Medical Hypotheses I
&did Hypofhfm (1992) 38, lrn-105 cJLAmgmmGrmpuKLtd1992
Organic Tooth Wear-Overlooked
in Anatomy Texts
H. N. COOPERMAN 800 Airport Blvd, Doylestown, PA 78901, USA
Abstract-Most anatomy texts depict gear-like apposition of adult upper and lower teeth. But this apposition generally does not occur in civilized man. On the contrary the widespread tooth attrition which occurs in primitive man, is well established (1, 2, 3). This attrition, which is not depicted in anatomy texts or correctly evaluated in medical and dental education, is a natural protective mechanism that functions to preserve, oral, pharyngeal, and respiratory physiology throughout life. As man removed grit, sand and other abrasive food from his diet, he deprived himself of a natural aid, i.e. attritional wear of teeth that protects the physiology of his mouth and the swallowing and respiratory apparatus (4). In contrast to this the unworn teeth, characteristic of present-day man, prevent anatomic and physiologic changes that normalize oral pathways. For these reasons, ‘textbook tooth occlusion should be re-evaluated.
Introduction
Research
Our research revealed widespread occurrence of mandibular retrusion in patients whom we treated for various conditions associated with uvula tongue malposture (5) and the absence of organic, i.e. attritional tooth wear (Fig.1). The complaints of our patients included asthma, emphysema, sleep disorders, snoring, difficult swallowing, shortness of breath and headaches (6, 7). All patients reported that they had been told, in one way or another, that, ‘Nothing further could be done.‘, ’ Research is being done on your problems.‘, and/or ‘You simply have to live with it.‘. However, when these patients were treated with respiratory wedges, and observed over a 4 year period, all reported significant improvement. Many of the patients stated ‘I can breathe better.‘, ‘I sleep better.‘, ‘I have more energy.‘, ‘ Most of my problems are gone.’
77 Hawaiian, Japanese, Chinese, Filipino, and Cau-
Date received 9 Aprtl 1991 _ Date accepted 4 November 1991
casian patients received a differential diagnosis in an Ear, Nose and Throat Department of a Hawaiian Medical Center and Hospital. The patients had been treated with respiratory wedges which open constricted pathways of breathing and swallowing by restoring normal function to impaired physiology of the throat. Respiratory wedges (9, 10) are removable, non-invasive, non-toxic, intra-oral devices (Fig. 2). They are made of soft mouth guard material or metal and fit over the teeth or dentures. They are designed and constructed in an analogue dental computer (11) that is programmed to accept anatomical landmarks provided by casts of the maxillary and mandibular jaws and their teeth.
102
ORGANIC TOOTH WAR
Fig.
1 Non-attritional
occlusion.
Respiratory wedges are effective in treating many patients with uvula tongue malposture. That condition indicates impaired physiological pathways of respiration, swallowing and speech (8). Uvula tongue malposture is initiated by inadequate tooth attrition due to our civilized diet which lacks abrasive food. This inadequate tooth wear maintains the mandible in a position where it is responsible for the proximity of the uvula to the dorsum of the tongue. Discussion Our clinical observations indicate that mandibular protrusion, resulting from organic tooth wear (Fig. 3) plays a significant role in the proper opening and alignment of oral pathways (12). We therefore believe that organic tooth wear facilitates normal mandibular protrusion and prevents mandibular retrognathia (retrusion). Mandibular retrusion, which is observed in most patients, causes the dorsum of the tongue and the uvula to impinge on one another, in the manner of overlying toes. These impingements may produce disturbances in breathing, deglutition, drainage of the accessory, and eustachian tube dysfunc’tions. Also, mandibular retrusion per se disturbs temporomandibular relationships (13). Recognition of
the above mentioned deranged oral pathways may permit physicians to correct many problems by using respiratory wedges (14). We believe this new appreciation of primitive man’s abrasive diet and consequent organic tooth wear is the missing link in diagnosis and treatment of numerous ailments. As organic tooth wear progresses, the lower mandible with its attachments moves forward in relation to the cranium. This is nature’s protective means of minimizing or avoiding airway obstructions. Some conditions which we have treated with respiratory wedges may have been caused, at least in part, by long standing hypoxia. We believe the wedges opened pathways and increased air intake, thereby decreasing body hypoxia. Many patients with chronic obstructive airway disorders may therefore be successfully treated with wedge therapy by a joint effort of the physician and dentist who are specifically trained in this area. If so, mechanical respiratory wedges may replace some medical and surgical procedures. How does one attempt to change erroneous concepts of supposedly normal healthy dent&ion in anatomy texts? Uncivilized man ate gritty, uncooked,
104
Fig. 2 Mechanical
MEDICAL HYPOTHESES
wedges for upper and lower dentition.
Fig. 3 Organic tooth wear and attritional
occlusion.
ORGANIC TOOTH WEAR
unclean, sandy, hard-to-chew foods. This required him to spend more time eating and to expend more force in mastication. Therefore, extensive tooth crown attrition deveIoped through the lifetime of his primary and permanent teeth. Anatomy textbooks present interdigitation of non-worn, adult teeth as normal and therefore healthy. However, we believe that textbook occlusion is an abnormal state resulting from our soft, non-abrasive diet. This new understanding of the natural, normal function of tooth wear is of vital importance in re-evaluating many patients who have been treated unsuccessfully for a wide variety of problems. Anatomy textbooks also have diagrams which invariably show a space between the uvula and the tongue. However that space is not observed clinically because most people have uvula tongue malposture. But the space does not occur in patients with respiratory wedges which produces that space. Conclusions Environmental and genetic factors are therefore not the only possible causes of chronic obstructive airway disorders (15). Respiratory wedges are effective because they mobilize ‘unlocked’ mandibles. They therefore provide modem man with a dental occlusion similar to that of his ancestors. This opens occluded airways and provides relief for a variety of respiratory and other problems which physicians frequently encounter.
105 References 1. Forde T H. Oral Dynamics-Principle and Practice. Exposition Press, New York: 41-48, 1964. 2. Begg P R. Orthodontic therapy and technique correct occlusion. The Basics of Orthodontia. W B Saunders. Philadelnhia: 5-36, 1965. 3. Kamijo M. Jaw Relationships. International Dental Journal, Tokyo, 1984. 4. Miura N. Observation of natural dentition. Nippon Dental, Tckyo, 1984. 5. Cooperman H N, Miura N. Uvula tongue malposture syndrome. Intervention with respiratory wedges. Treatment of 77 patients. Honolulu, Unpublished, 1980-1985. 6. Dictionary of Medical Syndromes 3rd ed. 201-202, 1990. 7. Dictionary of Syndromes and Eponymic diseases, 2nd ed. R E Krieger Publishing, Melbourne, Florida: 161, 1991. 8. Myodontics, Quintessence, Tokyo, 1983. 9. Practical Splints, Quintessence, Tokyo, 1987. 10. Cooperman H N, Miura N. Vanhakendover S. Rich H. Uvula tongue malposture. A new approach to Costen’s syndrome, Dental Diamond, Tokyo: 127-129, 1977. 11. Cooperman H N. A programmed analogue dental computer. Use in complete denture construction. Dental Digest 74: 1, 1968. 12. Cooperman H N. Oral Conditioners. Their role in the treatment of muscular imbalances. Dental Digest SO: 11, 1960. 13. Euno K, Futaki T. Use of respiratory wedges in otolaryngology complaints. Myodontics 14, Tokyo: 90-%, 1991. 14. Euno K, Hatada K. Use of respiratory wedges in neurological complaints. Myodontics, 14 Tokyo: %-104, 1991. 15. Strohl K P, Olson L G. Concerning the importance of phatyngeal muscles in maintenance of upper airway patency during sleep. An opinion, Chest 92: 918-920, 1987.
&did Hypofhfm (1992) 38, lrn-105 cJLAmgmmGrmpuKLtd1992
Organic Tooth Wear-Overlooked
in Anatomy Texts
H. N. COOPERMAN 800 Airport Blvd, Doylestown, PA 78901, USA
Abstract-Most anatomy texts depict gear-like apposition of adult upper and lower teeth. But this apposition generally does not occur in civilized man. On the contrary the widespread tooth attrition which occurs in primitive man, is well established (1, 2, 3). This attrition, which is not depicted in anatomy texts or correctly evaluated in medical and dental education, is a natural protective mechanism that functions to preserve, oral, pharyngeal, and respiratory physiology throughout life. As man removed grit, sand and other abrasive food from his diet, he deprived himself of a natural aid, i.e. attritional wear of teeth that protects the physiology of his mouth and the swallowing and respiratory apparatus (4). In contrast to this the unworn teeth, characteristic of present-day man, prevent anatomic and physiologic changes that normalize oral pathways. For these reasons, ‘textbook tooth occlusion should be re-evaluated.
Introduction
Research
Our research revealed widespread occurrence of mandibular retrusion in patients whom we treated for various conditions associated with uvula tongue malposture (5) and the absence of organic, i.e. attritional tooth wear (Fig.1). The complaints of our patients included asthma, emphysema, sleep disorders, snoring, difficult swallowing, shortness of breath and headaches (6, 7). All patients reported that they had been told, in one way or another, that, ‘Nothing further could be done.‘, ’ Research is being done on your problems.‘, and/or ‘You simply have to live with it.‘. However, when these patients were treated with respiratory wedges, and observed over a 4 year period, all reported significant improvement. Many of the patients stated ‘I can breathe better.‘, ‘I sleep better.‘, ‘I have more energy.‘, ‘ Most of my problems are gone.’
77 Hawaiian, Japanese, Chinese, Filipino, and Cau-
Date received 9 Aprtl 1991 _ Date accepted 4 November 1991
casian patients received a differential diagnosis in an Ear, Nose and Throat Department of a Hawaiian Medical Center and Hospital. The patients had been treated with respiratory wedges which open constricted pathways of breathing and swallowing by restoring normal function to impaired physiology of the throat. Respiratory wedges (9, 10) are removable, non-invasive, non-toxic, intra-oral devices (Fig. 2). They are made of soft mouth guard material or metal and fit over the teeth or dentures. They are designed and constructed in an analogue dental computer (11) that is programmed to accept anatomical landmarks provided by casts of the maxillary and mandibular jaws and their teeth.
102
ORGANIC TOOTH WAR
Fig.
1 Non-attritional
occlusion.
Respiratory wedges are effective in treating many patients with uvula tongue malposture. That condition indicates impaired physiological pathways of respiration, swallowing and speech (8). Uvula tongue malposture is initiated by inadequate tooth attrition due to our civilized diet which lacks abrasive food. This inadequate tooth wear maintains the mandible in a position where it is responsible for the proximity of the uvula to the dorsum of the tongue. Discussion Our clinical observations indicate that mandibular protrusion, resulting from organic tooth wear (Fig. 3) plays a significant role in the proper opening and alignment of oral pathways (12). We therefore believe that organic tooth wear facilitates normal mandibular protrusion and prevents mandibular retrognathia (retrusion). Mandibular retrusion, which is observed in most patients, causes the dorsum of the tongue and the uvula to impinge on one another, in the manner of overlying toes. These impingements may produce disturbances in breathing, deglutition, drainage of the accessory, and eustachian tube dysfunc’tions. Also, mandibular retrusion per se disturbs temporomandibular relationships (13). Recognition of
the above mentioned deranged oral pathways may permit physicians to correct many problems by using respiratory wedges (14). We believe this new appreciation of primitive man’s abrasive diet and consequent organic tooth wear is the missing link in diagnosis and treatment of numerous ailments. As organic tooth wear progresses, the lower mandible with its attachments moves forward in relation to the cranium. This is nature’s protective means of minimizing or avoiding airway obstructions. Some conditions which we have treated with respiratory wedges may have been caused, at least in part, by long standing hypoxia. We believe the wedges opened pathways and increased air intake, thereby decreasing body hypoxia. Many patients with chronic obstructive airway disorders may therefore be successfully treated with wedge therapy by a joint effort of the physician and dentist who are specifically trained in this area. If so, mechanical respiratory wedges may replace some medical and surgical procedures. How does one attempt to change erroneous concepts of supposedly normal healthy dent&ion in anatomy texts? Uncivilized man ate gritty, uncooked,
104
Fig. 2 Mechanical
MEDICAL HYPOTHESES
wedges for upper and lower dentition.
Fig. 3 Organic tooth wear and attritional
occlusion.
ORGANIC TOOTH WEAR
unclean, sandy, hard-to-chew foods. This required him to spend more time eating and to expend more force in mastication. Therefore, extensive tooth crown attrition deveIoped through the lifetime of his primary and permanent teeth. Anatomy textbooks present interdigitation of non-worn, adult teeth as normal and therefore healthy. However, we believe that textbook occlusion is an abnormal state resulting from our soft, non-abrasive diet. This new understanding of the natural, normal function of tooth wear is of vital importance in re-evaluating many patients who have been treated unsuccessfully for a wide variety of problems. Anatomy textbooks also have diagrams which invariably show a space between the uvula and the tongue. However that space is not observed clinically because most people have uvula tongue malposture. But the space does not occur in patients with respiratory wedges which produces that space. Conclusions Environmental and genetic factors are therefore not the only possible causes of chronic obstructive airway disorders (15). Respiratory wedges are effective because they mobilize ‘unlocked’ mandibles. They therefore provide modem man with a dental occlusion similar to that of his ancestors. This opens occluded airways and provides relief for a variety of respiratory and other problems which physicians frequently encounter.
105 References 1. Forde T H. Oral Dynamics-Principle and Practice. Exposition Press, New York: 41-48, 1964. 2. Begg P R. Orthodontic therapy and technique correct occlusion. The Basics of Orthodontia. W B Saunders. Philadelnhia: 5-36, 1965. 3. Kamijo M. Jaw Relationships. International Dental Journal, Tokyo, 1984. 4. Miura N. Observation of natural dentition. Nippon Dental, Tckyo, 1984. 5. Cooperman H N, Miura N. Uvula tongue malposture syndrome. Intervention with respiratory wedges. Treatment of 77 patients. Honolulu, Unpublished, 1980-1985. 6. Dictionary of Medical Syndromes 3rd ed. 201-202, 1990. 7. Dictionary of Syndromes and Eponymic diseases, 2nd ed. R E Krieger Publishing, Melbourne, Florida: 161, 1991. 8. Myodontics, Quintessence, Tokyo, 1983. 9. Practical Splints, Quintessence, Tokyo, 1987. 10. Cooperman H N, Miura N. Vanhakendover S. Rich H. Uvula tongue malposture. A new approach to Costen’s syndrome, Dental Diamond, Tokyo: 127-129, 1977. 11. Cooperman H N. A programmed analogue dental computer. Use in complete denture construction. Dental Digest 74: 1, 1968. 12. Cooperman H N. Oral Conditioners. Their role in the treatment of muscular imbalances. Dental Digest SO: 11, 1960. 13. Euno K, Futaki T. Use of respiratory wedges in otolaryngology complaints. Myodontics 14, Tokyo: 90-%, 1991. 14. Euno K, Hatada K. Use of respiratory wedges in neurological complaints. Myodontics, 14 Tokyo: %-104, 1991. 15. Strohl K P, Olson L G. Concerning the importance of phatyngeal muscles in maintenance of upper airway patency during sleep. An opinion, Chest 92: 918-920, 1987.
