Tammarie Heit’s research while affiliated with University of Alberta and other places

Purpose: To demonstrate the effect of an orofacial myofunctional therapy intervention by an interdisciplinary team composed of a registered dental hygienist who is also a certified orofacial myologist (COM®), a general dentist, and an orthodontist on the elimination of oral habits and changes in dental malocclusion. Method: This case study describes a 7-year-old female who underwent an individualized myofunctional therapy program and was given supervised education on a series of exercises targeting the muscles of mastication and facial expression over 5 months. Correct oral rest postures of the tongue and the lips were also established through therapy. Results: The intervention enabled the client to eliminate multiple oral habits, which corrected oral rest postures of the lips and tongue. This correction consequently improved the client's malocclusion and further prepared the client for future orthodontic treatment. Conclusion: Myofunctional therapy facilitated the elimination of unfavourable oral habits that led to malocclusion. Eliminating oral habits better prepared the client for orthodontic treatment and retention. Use of an interdisciplinary team facilitates optimal client care.

Obstructive sleep apnea (OSA) is a clinical disorder within the spectrum of sleep-related breathing disorders (SRDB) which is used to describe abnormal breathing during sleep resulting in gas exchange abnormalities and/or sleep disruption. OSA is a highly prevalent disorder with associated sequelae across multiple physical domains, overlapping with other chronic diseases, affecting development in children as well as increased health care utilization. More precise and personalized approaches are required to treat the complex constellation of symptoms with its associated comorbidities since not all children are cured by surgery (removal of the adenoids and tonsils). Given that dentists manage the teeth throughout the lifespan and have an important understanding of the anatomy and physiology involved with the airway from a dental perspective, it seems reasonable that better understanding and management from their field will give the opportunity to provide better integrated and optimized outcomes for children affected by OSA. With the emergence of therapies such as mandibular advancement devices and maxillary expansion, etc., dentists can be involved in providing care for OSA along with sleep medicine doctors. Furthermore, the evolving role of myofunctional therapy may also be indicated as adjunctive therapy in the management of children with OSA. The objective of this article is to discuss the important role of dentists and the collaborative approach between dentists, allied dental professionals such as myofunctional therapists, and sleep medicine specialists for identifying and managing children with OSA. Prevention and anticipatory guidance will also be addressed.

Journal of Craniomandibular & Sleep Practice 34(1), 6-12, 2016

Objective: In this study, the authors investigated 3D changes in nasal volume, to test the hypothesis that nasal cavity volume can be changed in adults. Methods: After obtaining informed consent, the authors undertook 3D cone-beam computerized axial tomographic (CBCT) scans of 11 consecutive adults (mean age: 37·9 years), before and after biomimetic oral appliance therapy (BOAT). The mean treatment time was 18·4±2·5 months. Volumetric reconstruction of the nasal cavity was undertaken, and the nasal volume was calculated in all cases. The findings were subjected to statistical analysis, using paired t-tests. Results: The mean nasal cavity volume was 41·9±12·0 cm(3) before treatment. After BOAT, the mean volume increased to 44·0±12·7 cm(3) (P = 0·022). Conclusions: These data support the notion that nasal cavity volume can be changed in adults. Use of BOAT might improve continuous positive airway pressure (CPAP) compliance in adults diagnosed with obstructive sleep apnea (OSA), by increasing the nasal cavity volume and decreasing nasal airflow resistance.

Aims: There has been much published evidence that balance can improve by changing the mandible's position relative to the maxilla as it comes together with the teeth (or oral device) as the endpoint. To help with the complexity of this topic, a definitions table* (in Appendix) has been included at the end of the manuscript for reference as needed. The aim of the current study is to evaluate whether the physiologic rest position of the jaw* (oral device overtop of the teeth as endpoint where the muscles of mastication are optimized) can have an effect on cerebral blood flow and physical balance using measurable data relative to the person's natural, or habitual bite (teeth as endpoint) in both healthy and diseased volunteers. Methodology: Seven healthy male professional football athletes and two females with multiple sclerosis were included in this observational study, which tested the subjects in both jaw positions. Cerebral blood flow was measured non-invasively by ultrasound over the temporal region of the skull using mean flow velocity (MFV)* and pulsatility index (PI)* of the right and left middle cerebral arteries while the subject clenched the teeth together in both jaw positions. The MFV is the average speed of the blood flow in a given region of a blood vessel. The PI measures cerebral intravascular resistance. Physiologic balance of the whole body was also tested while the subjects were in both jaw positions using the y-excursion balance test* and by videotape. Results: (i) Cerebral blood flow. On the natural teeth, the MFV dropped from baseline to clenching position (mean drop -2.6±7.7 cm/second, whereas, the MFV was slightly enhanced with the physiologic rest position (PRP) [mean enhancement is 0.82±3.7 cm/second (P=0.07)]. At baseline on natural teeth, the PI dropped slightly from baseline to clenching (mean drop 0.015±0.19). Whereas with PRP, the PI dropped by mean of 0.059±0.072 (P=0.15). (ii) Balance. The mean balance measurement while using the PRP was 119.54±12.56 cm (P=0.001), whereas the mean balance measurement on natural teeth was 110.72±9.47 cm. Balance improved subjectively in both MS patients on videotape. Conclusion: The physiologic rest position of the mandible might have an effect on balance by showing a trend (demonstrating a tendency) in enhancing cerebral blood flow as measured by transcranial Doppler. Further studies are needed to confirm this study's finding.

Background/objectives/aims: Controversy exists regarding maxillary bone changes in nongrowing adults. However, previous studies have relied on two-dimensional (2D) cephalometric analyses, which may be unable to capture three-dimensional (3D) phenomena. In this study, we investigated 2D and 3D parameters to test the null hypothesis that maxillary bone volume cannot be changed in nongrowing adults that had been diagnosed with midfacial underdevelopment. Methods: After obtaining informed consent, we undertook 3D cone beam computed tomography scans of 11 consecutive, adult patients prior to and after biomimetic, oral appliance therapy. The mean treatment time was 18.4 months ± 2.5 using the DNA appliance® system. The intramolar width and 3D volume of the midface was calculated prior to and after the midfacial redevelopment protocol. The findings were subjected to statistical analysis. Results: The mean intramolar increased from 33.5 mm ± 3.4 prior to treatment to 35.8 mm ± 2.9 after appliance therapy (p = 0.0003). Similarly, the mean midfacial bone volume was 17.4 cm3 ± 3.9 prior to treatment and increased to 19.1 cm3 ± 2.6 after appliance therapy (p = 0.0091). Conclusion: These data support the notion that maxillary bone width and volume can be changed in nongrowing adults. Furthermore, midfacial redevelopment may provide a potentially-useful method of managing adults diagnosed with obstructive sleep apnea, using biomimetic, oral appliances.

The purpose of this pilot study was to identify, measure and document an effect on the subjective multiple sclerosis symptoms and compare it to any objective data changes in the neuromuscular system of the head and neck, following the correction of the jaw position using a neuromuscular orthotic. The hope is to provide clinical evidence of improvement in the disease long-term without relying on the subjective evidence of remissions and exacerbations reported by the patient. The evidence found in the current pilot study measured improvement of head position, jaw position, jaw function, and airway in the neuromuscular bite position, which correlated with the improvement of subjective symptoms of craniomandibular dysfunction and multiple sclerosis. Studies show that the bite affects blood flow in the brain, which may explain the improvement of the patients in the current study.