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Oral Systemic Balance (dental device)

Hello, I was asked to post this as a new discussion topic.  I wanted to provide some information on the Oral Systemic Balance (OSB).  I am not a dentist, I am a professor.  I have had migraines for 36 years, have had every treatment from acupuncture to Zanadine (muscle relaxant). The migraines usually came twice a week, and lasted 1-3 days. You can see how this would define my life. I got the OSB (oral systemic balance) dental device from Dr. Lawler, and have not had a migraine in 3 months. I'm one of the people Dr. Lawler has videotaped. All I can say is, I hope the dental and medical communities embrace this research so others can benefit as I have.  Dr. Lawler is studying with Dr. Farrand Robson of Tacoma Washington.

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Permalink Reply by RockRpsgt on November 12, 2010 at 7:48am
I did not mean to down play what you do. I was just agreeing with you on the false postive thing. My statement on UARS, RERAs, and arousals was more me thinking out loud. Typing while doing so evidently. I am glad to here that you have a way of measuring the success of your product. I wish you and your patients luck. Please keep me updated.

David E. Lawler DDS D.ABDSM said:
Rock, we are not on the same page regarding our opinions of the Watch PAT. I have done well over 550 Watch PAT studies so I'm more than a little familiar with this instrument. The pRDI may be overly sensitive compared to a RDI obtained with a polysomnogram. They clearly are measuring something different. You obviously cannot measure air flow with something on your finger. However you CAN measure the EFFECT of diminished airflow by looking at sympathetic surge. How do you know that there is not something more subtile going on in the body that the PSG is overlooking?

This needs to be repeated: When the upper airway is managed the pRDI measured by the Watch PAT goes down. This is a straight line correlation. So something is getting better. I contend that the sympathetic surge measured by the Watch PAT signal has a deeper meaning than a respiratory effort related arousal derived from a PSG. Guilleminault himself said that he thought that there was some subcortical effect on the brain that was deeper than a RERA.

Those of us who are working with Oral Systemic Balance principles see amazing things that until now were completely overlooked by the medical community. There are many, many amazing stories by patients on this thread who have shared things that are not credible with conventional thought. I contend that the Watch PAT gives a window into this previously overlooked part of the body's physiology.



Rock Hinkle said:
You are very correct. I appreciate your honesty. I have been talking about false positives with the HSTs for sometime now. The military has done several studies on the technology behind the Watchpat listing it's limitations at recording sleep problems. basically the military said that it was "just" good enough for their needs. I believe that they said the same thing about the Hummer as well.

I do not see it possible to Dx UARS via this program. It's tough to see flow limitation on these units let alone arousals. Thanks foir the answers to my questions. Good luck!
Permalink Reply by David E. Lawler DDS D.ABDSM on November 12, 2010 at 8:23am
Rock, in no way did I interpret a negative comment regarding what we do. I think our disagreement is on the meaning of the PAT signal and what it reveals. Based on my clinical correlation with patient's symptoms before and after treatment, I have to accept that this number is meaningful even though it my be measuring something totally different than what is done in a PSG.

I have very much enjoyed this discussion with you. To bad we can't continue it over a cup of coffee.


Rock Hinkle said:
I did not mean to down play what you do. I was just agreeing with you on the false postive thing. My statement on UARS, RERAs, and arousals was more me thinking out loud. Typing while doing so evidently. I am glad to here that you have a way of measuring the success of your product. I wish you and your patients luck. Please keep me updated.

David E. Lawler DDS D.ABDSM said:
Rock, we are not on the same page regarding our opinions of the Watch PAT. I have done well over 550 Watch PAT studies so I'm more than a little familiar with this instrument. The pRDI may be overly sensitive compared to a RDI obtained with a polysomnogram. They clearly are measuring something different. You obviously cannot measure air flow with something on your finger. However you CAN measure the EFFECT of diminished airflow by looking at sympathetic surge. How do you know that there is not something more subtile going on in the body that the PSG is overlooking?

This needs to be repeated: When the upper airway is managed the pRDI measured by the Watch PAT goes down. This is a straight line correlation. So something is getting better. I contend that the sympathetic surge measured by the Watch PAT signal has a deeper meaning than a respiratory effort related arousal derived from a PSG. Guilleminault himself said that he thought that there was some subcortical effect on the brain that was deeper than a RERA.

Those of us who are working with Oral Systemic Balance principles see amazing things that until now were completely overlooked by the medical community. There are many, many amazing stories by patients on this thread who have shared things that are not credible with conventional thought. I contend that the Watch PAT gives a window into this previously overlooked part of the body's physiology.



Rock Hinkle said:
You are very correct. I appreciate your honesty. I have been talking about false positives with the HSTs for sometime now. The military has done several studies on the technology behind the Watchpat listing it's limitations at recording sleep problems. basically the military said that it was "just" good enough for their needs. I believe that they said the same thing about the Hummer as well.

I do not see it possible to Dx UARS via this program. It's tough to see flow limitation on these units let alone arousals. Thanks foir the answers to my questions. Good luck!
Permalink Reply by Rooster on January 25, 2011 at 10:22am
Permalink Reply by David E. Lawler DDS D.ABDSM on January 26, 2011 at 8:10pm

Rooster this video documents a classic situation where head and neck pain are a direct result of a dysfunctional swallow.  The patient in this video had been given a diagnosis of "exercise induced asthma".  My assessment is that it was not asthma at all, but rather her tongue getting in the way of her airway while awake.  This discussion group appropriately focuses on breathing during sleep.  It just so happens that breathing is important while awake as well!  I would be curious to know how many members of SleepGuide experience shallow or restricted breathing during the day.

 

As always, I am grateful to this patient for consenting to have this video record of her treatment recorded and published so that others may better understand the connection between breathing and swallowing and the widespread consequence of dysfunctional swallowing.

Rooster said:

Permalink Reply by RockRpsgt on January 28, 2011 at 10:39pm
I to am very intrigued and have many questions. Our lab currently titrates the Elastic Mandibular Advancement device (AMA). Can anyone tell me how the 2 compare?

Mike said:
I am intrigued by Dr. Lawler's work in this area. Thank you for sharing your experience. Looking forward to learning more about the OSB device.
Permalink Reply by David E. Lawler DDS D.ABDSM on January 29, 2011 at 10:36am

Rock, thanks for your interest.  There is a very distinct difference between the Oral Systemic Balance approach and the Elastic Mandibular Advance appliance or EMA.   The OSB orthotic used in the patient above during her treatment appointment ( http://www.youtube.com/watch?v=PKXoSt9jQeA&feature ) is worn in the mouth most of the day and during sleep.  It is removed for eating and at various times during the day depending on the wishes and symptoms of the patient.  It rarely interferes with speech as you can see in this patient's follow-up appointment ( http://www.youtube.com/watch?v=uPVf1RDLono )  If you look at her video of her consultation appointment where she presented her symptoms ( http://www.youtube.com/watch?v=qIlORFovLL4 ) you can easily see that she has come a long way in recovery.  This orthotic functions by repositioning the tongue and moving it more up into the mouth.  Keep in mind that the tongue is a huge muscle and the base of the tongue is fairly deep into the throat.

 

The EMA appliance merely moves the jaw forward.  In some patients, that is all that is necessary, but you would not get the significant amount of symptoms relief that is routinely achieved with an OSB orthotic.  The advantage of the EMA is its small size.  One of the disadvantage of most mandibular advancement appliance is the size and the fact that they encroach on the very tongue that they are trying to move out of the way.  

 

The OSB mandibular advancement appliance (like the one that Carl talked about earlier in this thread) combines the concept of the lower orthotic used by the patient above with the concept of the EMA appliance that you are familiar with.  If you go back and review the earlier part of this thread, Carl started out with the lower OSB orthotic for daytime use to relieve his head and neck pain and then used the OSB mandibular advancement appliance for sleep.  

 

The EMA appliance is quite flimsy compared to the OSG mandibular advancement orthotic.  I have been quite frustrated with how often the EMA appliances break.

 

There is more information about Oral Systemic Balance at http://www.centerforsoundsleep.com/blog/oral-systemic-balance/

Permalink Reply by RockRpsgt on January 30, 2011 at 5:30am
Frustration is the key word when discussing the EMA. My luck has not been all that great when titrating these units. although I have not broken one yet. ;) Thanks for the videos Dr. Lawler.

David E. Lawler DDS D.ABDSM said:

Rock, thanks for your interest.  There is a very distinct difference between the Oral Systemic Balance approach and the Elastic Mandibular Advance appliance or EMA.   The OSB orthotic used in the patient above during her treatment appointment ( http://www.youtube.com/watch?v=PKXoSt9jQeA&feature ) is worn in the mouth most of the day and during sleep.  It is removed for eating and at various times during the day depending on the wishes and symptoms of the patient.  It rarely interferes with speech as you can see in this patient's follow-up appointment ( http://www.youtube.com/watch?v=uPVf1RDLono )  If you look at her video of her consultation appointment where she presented her symptoms ( http://www.youtube.com/watch?v=qIlORFovLL4 ) you can easily see that she has come a long way in recovery.  This orthotic functions by repositioning the tongue and moving it more up into the mouth.  Keep in mind that the tongue is a huge muscle and the base of the tongue is fairly deep into the throat.

 

The EMA appliance merely moves the jaw forward.  In some patients, that is all that is necessary, but you would not get the significant amount of symptoms relief that is routinely achieved with an OSB orthotic.  The advantage of the EMA is its small size.  One of the disadvantage of most mandibular advancement appliance is the size and the fact that they encroach on the very tongue that they are trying to move out of the way.  

 

The OSB mandibular advancement appliance (like the one that Carl talked about earlier in this thread) combines the concept of the lower orthotic used by the patient above with the concept of the EMA appliance that you are familiar with.  If you go back and review the earlier part of this thread, Carl started out with the lower OSB orthotic for daytime use to relieve his head and neck pain and then used the OSB mandibular advancement appliance for sleep.  

 

The EMA appliance is quite flimsy compared to the OSG mandibular advancement orthotic.  I have been quite frustrated with how often the EMA appliances break.

 

There is more information about Oral Systemic Balance at http://www.centerforsoundsleep.com/blog/oral-systemic-balance/

Permalink Reply by Mary Z on January 30, 2012 at 10:52am

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