Resources and references
Why Choose The Neurodevelopmental Dental approach?
By utilizing principles of human physiology based on a natural method of nurturing the process of growth and development, the neurodevelopmental dentist can harnass the wisdom and power of the human body to create wellness.
Information and education at your fingertips
We encourage taking a deep dive into the many resources that are available for both patients and providers interested in learning more about the neurodevelopmental approach. Feel free to explore the resources available through The Synergy Academy's YouTube channel at https://www.youtube.com/@TheSynergyAcademy
Concepts at a glance
Many of the concepts that are embraced in the neurodevelopmental dental approach can be found on www.thefaceplace.us.
Educational Opportunities Offered
The curriculum created through The Synergy Academy allows multiple opportunities for the dental or orthodontic practitioner to incorporate neurodevelopmental principles and practices into their offices. For more information, please visit www.thesynergy.academy
Community Outreach
Neurodevelopmental Dentists embrace the value of their relationships with their colleagues in the many professions that work together to improve quality of lives for their patients. Providers outside of the dental field who are interested in collaborative care are welcome to join their dental colleagues in forming a common language to better support an elevated version of collaborative patient care by embracing the value of dental neuromodulation.
Faculty and Research
Our faculty is dedicated to advancing the field of dentistry through an evidence-based treatment model and ongoing innovation to improve patient care opportunities. Our faculty members are leaders in their respective fields and are committed to providing our community with a world-class education.
Evidence Based Medicine – New Approaches and Challenges
Izet Masic, Milan Miokovic, and Belma Muhamedagic
Additional literature to consider
Changing Minds Meeting References and Resources
Adverse Childhood Experiences, the Brain, and Sleep
As we age, it is normal to find it more challenging to get a good night’s sleep. However, it’s comforting to know that these strategies can improve the odds of optimizing brain health and function—preparing it to rewire negative neural pathways imprinted by ACEs.
Adverse Childhood Experiences (ACEs) and Insufficient Sleep among U.S. Children and Adolescents
https://pmc.ncbi.nlm.nih.gov/articles/PMC9484003/
Approximately half of U.S. children and adolescents (ages 6–17) experienced at least one ACE and a third did not get sufficient sleep
Children exposed to two or more ACEs were nearly twice as likely as those exposed to no ACE to have insufficient sleep duration (adjusted OR=1.7, 95% CI: 1.5–1.9). Moreover, each individual ACE, except parental death was significantly associated with more than one hour less sleep than recommended.
This study reports the association of adverse childhood experiences (ACEs) with age specific insufficient sleep among youth. The study findings demonstrate the importance of addressing both ACES and the associated sleep problems in youth.
A scientometric review of the association between childhood trauma and sleep
https://www.sciencedirect.com/science/article/pii/S0001691824003664
Identifying how early stress influences these markers can reveal the mechanisms through which it contributes to sleep disorders. For instance, elevated cortisol levels, altered heart rate variability, and disrupted brain activity patterns may offer valuable insights into how early adversity leads to chronic sleep problems. This knowledge would support the development of targeted interventions that address the specific neurobiological changes associated with and that maintain sleep disturbances
The combination of objective sleep assessment with the information regarding neurobiological markers of early adversities will enhance our understanding of the relationship between childhood trauma and sleep. In this way, it will be possible to identify clear developmental trajectories that link individual ACEs characteristics to objective sleep outcomes through the effect of neurobiological markers
"...understanding the connections between early life adversity and sleep health at different developmental periods, one of the major research efforts that emerged from the results of the current manuscript, may inform counseling and interventions in the hope of preventing various health problems that can ensue in both children and adults as a result of adverse sleep profiles."
Association between adverse childhood experiences and sleep quality, emotional and behavioral problems and academic achievement of children and adolescents
https://pubmed.ncbi.nlm.nih.gov/36869931/
ACE exposure is positively associated with poor sleep quality, emotional and behavioral problems, and lower academic achievement of adolescents, and there are significant dose–response relationships. Most types of ACEs are positively associated with these problems. Emotional abuse seems to show the strongest association with these problems of children and adolescents. Sleep quality and emotional and behavioral problems can mediate 45.9% of the effect of ACE exposure on math scores, and 15.2% of the effect of ACE exposure on English scores. Early detection and prevention of ACEs among children and adolescents are urgent and essential. For children already exposed to ACEs, targeted interventions for sleep, emotion, and behavior as well as early educational interventions may help improve their future academic achievement. Appropriate and collaborative programs are recommended to be constructed widely.
Introducing the Neuroplastic Narrative: a non-pathologizing biological foundation for trauma-informed and adverse childhood experience aware approaches
https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.1103718/full
The Neuroplastic Narrative, articulated here for the first time, demonstrates that the social determinants of health and mental health are biologically embedded through evolved mechanisms of neuroplasticity that ultimately serve evolution's end of survival in the service of reproduction. The premise of the Neuroplastic Narrative is that experiences shape brains and physiology in ways that are meaningful and adaptive (although not yet fully characterized), and which evolved to serve our survival and reproduction in the early environment we encounter.
Structural neuroplasticity after sleep loss modifies behavior and requires neurexin and neuroligin
https://www.sciencedirect.com/science/article/pii/S2589004224006989
These findings show that sleep is essential for proper maintenance of neuronal morphology at single neuron and behavior resolution. Additionally, our results indicate that sleep alters behavior by modifying plasticity at the level of specific synaptic and circuit connections. This work implicates neurexins and neuroligins in sleep dependent structural plasticity and identifies isoform specificity of nrx-1 alpha. Taken together, our results show that sleep disruption robustly alters DVB structural plasticity and behavior, and these changes are dependent on conserved SAMs that are associated with autism and other neurologic conditions.
A study identifies biomarkers in ADHD adults, linking the disorder to potential dementia risk
The findings support the hypothesis that ADHD may be associated with an increased risk of developing dementia later in life, offering the first evidence of a possible neurological mechanism behind this link.
Altered Regional Brain Cortical Thickness in Pediatric Obstructive Sleep Apnea
https://pubmed.ncbi.nlm.nih.gov/29403430/
Changes in cortical thickness are present in children with OSA and likely indicate disruption to neural developmental processes, including maturational patterns of cortical volume increases and synaptic pruning. Regions with thicker cortices may reflect inflammation or astrocyte activation. Both the thinning and thickening associated with OSA in children may contribute to the cognitive and behavioral dysfunction frequently found in the condition.
Factors related to pediatric obstructive sleep apnea-hypopnea syndrome in children with attention deficit hyperactivity disorder in different age groups
Hypoxia may be an important factor causing ADHD. OSAHS should be treated as early as possible to reduce the incidence of ADHD in children.
Previous studies have shown that the hypoxia in OSAHS is related to ADHD, and symptoms of ADHD are improved after treatment for OSAHS, but little is known about the relationship of adenoid hypertrophy, tonsil hypertrophy, and allergic rhinitis with ADHD. In the present study, results showed that there were no marked differences in the tonsil size, adenoid size, and allergic rhinitis between OSAHS group and OSAHS + ADHD group, but significant difference was observed between 2 groups after stratification according to age. This indicates that age is an important factor related to the pathogenesis of ADHD.
The gut microbiome as a target for adjuvant therapy in obstructive sleep apnea
Gut dysbiosis is assumed to play a role in obstructive sleep apnea (OSA)-associated morbidities. Pre- and probiotics, short chain fatty acids (SCFA) and fecal matter transplantation (FMT) may offer potential as novel therapeutic strategies that target this gut dysbiosis. As more mechanisms of OSA-induced dysbiosis are being elucidated, these novel approaches are being tested in preclinical and clinical development.
Snoring During Early Childhood and Academic Performance at Ages Thirteen to Fourteen Years
Children with lower academic performance in middle school are more likely to have snored during early childhood and to require T&A for snoring compared with better performing schoolmates. These findings support the concept that SDB-associated neurocognitive morbidity may be only partially reversible or that a “learning debt” may develop with SDB during early childhood and hamper subsequent school performance.
Vitamin D deficiency is associated with increased human sinonasal fibroblast proliferation in chronic rhinosinusitis with nasal polyps
https://pubmed.ncbi.nlm.nih.gov/26750566/
Vitamin D3 (VD3) is a steroid hormone with known antiproliferative properties. Patients with chronic rhinosinusitis with nasal polyps (CRSwNP) have been shown to be VD3-deficient.
VD3 deficiency is associated with increased human sinonasal fibroblast (HSNF) proliferation in CRSwNP. Further investigation into how HSNFs and VD3 impact CRSwNP pathophysiology is warranted.
The world epidemic of sleep disorders is linked to vitamin D deficiency
Because sleep disorders are known to increase the incidence and severity of hypertension, obesity, diabetes, heart disease, stroke, depression, and chronic pain, the observation of a clinical and anatomic link between sleep and vitamin D not only suggests a new treatment for sleep disorders, it also suggests a need for investigation of careful management of vitamin D levels to prevent or improve several medical conditions that have become epidemic in developed countries at the same time.
Our hypothesis, that vitamin D deficiency may be a primary cause of sleep disorders, should also prompt clinical trials for patients suffering from several sleep disorders that have historically
been very difficult to treat; primary insomnia, patients unable to tolerate CPAP, patients inexplicably tired on awakening. A simple, inexpensive way to improve or normalize sleep could have a very large impact on the health of much of the world population
From oral facial dysfunction to dysmorphism and the onset of pediatric OSA
https://www.sciencedirect.com/science/article/abs/pii/S1087079217300369?via%3Dihub
The upper airway is a collapsible tube, and its collapsibility increases during sleep. Extrinsic factors such as atypical craniofacial features may increase the risks of airway collapse.
Abnormal collapsibility in both children and adults has been related to sleep and different sleep states causing fundamental modifications of pharyngeal muscle tone and reflex responses.
The fetal oral reflexes function immediately at birth, but superimposed on these reflexes will be the development of active swallowing function between 6 and 12-mo post-natal age. The development of the cortico-geniculum pathway allows voluntary swallowing to become integrated with the initial fetal neuronal network. The primitive oral swallowing reflex is active throughout life.
OSA is related to the increased collapsibility of the UA during sleep. These series of investigations demonstrated that abnormal changes of anatomical supports in the upper airway increases the risk of collapse, which in turn leads to sleep apnea syndrome.
Rapid maxillary expansion in pediatric patients with obstructive sleep apnea: an umbrella review (2023)
https://www.sciencedirect.com/science/article/pii/S1808869423000113?via%3Dihub
We found no consistent evidence favoring RME for long-term treatment of OSA in children. All the studies presented considerable heterogeneity due to variability of age and length of follow-up.
Through this umbrella review, the need for methodologically better studies on RME is supported. Moreover, it can be considered that RME is not recommended for treating OSA in children. Further studies and more evidence identifying early signs of OSA are necessary in order to achieve consistent healthcare practice.
Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences (2013)
https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2012.00184/full
Results: Presentation of prospective data on premature infants and SDB-treated children, supporting the concept of oral-facial hypotonia. Presentation of evidence supporting hypotonia as a primary element in the development of oral-facial anatomic abnormalities leading to abnormal breathing during sleep. Continuous interaction between oral-facial muscle tone, maxillary-mandibular growth and development of SDB. Role of myofunctional reeducation with orthodontics and elimination of upper airway soft tissue in the treatment of non-obese SDB children.
Conclusion: Pediatric OSA in non-obese children is a disorder of oral-facial growth.
Impact of rapid palatal expansion on the size of adenoids and tonsils in children
https://www.sciencedirect.com/science/article/abs/pii/S1389945722000557?via%3Dihub
Our results demonstrated that RPE significantly reduced the size of both adenoid and palatine tonsils and revealed another long-term benefit of RPE treatment. To our knowledge, this is the first study to quantify the changes of adenoids and tonsils following RPE. RPE treatment can be considered as a valid and effective treatment option for pediatric OSA population with narrow high arch palate and adenotonsillar hypertrophy.
Altered gut microbiota and endocannabinoid system tone in vitamin D deficiency-mediated chronic pain
https://www.sciencedirect.com/science/article/pii/S0889159118312479?via%3Dihub
Our data suggest the existence of a link between Vitamin D deficiency – with related changes in gut bacterial composition – and altered nociception, possibly via molecular mechanisms involving the endocannabinoid and related mediator signaling systems.
... Vitamin D deficiency, and associated changes in spinal cord sensory neuron activity, possibly together with altered gut bacterial composition, may cause pain behavior via molecular mechanisms involving at least in part the endocannabinoid and N-acylethanolamine signaling systems. We also demonstrate that the neuropathic pain state induced in the present study, instead, does not affect microbiota composition. This latter finding seems to reinforce the hypothesis that, of the vitamin D deficiency-induced effects observed here, it is the dysbiosis that may concur to increase pain rather than the contrary.
...it is the dysbiosis that may concur to increase pain rather than the contrary.
Sleep Bruxism: An Oromotor Activity Secondary to Micro-arousal (2001)
Spontaneous rhythmic masticatory muscle activity (RMMA) during sleep occurs in relation to transient activation in the cerebral and autonomic nervous systems of normal subjects and in patients with sleep bruxism (SB). In this study, we made a quantitative assessment of the sequential changes in cortical electroencephalographic (EEG) and autonomic-cardiac activities associated with micro-arousals preceding RMMA episodes. We matched 10 SB patients with 10 normal subjects. The onset of RMMA episodes was defined in terms of the onset of activation in the suprahyoid muscles. In SB patients, an increase in cortical EEG activity was observed 4 seconds before the onset of suprahyoid activity in 79% of episodes. A significant acceleration in heart rate was initiated one cardiac cycle before RMMA onset. A clear sequence of cortical to autonomic-cardiac activation precedes jaw motor activity in SB patients. This suggests that SB is a powerful oromotor manifestation secondary to micro-arousal.
