Saturday, 30 January 2021

Maxillary Expansion: DNA appliance. ALF appliance. MSE

Jaws are a crucial factor that decides the facial profile of an individual. Sizes of the jaws vary in people and in some, the upper jaw is smaller than the lower jaw. A narrow upper jaw can cause various complications like deviation of the lower jaw, difficulties with speech and chewing, misaligned teeth, wear and tear of the teeth, temporomandibular joint dysfunction, bruxism, breathing difficulties and sleep apnea. Maxillary expansion is a common orthodontic procedure which is used to widen the upper jaw or maxilla so that it fits in harmony with the lower jaw. It works by  fitting an expanding appliance to the roof of the mouth to exert pressure on either side of your jaw. Some of the custom made appliances used for this at the Right Bite CPC are:

ALF Appliance

ALF (Advanced Lightwire Functionals) appliance is a light wired custom-made appliance generally used in children during their growth phase (till 15 years). It is used in slow expansion of maxilla and promotes rhythmic changes in muscle function to achieve stable results in improving the patient’s bite and TMJ function. ALF also improves the spinal alignment, posture, nervous system dysfunction, and airway reshaping. The wires to reposition jaws, dental arches, and teeth results in:

  •     Proper positioning of dental arches
  •     Corrects airway constriction to resolve breathing and sleep issues
  •     Corrects chewing, swallowing and speech abnormalities
  •     Improves sensory and nervous system regulation
  •     Creates optimal posture and spinal alignment
  •     Resolves TMJ disorders
  •     Corrects aesthetic and functional aspects of teeth alignment

DNA Appliance

The DNA Appliance (Daytime Nighttime Appliance) is a removable appliance used in adults for maxillary expansion and provides faster results than ALF (about 12-18 months). Based on rhythmic activation and pressure from the tongue, this device gently expands the space of the upper arch in three dimensions. This way, the lower jaw moves forward into a more natural position while pulling the tongue and soft tissues to increase the size of the airway. It is a pain-free, non surgical procedure which helps in gradual remodelling of the craniofacial bones and helps in:

  •     Healthy alignment of the teeth and dental arches
  •     Treating TMJ disorders
  •     Eliminating snoring and obstructive sleep apnea
  •     Improved breathing
  •     Cosmetic enhancement of facial features


MSE or Maxillary Skeletal Expander is used for faster, more aggressive and effective expansion of maxilla. MSE is ideal for people under the age of 25 years. In older patients this appliance is often coupled with a minor surgical procedure. This device uses mini implants as anchors to allow for expansion of the upper jaw in patients who are skeletally mature without the need for traditional jaw surgery.  It is a novel, non invasive procedure which is used for:

  •     Lateral Expansion of Maxilla
  •     Increasing airway volume
  •     Providing more space for tongue
  •     Increasing volume of nasal passages
  •     Aesthetic alignment of teeth

Maxillary expansion requires regular appointments with your TMJ specialist to ensure that you are on track with the treatment and to check on adjustments that need to be made. Using these devices, the Right Bite CPC has seen numerous successful cases of non-surgical maxillary expansion.

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Tuesday, 17 November 2020

Maxillary Skeletal Expander

When do you need a Maxillary Skeletal Expander?

When a person has a v-shaped upper jaw, with a high-arched palate and crowded teeth, there is a significant deficiency in the growth of their upper jaw which is called maxillary transverse deficiency. A narrow or constricted upper jaw reduces the space available for the teeth to fit, which leads to crowding and misalignment of the teeth. It can also have profound effects on nasal and sleep breathing. This may lead to insomnia, interrupted breathing during sleep, loud snoring or other irregular sleeping issues, which is generally termed as Sleep Apnea.

A Maxillary Skeletal Expander (MSE), is an oral device which is used to make predictable and profound expansion of the upper jaw and the nasal airway.  They use mini implants as anchors to expand narrow palates in adults without traditional jaw surgery.  This makes MSE a great option for patients who want to improve their bite, occlusion, breathing and airway disorders like Sleep Apnea without the fear of jaw surgery.

How does MSE work?

Constricted jaws result in narrowed air passages and nasal obstructions which hinders the normal breathing pattern. When an MSE device is placed in your palate, it aids in skeletal transverse expansion of the upper jaw. This makes more room in your mouth for the tongue and enables easy breathing. MSE also corrects any abnormalities in your bite and aesthetic problems due to narrow upper jaw by making space for aligning your teeth.

The experts in Sleep Medicine at The Right Bite CPC offer permanent solutions for Sleep Apnea and related breathing problems by providing you customized MSE appliance along with other advanced treatment options.

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Thursday, 25 June 2020

What will happen if TMJ disorder is not treated?

TMJ (Temporomandibular Joint) is a jaw joint, one on each side, acting as a hinge connecting the jaw to the skull. This disorder causes pain at the joints and to the jaw muscles. There is no one particular cause for this condition, and it can and does change from person to person and as such its treatment also varies.


What if it is left untreated? 

Left untreated, TMJ disorder can worsen, leading to excruciating levels of pain requiring immediate medical attention, possibly even surgery.

Untreated it can lead to other medical conditions. Self-medication to relieve the pain is a bad habit commonly found among TMJ patients and unfortunately if often leads to addiction. 
Constant and severe pain and the involuntary grinding of teeth also leads to sleep disturbance.

It can also adversely affect a person’s personal relationships, quality of life and also work performance, leading to depression.
Some patients consume only soft or liquid food or even not eat at all, leading to malnutrition and other eating disorders.

The constant clenching and grinding of teeth can lead to the worn teeth enamel and fractured teeth. TMJ patients also tend to favour one side of the jaw to the other leading to uneven muscle growth and swelling of the face. It also gives their face an uneven look.

As the TMJ is close to the ears, and it’s disorder can lead to symptoms like ringing or itching sensation of the ears. Body balance and vision can also be compromised.


This disorder can also cause serious jaw problems like Lock Jaw, where the jaw becomes permanently stuck, leading to a hospital visit.
All this is totally unnecessary as the disorder can be quickly and efficiently treated.

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Thursday, 19 March 2020

Is age an influential factor of TMJ disorder?

Temporomandibular Joint (T.M.J) is a joint in the human jaw that acts as a hinge connecting the jaw to the skull. TMJ Disorders (T.M.J.D) is considered to involve pain in and around the jaw joint caused by spasming of facial muscles due to displaced TMJ. 


Earlier, it was believed that this disorder was more prevalent in women than men. But, it has been found to be not so. Both men and women are equally affected. 

Is age an influential factor?  Studies have shown peak prevalence in the middle-aged population. 

TMJ is not one disease, but a combination of many. It is classified into three disorders; namely, that of the muscle, disk and joint. And, at all three of these parts of the human body, degeneration occurs and progresses as the age of the person advances. If not diagnosed properly it is shown that 40-70 percent of the population over the age of 65 have TMJ degeneration. 

However, in the majority of the cases, there are no obvious clinical symptoms and the disorder resolves all by itself. But, in at least 15 percent of the cases the disease worsens. It is now believed that as body ages, the functional demands of TMJ may exceed the repair and remodeling capability of the body, leading to degeneration.

Women above 50, during their menopause, are more likely to suffer TMJ degeneration than men, due to extremely varying hormone levels. Muscle disorders among the elderly and their unwillingness to seek TMJ degeneration treatment are also factors. 

All this shows that while age, though influential, is just one of the many factors involved.

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Tuesday, 28 January 2020

How does TMJ affect facial muscle?

The temporomandibular joint is located on each side of the head. This connects the jaw to the skull, making it possible to chew, speak, swallow, and open and close the mouth. Temporomandibular joint and muscle disorders or TMD are considered to be a group of conditions that would cause pain and dysfunction in the jaw joint and muscles. These muscles control the jaw movement; hence it leads to facial pain. A TMJ disorder can cause pain in the head and neck as well.

Normally, the pain and discomfort caused due to TMJ disorders would be temporary. Hence, it could be relieved with self-care or nonsurgical treatments. Surgery will be suggested as a last resort to treat TMJ disorders.


Causes of TMD

Usually, the reason behind TMJ disorder is unknown. However, the painful TMJ disorder can occur under the following situations:
  • When the disk erodes or moves out of its alignment 
  • When the joint’s cartilage is damaged.
  • When a blow or other impact damages the joint 

Facial muscles & TMJ disorders 

Usually, when people get stressed or due to Obstructive Sleep Apnoea the muscles would get tightened, especially the face and jaw muscles. This would lead to clenching of the teeth both on stress or during night resulting in pain or TMJ disorder. Any physical stress on the face and neck muscles.

TMD can wear down the teeth, disks, and bones. There will be excessive contractions in the muscles that would lead to accumulated muscle tissue. The tightness in the surrounding tissues would lead to poor lymphatic drainage, and at times causes skin conditions such as acne, rash, and cellulite. 

TMD can contribute to changes in the facial structure as the muscles would become disorganized with some overworking. The natural look of the face could be altered when the teeth shift, if a bone loss occurs, or if the bite and jaw are improper or off-balance.

It is crucial to have good circulation and coherence in the various layers of tissue as it would reflect in healthy and glowing skin. 


Normally, the doctor would recommend specific facial exercises to help relieve the pain and to get back the muscles in position. Medications, Orthodontics and splints would also be suggested. Surgery is advised only if there is a complete lock jaw.

At The Right Bite Craniofacial Pain Care, the doctor and his team would provide the necessary treatment that could help relieve the pain caused on the facial muscles due to TMJ disorders.

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Friday, 1 November 2019

Lethargic all day long? Are you sleeping well enough?

If you are tired one day out of seven, that may be normal. However, if you are tired all day, every-day that could very well be a medical condition. The root cause of constant lethargy in several cases is often a lack of sleep. If you aren’t well rested during the night, your body simply will not have the energy for the coming day, after all, the very point of sleep is to act like a recharge mode of the body.

Now, you need to analyze why exactly it is that you aren’t getting enough sleep. If you’ve been facing severe pain in your neck, head and to some extent your teeth then it is likely you are afflicted by a condition known as Temporomandibular Joint Disorder.

Temporomandibular Joint is the joint that connects our upper and lower jaw. All the joints in our body begin to wear out at some point. Temporomandibular Joint Disorder is the condition wherein this particular joint begins to wear out causing pain in facial joint area, the teeth due to night grinding, neck and head. This may also manifest itself in the form of migraines.The discomfort caused by Temporomandibular Joint Disorder has been known to disturb the sleeping pattern in many patients.
mandibular joint Disorder

If you or anyone you know may be experiencing these symptoms, please do reach out so we can get to the root of the problem and provide solutions.

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Reviewed By : Dr Rajesh Raveendranathan
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Thursday, 31 October 2019

Say goodbye to sleep disorder

Sleep disorders are various conditions that restrict the ability to sleep well regularly. Obstructive Sleep Apnea (OSA) is one of the major sleeping disorders and potentially a serious issue that is affecting lot of people.This disorder causes breathing to stop temporarily due to some obstruction. There could be multiple reason for OSA. While the person is asleep the throat muscles relax and blocks the airway or tongue moving back obstructing the airway due to narrow arch form which leads to the primary reason for obstructive sleep apnea. 


Symptoms of OSA
 People with sleep apnea will experience a lot of problems throughout the day, such as:

1.Drowsiness during day time
2.Lack of concentration during day time
4.Mood swings
5.Poor performance at the workplace or school
6.Hyperactivity in children
7.Disinterest in sex
8.Leg cramps
9.Night palpitations
10.High blood pressure
11.Snoring; loud or faint.
12.Clenching and grinding of teeth.
13.Restless Sleep.
14.Getting up often during sleep
15.Twisting and turning while Sleeping
16.Choking sensation during sleep.
17.Bed wetting in adults.
OSA could be a major reason for heart attacks.

Causes of OSA
 Obstructive sleep apnea occurs when the throat muscles relaxes leading the tongue fall back and block the airway. This would lead to difficulty in breathing, and the person tends to wake up for a few seconds, which he/she will not remember the next day.
  • Excess weight
  • High blood pressure
  • Narrow airway
  • Smoking
  • Nasal blockage
  • Diabetes
  • Hereditary factor
  • Asthma
  • Narrow arch form
  • Previously treated Orthodontic patients with or without extraction.
Medical care
The aim of treating sleep apnea is to allow proper airflow during sleep. There are various measures to treat obstructive sleep apnea, such as:
  • Weight loss
  • Nasal decongestants
  • Yoga
  • Exercise regularly
  • Quit smoking
  • Try not to sleep on your back
  • Avoid drinking alcohol several hours before you sleep
If these measures don’t improve the sleep pattern then, there are various treatments and few devices that could help treat obstructive sleep apnea.

1. Oral Devices like Silensor
2. DNA appliance
3. ALF
4. Maxillary Skeleton Expansion
5.Continuous Positive Airway Pressure (CPAP) - this is managed with a face mask that is worn at night.

In the worse scenarios, doctors would recommend surgery. The most common type of surgery is Uvulopalatopharyngoplasty (UPPP), which involves the removal of extra tissues from the back of the throat, thus, enabling the airways to be open. There are other procedures as well to treat sleep apnea such as jaw surgery, upper airway stimulation, surgical opening in the neck, nasal surgery, removal of enlarged tonsils, and implants. 


Consult with a Sleep Specialist for more information.

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Reviewed By : Dr Rajesh Raveendranathan
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