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TOOTH WEAR AND BREATHING
Harry Cooperman DDS
Noboro Miura DDSWhile it is known that neural activation of pharyngeal muscle exhibits respiratory periodicity and is an integral part of the respiratory control system, the mechanical consequences of neuromuscular activity in the upper airway muscles are not well known(1).
Musculoskeletal disturbances in the oro-pharynx may be subdivided arbitrarily into those of organic and those of functional origin, despite the fact that the former are inevitably complicated by postural strains and the latter by demonstrable lesions of misused muscles (2)joints and bones.
At one time or another in life, each individual suffers pain and/or disability as a result of some functional disturbances of the musculoskeletal system. Almost invariably the condition is due to faulty posture(2). Although the widespread occurrence of tooth attrition and mandibular protrusion is well established(3,4) the advantageous nature of these changes has not been recognized. Our research however, indicates that teeth and mandibular protrusion, resulting from tooth attrition, play a significant role, anatomically and physiologically, in protecting respiration.
Conversely, unworn teeth, which are characteristic of present-day man, prevent anatomical and physiological changes which are necessary for proper opening and alignment of oral pathways leading into the body.
We believe that tooth crown attrition, associated with mandibular protrusion and anatomical uvula tongue posture are protective mechanisms that function to preserve throat and neck physiology throughout life. We further believe (a) that unworn cusps prevent normal mandibular protrusion and therefore causes abnormal mandibular retrognathia(5), (b) that mandibular retrusion which is observed in most patients, causes the dorsum of the tongue and the uvula to impinge on one another, thereby producing irritation in the manner of overlying toes; (c) that uvula glossal impingement appreciably narrows respiratory and alimentary pathways in the oral pharynx; (d) that these impingements may produce disturbances in breathing, swallowing, drainage of the accessory sinuses, and eustachian tube dysfunctions; (e) that mandibular retrusion per se may disturb temporomandibular relationships; (f) that recognition of basic anatomic and physiologic alignment may permit physicians to correct the derangements by mechanical means(6), (g) that normal uvula tongue posture is a physiologic correction of the body which generally does not occur in civilized man.(7)(12).
Momentarily ignoring other considerations, the primary therapeutic indication in caring for the patient's upper airway manifestation of an anatomical and/or physiological disorder is that attacking the ailment at its source.
Overlooked oral diagnosis should be re-evaluated. This adjunctive examination is based on a thorough understanding of normal and abnormal relationships in the mouth and throat such as:
1). Lack of attritional crown wear of the teeth
2) Presence of uvula tongue malposture syndrome
3) Affliction orthopedic gait of mandible
4) Textbook dental occlusion
5) Mandibular retrognathia
6) Roller coaster transit plane of dental occlusion (HIP)
7) Collapsed bite
8) Diminished mouth volume affecting swallowing
9) Non replacement of missing teeth
10 Scalloped tongue 11 Clicking,
snapping, crepitus, noises in TMJDisturbances of the upper airway may be affected of any of the above. Patients with these disturbances may be distressed because (a) effects to diagnose the causes of their problems were not successful, and (b) a variety of treatments had not provided relief. For the first time the advantages and effects of tooth attrition and mandibular protrusion, which are widespread in primitive man and almost never occurring in civilized man, should be considered in diagnostic investigation of patients with obstructive sleep apnea syndrome.
Food preparation habits of man significantly influence the development and maintenance of a sound oro-pharyngeal apparatus. Sanitation habits of civilized man also influence the masticatory, deglutition and throat physiology through the uses of muscles, ligaments and blood supply in chewing exertion. Again as man began to remove from his food the grit, sand and other hard to chew food he unwittingly deprived himself of a natural aid to protect the oro-pharyngeal apparatus through vigorous employment of the muscles of mastication and attritional wear of the teeth(8,9). This impaired physiology could be the beginning of mouth degeneration syndrome. The oro-pharynx may exhibit signs of fatigue, disuse atrophy, loss of tonicity, loss of some functions, debilitation, loss of neural mechanics, narrowing of respiratory pathways, non attritional wear on the teeth, degeneration of the functions of the superior, middle and lower pharyngeal constrictor muscles. These clinical signs at the diagnostic level of upper airway manifested deformities are unmistakable and indisputable. They inhibit efficient operation of the neurophysiology throughout a lifetime of a healthy individual.
Correction of these orthopedic and physiologic encroachments can be made possible mechanically with respiratory wedges(1O),The effectiveness of individually designed intra-oral prosthetic devices (respiratory wedges) are inserted into the oral cavity and unlock 'locked teeth'. This maneuver facilitates the forward movement of the mandible and its anatomical and physiological attachments. These anatomical changes and their neurological effects, along with the reduction of complicated postural strains, may predispose to the treatment of OSAS.
Methods of fabricating and assembling respiratory wedges are described elsewhere(6,9,11,13).
REFERENCES
1. Strohl, KP, Olson, LG. Concerning the Importance of Pharyngeal Muscles in the Maintenance of Upper Airway Patency during Sleep--an Opinion.
Chest 1987; 92: 918-92O2 . Hyman, HT. Treatment in Internal Medicine, Philadelphia, J.B.Lippincott, 1958: 54O-541
3. Begg, PR. Orthodontic Theory and Technique, Correct Occlusion, The Basis of Orthodontics, Philadelphia
W.B. Saunders, 1965:5-364 . Kamijo, M. Jaw Relationships (Japan) International Dental Journal,1977
5. Forde, TH. Oral Dynamics-Principles and Practice, New York,
Exposition Press 1964:41-486. Miura, N, Ueno, K, Karasawa, J, Cooperman HN: (Theory) Practical Myodontic Splints, Japan,
Quintessence, 1986:148-149.7. Cooperman-Miura Syndrome. Dictionary of Medical Syndromes, 3rd Ed.,
Philadelphia, JB Lippincott, 199O:2O1-2O28. Miura, N. Observation of Natural Attrition, Japan, Nihon Shigi:1984
9. Cooperman, HN. Oral Conditioners-Their Role in the Treatment of
Muscular Imbalances, Dental Digest 196O:11-151O. Cooperman, HN, Miura N. Uvula Tongue Malposture Syndrome-Intervention with Oro-pharyngeal Wedges, 199O (In Print)
11. Miura, N, Ueno, K, Cooperman HN:(Theory) Myodontics (Japan)
Quintessence, 1984:11-2112. Cooperman-Miura Syndrome. Dictionary of Syndromes and Eponymous Diseases Florida, RE Kreiper, 199O:44 July 199O
13. Cooperman, HN. Immediate Care of Temporomandibular Joint Syndrome, Dental Digest, 1972:23O-235
