"I’ll keep my mouth closed and I’ll breathe through my nose."
Finn, The Very Stuffy Nose
For Medical Practitioners
In October 2017, the American Dental Association (ADA) passed a resolution entitled, “The Role of Dentistry in the Treatment of Sleep Related Breathing Disorders” (SRBD). See attached .pdf for full statement, here is a summary:
Dental professionals are well positioned to screen patients for:
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snoring
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Obstructive Sleep Apnea (OSA)
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Upper Airway Resistance Syndrome (UARS), and other SRBD
OSA has been associated with:
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metabolic disease
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cardiovascular disease
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respiratory illness
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dental malocclusion and bruxism
In children, undiagnosed and/or untreated OSA can be associated with:
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cardiovascular problems
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impaired growth
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learning and behavioral problems
Dentists play an essential role in the multidisciplinary care of patients with certain SRBD. Due to a number of multifactorial medical issues, SRBD are best treated through a collaborative model with medical colleagues.
In children, a dentist can mitigate these disorders by recognizing suboptimal early craniofacial growth and development or other risk factors which may lead to medical referral or orthodontic/orthopedic intervention to treat and/or prevent SRBD.
Some treatment options include surgery and Oral Appliance Therapy (OAT). Dentists are the only health care provider with the knowledge and expertise to provide OAT.
Airway Screening
Dentists are encouraged to screen patients for SRBD as part of a comprehensive medical and dental history to recognize symptoms such as:
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daytime sleepiness
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gagging
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snoring or witnessed apneas
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and evaluate for risk factors such as obesity, retrognathia, or hypertension
In children, screening through history and clinical examination may identify signs and symptoms of deficient growth and development, or other risk factors that may lead to airway issues. If risk for SRBD is determined, intervention through medical/dental referral or evidenced based treatment may be appropriate to help treat the SRBD and/or develop an optimal physiologic airway and breathing pattern.
Here are some Screening Tools to get started: Home - FAirEST.org, and:
Office Implementation
If you are ready to screen and treat SRBD, we recommend an office-based system called the Total Health Academy.
THA is a self-paced, digital-learning platform for doctors and their teams providing the information and systems necessary to screen, treat and prevent Sleep Disordered Breathing (SDB), inflammation, diabetes and other oral and systemic diseases.
We are ready to advise on the resources and training to implement SRBD treatment in your practice. Please Contact Us, or set up a Consultation.
Summary
SRBD can be the result of low tongue posture and soft diets that result in a decreasing mouth size, retrognathic maxilla and malocclusion. A tongue habitually suctioned to the palate will develop a wide arch and nasal sinuses and forward growth of the maxilla. In addition, historically we spent approximately 1.5 hours per day chewing and strengthening the alveolar process enough to accommodate all 32 teeth. Today's children grow up on soft, processed foods, drinking them through pouches which result in underdeveloped alveolar ridges and lingually inclined posterior teeth. The neutral zone is disrupted when the tongue is absent from the palate, therefore, the cheeks push the teeth lingual resulting in an improper arch form, narrow arches, crowding, and deviated nasal septum from the forces of the cheeks pushing the teeth in. When we mouth breathe, our tongues are always in a low tongue posture.
Soft, processed food in combination with things like a tongue tie, bottle feeding, pouch feeding, thumb sucking and pacifiers lead to a narrow arch, deviated septum and congestion. Often, mouth breathing becomes habitual and precedes chronic nasal congestion, enlarged adenoids and tonsils, dry mouth and cavities which influence craniofacial respiratory changes. The low tongue posture of a habitual mouth breather will develop a longer face with a higher gonial angle that grows down and back toward the airway. The consequences of this is a narrowing of the airway, less oxygen to the brain and fragmented sleep. When that happens, children experience symptoms of sweating, bed wetting, sleep apnea, night terrors, snoring, and restless sleep.
The nature of screening and treating SRBD falls into the preventative rather than reactionary medical response model. As all patients are unique and due to the multifactorial influences, treatment options are a combination of lifestyle and individualized intervention. Interestingly, once a Pediatric Airway patient has transitioned from mouth to nose breathing, the long term risk of that future adult developing hypertension, cardiovascular disease and type II diabetes are reduced.
In addition to OAT, some of the adjunct therapies that have been useful in treating SRBD and craniofacial disorders include
Myofunctional Therapy, Frenuplasty, expansion orthodontics, and the Buteyko Breathing Method.
The air we breathe needs processing, and our mouth cannot do it. Our noses are uniquely designed to filter, warm and humidify the air coming into our bodies along with providing nitric oxide from our paranasal sinuses. For a more granular analysis, please reference these leading White Papers. Also, check out the Recommended Products that have proven helpful in increasing the ease of nasal breathing during the day and in sleep.