Orthodontist highlights compromises to the human airway (Part 2)

Compromises to the human airway can manifest in the way we eat, drink, and sleep. Dr. Barry Raphael, an orthodontist with 33 years of experience, discussed these compromises in a session of the Airway Focused Dentistry Mini-Residency. The course was co-developed by Dr. Raphael and Dana Point dentist, Dr. Mark A. Cruz. Compromises include:

Craniofacial dystrophy

The problem of obstructed airways in not only limited to adults with sleep apnea, Dr. Raphael explained. When a patient suffers from craniofacial dystrophy, the maxilla is down and back, the mandible is retrognathic, and there is insufficient facial support. The nasal cartilage can collapse. However, the shape of the airway drives the shape of the face.

Tethered oral tissues (frenum and tongue-tie)

Most people thought tongue-tie only impeded speech. More recently, lactation consultants say if a person has a poor latch during breast feeding, there is a reason to release the tongue. Tethered frenum can lead to limited tongue movement, maxillary constriction, anterior crowding, and anterior openbite.

Myofunctional disorders

Myofunctional disorders include swallowing and chewing. A natural competence for swallowing at birth is geared toward suckling and nursing. As an adult, the muscles used for swallowing are different from ones used at birth. The competencies seen in infants during nursing become compensations in the mature swallow, in children and adults.

If children experience difficulty swallowing, then eating is an impediment to breathing. Signs there is difficulty swallowing include mouths hanging open, cheeks puffing out when swallowing, sloppy eating, chewing fast and swallowing to get rid of food in time to take their next breath. The parafunctions are tongue thrusting, facial muscles compensating, and mouthbreathing. Secondary effects include compromised jaw growth, crowded teeth, compromised facial form, and threatened airway. Children who do not swallow well will have smaller airways. Myofunctional therapy can help improve breathing.

Studies show that people breathe heavier and more rapidly than 100 years ago. The idea that people can breathe too much is an interesting concept that many do not understand. However, hyperventilation can occur when people breathe too rapidly. Therefore, breathing bothers sleep. It is not the other way around, Dr. Raphael said.

Understanding the role of the airway and how it leads to sleep disordered breathing and numerous dental health issues is one of the many reasons Drs. Raphael and Cruz developed the mini-residency. They are committed to educating doctors from multiple disciplines throughout the country.