Sleep Apnea Treatment in Fair Oaks, CA

Hello. For those of you who don’t know me, I’m Dr. Brian Orcutt. I’m a dentist and my office is located in Fair Oaks, California. My team and I strive to provide great comprehensive care for our family of patients and our mission is to always treat patients the way we ourselves would like to be treated. Given that we always do our best to educate our patients and to give them a foundation of knowledge so that they can make informed decisions for themselves, we do our best to stay on the cutting edge of technology and do everything we can to always provide top-notch care. And that’s why I’m here making this educational presentation to you. I want to give you a little background about myself. I graduated from Indiana University School of Dentistry in 2004. I’m originally here from Sacramento, California. Since I graduated, I’ve always been a dental nerd and I’ve always taken lots of continuing education units and that way I can provide a wide variety of services for my family of patients.

A little over a year ago I got involved with dental sleep medicine, albeit for some selfish reasons At first, for years I was interested in providing dental sleep medicine to my patients, but I really wasn’t happy with the array of services that dentists could offer at that time. Then just before Covid shutdown happened, I learned about a dental sleep medicine education company named Vivos Therapeutics. Vivos is an all encompassing dental sleep medicine education company and they taught me that I can help people with sleep apnea, sleep related breathing disorders, ADD ADHD, chronic migraine and headaches and many of the problems. Well, those are some of the things that my family and myself are suffering from, and so I dove in headfirst and I haven’t looked back. Let me show you a little bit about my why. I want to help my family and my friends and my patients with their sleep related disorders and comorbidities.

I have suffered with sleep apnea for years. My wife and daughter suffer from chronic migraines and my son has ADHD OCD and Tourettes and Vivos has helped teach me how to help each and every one of us. So I was diagnosed with sleep apnea in 2014, but probably, and according to my wife, she thinks that I had it much longer than that. I was always so tired and I know that if sleep apnea is left untreated that a lot of health issues will arise over time, like heart disease, diabetes, Alzheimer’s, sudden death to name a few. I also have many family and friends who suffer from it, and I know you guys probably do too. So in 2014 my pulmonologist prescribed me a C pap and like many people, I hated it. I felt claustrophobic, but eventually I taught myself to wear it through the night.

The masks though, they never fit very well and I tried several different types and it didn’t really matter which type I used. They would constantly leak and blow air on my face and into my eyes all night long and I’d still wake up tired. It was better, but I still wake up pretty tired. In addition to that, I’ve always struggled breathing through my nose, so I had to wear the full face CPAP mask, not the type that covers your nose, but being a dentist, I can assure you that the constant airflow into your mouth will keep your mouth super dry all night and there’s nothing worse for cavity formation than a dry mouth, a dry mouth ROTTs teeth super fast. I have seen firsthand the horrible results of long-term full masks, CPAP therapy on many of my patients’ mouths and is very unfortunate. Not only do they have to suffer wearing a C pap every night, but they also [00:04:00] have to endure lots of dental visits because of all the cavities they get because of the dry mouth, dry mouth and dry and mouth breathing is the number one cause of dental decay in my practice.

So up until the last few years, the only solutions for treating sleep apnea were not all that appealing to me as a patient or a dentist. The closest thing we had to cure was surgery to detach your upper jaws from your skull, section them in pieces, and then reposition them forward and sideways and downward and then place metal braces on your teeth and wire your mouth shut together for two months while you heal. Well, I’ve seen some people go through that and I’ll tell you that I want nothing to do with that for myself and I really don’t want my patients to have to suffer through that either. There are a few bandaids for sleep apnea and these include the C pap, which is currently the gold standard according to lots of physicians.

There’s an oral appliance that can hold your lower jaw forward that a lot of dentists will make, but that causes permanent TMJ damage. After a few years of wearing that, there’s the new inspire, which is surgically implanted into your chest like a pacemaker. It has an electrode that runs up through your chest and into your neck to the base of your tongue, and then when you stop breathing, it shocks your tongue and makes your mouth open so that you can breathe Unfortunately, except for those people who can use the CPAP mask that just covers their nose, all of these modalities rely on mouth breathing and like I said earlier, mouth breathing breathing causes lots of dental rot and to make things worse, your sleep apnea continues to get worse over time while you’re using those other modalities.

Not only do mouth breathers have more cavities, but they’re also more likely to have elevated blood pressure and suffer other comorbidities like ADD ADHD, anxiety, depression, heart disease, diabetes, and many others. But when you breathe through your nose, the air gets filtered by the nose. It warms the air as it enters your body, and the compound nitric oxide is released by your sinuses and that helps with gas exchange in your lungs, meaning your body is able to have more efficient gas exchange of oxygen and carbon dioxide, and many professional athletes understand this and they use this to their advantage.

Well, thanks to a lot of research over the past 10 to 15 years, there is now another modality to treat sleep apnea and sleep disordered breathing. It’s a simple and pain way to grow the size of your upper and lower jaws and by doing so, it actually enlarges the airway inside your nose and the area behind your nose and your tongue, and this is a permanent change in the shape of your jaws and your airway, not a temporary bandaid like the other modalities I discussed a few seconds ago. It’s simple and painless and following the vivos protocol, patients wear a single or double retainer for 14 hours a day for an average of 12 to 24 months, and by the end of that time period, the patients following the vivos method see an average of about a 65% decrease in their sleep apnea episodes. This may not be a cure for sleep apnea or sleep disordered breathing, but it’s the closest thing we have right now without major jaw surgery.

Today I’m going to be giving you a lot of information. You may be watching this for different reasons. You may have been told that you have sleep apnea and you want to know what alternatives there are to C pap therapy. You may have a child with a DD or a DHD depression or anxiety or one who struggles with bedwetting. You may be watching this because your spouse snores so loud that you have to sleep in different rooms. Well, by the end of this presentation, my goal is for you to understand that all these things that seem very different, but they may have a common root cause. As I go through this presentation, I will start off with a focus of children. If you were watching this as an adult with sleep apnea at first, it may sleep odd that I’m talking about children. What we have learned is that adults with sleep apnea and sleep-related breathing disorders often had signs and symptoms as kids, there is a good chance that I’ll be discussing some things that you struggled with as a child. Now why don’t we take a look at this slide presentation I’ve put together and let’s discuss why we are facing such a crisis when it comes to our airway issues.

So there is a silent crisis in America and throughout the world. Kids are having difficulty in school. Many seem to have ADD ADHD, anxiety and depression. They’re obese, they’re wetting their beds, and you can see from this exhaustive list that there are many signs and symptoms of sleep disordered breathing. The column on the left here refers to a lot of the symptoms that you may see in children, the chronic allergies, the daytime drowsiness, the swollen tonsils and adenoids, bedwetting, difficulty in school, their mouth breathing, crowded teeth is one of ’em. On the right hand side, the column on the right hand side, you see that these are signs and symptoms that you would see with adults. Depression and anxiety, hypertension, bruxism, carotid teeth should be on there too. Cancer premature death.

Alright, so I’m going to show you some pictures of some children. You can see the child on the left has a double chin evidence of an underdeveloped lower jaw. The child in the middle has a crooked nose. Her eyes are at different levels, her chin is asymmetric, all signs that an upper jaw, which extends from the upper teeth to the base of the eye sockets is underdeveloped. The middle child also has dark circles underneath her eyes, which is evidence of pore circulation due to an underdeveloped upper jaw and associated structures. The child on the right has a double chin, dry lips, dark circles under his eyes. His left eye is higher than his right. The cheek on his left side is larger than his right and you can see the white part of his eyes underneath his iris. All of these are characteristics of the facial bones being underdeveloped and here are some more signs of what to look for when we’re looking for underdevelopment of the facial structures in the airway.

They applied to both children and to adults. Let’s look at the child on the left first. The two things that I see most or look at her eyes. You can see the white underneath her iris. That’s a sign that she has an underdeveloped upper jaw as well as the dark circles underneath her eyes. You can also see that she has a very pointy chin, which is a sign of an underdeveloped lower jaw. The child in the middle doesn’t seem to be able to close her lips together because her teeth aren’t aligned properly, so just one crooked tooth and that’s a sign that the associated jaw is too small for all of that person’s teeth. She also shows a lot of asymmetry and her ears have a different can. Her jaws are different sizes. She also has dark circles underneath her eyes. We call that venous pooling.

The child on the right has a much larger cheek on the left side than the right, and you can sort of see that there’s a lot of asymmetry with the shoulders. There may be a common cause behind a lot of the health concerns we’re seeing today in both children and adults. Here you can see a lot of the visible health issues we all face on a daily basis. Daytime drowsiness, sleep issues, snoring, ADHD, chronic allergies, aggression, crowded and crooked teeth and ground down teeth and bedwetting to name a few. The underlying cause seems to be a compromised airway. You may be asking yourself, what is a compromised airway? Well, a compromised airway is one in which the airspace in your nose, mouth, and throat are smaller in volume compared to what they should be. This is typically caused by an underdeveloped upper and lower jaws, commonly seen as crowded and crooked teeth and bed bites.

As you can see from the previous slides, there are many other signs of underdeveloped jaws that are not commonly discussed. The root cause is multifold. In the past 400+ years, our diets have become softer and we are eating more and more processed foods when we don’t use our mouth muscles to chew hard foods. When we are young as people did centuries ago, we end up having weaker facial muscles and our facial bones don’t develop to our genetic potential. Another root cause is the fact that we no longer breastfeed our newborns and infants as long as our ancestors did. Humans now tend to bottle feed much more than breastfeed, and this results in a backward swallow which shapes the facial [00:13:30] bones in a manner different than what our ancestors had.

Here you can see a couple of pictures of children’s teeth that have a couple of different types of bad bites. On the left you can see that all the teeth seem to be crowding in and that there’s almost no spaces in between the teeth. There really should be absolutely no crowding in kids’ teeth. In fact, what we really want is a lot of spaces in between their front teeth, and we’ll go over this a little bit more in a little bit on the right here. You can see that there’s a foot of a child with a severe overbite bottle feeding and pacifiers tend to lead to these types of bad bites in kids. Our bodies are really just not genetically preplanned to use pacifiers or to bottle feed. These are environmental influencers that really cause the vast majority of all the bad bites out there and the need for at least 90% of our kids to need orthodontics. Children with the perfect bite have pretty much become an endangered species. You can see this in this picture that this child has straight teeth with lots of spaces between their front teeth. These spaces need to be present because the adult teeth are much bigger than the baby teeth and they need room to come. If there is no room for the adult teeth, then there will be crowding.

Is it that all of a sudden in the last 400 years or so children have really big teeth or is it something else going on now kids don’t all of a sudden have bigger teeth. We’ve just gotten to a point in our evolution where our facial bones aren’t growing to our genetic potential like they used to 400+ years ago. Our jaws are smaller and our teeth seem to be bigger. Now here is a sketch of normal human skull development. Each line here you see is taken at a different year in the kids’ development. The innermost line starts at two years old and the outermost line is the 17-year-old mark. You can see here that at two years old our skulls are about 55% developed already, and at 12 years old our skull growth is between 90%-95%. This illustration here shows us why it’s important that we need to do everything we can to help kids out to help them maintain their maximum growth at an earlier age instead of waiting until they’re 12 years old to begin thinking about orthodontics or expanders. You can see here that normal c craniofacial growth is wider forward and downward.

So let’s try to answer the question to why our facial structures are smaller today and how we know and how we know that. Let’s look at anthropology for the answers. So this is Dr. Robert Kini. Dr. Kini has done lots of research on the development of the human skull and is most renowned for his work in dental malocclusion anthropology, which means he’s looking at the bites of all of our ancestors basically is basically looking, he’s basically looking at why we have crooked teeth today, whereas our ancestors 400+ years ago did not. So we’re going to go ahead and look at his fossil studies and his population studies. What Dr Kini did was he looked at human skulls from 400+ years ago and he found that those skulls had bigger, upper and lower jaws and that there was room for all 32 teeth in those jaws, including room for the wisdom teeth. There’s very little incidence of crowded or crooked teeth, and of course there were no orthodontists or dentists around back then just straighten them. Today almost everyone needs to have their wisdom teeth removed because our jaws are just not big enough to allow them to erupt into our mouths. And even after having wisdom teeth removed, a lot of people still have too much or too little room for their teeth and still have more crowding.

So DR also studied isolated rural populations, groups of people who were not exposed to things like processed foods and formula, and what he found was that these populations breastfed their children for many years, two to three years, and that they ate a diet that was comprised of hard, tough foods, dried meat and hard root vegetables. In these populations, they had very little incidences of crowded and crooked teeth and they had perfectly formed upper and lower jaws and room for all of their teeth including their wisdom teeth. Here are Dr. CO’s conclusions. The dietary consistency and toughness promotes proper bone growth when processed food becomes the norm. After industrialization, crooked teeth show a rapid rise and a soft diet or processed foods increase the underdevelopment of the upper and lower jaws resulting in crooked teeth. Dr. Kini observed that as western culture was introduced into these isolated populations, he observed some changes in their c craniofacial development in the first generation. After they introduced processed foods and soft diets, about 50% of the population began to experience an increase in malocclusion, which is crooked and crowded teeth. The second generation after they introduced soft foods and processed foods into their diets increased to 70% and then the third generation jumped to 85% and today practically everybody has some form of a bad or bad bite or crooked teeth.

So it takes about 27,000 years for an actual genetic mutation to express itself in 51% of the human population. So how did this change in the craniofacial growth and development and the subsequent malocclusion happen in just one generation? It sort of tells us that malocclusion is not inherited. It is not a genetic mutation. It’s acquired. This means that our crowded and crooked teeth are not caused by our genetics, but it’s rather caused by something else. It’s caused by cultural change. We no longer breastfeed our babies for two to three years or longer and we no longer have the babies eat a hard diet. Instead, we nurse our babies for six weeks or maybe six months and then we give them bottles and soft food like puffs and mac and cheese and chicken nuggets. So this is what we feed our children Puffs mush puree formula. Everything that we put into baby’s mouth nowadays is pretty soft. I’m guilty of it. My wife and I are both guilty of it. Our kids grew up eating things like this. This is what we should be feeding our babies harder foods so that they can utilize their chewing muscles and exercise their oral facial muscles and their tongue muscle to promote the proper growth and development of their upper and lower jaws.

So here is what we now know that most male occlusion is acquired. It’s not inherited. Just because you have crooked teeth doesn’t mean your kids have to have crooked teeth, and just because your parents had crooked teeth doesn’t mean you automatically get crooked teeth. Malocclusion is unique to the western culture and the presence of malocclusion or crooked or crowded teeth is a key indicator of an underdeveloped airway. And underdeveloped airways increased for sleep, disordered breathing, including sleep apnea.

This is Dr. James Sim Wallace, a Scottish doctor and a dentist born in 1869. Dr. Wallace found that an early soft diet prevents the development of muscle fibers in the tongue, resulting in a weaker tongue, which cannot drive the primary dentition out into a spaced relationship with fully developed arches, which will lead to more crowding and of the permanent teeth. He and his contemporaries began measuring the palettes of their patients and then compared them to the skulls and palettes of those from before the Industrial Revolution and found that modern palates were significantly smaller. Unfortunately, his research was ignored until the 1970s when Dr. Kini took notice. So we now know that having a strong well-developed tongue is important in making sure that our arches develop correctly. A strong well-developed tongue is one which is kept on the roof of the mouth and swallows in a correct manner providing the scaffolding for the upper jaws. Like this diagram on the right, we want our dental arches to be U-shaped. Similar to a Roman archway way, when your tongue is not strong or fully functioning, you will end up with a v-shaped gothic arch with crowded and crooked teeth. When your tongue is strong and functions correctly, you’ll have a beautiful U-shaped arch that is room for all of your teeth, including the wisdom teeth.

This demonstrates what our upper jaws look like today compared to what they looked like in earlier times. You can see here in the pictures how narrow the palate is on the left and how wide the palate is on the right. Keep in mind that the palate is also the floor of the nose and the larger the airway space, the easier it is to breathe through your nose and breathing through your nose is very, very important, which we’re going to go into a more so here is an image of the maxilla or the upper jaw. Note that the upper jaw does more than just hold the upper teeth. It also makes up the sinus cavity and the lower orbits of the eyes. Dr. Gil Alt from Stanford University states that dental arch expansion improves sleep disordered breathing in patients with upper and lower jaw constriction and can be a valid treatment for different types of sleep, disordered breathing including sleep apnea.

So what does your airway look like? What does your child’s airway look like? Which airway would you rather have? Is your airway the size of a straw or the size of a garden? Hose? Here are some images of airways. We take images like these every day in my practice. The picture on the left shows you a severely constricted airway. You can see where the color changes to red, that’s where the severe constriction is. Our software actually automatically measures the size of our patient’s airways and the colors sort of mimic that of a stoplight. You have white and blue, which is really good. Green is also good. Yellow means caution and red means severe.

The second picture here is that of a typical mouth breather. The third picture is that of a child with Asperger’s, and we actually see kids with autism frequently have constricted airways. And the picture here on the far right is an adult with sleep apnea. So this video really says it all Right to grow is an organization dedicated to ending the practice of orthodontic growth stunting. Their aim is to legally ban the use of any growth stunting appliance used on a child’s skull. They’re a team of patients and practitioners backed by decades of published research and common sense that cannot be disputed. They stand for every child’s right to their normal and unimpeded growth.

Just a few hundred years ago, the human face was different. It was forward grown. Her wide profile and large dental arches ensured straight teeth and room for her tongue. Most importantly, she had plenty of space behind her upper jaw so she could breathe through her nose with ease. The modern face has changed from childhood. Her dental arches are less developed, crowding her teeth and giving her less space for her tongue, which impacts her airway. Many believe this stems from a number of causes such as allergies that affect breathing. Another is the poor nutrition and softness of modern diets causing toddlers to have underdeveloped chewing muscles and smaller dental arches. Because her upper jaw is too far back, she will struggle to breathe normally through her nose to get more oxygen. She will compensate by opening her mouth to breathe, bringing her lower jaw down and back, creating a downswing of the face. This is how her undergrown upper jaw creates the appearance of buck teeth. She’s actually compensating in order to breathe. If not corrected, the problem carries into adulthood. Extractions were documented in the 16 hundreds as a way to treat crowding. Although they’re a quick fix, they don’t treat the problem of underdeveloped arches and have been implicated in harming the facial profile, making them the subject of much debate. Even today in the 18 hundreds orthodontists in favor of extraction, we’re looking for more effective ways of pulling teeth back. And this is where the story of headgear starts

Not understanding the cause. Those orthodontists believed in a myth that in buck tooth’s children, the upper jaw was overgrown. They thought that if they restrained its growth with headgear, the lower jaw would catch up and the teeth would line up. Although studies done throughout much of the 19 hundreds have shown otherwise, this myth became a part of the foundation of conventional orthodontics. First studies have shown that headgear suppresses the growth of both jaws, causing them to grow down and back into the airway, creating a clockwise rotation of the lower third of the face. The industry coined these deformities, the headgear effect, the growth changes caused by headgear carry on into adulthood. In order to breathe, she will slouch her head forward to prop, open her airway, creating a lifetime of neck and back pain. This is the infamous forward head posture. A simple physics diagram shows that the growth stunting forces of headgear pass right through the skull. One study showed that headgear caused an abnormal rotation of the sphenoid bone, and no study has examined the impact of headgear on the skeletal blood flow and nerve pathways of a growing child or its long-term effects.

Having a healthy airway is crucial to the survival of life and especially so during sleep. When muscles around the throat relax during sleep, a healthy airway stays open because the tongue is sitting forward and has enough space to be suctioned up against the fully grown palate. With underdeveloped jaws and dental arches, the palate is too small for the fully grown tongue, which is sitting back to begin with. When she sleeps, her tongue does not suction, rather it falls back and cuts off her airway. This is obstructive sleep apnea, light, crooked teeth. It’s a modern condition, however, it can reduce life expectancy. Not surprisingly, obstructive sleep apnea is marked by the same traits that describe the headgear effect. Both jaws are grown down and back creating a clockwise rotation in the lower third of the face. If you have already been exposed to orthodontic treatment that caused the headgear effect, there are ways to reverse what happened. If your child wears a headgear or is exposed to an appliance or practice that retracts structures involving tongue space and the airway, his or her lifelong health may be in danger. There are plenty of alternatives to these practices, so make sure to get multiple opinions. The myth of the overgrown upper jaw that needs to be held back has long since been replaced with science. Science has shown that young children can be toothed naturally and that the lower jaw catches up over time with a fully developed upper jaw.

Essential to this is nutrition, the use of chewing muscles early on in life and good breathing habits. This means breathing through the nose with the mouth closed and the tongue resting up against the palate. Also, the practice of maxillary expansion has been shown for over a century to correct crooked teeth and improve nasal breathing space. And since 1918 or facial exercises have been shown to correct mouth breathing habits, there are better ways. Right to grow is an organization dedicated to ending the practice of orthodontic growth stunting. Please sign our petition online, share this video and get involved in making the world a safer, healthier place for our children.

Okay, so this is Eli. We did not make this video. His mom, who’s a nurse, made this video, but it is a great demonstration of what a child looks like when they’re struggling to get air and when they’re sleeping. It’s a little bit tough to watch sometimes, but it really gives you a good idea of what can happen.

Okay, this is a picture of Eli holding his breath right now. He’s snoring. We’re going to see what happens. This is February 6th, 2009. There he goes. You got it. He shakes. He kind of woke himself up. Okay, now let’s listen again.

Quiet

A few seconds. He’ll probably hold his breath again. You can hear him snoring and he’s breathing through his mouth, not through his nose, and he’s not congested. Now, there he goes. Saw that now he’s gasping for air. The breath he took beforehand, he was actually not getting anything into his lungs. Now again, he’s only kind of, he’s not really getting anything in right now. I was going to take a deep gasp in a few seconds. There he goes. And again, he’s going to hold it now there goes a deep breath again. That was a clear breath. And now again, he’s going to start holding it. All of these breaths that he’s taking right now, he’s not really getting much into his lungs. There he goes. Now, every time he shakes like that, he’s essentially disrupted his sleep. Now he’s holding it that was holding it. He’s still holding it. He’s trying to take an air there. He goes, okay, now watch. He’s holding it, he’s holding it, he’s holding it, he’s holding it. He’s still holding his breath and i’s going to gulp again. There he goes. That was it again. And again, he’s holding.

He’s holding, he’s trying. There he goes. So this has been three minutes and 15 seconds and you can see how many episodes he’s had of not getting calm breath in. Now watch what happens when I take his jaw and I just bring it forward if I can. Let’s see if I can. And I open his airway, just bringing his airway forward. Now listen to the quiet breathing. There we go. Now he’s breathing through his nose and I brought his airway. I’m opening his airway, just pulling his jaw forward ever so slightly. And now he’s breathing through his nose quietly. His mouth is a little bit open, but he’s breathing through his nose just by ear quietly his breathing. You don’t hear him anymore. And all I did is gently bring his jaw forward. That’s it, essentially allowing the air to go in through the nose and clearly down into the trachea. Tonsils aren’t blocking anymore. I’m going to let go. Let’s see what happens. Now he’s in a comfortable position. The jaw is still forward a little bit.

So what does Eli’s video tell us? That the development of the upper and lower jaws has a huge impact on how we breathe. You can see here in this picture on the left how the jaw, the lower jaws push back so much that makes it really hard for air to pass through the airway. On the right hand side, the right picture, it sort of shows you how the tongue is plastered against the back of the airway and air just can’t get through there. And that’s why Eli’s mom was able to pull the jaw forward to open up his airway,

Nasal breathing versus mouth breathing. If you are unable to breathe your nose, you obviously have to breathe your mouth. And when you breathe your mouth, the air is dry and unfiltered and your tonsils and adenoids tend to swell and become inflamed because of all of the allergens that are not being filtered out by your nose. And this may further impact your ability to breathe through your nose, but let’s say that you are able to breathe through your nose when you do, the air is warmed, humidified and filtered. Also, when you breathe through your nose, there’s a chemical called nitric oxide that is released from your sinuses. And as you breathe that in, it goes into your lungs and it is a vasodilator. It actually helps our bodies absorb the oxygen that we breathe a lot better. And nasal breathing is very important for our bodies and for our overall health.

So how does this all connect to a DD and A DHD? So when you have a child who is mouth breathing and has a small airway, it really impacts how the child is able to sleep and they may experience restless sleep and nighttime arousals just like an adult. When a child doesn’t get a good night’s sleep, especially after night after night for maybe years on end, it really impacts their life. This video is a video from Dr one of my mentors and he talks about how a DD and ADHD are related to sleep disordered breathing.

Now take a child, alter their quality of breathing and sleeping, and the real big issue now is how will they be during the day? So now you take a child who’s 5, 6, 7, 8, it doesn’t matter. Their issue has begun years ago. So it’s not like you had one or two bad nights of sleep. You’ve had a poor quality of sleeping and breathing for years. And the parents have been struggling with so many different issues and not the least of which is the ADD ADHD discussion because the child who doesn’t get a proper night’s sleep with a good quality of breathing throughout the entire night is going to wake up and be unrested. And when you get a child who’s had a poor quality night’s sleep, poor breathing all night long, and you make that happen for years, you know what? You’ve got a six, seven or 8-year-old that’s going to go to school and have trouble learning, have trouble sitting, still have trouble behaving, have trouble cooperating, basically have trouble fitting in to what is supposed to be a quiet and peaceful and learning environment.

And it’s not long after that where the phone call comes to the parent and when the phone call comes to the parent from the school, what happens is we have little Jimmy here and he’s a little bit disruptive and we really want you to have him evaluated for a DD and ADHD. They’re going to be diagnosed with a DD and ADHD, and our solutions are pharmaceutical. If we are given a pharmaceutical, it’s usually in the form of some sort of a stimulant. And what that does to the child is it kind of pushes them over the edge and it brings them back to calm. So you basically take an excited or hyperactive child, you stimulate them more and you bring them back to so-called calm, but it doesn’t make a better learning child. You’re not going to have a child who’s able to learn as well.

So now you might have the child sitting still in class. They might be a little more numb or relaxed or calm, but it doesn’t necessarily make them a better learner if we have the So-called ADD ADH, ADHD diagnosis. We’re talking about hyperactivity, we’re talking about all of the things about behavior and development that land in this category. And the interesting thing about research is, and there is current, ongoing and past research that shows children who are sleep deprived produce the same exact symptoms as kids who are diagnosed with a DD and ADHD. In fact, there’s a nice study that showed children who were diagnosed with a DD and ADHD were mixed with children who were sleep deprived. And in that group of kids, when they tried to analyze them and look at their symptoms and diagnose them, they couldn’t tell them apart. And if you have a group of kids and you can’t tell apart who’s an a DD child and who’s a sleep deprived child, it’s no surprise that maybe the ADD and ADHD has a cause and maybe that cause has to do with the quality of the breathing and the sleeping overnight.

And there’s a lot of research out there. And one of the pioneers here is a Dr. Steven Sheldon out of Laurie Children’s Hospital in Chicago, and he does a wonderful job of researching. And over the decades he’s come to a conclusion and I’ve seen him speak and it’s not soon after he jumps on stage and he makes a statement that ADHD and a DD do not exist. They are an outcome of a sleep disorder breathing, they’re an outcome of a poor quality of sleep. It’s all about the quality of sleep. Another researcher who has produced beautiful research on the same topic is Dr. Karen Bock out of Einstein at Yeshiva University. Dr. Karen Bock has the largest study to date. 11,000 children were watched over seven years and they were divided into two groups. Sleep disorder, breathing, children and children who do not have sleep disorder breathing issues, the children in the sleep disorder breathing group over their seven years, her study showed that they were 50% more likely to be diagnosed with an ADD or A DHD diagnosis and treated with medication.

50% is a coin toss for our child to be diagnosed and treated with a medication. Also in her group, they were doing testing, they were doing IQ or intelligence testing along those seven years. And the children with the sleep disorder breathing, their intelligence testing, their IQ scores were dropping over those seven years. And that’s really not the way it works when you’re growing and forming the formative growing years for a child when they’re sleeping and breathing well, your IQ raises to a certain point and then you kind of plateau. We don’t see IQs diminishing amongst children.

Well is the research that Dr. Lia references from Dr. Karen Bonk. She studied 11,000 children over six years and she found that there was a strong and persistent association between sleep disordered breathing and diminished iq. She also found that sleep disordered breathing increases the risk of being diagnosed with a DD or ADHD by 50%. So now you may be asking how is this all connected to bedwetting? In this next slide, Dr. Morali is going to explain the connection between bedwetting airway and sleep.

Another thing that might happen is bedwetting. Bedwetting, it’s a little more common than people are aware because it’s also a best kept secret. Not many people are running around and advertising that their child is bedwetting at the age of 5, 6, 7, 10, 14 years old. But bedwetting does have a relationship to how we’re breathing and our quality of sleep. And some of the causes for bedwetting relate to the way oxygen is exchanged in our body. And the way I’ll describe it is this, if we’re breathing through our mouth, that air coming into the lung isn’t really filtered, warmed or humidified appropriately, and the body can’t exchange it appropriately. So a little less oxygen goes to the brain. Now the brain is a very sensitive organ. When the brain recognizes little changes in oxygen, it goes to work immediately because once the brain starts to recognize a little less oxygen, it doesn’t know if we’re being choked to death, a very serious condition or if there’s an imbalance in how we’re breathing at night.

But it does start to trigger a little bit of the fight or flight response and a little bit of the fight or flight response means the brain’s going to look at the body and say, all right, if we’ve got a little bit of an oxygen issue going on, I’m going to pull oxygen from something that it picks to be unnecessary right now and maybe deliver it somewhere that might be more important. Planning on the rare occurrence as if the oxygen was going to stop. So if the brain’s recognizing a little less oxygen, all of a sudden it’s pulled from the urinary tract. If the body pulls a little oxygenation from the urinary tract, it might void. So we might wet the bed.

So what can we possibly do? It may not be what you think. Let’s meet Connor Degan and see what his mom has to say about him. So this next video was made by Connor Deegan’s mom. He was not treated with a vivos appliance, but it is a very powerful video on how airway and sleep can impact a child.

So what do we do now? What is the essential role of dentistry in this? So this is Hunter. At age 10, hunter struggled with bedwetting and when you look at his teeth, he had a deep bite and no room for his permanent teeth to come in. Now we know that this is a sign of an underdeveloped upper and lower jaws on the right hand side here. You see this is what he looked like after 10 months in treatment and he stopped wetting the bed in just one after you started treatment. Why? Because who is able to breathe better and sleep better?

So this is page at age 11. Paige also had a really deep bite and a lot of crowding as you see on that picture on the bottom left of the screen and on the right hand side, this is what Paige looked like after treatment. You can see how much more her jaws are developed and look at her teeth. There is no deep bite there. It’s there perfectly straight. Well, do you remember Michael? He was the boy we saw earlier in the presentation who looked a little bit overweight, had a double chin, but he really wasn’t overweight. He just had a really underdeveloped lower jaw. Well, after a couple years of oral appliance therapy, you can see what he looks like at age 14. It’s a really big difference.

And here’s Michael, a different look at his teeth. Once again, at age nine he had a really deep overbite. And then at age 14, after only a couple of years of oral planes therapy, he’s, his bite is really stable. He doesn’t wear braces or retainer. He’s really healthy. His teeth are really healthy now. So let’s look at Michael’s airway and the changes in his airway at age nine. On the left, you can see his airway right there, that little black area. You can see how retruded his lower jaw is because it was undergrown, it was underdeveloped on the right hand side here. This is his airway at age 14, that black area right there. Look how much bigger the airway is and it’s because he had oral appliance therapy and it was able to grow his upper and lower jaws towards his genetic potential. Well, you might be thinking, what about me? What about my spouse? What about my child? Well, first let’s meet Dr. Terry Griffin, one of my mentors.

I am Dr. Tara Griffin. We are here today in my clinic in Panama City Beach. I’ve been practicing dentistry for over 11 years. Before I discovered the vivos appliance, I was suffering every day with chronic head and neck pain, TMJ pain. I was practicing dentistry and been practicing for five years, but I was already looking for an out. I knew that with this much pain I could not continue to practice dentistry. I had chronic sinus and allergy problems, bronchitis, I was not sleeping throughout the night very well, was waking up during the night. I had severe daytime fatigue where I would need to go home and actually take a nap in the afternoon just at lunch. And so I was looking for a solution to the problem, but I didn’t know what the root cause was until I learned about the vivos appliance. As soon as I started treatment with the Vivos appliance within the first two nights, I was sleeping soundly throughout the night.

My energy was better. During the day, the pain that I was undergoing took a bit longer to get resolved, but within the first three to four weeks, my pain level was reduced by two thirds or more. Within a month’s period of time, I was breathing through my nose better. I wasn’t having the same sinus symptoms that I was having before. And within three months of treatment, my asthma had improved so much. I had no more problems with the inhalers and the frequency I was having to use with all of my asthma inhalers. My overall health started to improve very quickly. I was my own first patient. However, as I continued to treat the next patient and the next patient going forward, I was curious to see if they were going to have the same outcome that I had and they did. Nine out of 10 had the very similar outcome that I had, so they were sleeping better in just a few nights actually getting their energy back.

They were less irritable. The pain that they had was going away very quickly. The teeth were beginning to straighten and align over time. So even though with this type of problem it can take some time to get the long-term results, the immediate symptoms start to improve very quickly. Comparing my before and after picture with the Vivos appliance, my smile was not symmetrical, my teeth were crowded. The gumminess of my smile was a major problem that I didn’t like. I had unevenness in my eyes, also in my nose. My face was more round and less balanced and that all helped to correct itself as well as I went through the treatment. When the vivos appliance is worn in the early evening while you sleep at night, it allows the jaw to relax. It allows the airway to open up. It allows you to breathe through your nose and to get the oxygen that you need to the rest of your body, for your body to begin to heal.

By breathing through our nose, we are actually getting much more oxygen to our brain as well as our lungs. And we are producing nitric oxide, which is a vasodilator to allow the blood flow and everything to circulate better. And so a big component with this is it forces you to actually breathe through your nose to get the oxygen where it needs to go into the body. So that’s a very important part of this. If you’re interested in learning more about the vivos appliance, if this would be good for you, then I recommend you coming into a vivos center to be evaluated to determine if this is something that could help you.

So I wanted to share this image with you. It’s of an adult patient that was treated with a vivos oral appliance. You can look here, the airway here very constricted. You can see the red area where it’s sort of dangerously constricted. He started at 7.7 centimeters and after 15 months he ended up at 24.1 centimeters, almost tripling in size. And you can sort of see here his airway looks so much better, white and blue. I take that all day. Here’s another adult case I wanted to share with you. You can see on the left hand side before she started, she sort of had a narrow straight face, almost looked like it was stretched a little bit, and you can see as treatment progressed, you can see her transformation into a much younger looking person. It almost looks like she had surgery, but this was from oral appliance therapy.

This is another adult that was treated with an oral appliance on the left there you can see her before picture the second picture. You can see what her smile looked like after her treatment was done. On the third picture there, you can sort of see her profile, you can see her retruded chin right there. And after therapy you can see how the chin came forward. Quite astonishing. She had a testimonial. She said. When smiling, I noticed that I am now physically unable to smile as big as I used to. My gums are barely showing. Now my face feels different when I smile. Now I don’t know how to explain it, but it’s a great thing When I eat, I’m sorry, when I speak and eat, my jaw no longer pops. I can speak more clearly and I feel a noticeable difference in the amount of room my tongue has. I can breathe very well through my nose. Now I’m very happy with the results. So what does that mean for you here in our office? If you’ve identified that this treatment is right for you or for a loved one, I invite you to schedule an appointment to learn more. Vivos is a treatment system made up of screening, medical imaging, and diagnostics. We’ll take a series of 3D scans, photographs, go over your medical history, and then we’ll sit down and discuss an integrative plan that works best for you.

This treatment can include oral appliance therapy. There are a few different options for you, and this appliance will be designed specifically just for you and we’ll discuss your comprehensive treatment plan as well. We may be including a myofunctional therapist, an ENT, a functional medicine doctor, your primary care physician or chiropractor. In our practice, we believe that it takes an integrative approach for your health and your well-being. We work with innovative state-of-the-art, patient treatment technology, and one of these technologies that we use on our practice is a home sleep test. Again, if you feel like this treatment may be right for you, please get scheduled for a private screening with me. I know that’s a lot of information and everybody tends to have at least three questions. The first one is usually how long does it take? That’s a great question. Every case is different, every person is different, and the length of time varies as well, but typically it takes between 12 and 24 months. Some longer, some shorter, but compliance, wearing your device is really, really key. And so it’s important that you wear it like we prescribe it. A lot of people ask about how much does it cost and does insurance cover it? It’s another great question. Treatment typically ranges between 4,590 $500 and medical could help with it. It depends on your plan. And then three, does it hurt? No, this treatment is all natural.

If you have any other questions, please feel free to reach us at (916) 961-8454. You can also contact us through our website at www.orcuttfamilydentistry.com. Thank you so much for your attention, and I’m going to leave you with this breathing wellness movement video from Vivos Therapeutics.

Really feel like Vivos is one of the great answers to the healthcare crisis that’s in America because we’re getting to the root cause of what ills a lot of us, and that is not breathing well and not sleeping well.

If you trace back the journey of a sleep apnea patient, that patient is suffering for years before they ever get diagnosed. Once they are diagnosed, they’re presented really with two fundamental options. You can go into CPAP and wear a contraption over your face every night for the rest of your life. Or you can have what’s called a mandibular advancement device, which will actually protrude your lower jaw in an unnatural position to hold your airway open while you sleep, and you can wear that for the rest of your life. Either of those two modalities are going to present that patient with a life sentence of having to wear this contraption, one or the other for every night for the rest of their life.

The interesting thing about CPAP and oral appliances is although they’re very effective treatments, if they’re used over a lifetime, the person’s condition actually gets worse over time.

Along comes vivos and says, wait a minute, we have a better option. That’s all natural. We can say to a patient, you go into this oral appliance therapy with our protocols, and you go through this treatment for 12 to 24 months, and at the end of that time, there’s a high probability that you will no longer have to wear an appliance or any kind of device.

Vivos is literally changing my patient’s lives.

It has drastically changed my life. I don’t have to use the CPAP anymore. Within just a couple weeks of using the appliance, I was able to breathe through both nostrils, something I couldn’t do my entire life. This was revolutionary, pretty much made me feel excited about life again. If she’s sleeping better, I’m sleeping better. You really feel like you’ve been given a new life.

It’s amazing. I wake up and I’m not in pain

Because she’s sleeping. Better is her attitude. During the day is better.

I have a better quality of life now. I can’t say enough good about

It. I’m getting instant benefit from it. I was amazed. I dreamed every night for two weeks straight and I told my wife, I said, it’s amazing. I feel sharp now. I don’t feel drowsy all the time. It’s been a long time since I felt this good. I wouldn’t lay down and try to sleep right now without my vivos device.

My asthma has gotten much, much better. Without the vivos, I wouldn’t be outside right now. There’s no numerical value you can put on this kind of a change. I smile and I haven’t smiled for a long time.

Right after I started using it, I noticed the results. Really, especially with the snoring. My sleep apnea episodes are a fraction of what they were before. This product is phenomenal. It changed my life. It’s

A very comfortable process, but I can see dramatic differences. Now. I can really open my mouth before it would almost always click.

His ADHD is calming down. He is doing better in school. I can definitely see the difference and the change in him. It’s a miracle

I get to do things now that I would not have been able to. I would not hesitate to do it again.

I am 100% happy that I did this, and I am thankful every day that I have it, I can breathe.

We bring hope to the millions of people and the millions of families, men, women and children who suffer from this disease.

It promotes the body’s own ability to heal itself because now the body can breathe and sleep well. That’s exciting.