HEALTHYSTART® BLAZES THE TRAIL
AT THE ADA PEDIATRIC AIRWAY SUMMIT!!
Dr. Bergersen
What's Inside?
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50 Years Before & After Q&A HealthyStart® APP SDB in Children Upcoming Events What's New? In The Spotlight And more...
ON THE COVER HealthyStart® by OrthoTain® Sponsors Pediatric Airway Health Symposium. ADA chooses Premier HealthyStart® Provider, Dr. Jill Ombrello to speak on Children's Airway Health
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The orthodontist that invented the FDA Approved appliances knows that, “If we can intervene at a young age, yes we can permanently and profoundly improve their health for life. If you miss that window of growth as a child enters puberty, you are left with what many adults must accept as lifelong conditions and look for Band Aids rather then permanent solutions. Yes we can still help them, but the earlier we start, the greater impact we have on their bone structure, appearance and breathing capacity.”
Dr. Jill Ombrello On Bed-wetting. “When the child is able to keep the appliance in all night, which sometimes happens in a matter of days sometimes weeks, it will generally stop their bed-wetting. As Doctors we often find that we treat more than the patient, we help the whole family. A child develops self-confidence and starts socializing once they get past this condition. That brings a satisfaction that goes deeper than most days on the job!”
IN CASE YOU MISSED IT! ORTHO-TAIN® / HEALTHYSTART® CELEBRATES 50 YEARS OF CONTINUED INNOVATION IN CHILDREN'S HEALTH
IN 2017 WE HIT A 50 YEAR MILESTONE AND ANNOUNCED NEW TECHNOLOGY IN PEDIATRIC AIRWAY DEVELOPMENT BY HEALTHYSTART® CEO/PRESIDENT, LESLIE STEVENS Ortho-Tain / Healthy Start’s Founder, Dr. Earl O.
Announcing New technology bringing Healthy
Bergersen was honored and presented the 2017
Start’s ability to address the deficiencies in both
Humanitarian Award and nominated to the
the upper and lower jaws by promoting the
Patent Hall of Fame at Northwestern University
natural growth, development and advancement
August 2017. Many past and current patients,
of both jaws. The “Max A” (Maxillary
representing the 3.5 million children treated,
Advancement) is the newest addition to the
thanked Dr. Bergersen for his dedication and his
Healthy Start techniques continuing to bring 50
perseverance in changing their lives.
years of breakthroughs to the industry promoting growth and development in our pediatric
Dr. Bergersen is responsible for developing early
patients.
orthodontic treatment with oral appliances. Over 50 years of innovation linked 28 years ago the connection and the negative impact of mouth breathing by creating treatments that promoted nasal breathing. Fast forward to today; Ortho-Tain introduces the Healthy Start series of appliances that address the underlying root cause of sleep disordered breathing. Treatment with MAX A allows for forward movement of the upper jaw and lower jaw
TREATMENT WITH HEALTHYSTART® Objective is to identify, evaluate, and address the airway, oral habits and improper growth and development of the pediatric patient. Educate parents, educators, and other medical providers to understand and identify the outward symptoms of Sleep Disordered Breathing and refer to the dental professional. “Research shows that 9 out of 10 children suffer from one or more symptoms of Sleep Disordered Breathing”. – Journal of the American Orthodontic Society, by Brooke Stevens, BS, University of Michigan and Earl O. Bergersen, DDS, MSD Dental Professional to evaluate and provide the possible link to the outward symptoms of Sleep Disordered Breathing with the underlying root causes: • A compromised airway • Narrow arches
Treatment with the American-made Healthy Start
• Poor oral habits including mouth breathing and
system is a FDA Cleared, comprehensive,
tongue placement
conservative, non-pharmaceutical and
• Improper growth and development effecting jaw
noninvasive treatment in children ages 2 to 12
relations
worn primarily at night with older children possibly wearing appliance for an additional two hours per day.
Dr. Earl O. Bergersen, DDS, MSD, ABO
PEDIATRIC OPEN AIRWAY DENTISTRY™ HEALTHYSTART® IS THE TECHNOLOGY OF OUR GENERATION Before
53.6 mm² Airway Dimension
After 1 Month
337 mm² Airway Dimension
AIRWAY INCREASE AFTER ONE MONTH OF NIGHTTIME WEAR WITH THE HEALTHYSTART® HABIT-CORRECTOR®
Before (deficient facial growth)
After (deficient facial growth)
Courtesy Dr. Lee Ostler
Results after ONE month of treatment with the HealthyStart® System
By HealthyStart® Premier Provider, International Lecturer and Trainer, Dr. Amanda Wilson, DDS, MDS
1. What is the best age to start treatment using the HealthyStart by OrthoTain® system? We recommend screening all patients by age two for habits, airway, sleep-disordered-breathing (SDB), retrognathic mandibles, and deep overbites. In the absence of these concerns, the best time to begin orthodontic intervention treatment is when the lower permanent incisor begins to erupt. 2. Which cases can be treated with the HealthyStart by OrthoTain® system? Almost all malocclusion cases can be corrected with a series of removable appliances, including overbite, overjet, gummy smile, cross-bite, open-bite, crowding, spacing, and pseudo Class III. 3. How many cases have been treated with the HealthyStart® by Orthotain® appliance system? Since 1967, our doctors have treated nearly 4 million cases in 43 countries. 4. How can the HealthyStart® by Orthotain® appliance system straighten teeth without using external forces? Using a series of removable appliances, the eruptive forces of a child’s own teeth can be utilized for arch expansion and dental alignment. 5. Are there any risks associated with using the HealthyStart® by Orthotain® appliance system? The gentle, eruptive forces of a child’s own teeth can be utilized for arch expansion and dental alignment, eliminating the discomfort and risks associated with traditional braces, such as poor hygiene, root resorption, devitalization, moving teeth out of bone, and white-spot lesions. 6. Do I need to use retention after the HealthyStart® by Orthotain® appliance system? Early treatment allows for greater stability for crowding and rotational corrections, reducing the necessity for lifelong or long-term orthodontic retention. Moreover, the final appliance in the HealthyStart system can be used as lifelong retention and is warrantied against bite-throughs.
USING THE HEALTHYSTART® APP TO EDUCATE PARENTS BY SUSIE LAFREDO
The HealthyStart® APP is a great tool
Once they become a HealthyStart®
your office can use to help educate
patient, you will submit their case
parents on how Sleep-Related
through the Doctor Portal and the
Breathing Disorders affect children, the
system will automatically send them a
habits to look out for, the symptoms
welcome email with a password that
and how the HealthyStart® Appliance
will give them full access.
System can help. One of the buildings that is accessible The first thing you will want them to do
as a guest
is go to their App Store and download
user is the Visitor's Center. This
the app. You will want to be sure to
building is a great resource! In the
direct them to search for Healthy Start as two separate words and look for the signature HealthyStart® tooth. Once they have the app on their phone, they can log in. At this time, they will only have Guest User limited access.
Visitor's Center, they will find: **A television where they can watch a movie that explains the habits and symptoms related to Sleep Disordered Breathing **A brochure's rack that leads them to the HealthyStart速 Education Center ** A calendar with upcoming events ** A Sleep Questionnaire - which is always the first step in receiving treatment. The HealthyStart速 App is the perfect way to get the conversation started and as a Certified HealthyStart速 Provider, you already know that "Every Child Deserves a HealthyStart速!!"
SLEEP DISORDERED BREATHING IN CHILDREN IT'S HEALTH IMPLICATIONS, DIAGNOSIS, TREATMENT AND PREVENTION
HEALTHYSTART® IS THE ULTIMATE PHASE 1 PLUS™ SOLUTION BY EARL BERGERSEN, EO, DDS, MSD; LESLIE STEVENS, L, BS
Sleep issues in children are strongly associated with improper growth, oral habits and various orthodontic issues.1,2,3,4 These factors are correctable, preventable and can be treated with appliance therapy. The HealthyStart® Appliance System stands apart in its ability to correct mouth breathing, a narrow palate, abnormal tongue posture, open bite, tongue thrust, thumb and finger sucking as well as certain speech problems. This appliance is preformed and sized for various age group and stage of the dentition. They are also available according to whether the child has an excess overbite or openbite and the sizes are for the 2-4, 5-7, 8-12 and adult age groups. Figure 1
Identifying characteristics of sleep disordered breathing Sleep disordered breathing is a condition involving the reduction of the pharyngeal airway. A complete closure of the airway is called Sleep Apnea while a partial closure with struggled breathing is called hypopnea. The airways of children only rarely exhibit these severities. It has been estimated that about 1.6% have habitual apnea, while it occurs occasionally in 3.4%.5 There are several variations in percentages of incidence depending on the degree of severity, snoring, oxygenation of the blood and the actual apneic events.6 There are many symptoms and skeletal characteristics frequently presented in the literature, many of which represent questionable significance when statistically analyzed in relation to the frequency and severity of snoring. Various questionnaires regarding sleep symptoms in a child have been developed7-9 while the author has developed a questionnaire specifically for the dental profession.10 It consists of the symptoms that have the highest statistical significance (level of confidence P=0.001) and have been obtained by mainly 5 different sources.11,12,13,14,15 A complete description of this dental sleep questionnaire is presented in a study by the author in 2015.10 There have been several possible explanations for the many symptoms of abnormal sleep issues. A recent study by Xie et al16 describes research on live mice regarding the toxins produced by normal daytime brain activity (specifically beta-amyloid, alpha-synuclein and tau). During sleep these toxins are flushed out by the cerebrospinal fluid (called the glymphatic system similar to the lymphatic system). By preventing quality sleep, this flushing of toxins from the interstitial space is severely reduced due to the brain cells not being reduced in size during normal nighttime sleep, which would normally provide an increase in intercellar space. As a result, it is concluded that the reduction of oxygen caused by the restriction of the pharyngeal airway affects the brain, as well as the endocrine and immune systems. Several studies have linked abnormal sleep issues with school performance17,18, behavioral problems19, dental arch size,20 ADHD (Attention Deficit Hyperactivity Disorder),21,22 depression23 and daytime sleepiness.24 The research of Stevens et al25 indicates that many of the symptoms in the dental sleep questionnaire (Fig. 2) can be categorized by their rank in severity, as well as to their level of incidence, and according to various ages (Fig. 3). Various symptoms seem to be more prevalent and at certain ages, but the last column presents the mean percentage at all ages from two to 12 years. The most frequent symptom and the one that does not seem to vary much from age to age is nighttime mouth breathing. Also, the category of “snore at all” is a “catch all” phrase and encompasses any severity of snoring. However, when it is segregated according to various degrees, it does vary with age. It must be stressed that nighttime mouth breathing occurs 42.7% of the time from two to 12 years. When observing snoring, the mouth is typically open, so that any child that snores audibly is also usually mouth breathing. On the other hand, not every child that mouth breathes will snore. Mouth breathing while sleeping is associated with an average of seven other symptoms (namely snoring 45.7%, talks in sleep 43.9%, difficulty listening and often interrupts 41.5% and allergic symptoms 37.8%). Of the children that mouth breathe at night, 47% also mouth breathe during waking hours.25
Figure 2
Figure 3
Ranking of most frequent outward symptoms of Sleep Disordered Breathing. A few simple questions can alert a parent that problems exist and warrant an investigation, namely: a) Does your child have difficulty with school achievement – especially math, spelling or science?18 b) Does your child often have nightmares or night terrors?17 c) Restless sleep?17 d) Bedwetting?17 e) Tooth grinding?17 f) ADHD?21,26 g) Allergies, asthma, throat infections?17 Many of these symptoms trigger a parent’s interest in finding out more about serious sleep issues (sleep disordered breathing). A progression of symptoms usually leads to serious problems with neuro-brain function, as well as the endocrine and immune systems. These three issues have a serious impact on a child’s wellbeing. The progress of these factors and their implication to health are outlined in Fig. 4. There is a strong emphasis by the medical profession on upper airway resistance and the importance of gaining proper nasal breathing,27 which the author is also very interested in achieving. To stress nasal breathing and the naso-pharynx as the primary important cause of abnormal sleep issues is misleading in the author’s opinion. Most children have restriction of the oro-pharynx rather than the upper airway (naso-pharynx). It has been reported that 84% of improper breathing issues involve the oropharynx,28 as opposed to the nasopharynx (upper airway). In an unpublished study of 151 children29, 83% were able to breathe normally through the nose while 17% had either moderate or severe problems in nasal breathing, fortytwo percent of the Stevens et al study of 501 children25 exhibited nighttime mouth breathing which directly impacts the oropharynx.
Figure 4
Sleep deprivation and its affects. There are several suspected causes of mouth breathing. It appears to the author that mouth breathing is a habit since it can be so easily changed by preventing it with an appliance that forces the child to breathe through the nose. Figure 5 explains the several suspected and varied causes such as prolonged bottle feeding and pacifier use. These nipple devices encourage an inferior tongue resting posture, and also encourages tongue thrust swallowing. During swallowing, a negative pressure (vacuum) is developed in the oral cavity and since the tongue is not positioned within the palate, there is a tendency for the palate to narrow itself. In unpublished research29 of 168 cases, the following data outlines the status of the upper posterior arch width: a) Normal arch widths 50% b) 3 mm or less constriction 39% c) 4-6 mm constriction 9% d) 7 mm or more constriction 2%
Figure 5
The cause and effect of Sleep Disordered Breathing. It is interesting that those with a normal upper arch width (50% is almost the same as those that do not nighttime mouth breathe (57.38%). An interesting case (courtesy of Dr. Harrell) while after one month’s use of the HealthyStart Habit Corrector appliance (Fig. 1) shows an initial airway area of 53.6 mm2 while after correction of the nighttime mouth breathing the airway is 337 mm2 (Fig. 6). Of particular interest is not only the increase of the oropharynx, but a dramatic increase of the nasopharynx. Figure 7 indicates that the airway was increased after one month’s wear by 624% or 3.7 times the normal area for a 9-year-old child.
Figure 6 CBCT scan of 9-year-old HealthyStart® patient that mouth breathed.
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11
The problem with techniques for increasing the nasal airway such as rapid palatal expansion therapy (RPE appliances) is that nasal breathing is increased, but this procedure does not necessarily correct mouth breathing. In fact, it can interfere with normal tongue posture and swallowing because the appliance is positioned in the upper posterior arch. If the problem is with nasal air exchange and there is no evidence of mouth breathing, this is a very efficient procedure. Similar reasoning can be used with the removal of swollen adenoid tissue or surgical correction of an enlarged uvula. If the problem is mouth breathing, these surgical procedures may have little effect on the oropharyngeal airway restriction as well as the other symptoms. Importance of nighttime mouth breathing is the distalization of the mandible and tongue while sleeping which reduces the oropharynx. The HealthyStart Habit CorrectorÂŽ advances the mandible with an excessive overjet or the presence of a retrognathic mandible. The appliance prevents the mandible from being posteriorly displaced, and at the same time encourages nasal breathing and terminates the mouth breathing habit. Figure 9 shows the sleep questionnaire of a 6-year-old male. This boy has 18 of a total of 27 symptoms filled out as present, which occurs in only about 2% of the population. He also had 11 of 14 symptoms for ADHD (Fig. 10). If eight out of 14 questions are present, the child is considered to have ADHD. This 6-year-old has serious ADHD. He was given extra recess time at school and periodically was told to run up and down the staircase to try to calm him down. In fact, his chair was tied to his desk, but this was also not successful. What is of particular interest is his math and reading progress. His Student Progress Report (by NWEA) (Fig. 11) was registered for math at the 6th percentile at the start of the HealthyStart treatment. Three months later, he registered at the 53rd percentile in math and his reading . Similar reports three years later (Fig. 12) showed similar progress, however, at a slower rate. showed that he remained at the high level in both math and reading. His sleep questionnaire at 13 years of age (Fig. 13) shows a 94.5% improvement with only one item marked. Figure 14 shows a similar improvement in his ADHD American Psychiatric Association ADHD questionnaire (1987), which shows a 91% improvement to 13 years of age. The patient initially was recommended Ritalin, but the mother refused this route prior to his HealthyStart program. Figure 15 is a pilot study on the result of HealthyStart Habit Corrector therapy.
Figure 12
Figure 13
Figure 14
Figure 15
There are four important factors that are of primary interest in analyzing a child for abnormal sleep issues as part of a regular dental exam. They are: a) Mouth breathing b) A narrow posterior upper arch in relation to the lower arch. c) Improper tongue position at rest and during swallowing d) Improper jaw relation with the mandible being retrognathic (more posterior than it should be) It should, however, be understood that many attributes of the occlusion are involved: either as being affected by sleep disordered breathing, and are important to be corrected to enhance the correction of the sleep issues, or as a preventive procedure. Figures 16, 17 and 18 outline 22 such items and their affects on improper breathing. Serious sleep issues can be the cause of cardiovascular problems in children (high blood pressure, hypertrophy of left side of heart, less blood to lungs from right side of heart, or cor pulmonaile), depression, increased allergies, infections, interference with normal growth and can also play a part in many social issues. In that school achievement can be improved, there is a considerable advantage in starting prior to school age to increase their success in school. Proper oxygen levels in the blood are extremely important for the health of a child. As stated previously, insufficient oxygen affects the brain and its ability to rid itself of the toxin buildup during the day (particularly beta-amyloid). In fact, beta-amyloid toxin present in children with sleep issues is the same toxin found in Alzheimer and dementia patients, responsible for interfering with the communication between brain cells. Insufficient oxygen also affects the endocrine and immune systems. Oxygen deficiency reduces REM sleep, which is considered the reparative segment of sleep, while delta sleep (deep sleep) does not require oxygen and increases as REM decreases. When the pharynx remains open with a free exchange of air (oxygen and CO2) the child will almost immediately feel the difference. Often personality changes may be seen, a child may experience an increase in their social ability with other children. They may see an increase in friends and the elimination of symptoms such as bedwetting, frequent headaches, difficulty with school work, daytime sleepiness, irritability and lack of concentration. These are just a few of the changes that can dramatically change a child’s life. Addressing the habitual problems with implementation of the Habit Corrector usually takes precedence over the factors of occlusion. However, as seen in Figures 16, 17 and 18, the occlusion factors are important to aid in the future stability of the corrected sleep issues.
 The orthopedic and habit corrector appliances are worn primarily while the child sleeps and are designed to address the underlying root causes of Sleep Disordered Breathing including narrow palate, improper swallowing habits, mouth breathing, improper growth and development, jaw relationship and airway issues. The appliance is worn nightly until almost all of the symptoms are corrected or significantly reduced. This orthopedic technique can begin as early as age two. Figure 16
Figure 17
Figure 18
All of these symptoms discussed above do not self-correct with an increase in age25 and it is suspected that adults that suffer with sleep issues may have experienced these same problems during childhood. Giving a child a healthy start in life by recognizing these symptoms and treating them early can enhance a child’s success and their confidence in their future.
References Bergersen EO. Preventive Eruption Guidance in the 5 to 7 Year Old: The Nite-Guide® Technique. J Clin Orthod 1995;29:382-395. Methenitou S, Shein B, Ramanthan G, Bergersen EO. The Prevention of Overbite and Overjet Development in the 3 to 8 Year Old by Nighttime Guidance of Incisal Eruption: A Study of 43 Individuals. J of Ped. 1990;14(4): 219-230. Keski-Nisula K, Lehto R, Lusa V, Keski-Nisula L, Varrella J. Occurance of malocclusion and need of orthodontic treatment in early mixed dentition. AMJ Orthodent Orhop 2003;124(4). Keski-Nisula K, Keski-Nisula L, Salo H, Volpio K, Varrela J. Dentofacial changes after orthodontic intervention with Eruption Guidance Appliance in the early mixed dentition. Angle Orthod 2008;78:324-331. Gislason T, Benediktsdottir B. Snoring, Apneic Episodes, and Nocturnal Hypoxemia Among Children 6 Months to 6 Years Old. Chest 1995;107:963-966. Urschitz MS, Eitner S, Guenther A, et al. Habitual Snoring, Intermittent Hypoxia, and Impaired Behavior in Primary School Children. Pediatrics 2004;114:1041-1048. Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Medicine 2000;1 (1):21-32. Kump K, Whalen C, Tishler PV, et al. Assessment of the validity and utility of sleep symptom questionnaire in a community sample. Am J Respir Crit Care Med 1994;150:735-741. Spilsbury JC, Drotar D, Rosen CL, et al. The Cleveland adolescent sleepiness questionnaire: A new measure to assess excessive daytime sleepiness in adolescents. J Clin Sleep Med 2007;3(6):603-612. Bergersen EO. Sleep Disordered Breathing Questionnaires for Young Children. J Am Ortho Soc 2015;14-17. Sahin U, Ozturk O, Ozturk M, Songur N, Bircan A, Akkaya A. Habitual snoring in primary school children: Prevalence and association with sleep related disorders and school performance. Med Princ Pract 2009 18:458-465. Urschitz MS, Eitner S, Guenther A, Eggebrecht E, Wolff J, Urschitz-Duprat PM, Schlaud M, Poets CF. Habitual snoring, intermittent hypoxia, and impaired behavior in primary school children. Pediatrics 2009;18:458-465. Attanasio R, Bailey DR. Dental Management of Sleep Disorders. Ames, Iowa: WileyBlackwell 2010. American Thoracic Society Association: Medical Section of the American Lung. standards and indicators for cardiopulmonary sleep studies in children. Am J Resp Crit Care Med 1996;153:866-878. Barr L, Thibeault SL, Muntz H, De Serres, L. Quality of life in children with velopharyngeal insufficiency. Arch Otolaryngol Head Neck Surg 2007;133:224-236. Xie L, Kang H, Xu Q, Chen MJ, Liao Y, Thiyagarajan M, O’Donnell J, Christensen DJ, Nicholson C, IIiff JJ, Takano T, Deane R, Nedergaard M. Sleep Drives Metabolite Clearance from the Adult Brain. Science 2013;342(6156):373-377.
Sahin U, Ozturk O, Ozturk M, Songur N, Bircan A, Akkaya A. Habitual Snoring in Primary School Children: Prevalence and Association with Sleep-Related Disorders and School Performance. Med Princ Pract 2009;18:458-465. Urschitz MS, Guenther A, Eggebrecht E, et al. Snoring, Intermittent Hypoxia and Academic Performance in Primary School Children. Am J Resp Crit Med 2003;168:464468. Urschitz MS, Eitner S, Guenther A, et al. Habitual Snoring, Intermittent Hypoxia, and Impaired Behavior in Primary School Children. Pediatrics 2004;114:1041-1048. Lofstrand-Tidestrom B, Thilander B, Ahlqvist-Rastad J, Jakobsson O, Hultcrantz E. Breathing Obstruction in Relation to Craniofacial and Dental Arch Morphology in 4year-old Children. Europ J Orthod 1999;21:323-332. Chervin RD, Ruzicka DL, Archbold KH, Dillon JE. Snoring Predicts Hyperactivity Four Years Later. Sleep 2005;28:885-890. Kaplan BJ, McNicol J, Conte RA, Moghadam HK. Sleep Disturbance in PreschoolAged Hyperactive and Nonhyperactive Children. Pediatrics 1987;80:839-844. Crabtree VM, Varni JW, Gozal D. Health-related Quality of Life and Depressive Symptoms in Children with Suspected Sleep-Disordered Breathing. Sleep 2004;27:1131-1138. Melendres MCS, Lutz JM, Rubin ED, Marcus CL. Daytime Sleepiness and Hyperactivity in Children With Suspected Sleep-Disordered Breathing. Pediatrics 2004;114:768-775. Stevens B, Bergersen EO. The Incidence of Sleep Disordered Breathing Systems in Children from 2 to 19 Years of Age. J Am. Ortho Soc. 2016;24-28. Fischaman S, Kuffler DP, Bloch H and C. Disordered Sleep as a Cause of Attention Deficit / Hyperactivity Disorder: Recognition and Management. Clinical Pediatrics 2015;54:713-722. Guilleminanlt C, Sullivan SS. (2014) Towards Restoration of Continuous Nasal Breathing as the Ultimate Treatment Goal in Pediatric Obstructive Sleep Apnea. Enliven: Pediatrics and Neonatal Biology 2014;1:1-5. Morgenthaler TI, Owens J, Alessi C, Boehlecke B, Brown TM, Coleman J Jr, Friedman L, Kapur VK, Lee-Chiong T, Pancer J, Swick TJ. Practice Parameters for Behavioral Treatment of Bedtime Problems and Night Wakings in Infants and Young Children. Sleep. 2006;29(10):1277-81. Bergersen EO. Unpublished material.
Dr. Bergersen taught at Northwestern University for 25 years on the growth and development. Dr. Bergersen has lectured throughout Europe, the United States, Canada, Asia, Africa, and South America on growth and development research, as well as at the pediatric post-graduate school of dentistry at Tufts University in Boston, Massachusetts. He has done extensive research on the use of skeletal age assessments of maturity in relation to facial and body growth and its influence on orthodontic treatment and retention timing.
Parent Webinars EVERY TUESDAY 8:00 P.M. (CST) Invite the parents in your community to hear from experts on: Sleep-Related Breathing Disorders The Symptoms How children's health is affected HOW YOU AS A HEALTHYSTART® PROVIDER CAN HELP. COMPLIMENTARY WEBINAR REGISTRATION: www.healthystartwebinar.com
9 out of 10 kids suffer from one or more symptoms of Sleep Disordered Breathing - Bergersen, Stevens (JAOS)
Playing 20 Questions: A Staff Spotlight with Julia Brecht Let’s get up close and personal (and have some fun) with one of our favorite team members!
1. How long have you been with HealthyStart®? 2.5 years 2. What is your primary role at HS? Healthy Start Coordinator. I am the go-to girl for all treating doctors to answer all of their questions 3. What drew you to HS originally? A close friend of mine worked here and loved it. Then, once I heard of what this system could do for so many people… I was so excited to share it. 4. How has the company changed since? It has grown significantly both with staff and with providers! 5. 2 pieces of advice for HS Providers 1.) Patient/parent selection is very important and 2.) Ask for help when you need it – that’s what we are here for! 6. What’s one thing you could not live without? My family 7. What’s one thing you cannot resist? Shopping on Amazon. I have a PROBLEM!
8. If you could learn to do anything, what would it be? Sing 9. What is your favorite thing about working with HS? Hearing all the amazing stories about the impact our appliances have made in patients’ lives. It is so cool, especially because three years ago I had never even heard about SDB! 10. Where would you love to travel to? Greece 11. What does a typical day look like for you? Emails, phone calls, phone calls, emails, emails. 12. Given a chance, who would you like to be for a day? Jimmy Fallon 13. How do you like to spend your free time? Spending time with my kids. I love cooking, photography, and being outside as much as Chicago weather allows me to! 14. What’s your favorite tv show? It’s a tie- Game of Thrones and Veronica Mars 15. What is your favorite movie? I am a proud Harry Potter fan!
THE SECRET TO GAINING A HEALTHY START FOR A SUCCESSFUL SCHOOL YEAR BY: SUSIE LAFREDO
National statistics show that millions of children have been diagnosed with ADD/ADHD. In fact, on average, every classroom of 30 students has 2-4 children with ADHD, many on medication. 46.5% miss school due to chronic allergies. 39.6% feel sleepy and/or irritable during the day. 34.7% have difficulty listening and focusing, often being disruptive in class. More than 18% of children wet the bed. That is almost 1 in 5 grade school age children. Unfortunately, many children are misdiagnosed and many more are left untreated which can lead to lifelong health problems. Unless educated, parents are unaware that all of the health issues listed above are symptoms of Sleep-Related Breathing Disorders. SRBD is the interruption of breathing impacting a child's ability to receive the appropriate amount of oxygen and preventing this child from obtaining REM sleep, which is essential for proper growth and development. 9 out of 10 children suffer from SRBD. Quantity of sleep is no longer the issue, it is all about quality of sleep. As adults, we know when we do not sleep well, and we can bring our symptoms to our doctor. Children, on the other hand, do not realize that they have had fragmented sleep. They do not know to tell their parents, and many parents do not know the habits or symptoms to look for in their child. How do we know if children are receiving quality sleep each night? Every parent should have The HealthyStart® Sleep Questionnaire in their hand before they leave your office. (https://www.thehealthystart.com/guest-speechquestionnaire) so they can begin to evaluate the quality of thier child’s sleep. Mouth breathing, tossing and turning, bed wetting, teeth grinding, bad dreams, and sleep walking are just some of the signs of SRBD that can affect a child’s sleep and even negatively affect the whole family. These symptoms do not self-correct, in fact 92.6% of children will continue to exhibit these symptoms throughout their life and 30% will worsen with age. (JAOS, Brooke Stevens and Dr. Earl Bergersen
As an Oral Physician who is certified and trained to assess and treat airway and SRBD, , an airway assessment should be incorporated into every dental screening. Parents should be very concerned that their child may not be getting a quality night of sleep. The underlying root causes of SRBD include: a compromised airway, narrow upper palate, which prevents the tongue from resting in the proper position (in the upper palate) as well as being a mouth breather rather than a nasal breather. The HealthyStart® System is a comprehensive, conservative, non-pharmaceutical and non-invasive treatment which uses a child's own ability to guide and develop their growth and development while helping them get a quality night of sleep. HealthyStart® is also a great alternative to straightening teeth without braces. This type of treatment is less expensive than braces, more permanent, addresses both health and dental conditions, and usually takes less time. A win-win for life. The HealthyStart® system can treat children as young as two. Addressing children during their growing years is critical for permanent change – so timing is of the essence. Do not let time slip by without educating the parents in your community. Waiting can put children in a position that their growth and development has already occurred and therefore missed their opportunity for permanent change. Older children and adults realize that treatment for sleep issues can only occur with a day-to-day treatment offering a band-aid type of treatment. Parents use the Doctor Locator on the HealthyStart® website everyday. Be sure your information is up to date. Many HealthyStart® Providers offer airway assessments complimentary by hosting 'Healthy Start Days' in their office. Are you one of them? Are you letting parents know? We can help! See the Tools for Success' Promo below.
y r a t n e m i l Comp h t n o 1st M
For more information contact: susie@healthystartchild.com
Children With a Healthy Start Could Prevent Adult Sleep Issues Trending in today’s news is adult sleep issues. The concern? As an adult with sleep disorders, treatment options tend to be more of a “band-aid” than a solution.
A recent study looking at children with Sleep-Related Breathing Disorders (SRBD) gave evidence that gray matter – the information processing part of the brain showed a widespread neuronal damage or loss compared to the general population. - Dr. Leila Kheirandish-Gozal According to Dr. David Gozal, MD, MBA (co-author of the study), “If you are born with a high IQ – say 180 – and you lose 8-10 points, which is about the extent of IQ loss that a person with SRBD will induce on average, that may never become apparent. But if your IQ as a child is average, somewhere around 90-100, and that child has SRBD that went untreated and lost 8-10 points, that could potentially place you one standard deviation below normal. This could cost that child $1-2 million dollars over their lifetime.”
Additional research involving 501 children showed that 9 out of 10 children will exhibit one or more outward symptoms of SRBD. These outward symptoms can be identified through a HealthyStart® Sleep Questionnaire where parents indicate their child’s applicable symptoms and provides the degree of prevalence. On average, 60% of children will have at least four outward symptoms which can include: ADD/ADHD, headaches, nightmares, teeth grinding, bed wetting, difficulty in school, chronic allergies, restless sleep, dark circles under the eyes, mouth breathing, daytime drowsiness, snoring, swollen tonsils/adenoids, delayed growth and defiance/aggression. – Dr. Earl Bergerson / Brooke Stevens Trending in today’s news is adult sleep issues. Recently a popular morning talk show, Megyn Kelly TODAY, dedicated their entire show hour to this topic. The concern remains that as an adult with sleep disorders, treatment options tend to be more of a “band-aid” than a solution. Fortunately, Pediatric Sleep-Related Breathing Disorders can be addressed and treated; not with medication or surgeries that are invasive and only control symptoms, but with an FDA Cleared, non-aggressive, non-pharmaceutical treatment that addresses the underlying root cause of the problem.
Ortho-Tain® Founder and HealthyStart® Appliance System Inventor, Dr. Earl Bergersen is the World Changer, blazing the trail for 51+ years. The HealthyStart® System has changed the lives of over 4 million children through certified Dental Professionals around the world. Taking a proactive approach could save a child from a lifetime of suffering with sleep disorders and the health problems associated with them. The first step? Analyze or evaluate children with the HealthyStart® Sleep Questionnaire. The optimum time is when children are still within their growth and development years. Time is of the essence. Every child deserves a Healthy Start!
Susie LaFredo HealthyStart® Marketing
HealthyStart® Implementation Specialist Jessica Ballard Blunt I was born and raised in San Luis Obispo California and am lucky enough to still live on the beautiful Central Coast of California. My journey in dentistry started over 8 years ago working in Pediatric Dentistry as an RDA. From the first day of dental assisting school I knew I was going to work in Pediatrics. As a child I was completely terrified of the dentist, I was “that” patient and had to be sedated for dental work. That’s some real scary stuff for a young child but because of the amazing staff at my Childhood Pediatric Dental office, I overcame those fears and turned my experience into a career I am extremely passionate about. My absolute favorite thing about Pediatric Dentistry is watching children grow up and evolve into unique one of a kind individuals. It’s a great honor for parents to trust their children in your care.
3 years ago, I attended the HealthyStart Live Course with my office and my life was forever changed. I was the kid with night terrors, snoring, grinding teeth, talking in my sleep, walking in my sleep and was always tired in the morning. Everything I was learning truly hit home and it was clear that we were going to change lives with this system. We were lucky enough to have some of our very own patients make the drive to our live patient day and just like that we were up and running as a HealthyStart Provider. I even stayed late at the live course to get a digital scan of my mouth to see if these appliances could help me with my sleep. Not only was HealthyStart going to change the lives of my wonderful patients back home but I was going to start getting quality sleep, something I had never had. Now what happens when you get back to the office? My doctor had already made the decision, I was going to be the HealthyStart® Coordinator and continue my responsibilities as an RDA as well. What codes should we bill this under? What should our fee be? What kind of tools, equipment and technology do we need to be successful? How are we going to get parents to accept this new type of treatment? So many questions spiraled through my head but with the support of HealthyStart® and my team members we were going to implement systems into our practice and see what worked and what didn’t.
There was some trial and error from time to time, but one thing was clear, these appliances were working, and we had just tapped into something great. It didn’t take much time to see that my career had shifted from an RDA to so much more. I was the HealthyStart® guru in our office and could take one look at a kid and know what kind of treatment they needed. After 3 years of dedicating all my time to HealthyStart® in our practice I had created relationships with the staff at HealthyStart®. Let me tell you that these are some incredible people that work for this company. I felt like there was maybe a missing piece to the equation and what if that was me? Being able to support other offices in something I had successfully done at my practice in my mind meant, helping even more children on a bigger scale. And that is how the HealthyStart® Implementation Specialist was created.
I’ve first hand seen a practice go from 2 to 500 HealthyStart patients in a matter of 3 years. I can’t tell you how many parents have cried on my shoulder because the overall quality of life within the entire family was changed for the better.
I am here to support doctors, staff integration as you are implementing HealthyStart® into your practice so you can be successful! While also taking the time to embrace the warm and fuzzy moments that you will encounter…because you are working with children and there will be warm and fuzzy moments, so get comfortable with it! I’m looking forward to the future and being a key player in supporting our providers in helping children grow up into healthy adults!
As our new Implementation Specialist, Jess works directly with our Provider offices who would like additional support organizing HealthyStart® into their Practices. To schedule a meeting with Jess, contact her directly at: jblunt@thehealthystart.com
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SEND INQUIRES TO: SUSIE LAFREDO slafredo@thehealthystart.com