Why Dr Maruko Only Does Airway Orthodontics and Complex Ortho:
Complex orthodontics and airway orthodontics comes with more administrative duties and seeing a smaller number of patients gives her more time for individualized attention. Dr Maruko has extensive additional training in sleep and airway, this helps her treatment plan for her part in the overall big picture of better health and longevity, which is what she enjoys most.
Do you extract teeth:
Dr. Maruko does her best to avoid extractions. The goal is always to have your natural teeth and make space for them. Dr. Maruko does expansion orthodontics to increase the size of the jaw to create space for teeth, tongue, and improve nasal breathing. There is an optimal time to treat children before additional intervention is needed, such as MARPE. Correction to move the jaws forward is also important. With age, the need for surgery becomes more likely. In some cases the tooth is too unhealthy to save or in such a poor position that it is best to remove it. If you are interested in only extraction orthodontics, another office may be a better option.
Are X-Rays required at your office:
Yes, orthodontists are trained to use x-rays to diagnose tooth eruption problems and assess whether the root and bone are healthy enough for orthodontic treatment, as well as analyze the position of the jaws and teeth. Healthy bones are needed for orthodontics to be successful. Dr. Maruko does not move teeth without x-rays.
What about Conebeam CT:
Dr Maruko uses a Conebeam machine with a larger field of view to see the airway and avoid taking multiple small x-rays. She finds this to be a valuable tool for diagnosis and treatment planning for health. Just one x-ray can evaluate the jaw joint, the airway, and overall structure of teeth and bones all at the same time. Once treatment starts, a low dose setting is used to verify root length and position and your dentist may want smaller x-rays to do their diagnosis for cavities and bone problems. Also, CT is not used to diagnose soft tissue problems.
Endoscopy is sometimes used to diagnose airway problems and they are a valuable tool. However, this is not a substitute for assessing the health of the teeth, bones, and position of the jaws and roots.
Do you treat adults with sleep apnea:
Yes, sleep and airway orthodontics is part of a larger picture of reducing obstructions and improving sleep quality. Sleep apnea frequently overlaps with other health issues. Treatment may be simple to complex, from improving tooth alignment and tongue space, to orthodontics with jaw surgery.
How do I tell if my child needs early orthodontics for airway:
The most important sign is difficulty breathing while sleeping, snoring, restless sleep, and sleeping with the head tilted back. Other signs may be no space between baby teeth or permanent teeth erupting with not enough space, bed wetting and symptoms of ADHD. Children with airway problems are sometimes misdiagnosed with ADHD, when they are sleepy kids just trying to stay awake.
What is the right age to start airway orthodontics:
Every patient is different. The American Association of Orthodontists recommend an initial visit at age seven. Dr. Maruko prefers to see patients younger if there are airway or space problems. Patients below the age of five may benefit from starting with myofunctional therapy first.and it may be enough to improve growth and nasal breathing. On the other hand, if there are severe health issues such as difficulty breathing, early intervention by multiple health fields may be needed. Dr. Maruko will work with a child as young as four who has started myofunctional therapy and demonstrated that they are mature enough for orthodontics. Other dental practitioners may start expansion at an earlier age.
Why work with a myofunctional therapist in addition to Dr Maruko:
Myofunctional therapists are an important part of the airway team. They work on improving function, and are trained to screen for airway, posture, and structural sleep and airway problems. Some have additional training for more complex problems. They are not an orthodontist and are not licensed to determine the specific optimal timing for orthodontic treatment.
Do you use a certain appliance:
An orthodontist is trained to move teeth through bone according to bone biology and physics learned during residency. Orthodontic movement is achieved with pressure like pushing a ball up a hill. The tooth does not care about the name of the appliance. Each appliance has advantages and disadvantages. Dr. Maruko has tried many appliances and has her favorites based on the patient’s needs. She is looking for the best tool for the situation.