The Facial Aesthetic and Lingual Orthodontic Clinic

Beauty and altered appearance defines society today and the onus on facial change and a perfect smile devolves on a good specialised setup. Dentistry is increasingly becoming demand based and with growing awareness, information at finger tips, altered facial appearance, and the need for a perfect smile is defining health care trends. The oral health related quality of life is directly related to crooked teeth, poor smiles and less than desirable facial appearance.

The Facial Aesthetic and Lingual orthodontic clinic at Max dental heralds a patient centred, evidence based initiative wherein the full portfolio of issues has been addressed.

The successful launch of the fully customised, lingual precious metal appliances, Incognito now offers aesthetic solutions to correcting crooked teeth, creating functional and beautiful smiles with complete invisibility and a special focus on adult orthodontic needs where your life is not disrupted and yet you can keep your social and professional commitments.

One of the most frequently asked questions in orthodontics

Relates to how long do you have to wear braces?

This clinic offers the newer self-legating metal and aesthetic braces which not only use much lighter forces but also reduce 4 - 6 months on treatment times. Both children and adults can be efficiently treated with these technologically advanced systems.

Orthodontic treatment of adults has been compromised by the need for surgery to bring about change in skeletal structures and that many times key teeth are missing. We now offer Orthodontic mini implants , placed painlessly and used to correct such mutilated anomalies without need for extensive surgery .This opens a new dimension in efficient correction of not only crooked teeth but alteration of facial appearance without surgical intervention

We also offer the careful integration of orthodontics and surgical correction of the skeletal tissues of the facial region to address major issues of facial deformity. Max boasts of an internationally certified and competent team of orthodontics and maxillofacial surgery where in issues of function, facial balance and harmony are addressed using evidence-based techniques with assured outcomes.

We also propose and endorse the concept of early orthodontics wherein children as early as 7 – 8 years of age can be treated with a balance of patient friendly orthopaedicappliances and braces to address growth issues and complement the natural growth of the child rather than just waiting for all the permanent teeth to erupt and then extract some teeth and use braces.

Treatment at the facial aesthetic and lingual orthodontic clinic is multifaceted,comprehensive, patient friendly and evidence based.

Dentistry for Children, The Paediatric Dental clinic

Children are special and they need to be treated so. The tendency to treat children as little adults has done untold damage to growing faces, occlusions and psychology.

We provide a comprehensive Paediatric dentistry service where the children get the attention they deserve while providing comprehensive solutions to decayed, missing teeth, psychological and growth issues. Early interceptive treatment and a full preventive care system ensure healthy smiles for your children.

Children with special needs, handicapped children get all the attention they deserve from our competent team of skilled paediatric dentists.

We build happy smiles.

Obstructive sleep apnea (OSA) is a disorder in which a person stops breathing during the night, perhaps hundreds of times. These gaps in breathing are called apneas. The word apnea means absence of breath. An obstructive apnea episode is defined as the absence of airflow for at least 10 seconds.

Sleep apnea is usually accompanied by snoring, disturbed sleep, and daytime sleepiness. People might not even know they have the condition.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) occurs when tissues in the upper throat collapse at different times during sleep, thereby blocking the passage of air. In general, OSA occurs as follows:

1. On its way to the lungs, air passes through the nose, mouth, and throat (the upper airway).
2. Under normal conditions, the back of the throat is soft and tends to collapse inward as a person breathes.
3. Dilator (widening) muscles work against this collapse to keep the airway open. Interference or abnormalities in this process cause air turbulence.
4. If the tissues at the back of the throat collapse and become momentarily blocked, apnea occurs. Breath is temporarily stopped. In most cases the person is unaware of it, although sometimes they awaken and gasp for breath.
5. In some cases, the interference is incomplete (called obstructive hypopnea) and causes continuous but slow and shallow breathing. In response, the throat vibrates and makes the sound of snoring. Snoring can occur whether a person breathes through the mouth or the nose. (Snoring often occurs without sleep apnea.)
6. Apnea decreases the amount of oxygen in the blood, and eventually this lack of oxygen triggers the lungs to suck in air.
7. At this point, the patient may make a gasping or snorting sound but does not usually fully wake up.
Obstructive sleep apnea is defined as five or more episodes of apnea or hypopnea per hour of sleep (called apnea-hypopnea index or AHI) in individuals who have excessive daytime sleepiness. Patients with 15 or more episodes of apnea or hypopnea per hour of sleep are considered to have moderate- sleep apnea.

Complications:

Sleep apnea can lead to a number of complications, ranging from daytime sleepiness to possible increased risk of death. Sleep apnea has a strong association with several diseases, particularly those related to the heart and circulation.

Daytime Sleepiness

Daytime sleepiness is the most noticeable, and one of the most serious, complications of sleep apnea. It interferes with mental alertness and quality of life. Daytime sleepiness can also increase the risk for accident-related injuries. Several studies have suggested that people with sleep apnea have two to three times as many car accidents, and five to seven times the risk for multiple accidents.

Undertreated sleep apnea is a major risk factor for injury at factory and construction work sites

Effects of Sleep Apnea on Heart and Circulation

A number of cardiovascular diseases - including high blood pressure, heart failure, stroke, and heart arrhythmias - have an association with obstructive sleep apnea. This link may be because both cardiovascular illnesses and sleep apnea are associated with obesity and its consequences. However, large studies have increasingly suggested that OSA itself may lead to or worsen cardiovascular disease.

At this time, however, evidence of a clear causal relationship between obstructive sleep apnea and cardiovascular events is lacking. Likewise, whether treating obstructive sleep apnea improves cardiovascular outcomes has not been demonstrated.

High Blood Pressure - A number of studies have found a strong association between sleep apnea and high blood pressure (hypertension) even when obesity is not a factor. A weak, but still higher-than-normal, association with high blood pressure has also been observed in those who snore, wake frequently during the night, or have mild sleep apnea.

Coronary Artery Disease and Heart Attack - Sleep apnea has been associated with heart disease regardless of the presence of high blood pressure or other heart risk factors. Studies have shown that patients with moderate-to-severe obstructive sleep apnea have a higher risk for a heart attack.

Stroke - There is some association between the presence of sleep apnea and risk of death in patients who have previously had a stroke.

Heart Failure - Up to a third of patients with heart failure also have sleep apnea. Both central and obstructive sleep apnea are linked with heart failure. Obstructive sleep apnea can make heart failure worse, and patients with apnea have a higher mortality rate than those who do not. Treatment of obstructive sleep apnea may help improve heart function, although this is not certain.

Atrial Fibrillation - Sleep apnea is more common in people with Atrial fibrillation (irregular heartbeat) than in patients with other heart conditions.

Other Adverse Effects on Health

Sleep apnea is associated with a higher incidence of many medical conditions, other than heart and circulation. The links between apneas and the conditions are unclear.

1. Diabetes. Severe obstructive sleep apnea is associated with type 2 diabetes.
2. Obesity. When it comes to sleep apnea and obesity, it is not always clear which condition is responsible for the other. For example, obesity is often a risk factor and possibly a cause of sleep apnea, but it is also likely that sleep apnea increases the risk for weight gain.
3. Pulmonary hypertension.
4. Asthma. Sleep apnea may worsen asthma symptoms and interfere with the effectiveness of asthma medications. Treating the apnea may help asthma control.
5. Seizures, epilepsy, and other nerve disorders. There may be an association between seizures and obstructive sleep apnea, especially in older adults. Some studies have shown treatment of obstructive sleep apnea, when present, may help in the control of refractory seizures.
6. Headaches. Sleep disorders, including apnea, may be the underlying causes of some chronic headaches. In some patients with both chronic headaches and apnea, treating the sleep disorder has cured the headache, even the very severe and disabling form known as a cluster headache.
7. High-risk pregnancies. Sleep apnea causes higher rates of pregnancy complications, including gestational diabetes and high blood pressure.
8. Eye disorders, including glaucoma, floppy eyelid syndrome, optic neuropathy conjunctivitis, dry eye, and various other infections and irritations. Some of these latter symptoms may be associated with CPAP treatment.

Psychological Effects

Studies report an association between severe apnea and psychological problems. The risk for depression rises with increasing severity of sleep apnea. Sleep-related breathing disorders can also worsen nightmares and post-traumatic stress disorder.

Effects on Bed Partners

Because sleep apnea so often includes noisy snoring, the condition can also adversely affect the sleep quality of a patient's bed partner. Spouses or partners may also suffer from sleeplessness and fatigue. In some cases, the snoring can disrupt relationships. Diagnosis and treatment of sleep apnea in the patient can help eliminate these problems.

Effects in Infants and Children

Failure to Thrive. Small children with undiagnosed sleep apnea may "fail to thrive," that is, they do not gain weight or grow at a normal rate and they have low levels of growth hormone. In severe cases, this may affect the heart and central nervous system.

Attention Deficits and Hyperactivity. Problems in attention and hyperactivity are common in children with sleep apnea. There is some evidence that such children may be misdiagnosed with attention-deficit hyperactivity disorder. Snoring, rather than sleepiness, is a stronger risk factor for hyperactivity in many of these children, especially boys under 8 years old. (Even children who snore and do not have sleep apnea may be at higher risk for poor concentration.)

Dental Sleep Medicine and OSA Clinic

While detailed sleep studies are carried out jointly with the department of pulmonology and respiratory medicine at MSSH , the use of dental devices in mild to moderate sleep apnoea is extremely relevant . The mandibular advancement devices, tongue repositioning and also a direct physical alteration of compromised airways by expansion of the maxillary arch and mandibular advancement to enhance the transpharyngeal airway space.

In severe cases a mandibular advancement surgery again jointly planned and carried out by the orthodontist and the maxillofacial surgeon has proven clinical success.

The Dental Sleep Medicine clinic will directly complement and work in close association with the department of respiratory medicine to offer comprehensive solutions to this increasingly relevant issue.