I have been diagnosed with severe obstructive sleep apnea almost 3 years ago and have been working on various jaw health related interventions. While I am still in process of doing so, I have had very good improvements to my condition.
From the book "Jaws, The story of a hidden epidemic”
There's a silent epidemic in western civilization, and it is right under our noses. Our jaws are getting smaller and our teeth crooked and crowded, creating not only aesthetic challenges but also difficulties with breathing
Generally, jaw health and size are closely related to obstructive sleep apnea (OSA). OSA is associated with a massive range of negative health outcomes, including but not limited to anxiety, depression, daytime sleepiness, insulin resistance, neuro-degenerative diseases such as Alzheimer’s, ADHD, loss of IQ, heart disease, car accidents, cancer and many others.
One of the key causes of OSA aside from being overweight is an under-developed jaw, which is related to a generally under-developed skull.
Jaw under-development is not completely understood and likely has many causes. Most common hypothesi include:
- Insufficient breastfeeding
- Allergies, such as pet allergies and mold allergies
- Insufficient meat in childhood
- Insufficient chewy foods in childhood
- Hormonal deficiencies
- Mouth breathing
- Physical Facial trauma
- Emotional Trauma
- Bad orthodontics, including improper teeth extraction
There are many suggested solutions for jaw-maxxing. Several sites are dedicated to publicizing information on the topic, such as Jaw Hacks and the Great Work
In regards to trying to fix sleep apnea and other jaw-related issues, there are some alternatives to jaw surgery or supplements to it. Very few of these except apnodent are true “replacements” in that their effects are likely smaller than a full jaw surgery or quasi surgical expanders.
1. Apnodent and it’s more sophisticated version ApnoTX are night-time devices to hold the lower jaw forward. For me apnodent provided strong night-time relief for managing sleep apnea in addition to acting as a night guard to prevent damage from teeth grinding. The device needs to be worn every night and periodically readjusted if you are doing any kind of orthodontics.
Generally, apnodent is more gentle than older versions of maxillary adjustment devices (MAD) and avoids bite re-alignments and other issues frequently associated with them. It can still exert pressure on the front teeth in some cases, which could be in an issue in rare situations of severely damaged front teeth or gum line.
Apnodent is one of the few “clean” ways to manage deficiency in the length of the jaw (especially lower jaw) without resorting to something as drastic as a jaw-lengthening surgery.
2. NCR
Neuro-cranial restructuring (NCR) acts on the sphenoid bone and moves bones of the skull into a more symmetrical shape. While it does not directly act on the jaw, it can aid in widening the face and releasing tension that could be acting to make the jaw more narrow. In my case I tried to do a Maxillary Skeletal Expander without any associated surgery (DOME/SARPE/EASE), but with an NCR session before and after installing it. I had a split, which is rare for a man over 35. I suspect that this interaction can be fruitful, but only have myself as a data point.
3. Mewing
Proper tongue posture, putting the tongue on the roof the mouth is an important component of overall posture. Mewing is a popular exercise to do this. While it’s worth checking out, I generally don’t expect the exercise alone to significantly alter one’s facial structure past a certain age. And while it can potentially prevent further deterioration and that is important, I view it as more of a component, rather than a full solution.
4. Fixing forward head posture
Forward head posture can be both a cause and an effect of an under-developed lower jaw and associated TMJ issues. Being mindful of it and using various stretches whether from PRI or yoga is worthwhile. Some chiropractors can help as well. The impact to your health is likely very important, the impact on jaw issues specifically may vary.
5. Side sleeping (be careful with those shoulders).
“Sleeping position” is surprisingly contentious topic. Sleep apnea sufferers recommend sleeping not on the back to avoid one’s jaw dropping down and blocking the airway. Gym broscientists recommend sleeping on one’s back to aid proper shoulder rotation. Side sleeping seems to offer a compromise solution as long as you are careful about your shoulders. In either case, if you do choose to sleep on your back, it’s best to elevate your head as little as possible with potentially only a very thin pillow or only a neck pillow.
6. Chewing gum
Chewing mastic gum can strengthen jaw muscles and bones which can certainly improve aesthetics of your jaw.
7. Checking your dwelling for mold issues.
Mold allergies can be very disruptive to sleep and cause a number of other problems. It's worth having a plan for checking and destroying mold if it arises in one's house.
8. Whole Body Breathing:
Whole body breathing (also here) is a new technique that hopes to utilitize breathwork for improved skull growth.
A Maxillary Skeletal Expander (also known as MSE), is a class of devices that use at least 4 screws also known as Temporary Anchorage Devices / TADs to attach to the upper palate. While it’s not considered a “surgery,” the screws generally need to be inserted by a surgeon under anesthesia. It works by separating the mid-facial bones that were previously two separate bones, but fused together at the mid-palatal suture. The MSE is a newer version of Miniscrew-Assisted Rapid Palatal Expansion (MARPE), which is a type of Rapid Palatal Expansion (RPE).
Rapid palatal expansion historically used teeth-based forces and only worked in teens. Trying to do tooth-borne-only appliances in adults would likely only damage teeth. An MSE generally uses only bone-based forces and can work in adults. There are MSE variants such as MANE which uses both screws and teeth attachments to exert forces. The last one is what I had done and my experience has been fairly positive.
Generally, an MSE can have issues, such as insufficient grip of the bone with the screw and the suture being too strong to split. In this case it’s very possible to either get “screw drag” where the screws cut through the soft tissue with no expansion or a partial expansion either on only front or back or skewed to one side. Some undesirable teeth “tipping” can occur as well, where the angle of the teeth changes from being straight down due to pressure. In case one’s issue is only a partial expansion, a second MSE or one with more than 4 screws might finish the expansion.
However, if successful, and MSE and similar devices can improve the airway and create a great improvement in sleep apnea outcomes.
Jaw Surgeries and orthodontic expanders for sleep apnea purposes are very complex topics with many approaches and branches with slight variations. A lot of procedures are relatively new, used by only a few doctors. Procedures frequently go through refinement over time, sometimes getting new names. There does not seem to be a good central repository of all the possible surgeries and variations, which makes communication somewhat difficult. I am mainly considering the purpose of surgery being improvement in sleep apnea, sleep breathing as well as some potential postural and symmetry benefits. There are frequently aesthetic benefits to jaw surgeries or post / pre surgery teeth alignment work, however I don’t focus on those.
Of the good type of surgery and devices that are worth considering there are several commonalities. Generally, they target either low or upper jaw being either too narrow or too far back. It is common for the width of one’s jaws to match and therefore both be too narrow, necessitating a plan for both jaws to maintain long-term teeth alignment.
Tongue tie release
Tongue ties can prevent the tongue from properly reaching the upper palate. An adult tongue tie release surgery may or may not help with this problem.
Surgically Facilitated Orthodontic Therapy (SFOT)
Surgically Facilitated Orthodontic Therapy is generic name. However, in practice it usually refers to a procedure that “packs bone” onto the jaw, thus is capable of extending it a few millimeters as well as strengthening the bone. The teeth then can be safely moved in the desired position and tooth movement can also occur faster. Teeth can be moved using a fast Invisalign or an SFOT-specific device. Generally, the benefits of SFOT are said to be faster orthodontic outcomes, however in my view avoiding tooth extractions is likely the main benefit, as well as potential for safe movement of the teeth forward a few millimeters.
Lower Jaw Sideways Expansion Osteotomies (MSDO / DAME)
Mandibular Symphyseal Distraction Osteogenesis (MSDO) and Distraction Assisted Mandibular Expansion (DAME) are a single cut to the middle or close to the middle of your jaw.
After MSDO / DAME cut to the lower jaw, it’s followed up by an expansion using a device. I expanded the device around 8 mil, which made my lower jaw actually wider than the upper jaw (until I got the MSE). Preparing for surgery may need to do some orthodontic work. For example, I had to do Invisalign for 10 months in order to separate the two front teeth’s roots and simplify the surgical procedure. This is one of the least invasive ostetomies.
Upper Jaw Sideways Expansions ( SARPE/ DOME / DONE / EASE)
This is a class of procedures used to help expand the upper jaw sideways. Ideally used with an MSE-style min-screw appliance.
Surgically Assisted Rapid Palatal Expansion (SARPE) is the oldest and most invasive version and is likely not needed anymore. While it’s possible to use it with a tooth-borne appliance, the overall invasiveness is much higher and results are likely similar
Distraction Osteogenesis Maxillary Expansion (DOME) is the newer version of SARPE which makes fewer cuts. See also
DONE is the version of DOME, which aims for nasal expansion as well. Many of the procedures mentioned aim for nasal expansion, so the differences are likely minor.
Endoscopically-Assisted Surgical Expansion (EASE)
Endoscopically-Assisted Surgical Expansion (EASE) by Dr Li is another procedure claiming to make fewer cuts than other surgeries, which uses a custom expansion device rather than a standard MSE. It claims to have better recovery time than other techniques and smaller eventual gab between the front teeth and therefore a smaller tooth movement required to close it.
Double jaw surgery / Maxillomandibular advancement (MMA)
Maxillomandibular advancement (MMA) is a combination of Lefort 1 Osteotomy for the upper jaw and Bilateral Sagittal Split Osteotomy (BSSO). The upper jaw is cut from the rest of the skull and then held in place using either plates or wires. The lower jaw is cut on both sides and moved forward after which it’s help together by screws and/or plates. See image Both components of MMA are quite invasive. As a whole MMA is one of the most invasive jaw surgeries with a very long recovery time. It is highly worth exhausting all available alternatives, less invasive surgeries mentioned here, various devices, night-time devices, Neuro-Cranial Restructuring and postural correction, before coming to this path.
There are also Jaw Interventions to Avoid
The general message is that while sleep apnea is an extremely dangerous threat to one’s health, there are number of mitigations and solutions available for it.