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So I'm several months into treating my UARS with Homeoblock, AHI 0.2, RDI 10.8. Things are going fine, although I can't say I've noticed much improvement in sleep yet. I also have a posterior tongue tie which has undoubtedly been a factor in my mouth breathing as a child and subsequent CFD. I had extensive orthodontic treatment as well, no extractions fortunately but I spent some time in a headgear. It left me with an IMW of 34mm, and I'm closing in on 36mm now.
My question is, what to do about this posterior tongue tie? Part of me really wants to get it as I have tension all over my body and various structural imbalances which are no doubt originating from my head. And yet, I'm worried that my UARS may morph into sleep apnea. Dr. Zaghi talks about moving forward with frenectomy only if there's enough room in the mouth, but what happens when you sleep with a removable appliance in your mouth? Any increased risk in the tongue falling back?
Could getting released now actually cure my UARS?
Curious to hear your thoughts!
I don’t know if TTR will cure the UARS or not, but generally most DNA providers I have consulted with advocate doing it only once there’s enough room in the roof of the mouth for the tongue to evenly rest there (when the appliance is out) and not before then.
And I’ve seen some DNA providers present that tongue ties will sometimes go away as a result of treatment, and a frenectomy is not necessary.
My current provider is of a mindset to let the myofunctional therapist decide. If they think I have good oral posture once I’m far enough along, then no need.
@toomer My myofunctional therapist is very pro-frenectomy, she got one herself and it resolved her UARS. The difference is she didn't have an appliance in her mouth. When there's no appliance, it makes sense to pursue frenectomy if there's enough space as it will allow the tongue to go up and open the airway. But with Homeoblock /DNA, where is the tongue actually resting? It can't be the roof of the mouth because the appliance is in the way.... In which case the whole notion of having enough room for the tongue seems less important, if not irrelevant. The tongue doesn't have to "fit" anywhere, it just has to rest on top of the appliance.
So it seems like a different ballgame now. And I don't really understand the interaction between tongue and appliance and how it effects the airway.
@pizzaman500 That's awesome that a TTR cured her UARS. Did she do a sleep test before and after in order to confirm this? UARS is tricky to diagnose...
I know one patient on DNA who had their sleep apnea AHI go from 11 (mild) to 1 (no sleep apnea), but RDI was at like 15 originally and got down to 8 or so ... so she still has some latent UARS. She's looking to go get a TTR done now that DNA has opened up enough space at the top of her mouth, I bet she'll be ecstatic if that wipes out the rest of her UARS as well (in case DNA can't do it on its own).
@toomer It sounded like she did a number of sleep studies that didn't score RERAs, she didn't have apneas so she made a self-diagnosis. After doing a TTR her anxiety went away and sleep returned to normal. Obviously it was in conjunction to myofunctional therapy as well.
Interesting to hear. It's likely TTR will put another dent in her UARS, if not remove it altogether. Dr. Zaghi has lots of research showing this, provided there is enough space for the tongue in the mouth.
@pizzaman500 Thanks for all the info. This is such weird, wild stuff. I mean, it was already kind of way-out-there what I've been looking at with considering DNA treatment ... but then to think that just a tiny bit of extra flesh under the tongue could cause so many problems. A DNA-treating dentist that I know got trained on Zaghi's technique, and her and her brother (also a dentist) both did frenectomies on each other. She said she gained range-of-motion in her neck and in her shoulder that she hasn't had for over a decade.
As to your original question - I get a sense that doing the TTR while you haven't finished all the way through Homeoblock treatment shouldn't be much of an issue, given that you're not wearing the Homeoblock 24 hours a day. While it's out during the daytime, you should absolutely be practicing your proper oral posture and taking advantage of all of that space at the roof of your mouth. Mostly, I think the key concern post-TTR is making sure the tie doesn't re-form. Daytime Myofunctional exercises while you're healing should hopefully ensure that.
BTW, have you seen Dr. Zaghi's video from the Vivos conference last year? https://vimeo.com/363360584
@toomer Fascinating. Yes, this is a crazy world and it's remarkable the downstream effects a tongue tie can have. I'm scheduled to speak to Zaghi next week. Will let you know if there's anything worth sharing.
@toomer Fascinating. Yes, this is a crazy world and it's remarkable the downstream effects a tongue tie can have. I'm scheduled to speak to Zaghi next week. Will let you know if there's anything worth sharing.
So did you have your consult with Zaghi?
That DNA treating dentist that I referred to earlier, that did DNA on herself and her and her (also dentist) brother were both trained by Zaghi so she had that done too ... I was chatting with her the other day, and above and beyond the range of motion she regained, she really felt like the TTR got her that last bit of the way to completely cured of OSA. She had finished her DNA treatment (about 1 year) and she had started with an AHI of 26, which got down to 6 towards the end. Then she got the TTR done, and after a month or so she ran her sleep test again 3 different ways - no device in the mouth, upper (DNA) and upper + lower MRNA. She said the worst configuration her AHI was now 2. So TTR she thinks DNA got her 90% of the way there and then TTR got her over the finish line.
We have a great FB group with a lot of on-treatment patients getting DNA, AGGA, MSE, etc. and many are also getting tongue tie releases. PM me if you want the name of the group, as much as I found TGW here helpful ... there’s a heavy focus on mewing, which just isn’t going to work for some of us.
@toomer Sure did. It was a quick appointment where he looked at my palate and tie and gave the green light for the release. I posed the same question to him I posed here regarding getting the release with a nightly appliance and he said it should be fine, having a large enough cave is all that matters. No further clarity but I'll take it. I'm scheduled for the 15th this month.
That's great to hear; stories of TTR improving sleep are always encouraging. I'm glad the DNA / TTR combo is proving to be effective. I have so many issues potentially related to tongue tie I'm almost giddy with anticipation. UARS, poor posture, tension, back pain, scoliosis, orthodontic relapse... if I could get an improvement in even half of these it would be life-changing. I'll come back with an update once it's done.
@pizzaman500 how did the TTR go? have you noticed any improvements/was it good timing to do while using the homeoblock?
@vplatt It went well. I feel less tension, better breathing and improved tongue mobility. Mewing is second nature now that there's no restriction. Overall I'm really happy I did it, but it has not solved UARS for me. I need to get structural improvement for that.
