical standpoint where I'm starting to think, okay, how am I going to manage this. This for me, first of all, it requires management, what do we need to do? We have to remove it. Can we wait? Can we watch and see? So I guess a simple thing which all of us in clinical practice can do to start with is a periapical you could, and I know a lot of us practitioners do have our own OPG machine, which you can do to get an overall view. However, the only thing I would probably suggest is to get a cone beam scan and again a lot of practitioners I know have their own cone beam machine. The benefit or the value of a cone beam x-ray, sorry, a cone beam scan is that it also acts as a surgical means to localize the tooth and guide surgery planning. Dr. Diane Tay: So from a surgical standpoint if I'm going in, it's good to know exactly where the tooth is and also relative, obviously how much with bone is overlying it where to position it, how easy to retrieve it, what the proximity to adjacent structures adjacent developing permanency. So these are all really important to decide on a really separate known because I do have a really keen interest in that other, you know, other in children, managing kids with medical comorbidities and certain syndromes. I think it's also relevant and important to just consider if you do take an X-Ray and you see multiple supernumerary that you have to stop thinking of other systemic causes such as Gardner's syndrome, or cleidocranial dysplasia. I know those things tend to exhibit other signs as well. However, it's just valuable to start thinking about things. And that was just a really side comment I thought I'd make off the top of my head. Dr.Andrew Chang: Yes, yes. All clinical clinician. And I think I do recall with an opg, if it's outside the focal trough and there's multiple supernumeraries, that may not necessarily pick that up. Is that correct? Dr. Diane Tay: Yeah thats right. So, which is why I think a periapical is used if you're concerned that there may be another, you can always do that simple SLOB rule, have a look in and do a few angles to get, but I guess a cone beam CT, which is very easily obtainable these days,and the radiation is very low and comparable now. It's a worthwhile x-ray or diagnostic film to get so you can also use it for your surgical planning as well. Dr.Andrew Chang: So to recap for dentists, if you suspect there's a supernumerary, i.e as in you see a large gap between their front teeth or delayed eruption, you would take a screening, a x-ray like a periapical. And if one is considering in terms of the surgical management or in terms of how do we go about approaching this orthodontically then it would definitely need a CT. From my perspective and what I look at, I definitely require a CT to locate the tooth, so we can see in terms of is it close proximity to the developing adult teeth. Let's say if it's the upper central incisors, which may not be able to erupt because there's an impediment with the supernumerary and the permanent central incisors from erupting. I would want to make an assessment, well what is it's proximity because that would be an indication of what are the risks associated with the exposures in terms of with the surgeon accessing that area. And also in terms of moving that central incisor down. Having a CT provides three dimensional information that it goes far beyond what an OPG can provide. Dr. Diane Tay: I think cone beams are definitely coming up in terms of not being diagnostic and clinical management. Dr.Andrew Chang: So I suppose it now leads into the you did raise an important point. One of the things that you had talked about with the classification, these uninterrupted supernumeraries is that they often atypical as in, does that mean that the crown is usually not like a normal size is usually perhaps smaller or a a funny shape perhaps? Dr. Diane Tay: Yeah. In my experience, usually the unerupted supernumerary tend to be very, they have a very clinical form, the smaller and oftentimes when they're inverted, as I said, they don't actually, they won't erupt until, I guess it is. I tend to advise parents that these are probably the ones that will need to be removed. But again, that goes into looking at what other factors to consider. Dr.Andrew Chang: I suppose this is now a segue into this topic. So we've located the Supernumerary. What are the implications of having a supernumerary and what happens if we don't do anything? What may happen? Dr. Diane Tay: Because parents do want to know, they want to understand, do we often question is really do I need to remove this as is not causing a problem or my child has not complained. What do I need to know? When should I look at managing it? I think the important thing with supernumeraries is because generally of where they are located, they can or tend to cause failure of eruption in incisors, eruption of the permanent and you know, usually the central incisors and sometimes they can also cause ectopic positioning and movement of the permanent teeth or displacement in some way of, of adjacent teeth. And sometimes I've also seen supernumeraries that do not impede the eruption of the permanent teeth. Dr. Diane Tay: And parents say the permanent teeth are coming out. Do I really need to remove the supernumeraries cause it's clearly not blocking the way. However, you also have to consider from an orthodontic, and obviously we value your opinion but from an orthodontic perspective, can supernumeraries interfere with orthodontic teeth movements? And that's where, for me, I always tend to work with orthodontists to treatment plan these things. And I think you and I, Andrew had worked in a few cases very successfully together. Dr.Andrew Chang: I have. So I should talk about in terms of three patients I can recall on this one was that we collaborated on where the supernumerary or that extra tooth was what we call incisal to the adult developing adult front tooth. So it was clearly in the path of the erupting tooth. And,fortunately one of the things is we got to that early. Generally, If the root of the adult front tooth has fully formed, there's a lesser chance of it wanting to erupt by itself. So it becomes a balance of well, do we go in soon knowing that the root of the front tooth has not fully developed, possibly it may be risking its root development by doing this surgical exposure, or do we wait and let the root form a bit longer and then do we expose it,remove the supernumerary and expose the tooth at the same time. Dr.Andrew Chang: So generally, we normally would like to have at least half to two thirds root formation on that central incisor before I go in, as I don't want to make a surgical intervention too early, in terms of removing that supernumerary,if I felt that there was a high risk of interfering with development of the upper central incisor root. Dr.Andrew Chang: In another case where we collaborated. In this case, the girl was a bit older. She was about, 9 if i recall. So,the root was literally almost fully formed. So in this case we made a decision to remove the supernumerary and expose the central incisor at the same time. There was another instance where I saw another patient who was a slightly younger and we clearly had enough space for the adult, cetral incisor that to come down. And I can't exactly recall, it may have been a mesiodens right in between or may have been a supernumerary. But in that instance she had the mesiodens removed and the central incisor erupted without orthodontic intervention. Dr.Andrew Chang: And the last patient that I can recall quite clearly is an adult where the supernumerary in this case it's probably a mesiodens where it was right in between the two front teeth. It was actually located incisal to the upper permanent incisor. So the tooth was inverted and was conical in shape exactly what you described. And it was actually right below the nasal floor. So being an adult, she's very wary of having that removed, so the consideration for orthodontics is would its presence interfere with the zones of movement or the boundaries of movement of the teeth. Dr.Andrew Chang: And in this case we took a cone beam CT & we've verified that supernumerary was actually quite high superiorly and along the palatal aspect and we determined that at that point in time we would be monitoring with another CT in 12 months time, and as you may understand she was very hesitant about having the supernumerary removed. So we went through a discussion of the risks and benefits, the pros and cons,but because it was quite high up, d after running through that with her, e made a decision together to review that in 12 months time with another cone beam CT. Dr. Diane Tay: Yeah i think that explains things really well. You have a really good point about all of them. Dr.Andrew Chang: I mean there's one other thing in terms of implications of having an extra supernumerary is sometimes leaving it too long can lead to displacement, not just of the central, but it can also lead to displacement of the lateral incisor, which may be impeded in its eruption. So depending on where that location of that supernumerary is keeping it in there, f it's located incisal to the adult upper incisors is probably not something I would do, indefinitely, ue to the effects on eruption of the adjacent teeth there. Definitely, if you're going to monitor that, it will need closely monitoring and at some point you need to make a decision to have that supernumerary removed. And working in conjunction with in this case a surgeon or a pediatric dentist and an orthodontist is definitely very helpful as a team effort. Dr. Diane Tay: Absolutely. No, Andrew, I think your cases really classify and very well illustrate what we were looking at and talking about before. So what are important things to consider when we're managing supernumeraries because identifying it is easy, but what are you looking at when you're thinking about how to manage it? So, I mean from my perspective as you correctly saying you illustrated it again, you know, across your cases, the age of the patients shouldn't just be a guide, because we're looking at the root development stage of the permanent incisors. So you're weighing up the risk benefits of surgery of damaging developing permanent teeth & waiting too long and impeding or preventing the spontaneous eruption of the permanent incisors. Dr. Diane Tay: You also have to think and consider as we discussed, the number of supernumeraries, the position, where is it, is it inverted, what type of supernumeraries and which is why we say use the cone beam to determine exactly, the locality and the position and, and proximity to adjacent teeth, we have to consider which tooth is it around, is it an erupted supernumerary or unerupted supernumerary? And also what are the parents' expectations? What's the occlusion like? Is this, you know, is this child likely to require orthodontic movement of teeth so is it something, can you leave it or monitor it. So is the supernumerary actually causing ectopic or displacement of the permanent teeth? In which case then you may need to consider,acting and being more proactive in your approach. Those are some of the things I'll be be thinking about. Was there any other points, Andrew, that you'd like to get from your clinical experience? Dr.Andrew Chang: I think if we had to list out the factors which we covered on, all we touched on. One was the, the age of the patient. We talked about in a child, we also talked about it as an adult. As we talked about it, I can recall a teenage patient who also had a supernumerary where he was in his permanent dentition and he was about 13 or 14, and most of the supernumeraries that I've had in the anterior maxilla tend to be slightly along the Palatal. And I can recall because this patient, while he had crowded teeth but his upper front teeth were also,proclined as well. And when the mum went to see the surgeon because of where the supernumerary was, it was located apical but close to the apices of the permanent central incisors. Dr.Andrew Chang: But because the surgeon mentioned there is a risk of the upper front teeth losing their vitality or nerve, and in case what it means by that if there's any parents listening to this, is that nerve could suffer and a tooth may die or darken, in which case he may require a root canal, as a complication of surgery to remove the supernumerary tooth. But because of that risk, the possibility of that risk, they held off removing this supernumerary. And because the supernumerary was lying more a bit more palatal, we could not bring his upper front teeth back. So we kept them at a forward inclination. In other words, the upper front was sloping forward. So while his teeth were crowded, we straightened them. We didn't really bring them back but of course, then we came to a point where I said, well, we can't move it back. She wasn't happy with the current smile either. Dr.Andrew Chang: So at the end she made a decision, yes, the risks, but based on what the surgeon said, the risk was actually very small. So she went back to the surgeon and found out the risk was actually very small. So then she said, well I made a decision, I mean it's a balance of benefits versus risks. Okay, we'll have that supernumerary out,and turn out in the end the upper central incisors were fine, the vitality was fine and we managed to move the upper adult front teeth back and correct the protrusion and he is very close now to getting his braces off. So it's a balance of where, when we talk about for teenage patients, it's more getting the orthodontist involved and in terms of where the movements of their adult teeth are going to go and would the presence of the supernumerary interfere with them getting an ideal treatment outcome in terms of their smile & orthodontic correction for teenage patients. Dr.Andrew Chang: That's a main consideration for the adults of course there's often may be other medical histories that may affect in terms of surgical risk, and would involve maybe a closer conversation with the oral surgeon. Often adults,need to be more aware of the situation and they tend to be less inclined doing invasive surgery,particularly if its quite high. If a decision is made to keep a supernumerary, close monitoring is important and if the patient goes and for some reason doesn't come back, they need to be aware of that, that a supernumerary needs to be monitored because in a very, very small number of cases there can be cases of cysts. I mean the possibility is very small. It's just something that the patient needs to be aware about. Dr.Andrew Chang: So is there any other important factors I suppose to consider if we had to list it out, we've already covered root development, child, teen and adult management, is this a permanent incisor or primary incisor? Is the supernumerary erupted or non erupted? I suppose the good thing is nowadays with a CT you can easily see the shape and the size and the widths of the supernumerary. Some supernumeraries are generally smaller in size as we touched on. Very briefly and I know this is not really the topic on this podcast it becomes a bit harder when it's a supplemental, when a tooth is already erupted and is quite close in shape to the other incisors. Dr.Andrew Chang: One of the things that I'm inclined to look at is the width, but also the root formation and because sometimes some supernumeraries may have dilacerations in terms of root or dens in dente associated with them. So there's something that I'll be looking at quite closely, in terms of their pulpal status, but the main decision is which tooth could look nicer, both on the clinical point of view or aesthetic point of view and has got a good pulpal health as well. The other consideration for important factors is root development stage. And I know we touched on the risk of surgery and the position of the adult incisors, is a supernumerary causing displacement of the other incisors , patient factors: cooperation and the parent factors as well. Is there anything you want to elaborate on Diane? Dr. Diane Tay: No. Covered points very, very thoroughly and exactly what you're saying with looking out for these things. I think that's a key to success and management of the case. Dr.Andrew Chang: We've touched on these management options earlier by talking about these case studies, but could you briefly outline the management options if you haven't covered any of it? Dr. Diane Tay: We pretty much covered it through our discussion on the cases. But I guess to just really summarize it, mainly first if the option is to monitor, say maybe because the child's only three or four younger, we're waiting to decide what we're going to do or versus if the patient's older to say, then monitoring closely, ensuring you get appropriate radiographs just to manage monitoring for any specific changes such as cone beams would be very good and very clear x-rays or scans. So sometimes it may just involve simple surgical extractions. Dr. Diane Tay: And then let's say the child is six, six and a half, seven, and we know this, a supernumerary that's impeding the eruption of the permanent incisor and you have an over retained say 51 or 61. So you'd want to remove the primary incisor as well as the supernumerary and then monitor the eruption of the permanent incisors. So this would obviously be, and I often at times in the cases I've done before, work together with the orthodontist to determine and finalize the treatment plan: So if I'm going in surgically knowing whether we're just going to monitor the incisor based on the root development as you correctly say Andrew, we're looking at the root development if its about half to a third of roots. Dr. Diane Tay: However, conversely, if the roots, let's say this has been picked up and now the child is 10 or 11 years old and the root of the permanent incisors have already formed, then sometimes what we'll need to do is in addition to removing the supernumerary and the retained primary incisor, then we would really would be looking at doing a surgical exposure and potential bonding of the tooth orthodontically, to bring the tooth down into the arch. Oftentimes I get them to see the orthodontist first to lay down those braces archwires. And prior to surgery, was there anything else Andrew you'd like to add to that? Dr.Andrew Chang: I think we covered that really well. And it's really nice to have you on Diane and I hope the audience took something away today. Dr. Diane Tay: And thank you so much for listening again, and we will have more interesting topics to discuss next time. Thank you.
A la hora de estudiar las velares tenemos que detenernos en ver por qué reconstruimos velares palatales si no se conservaron como tal en ninguna lengua. Aunque ya lo adelantamos en la clase anterior, hoy desarrollamos la explicación y planteamos las dos posibles teorías, opuestas, sobre el origen y desaparición de esta serie de velares palatales. ?? Este vídeo es una parte de la quinta clase del CURSO DE LINGÜÍSTICA INDOEUROPEA. Tienes la clase completa aquí ???? https://academialatin.com/curso/linguistica-indoeuropea/sordas-sonoras-aspiradas-velares/ En la quinta clase del curso de lingüística indoeuropea proseguimos con el consonantismo indoeuropeo, concretamente con las oclusivas. En esta lección haremos un repaso de todos los puntos de articulación oclusivos y aclararemos las tres series velares del protoindoeuropeo y por qué y cómo se reconstruyen. ???? Aquí tienes el curso completo: https://academialatin.com/curso/linguistica-indoeuropea/ En este curso haremos una introducción a la lingüística indoeuropea, de especial interés para lingüistas relacionados con las lenguas clásicas como el latín y el griego, en las que haremos cierto hincapié. El curso de lingüística indoeuropea va dirigido a quienes quieran profundizar mucho en el estudio de las lenguas clásicas (principalmente latín y griego, pero también sánscrito). Gracias a los conocimientos de la fonética y la morfología indoeuropeas se pueden explicar muchos fenómenos de estas lenguas derivadas.
In this episode, I discuss the misdiagnosis of a swelling on the roof of the mouth that turned out to be cancer. This was misdiagnosed twice and can have serious implications for patients. In addition, we talked about the incidental radiographic finding with a panorex showing calcifications in the Carotid artery and its association with obstructive sleep apnea heart attacks and strokes. We also discuss using dental implants to help a patient with severe erosive lichen planus. Lichen planus can be a painful mucosal condition making Dentures very difficult or impossible to wear. Dental implants offers the opportunity to elevate the appliance off of the mucosa making impossible to wear Prosthetics without pain.
Does Your Patient Have Streptococcal Pharyngitis? No Problem -- I'll just Swab. Not So Fast... Fagan Nomogram for Likelihood Ratios 1. Decide on your pre-test probability of the disease (choose an approximate probability based on our assessment) 2. Use the likelihood ratio that correlates to your exam. 3. Draw a straight line frm your pre-test probability starting point, to the LR of the feauture/test, take it through to find your post-test probability 4. Use this new post-test probability to help in your decision Your patient has palatal petechiae, which confers a positive likelihood ratio (LR+) of 2.7 See below how to use this statistic based on your clinical assessment" Low Probability Moderate Probability High Probability List of Likelihood Ratios for Streptococcal Pharyngitis Symptoms and signs Positive LR (95% CI) Negative LR (95% CI) Sensitivity (95% CI) Specificity (95% CI) Scarlatiniform rash 3.91 (2.00-7.62) 0.94 (0.90-0.97) 0.08 (0.05-0.14) 0.98 (0.95-0.99) Palatal petechiae 2.69 (1.92-3.77) 0.90 (0.86-0.94) 0.15 (0.10-0.21) 0.95 (0.91-0.97) Chills 2.16 (0.94-4.96) 0.88 (0.79-0.98) 0.21 (0.18-0.24) 0.90 (0.83-0.97) Anorexia 1.98 (0.83-4.75) 0.53 (0.26-1.10) 0.62 (0.12-1.11) 0.62 (0.12-1.12) Pharyngeal exudate 1.85 (1.58-2.16) 0.78 (0.74-0.82) 0.38 (0.32-0.44) 0.79 (0.73-0.84) Vomiting 1.79 (1.56-2.06) 0.85 (0.81-0.90) 0.28 (0.21-0.36) 0.84 (0.79-0.89) Tender cervical nodes 1.72 (1.54-1.93) 0.78 (0.75-0.81) 0.40 (0.35-0.46) 0.77 (0.71-0.82) Sibling with sore throat 1.71 (0.82-3.53) 0.92 (0.82-1.03) 0.18 (0.14-0.23) 0.89 (0.83-0.94) Halitosis 1.54 (0.79-2.99) 0.95 (0.81-1.12) 0.12 (0.05-0.29) 0.92 (0.86-0.99) Tonsillar and/or pharyngeal exudate 1.40 (1.10-1.77) 0.86 (0.75-0.98) 0.37 (0.28-0.46) 0.74 (0.68-0.78) Large cervical nodes 1.39 (1.16-1.67) 0.67 (0.53-0.84) 0.64 (0.50-0.76) 0.54 (0.41-0.67) Lack of cough 1.36 (1.18-1.56) 0.59 (0.48-0.73) 0.73 (0.66-0.78) 0.46 (0.38-0.55) Tonsillar exudates 1.35 (0.98-1.87) 0.81 (0.63-1.06) 0.46 (0.27-0.67) 0.66 (0.48-0.80) Tonsillar swelling 1.27 (1.04-1.54) 0.67 (0.52-0.85) 0.70 (0.64-0.76) 0.44 (0.32-0.57) Dysphagia 1.22 (1.00-1.48) 0.68 (0.51-0.91) 0.72 (0.55-0.85) 0.41 (0.23-0.62) Headache 1.22 (0.95-1.57) 0.90 (0.77-1.04) 0.39 (0.28-0.51) 0.68 (0.58-0.76) Lack of coryza 1.21 (1.08-1.35) 0.69 (0.55-0.88) 0.72 (0.64-0.79) 0.40 (0.34-0.48) Abdominal pain 1.18 (0.92-1.51) 0.95 (0.89-1.03) 0.24 (0.19-0.30) 0.79 (0.75-0.83) Red tonsils and/or pharynx 1.13 (0.96-1.33) 0.41 (0.16-1.02) 0.93 (0.85-0.96) 0.18 (0.09-0.35) Reported fever 1.07 (0.96-1.19) 0.86 (0.67-1.11) 0.71 (0.58-0.82) 0.33 (0.23-0.49) Red tonsils 1.07 (0.86-1.34) 0.82 (0.40-1.69) 0.80 (0.60-1.00) 0.25 (0.00-0.51) Red pharynx 1.06 (0.95-1.18) 0.56 (0.27-1.17) 0.93 (0.81-0.98) 0.12 (0.03-0.34) Documented temperature >38° or >38.5°C 1.02 (0.87-1.21) 0.98 (0.83-1.15) 0.50 (0.36-0.63) 0.51 (0.38-0.65) Summer 0.86 (0.61-1.20) 1.02 (1.00-1.05) 0.13 (0.00-0.33) 0.85 (0.65-1.04) Arthralgia 0.74 (0.18-3.08) 1.02 (0.97-1.06) 0.09 (0.00-0.25) 0.90 (0.77-1.04) Conjunctivitis 0.73 (0.46-1.16) 1.02 (0.98-1.05) 0.05 (0.02-0.11) 0.94 (0.85-0.98) Acute otitis media 0.65 (0.14-2.91) 1.04 (0.93-1.16) 0.03 (0.01-0.05) 0.94 (0.84-1.04) History of tonsillectomy 0.64 (0.49-0.84) 1.07 (1.03-1.11) 0.11 (0.08-0.13) 0.84 (0.81-0.86) Hoarseness 0.62 (0.46-0.83) 1.04 (1.03-1.06) 0.06 (0.03-0.12) 0.90 (0.85-0.93) Diarrhea 0.51 (0.33-0.79) 1.04 (0.99-1.11) 0.03 (0.00-0.06) 0.93 (0.86 Modified from: Shaikh et al. 2012 This post and podcast are dedicated to Sarah Werner for her constant encouragement of the story in all of us. Check out Write Now with Sarah Werner. Selected References Cheung L et al. Throat swab have no influence on the management of patients with sore throats. J Laryngol. 217; 131:977-981. Ebell MH et al. Rational Clinical Examination: Does This Patient Have Streptococcal Pharyngitis? JAMA. 2000;284(22):2912-2918 Homme JH et al. Duration of Group A Streptococcus PCR positivity following antibiotic treatment of pharyngitis. Diagn Microbiol Infect Dis. 2018 Feb;90(2):105-108. Nakhoul GN et al. Management of Adults with Acute Streptococcal Pharyngitis: Minimal Value for Backup Strep Testing and Overuse of Antibiotics. J Gen Intern Med. 2013 Jun; 28(6): 830–834. Oliver J et al. Group A Streptococcus pharyngitis and pharyngeal carriage: A meta-analysis. PLoS Negl Trop Dis. 2018 Mar 19;12(3):e0006335. Shaikh N, Leonard E, Martin JM. Prevalence of streptococcal pharyngitis and streptococcal carriage in children: a meta-analysis. Pediatrics. 2010 Sep;126(3):e557-64. Shaikh et al. Accuracy and Precision of the Signs and Symptoms of Streptococcal Pharyngitis in Children: A Systematic Review. J Pediatrics. 2012; 3:487-493.e3
In this episode I discuss the appropriate timing of a wisdom tooth consult and timing of extractions when they are necessary. I discuss anatomical guidelines and parameters and then go into depth on what my third molar consult is like including a description of the logistics from beginning to end with each team members role.
It’s a Winter Olympics wonderland as the Working Interferences reconvene for their weekly pow-wow. The first question this week comes from Aaron, who is somewhat dejected from not closing a few cases. Josh and Lance come up with some solutions to increase his case acceptance rate. Then the WI Boyz cover the topic of maternity leave and temps but there is some confusion as to what the question actually is. Once again, we learn that Lance is a “heartless bastard.” Our Reddit question this week comes from the world’s worst super hero… Very Neurotic Dry Socket Man. Upon answering his question, the Working Interferences happen upon an incidental finding that leads us to believe that Very Neurotic Dry Socket Man enjoys the company of other men.
This week’s podcast is dedicated to the Pleomorphic Adenoma I was introduced to and treated over the last 3-4 weeks. I go over the history of this lesion, the initial treatment and definitive treatment and if you go to www.dentistbraincandy.com episode 120 Interesting Cases Section you will find some killer photos of the lesion.
Dr Nicholas Jufas interviews Dr Dave Pothier, a Staff Otologist & Neurotologist in the Department of Otolaryngology, Head & Neck Surgery at Toronto General Hospital, and Assistant Professor at the University of Toronto. He has a strong interest in clinical and translational research and has published and presentented extensively. In...
Dr. Nicholas Jufas speaks with Professor Thomas Balkany, an otolaryngologist and neurotologist specializing in cochlear implantation. He is the Hotchkiss Endowment Distinguished Professor and Chairman Emeritus in the Department of Otolaryngology and Professor of Neurological Surgery and Pediatrics at the University of Miami Miller School of Medicine. He holds 14...
Dr Nicholas Jufas interviews Professor Manohar Bance, an Otologist and Neurotologist and Head of Otolaryngology-Head and Neck Surgery at QEII Health Services Centre and Dalhousie University in Halifax. He is Director of the EAR lab, a middle ear mechanics laboratory at Dalhousie University. The interview covers the basics principles in...
In this podcast, Dr Niall Jefferson interviews Dr Gregory Postma, an international leader in the diagnosis and management of dysphagia. The discussion defines the symptom and elaborates on the history, exam and relevant investigations. We close with a discussion on current and future directions for diagnosis and management of this...
Dr Niall Jefferson sits down with Dr Dan Choo, current director of the division of pediatric otolaryngology at Cincinnati Children’s Hospital and medical center to discuss Congenital aural atresia. The discussion covers incidence, clinical examination and physical examination pearls of the CAA patient as well as operative candidates, tips and...
Dr Nicholas Jufas interviews Professor Michael Seidman, Director of the Division of Otologic/Neurotologic Surgery at the Henry Ford Health System in Bloomfield, Michigan. He is also the Director of the Center for Integrative Medicine and Professor at Wayne State University. He is the past chair of the Board of Governors...
In this podcast Dr Niall Jefferson sits down again with Dr Phillip Chang an ENT surgeon based in Sydney to discuss bone anchored devices. The discussion covers typical presentation, standard workup, relevant investigations and the pros and cons of different implant devices as well as expanding technologies and future directions.
Dr. Niall Jefferson talks Thyroid Nodules with Dr. Faruque Riffat
Dr Nicholas Jufas interviews Dr Nirmal Patel. The interview covers the definition, workup and prognosis and treatment of sudden sensorineural hearing loss, as well as salvage treatment and management options and future directions.
Dr. Niall Jefferson discusses the evolving trends in Cochlear implantation with Dr. Phillip Chang
Dr Niall Jefferson talks with Associate Professor Jeffery Koempel about thyroglossal duct remnants. They discuss its origins, presentation and relevant investigations in particular the role of imaging. The surgical management covers the key tips and pitfalls especially when managing the supra-hyoid area.
Dr. Nicholas Jufas interviews Prof. Daniele Marchioni, an ENT surgeon based in Verona, Italy. He is a founding member of the International Working Group on Endoscopic Ear Surgery (IWGEES). Prof Marchioni has recently published the first textbook on the technique - "Endoscopic Ear Surgery: Principles, Indications and Techniques". The interview...
Dr Niall Jefferson interviews Dr Stephen Cooper, a radiation oncologist and current chair of the multi-disciplinary Head and Neck cancer meeting at St Vincent’s hospital in Sydney on the topic of radiotherapy for metastatic squamous cell carcinoma of the head and neck. The discussion covers the basics of radiotherapy, current...
Professor Paul Fagan is one of Australia's most influential skull base surgeons. In this interview we discuss canal wall up and canal wall down surgery, the role of the facial nerve monitor as well as pre and post operative considerations. It is important to note that the bulk of Professor...
Dr Niall Jefferson interviews Associate Professor Gerald Fogarty a leading global expert on cutaneous melanoma
Dr Jefferson talks with Melisha Sirisena, a paediatric audiologist about hearing loss in children. The discussion covers newborn hearing screening, the age-appropriate tests to assess hearing, as well as future directions for audiology. This podcast is a comprehensive discussion on hearing in the paediatric population.
Dr Sean Flannagan and Niall Jefferson talk Glomus tumours which are a vascular tumour that can affect the head and neck.
Dr. Jefferson and David Fitzsimmons discuss the latest in the assessment of Pediatric Speech for Cleft Palate
Dr. Jefferson and AProf. Cathrine Birman discuss Pediatric Cochlear Implants- newborn screening, intraoperative tips and pearls, post op considerations and the future of cochlear technology.
Dr. Piera Taylor: Pediatric Drooling
Prof Alan Cheng: Pediatric Laryngeal Cleft
Dr Sam Dowthwaite: Oropharyngeal Reconstruction
Dr. Niall Jefferson: Who What Where Why
AProf Richard Harvey: Allergic Rhinitis
AProf Bradford Woodworth: Cystic Fibrosis and CRS- Assessment and Implications for Management
AProf David Conley: CT Scans in Chronic Rhinosinusitis
Prof. Rodney Schlosser: Spontaneous CSF Leak- Presentation and Management
Dr. Shyan Vijayasekaran: Pediatric Tonsils and Adenoids
Dr. Nick Hogan: Anesthesia in Pediatric ENT
AProf Stuart MacKay: Surgical Management of Adult Sleep Apnea.
AProf Stuart MacKay: Assessment of Adult Sleep Apnea
Dr. David Pohl: Otosclerosis and Stapedectomy
Dr. Shyan Vijayasekaran: Pediatric Vocal Cord Palsy
Prof Mike Rutter: Balloon Dilatation
Dr Shyan Vijayasekaran: Airway Reconstruction
Finally, Answers to Why Your Child Can't Sleep… Dr. Park interviews premier pediatric orthodontist and palatal expansion expert, Dr. William Hang about the advantages of using orthodontics to straighten your child's smile and sleep. Listen to this riveting and enlightening discussion on pediatric, as well as, adult sleep apnea that can help you and your loved breathe, sleep, and live better. Learn: Why your child's sleep problems could be a sleep apnea issue How your kids can go from sleepless and fatigued to rested and energized after a couple of trips to the orthodontist. Even more alternatives to CPAP for sleep apnea, like palatal expansion other orthodontic procedures.
In this podcast AAO-HNS Journal Editor, Richard Rosenfeld, is joined by M. Boyd Gillespie and Eric Mair in discussing "Effect of Palatal Implants on Continuous Positive Airway Pressure (CPAP) and Compliance," published in the February 2011 issue of Otolaryngology Head and Neck Surgery. This randomized clinical trial shows no significant impact of palatal implants on CPAP pressure or compliance compared to sham controls. Click here to read the full article.
Episode 6 sees Eric and Phil dissecting the final pair of stop/plosive sounds in English: /k/ and /ɡ/. As always, we work our way around the task of describing the sounds, their history, and usage in the course of about an hour and 10 minutes.Show Notes:Correction: Phil referred to "Findlay" as derived from Finn's Lea, but it turns out that it's from Gaelic, and that means Fionnlagh – "fair warrior." Bradley would have been a much better example: Brad=broad and Lea=meadow.voiceless/voiced velar plosive: co-articulation, double action of closing the mouth with the back of the tongue at the soft palate, and closing off the nasal passage by lifting the soft palate at the velo-pharyngeal port.Let’s take a tour of the anatomy. This will help us to deal with the idea that /t/ is apico alveolar but /k/ is dorsovelarThe Roof of the MouthTectal: an adjective derived from the anatomical term "tectum," a roof-like structure. Labia/labial: the lips; bilabial with both lips, labio-dental with lower lip and upper teeth, as in /f/ and /v/. (For people with an extreme overbite, one might make a dento-labial sound (upper lip and lower teeth.)Dental: the teeth (as heard in the “th” sounds, /θ/ & /ð/ )Alveolar ridge/alveolar: the gum ridge, behind the upper front teethPalate/palatal: the hard palate, rising up behind the alveolar ridge. Phil describes a small hole in his palate; Eric, in searching the net for information on this, could only find stuff about "Jacobsen's Organ" aka Vomeronasal organ http://en.wikipedia.org/wiki/Vomeronasal_organ, an auxiliary olfactory sense organ; it's thoroughly debatable whether it exists in humans at all. Who knows what Phil has? (apparently, he hasn't had any of this since college days...)Velum/velar: the soft palate, behind the hard palateUvula/uvular: the "small grape"-like structure that hangs down from the arch of the soft palatePharynx/pharyngeal: the column or space behind the tongue, the "chimney" that goes from the larynx up to the noseEpiglottis/epiglottal: the flap-like value that protects the larynx during swallowingGlottis/glottal: the vocal folds (technically the SPACE between the vocal folds, which disappears every time the vocal folds vibrateAri-Epiglottal/ False Vocal Folds: [there was some debate between Phil and Eric how Dudley Do-Right sounded, and whether it was ari-epiglottal tension or velar tension...The Parts of the TongueTip or Apex/apical: front edge of the tongue, the 'rim' of the tongueBlade or Lamina/laminal: the front part of the tongue, the top surfaceBack or Dorsum/dorsal: the back of the tongue, which is subdivided into: Front, Middle, Back, or, Front and Back —antero-dorsal or postero-dorsalRoot or Radix/radical: the root of the tongue/k/ and /ɡ/ are different from other plosives because it is made on the back of the tongue, which works in a more gross mannercan be made further forward /ki/ or further back /kɑ/. Challenge of learning /k/ and /ɡ/ for children because they are made further back in the mouthThe McGurk Effect Experiment: Can you identify Phil's 3 sounds? World Atlas of Language Structures: http://wals.info/ WALS shows 2,650 languages and notes 32 missing / ɡ /Languages that are missing /ɡ/ but not /k/From Wikipedia [http://en.wikipedia.org/wiki/Voiced_velar_plosive ] "Of the six plosives that would be expected from the most common pattern world-wide—that is, three places of articulation plus voicing ([p b, t d, k ɡ])—[p] and [ɡ] are the most frequently missing, being absent in about 10% of languages that otherwise have this pattern.[...] It seems that [ɡ] is somewhat more difficult to articulate than the other basic plosives. "Ian Maddieson speculates that this may be due to a physical difficulty in voicing velars: Voicing requires that air flow into the mouth cavity, and the relatively small space allowed by the position of velar consonants means that it will fill up with air quickly, making voicing difficult to maintain in [ɡ] for as long as it is in [d] or [b]."HISTORY OF THE LETTERS:In Greek the symbol of the K (Kappa) turned the "right way" (the way it is in our writing), prior to this it was facing the other direction. Gamma was brought into Latin to represent the C. C had a line added to it to indicate the voiced version, G.SPELLINGS:k “key, keep, koala, kangaroo” “mask, make, pink, walk”c “cat, cost, cut” (contrast “cease, ace, ,macerate ”) Hard/softcc “accuse, stucco” ck “pick, stock”ch “charisma, Christ, choir, ache”Shakespeare's "Petruchio" probably should be [pəʼtɹu.tʃo] not [pəʼtɹu.ki.oʊ]g “game, gate, bag, agony” (contrast “gem, badge,magical ”) Hard/softgg “egg, dagger”gh “ghost, ghetto” (contrast “night, ought”)gu “guide, guest, guerrilla” foreign originckg blackguardx “examine, exhaust”Note that "x" can be /ks/ or /gz/ depending on the word, e.g. /ks/ "excellent" , /gz/ "exist".Soft G is the affricate /dʒ/, while Soft C is /s/.PHONETIC NOTATION: represented by lower case k and ɡIPA symbol for /ɡ/ is the "single-story" version of the g lowercase with an open tail, rather than a looptail. VARIATIONS:Not a lot of variations: mostly to do with voice onset timeVariation: final /k/ becoming fricative in Liverpool week [wiç], like [laiç], back [bax], dock [dɒχ]John Maidment, commenting on JC Wells' blog post on "VOT is more":"One might also like to add that VOT is sensitive to place of articulation. Other things being equal, the VOT of posterior articulations, velar and uvular, are considerably longer, at least for native English speakers, than articulations further forward in the vocal tract. A typical VOT for stressed syllable initial [k] in English is in the region of 120ms, while that for an equivalent [p]is only 60-70ms. I am pretty sure that this difference is an important secondary cue for the perception of place in voiceless plosives and one which, as far as I know, has not been properly investigated."Non-English Stop plosivesPalatalized stops (often heard in Russian, [tʲ] [dʲ] vs. Palatal stop [c] or [ɟ]Uvular stop, as in Arabic pronunciation of Qatar or Iraq [q].Though it's unlikely that a character will do a sound substitution on stop-plosives, however, characters might speak foreign language work, or say words within the text, such as place names or character names.Original Pronunciation: David Crystal is the leading proponent of this type of pronunciation, especially at the Globe Shakespeare Company in London. http://www.davidcrystal.com/DC_articles/Shakespeare11.pdf
We’re digging into /t/ and /d/ on Glossonomia this week. Hosts Phil Thompson and Eric Armstrong discuss how we make this cognate pair of consonants, voiceless and voiced alveolar stop/plosives. Today’s Topics include: • the concept of Lenition (softening), in particular, the terms Fortis vs. Lenis. • Voice Onset Time (VOT): when does the voicing begin? Normally, /t/ in English is aspirated at the beginning of stressed syllables. In English, initial /d/ in stressed syllables is, essentially voiceless but unaspirated, whereas intervocalic (between two vowels). • In Phonecian, the word for the letter D was, in fact “door”—daleth. • T comes from Greek Tau, and Semitic Tav, which resembled a simple cross. • Spellings: t (Ted, atop, get), th (Thames, Thomas, thyme), pt- (ptarmigan, pterodactyl, pterigoid) • Wikipedia has a paragraph on the origins of the name Thames, and its Greek influenced Th- spelling • IPA [th] for aspiration, [t=] for unaspirated; [d] • There is no perfect phonetic way to notate things; there are many ways to heaven in the phonetic realm • Apart from English, there are many languages where /t/ is not aspirated • “Cool” words of the week—prevocalic: before a vowel; postvocalic: after a vowel; intervocalic: between 2 vowels. • No audible release of final /t/ “but, not, that” IPA [ bʌt ̚ nɒt ̚ ðæt ̚ ] • devoicing of consonant clusters tr-, -tl, tw-, • preceding /s/, as in steam, “deaspirates” the /t/, and may reduce the devoicing in stream. • past-participles: -ed endings following a voiceless consonant are /t/ e.g. hoped is pronounced [ hoʊpt ], following a voiced consonant or vowel are pronounced /d/ • Orthoepy: the “correct” pronunciation of a language, or a tradition of pronouncing words as they are spelled; e.g. often with a /t/ or not • Intervocalic /t/: In North America typically a voiced tap [ɾ] or [ t̬ ] • Sound Patterns of Spoken English by Lynda Shockey • Glottaling, using the glottal stop, as it “Hit me, baby, one more time” • Assimilation, where the sound is moved to the place of the following consonant • Glottal reinforcement: /t/ supported by closure in the glottis • Ejectives: non-pulmonic is “not from the lungs” IPA [ t’ ]: the glottis is closed and the larynx rises to pressurize the [ t’ ] behind the closure at the gum ridge • geminate or twinned consonants, e.g. hit Ted, either the first is unreleased, or we may use “double tapping” (to release both /t/ sounds) • Raymond Hickey Irish English Resource Centre slit /t/ and in Newfoundland, Australia, New Zealand; Kath & Kim’s grayshsh; JIPA: The acoustic character of fricated /t/ in Australian English: A comparison with /s/ and /ʃ/ by Mark J. Jones and Kirsty McDougall • Palatal versions of /t/ and /d/ (IPA [c] and [ɟ] ) • Back of tongue sloppiness vs. Front of tongue agility; greater phonetic variation with tongue tip • /t/ epenthesis, e.g. Prince vs. prints; tense vs. tents; sense vs. cents • Prescriptions: watch out for [ts] in initial settings “splashy /t/”; skills to be able to do unaspirated /t/ or to have an early voice onset on /d/ (I’d probaby notate that as [d̬]“Some of the things we’re talking about are questions of precision. ‘Inappropriate Precision’ is what robots do. What dancers do is ‘appropriate precision,’ we hope. And so, dancers of the mouth ought to be equivalently curious about, and in love with, the possibility of precision but only as it achieves the gracefulness, or expressiveness, or wildness that’s required of the artistic endeavour in front of them.”Next week we’re on to the vowel sound happY. Email us at glossonomia@gmail.com!Write a review about our show at the comments on iTunes here.
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