Patient Education

As experts in airway health, we answer FAQs about fostering optimal breathing, avoiding health consequences and treatment approaches

At Mark A. Cruz, DDS in Dana Point, California, we are innovative leaders in airway-focused treatment. In fact, Dr. Cruz founded the longest-running and most well-respected airway curriculum in the U.S., the Airway Collaborative. He remains an authority in the field and a sought-after lecturer and educator.

Below, we answer some of the most frequently asked questions about airway health and airway-focused treatments.

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Parents' Voice USA October 2025 event, talk on sleep by Dr. Mark A. Cruz

Video Transcript

All right. So, I am really thrilled you are all here. I want to begin by acknowledging some of the guests in the room. The Fullerton mayor was here, but he had to go to another event, so he said hello. Fullerton City Council member Ahmad Zahra is here, and I am thrilled to have him. The famous Steve Mclottwin, superintendent of the Fullerton High School. Marilyn Bush, who is also an elected trustee and official for Fullerton High School.

Dr. Stephan Bean, who I am thrilled to have, superintendent of Orange County Department of Education. Dr. Emmy Flores, superintendent of schools, West Covina Unified. She kind of looks like J Lo, doesn’t she? Senator Josh Newman, former California senator and a candidate for the Superintendent of Public Inspection. Fullerton Host Lions past presidents Dr. Polley and Dr. Roundtree. President of the Fullerton Rotary Club Kathy Gat. Fullerton School District deputy superintendent for human resources Dr. Chad Hammet. Fullerton assistant superintendent of instruction Jeremy Davis.

The former FST president and elected trustee Hilda Sugarman. I need to thank the Fullerton Library because they really assisted us in this event and for the delicious food. It’s Fatalino and Finanada in Anaheim that did the baked goods.

The Parents Voice has a dynamic team, and we are blessed to have them because of their dedication and service to the Parents Voice for many years. I thank all the ladies and gentlemen that are here helping us. I wanted to remind all of you that the Parents Voice was founded in 2009. We are going on seventeen years. We began in Fullerton and now we are across the country. We try to help parents navigate their children through the schools.

Wake up. Wake up. We have to get to school. Mom, I am really sleepy. Mom, I can’t get up. Well, that is a problem. Why are the children not refreshed after a full night of sleep? Why are they showing up late to school and being absent?

We found that parents, educators, and their friends need to pay attention to a problem that is not just the result of a late-night obsession with social media, but a problem with getting to sleep. Once the children are asleep, why are they not sleeping deeply and waking up refreshed?

We are finding that there is a behavioral problem, and it might be related to sleep. Breathing disorders in the pediatric population might be related to sleep. My desire as founder of the Parents Voice is to share a perspective grounded in data, evidence, and science about this silent epidemic. Tonight, we are presenting solutions facing symptoms and management of root causes to that end, I invited the world-renowned Dr. Mark Cruz, airway specialist and pioneer in the realm of airway-based dentistry. He is going to speak about the truth of struggling children today.

Years ago, there was a story that at MIT, Einstein was supposed to give a lecture. When he was getting there, his driver, who had been with him for many years, said, “You know, Dr. Einstein, I would like to give the speech.” Einstein said, “What?” The driver said, “I have heard it so many times. Let me give the speech.” Einstein said, “Okay.”

The driver took off his cap and gave it to Einstein. Dr. Einstein sat in the back of the room. The driver stood up and gave the speech. It was perfect. Then they came to the question-and-answer period. Somebody raised their hand, and as he was answering, the driver said, “You know, that is a very simple question. It is so simple, my driver knows the answer. Would you come up and answer that question, please?”

Well, these questions tonight are not that simple, but we are going to have a question-and-answer period. With that, I would like to introduce Dr. Cruz. He is our Einstein tonight and an amazing gentleman. Thank you so much for being here.

Dr. Cruz: Thank you,

MJ, for that kind introduction. I appreciate you all being here late on a Thursday evening when you could be elsewhere. My hope is that with the information I will share tonight, we can go beyond a question-and-answer and maybe have a discussion, because the reason I am here is that I believe we need policy change. I really think for our kids, when you truly understand what is going on, it is not a small problem. It is not nuanced, and it is global.

So, with that, I will launch into my presentation and hope that you find the information interesting and enlightening. Please, as I am speaking, if there is something I say that you don’t understand, or you have a question so that you can understand the next thing I am going to talk about, don’t hesitate—just raise your hand. There are no dumb questions. I think this will hopefully be more interactive than me just talking.

Yes, it is an unrecognized crisis. Before I really launch into my presentation and the data, I would like to start with a prologue and some concepts that will set the basis for the information as I develop it throughout the evening.

We have to understand that the infant child is an obligate nasal breather when they are born, certainly for the first three months of life. It is developed through a natural feeding and breathing function. The most important physiologic function of that baby, moment to moment, is taking the next breath – not worried about what is happening a minute from now, but taking that next breath.

All mammalian species only breathe through their nose. There is not a mammalian species anywhere on the planet that breathes through its mouth – only Homo sapiens, and only during the first three months of life. The reason we have oral tidal breathing is because we have language and need that to speak. Otherwise, gas exchange only happens through the nose unless you are forced otherwise in a life-and-death situation.

Don’t confuse a dog panting as gas exchange – that’s heat exchange. This function overrides every autonomic and non-autonomic function from one moment to the next, and this reality does not change for the lifetime of the individual. We come in with an inhalation and go out with an exhalation. Breathing through the nose for us is really important.

Some years ago, one of my teaching partners, an orthodontist on the East Coast of New Jersey, and I wrote an article to the orthodontic community introducing the concept of medically indicated orthodontics. We felt it was important to look beyond malocclusion – beyond the crooked teeth.

Think about it: crooked teeth are not really a problem for us to fix, it is actually nature’s solution to a problem – that there wasn’t enough room to begin with. We never had this problem before 500 years ago, 1,000 years ago, 1,500 years ago. Looking at archeological digs, we never needed orthodontists. We had straight teeth with wisdom teeth.

One of the things we started understanding is, as Joseph Gafari wrote, we have to really start paying attention to the patient attached to the teeth rather than just focusing on the teeth attached to the patient. With that, Sashi and Jane from the medical school at Stanford also said it is time for medicine and dentistry to start working together and integrating. We have to stop living in our silos. That is the problem – we live in these small specific areas where no one talks to each other. There is no integration.

When you understand the role of craniofacial growth and development, you realize that the growth of our facial skeleton relates directly to health because of breathing. It is directed as a result of breathing. How our faces grow is directly related to how we breathe.

John Godfrey Saxe, an American poet from the 1800s, introduced the story to the West about the blind men and the elephant. I see this as a metaphor for a highly siloed, disease-management healthcare system. Everyone is convinced they have the answer by looking at just part of the animal, while the real problem – the elephant – is hidden in plain sight. We tend to incentivize learning more and more about less and less, so we lose the global view.

I would like to start with a personal story about how I began connecting some dots. Some years ago, when my son was young – three or four years of age – my wife and I really struggled with his nightly bedwetting. He was wetting the bed almost every night. He would also complain of what he called “baby barf,” which I came to understand was reflux. He also didn’t like to exercise much. He just liked playing on the LeapFrog, which at the time was one of the first electronic devices for kids. Otherwise, he was a normal child.

Now, the story: one weekend we were at a family gathering out of town. After the main event, we returned to our room and went to sleep. My wife woke me up about two in the morning saying our son wasn’t breathing. Thank God for moms, because I would have slept right through it. I knelt down, put my ear close, and felt his thready pulse and raspy breathing. We immediately went to the emergency room around 2:00 a.m. They put him on a pulse oximeter to check his oxygen saturation, and he was desaturating below 80%.

Normally, a child’s oxygen saturation at night should not drop below 92%. Most people here would have a normal oxygen level around 96% or 97% unless sick. About four hours later, he was discharged with a diagnosis of asthma, which in my heart I knew was not correct.

In the following weeks, my wife was getting calls two or three times a week to bring him his rescue inhaler because the principal didn’t want him carrying it around school. Understandable, but it was exhausting.

The red arrow on this scan shows a swollen adenoid constricting the airway. This happens with inflammation from adenoids or tonsils. Notice the thin upper lip compared to the fuller lower lip- that’s a sign of maxillary retrusion, meaning not enough forward growth of the face. The face should grow downward and forward, giving proper lip support. The lower lip was dry, which is another sign of mouth breathing.

The edges of his front teeth were hidden by the lower lip, another indication of vertical growth. It’s not just the teeth growing downward; the entire midface is growing vertically. This is how he would typically sleep – on his stomach, mouth open, neck hyperextended, moving around restlessly.

There are significant ramifications with airway dysfunction. Dr. David Gozal has shown in studies that children with sleep-disordered breathing can lose 10 to 15 IQ points. They may suffer from cognitive dysfunction, anxiety, social problems, reduced attention, and ADHD-like behavior. He already had nocturnal enuresis (bedwetting), reflux, and clenching. But what shocked me most was realizing how this affects brain development, carrying lifelong consequences.

Someone asked if he had CPAP yet. Yes, he did, but that’s part of the problem. Sleep apnea is only the tip of the iceberg. Diagnosing someone with sleep apnea is like saying you have late-stage cancer – it’s already advanced. It starts as snoring and gradually worsens into sleep apnea. When you stop breathing for more than 10 seconds, it means there has already been brain damage.

For children, the criteria are different. An apnea-hypopnea index (AHI) of less than one is already concerning. For adults, it must be over five. I screened my son, as I do with all my patients, and his data showed severe issues during sleep. After less than three months of treatment, his readings dropped significantly, showing real improvement.

It’s known that chronic repetitive short exposure to hypoxia weakens bones in adults. Recently, studies in children showed that intermittent hypoxia causes changes in facial bone growth – reduced bone hardness and elasticity due to low oxygen. This was unexpected. Intermittent hypoxia also damages the sympathetic cardiovascular ganglia and the dorsal motor nucleus of the brainstem – structures that influence long-term risk for diabetes and obesity.

Short bursts of oxygen deprivation can even damage the pancreatic islets that regulate metabolism. So, while we often blame diet alone, these metabolic problems often start very early in life.

Dr. Ron Harper at UCLA’s Brain Research Institute has shown that fluctuating oxygen levels in infants – especially in neonatal intensive care—can cause long-term consequences. These issues are often ignored once a baby leaves the NICU. His team believes this may be a public health catastrophe, and they are gathering data through multi-center studies.

Another study showed that even minor sleep fragmentation in children causes inflammation in the brain. Once the brain is inflamed, every organ system is affected. This chronic inflammation doesn’t show up on a blood test but manifests through elevated cytokines like IL-6 and TNF-alpha.

In a sleep restriction study, researchers looked at children ages four to eight. Both groups had good sleep health at baseline. The experimental group stayed up one hour later for one week. Those children performed significantly worse on cognitive tests, and their brain scans resembled ADHD patterns – scattered activity in the prefrontal cortex.

Dr. Gozal also found that the two lowest-performing students in a school district invariably had fragmented or poor sleep. Even a single lost hour of deep sleep can reduce attention, memory, and emotional regulation.

When journalists monetized the IQ drop associated with poor sleep, they found that each lost IQ point corresponded to around $10,000 to $15,000 in annual lifetime earnings. Imagine losing five points of IQ at age six due to chronic sleep issues—that’s life-changing.

Studies also show that snoring itself reduces brain matter—less gray matter in areas like the hippocampus and insula, critical for memory and learning.

Now, let’s look at how this all connects to facial growth and airway development in children. We have to understand that the maxilla, or upper jaw, is the keystone of the face. It dictates how the rest of the facial bones grow and determines the airway size and function. When the face doesn’t grow properly forward and outward, the airway gets smaller, and the child starts to compensate by breathing through the mouth.

When a child breathes through their mouth instead of the nose, the tongue sits low in the mouth rather than resting against the roof of the mouth. This means the palate never develops properly. It stays narrow and high, which further constricts the nasal passages and reduces airflow. The more the child mouth breathes, the worse the structure becomes. It’s a vicious cycle.

The lack of nasal breathing affects the facial muscles as well. The lips become dry and weak, and the cheeks flatten. The face elongates, creating what we call “long face syndrome.” These children often have dark circles under their eyes, open-mouth posture, forward head position, and chronic fatigue.

You can look at a classroom photo, and often you can tell which child has airway problems. They tend to have a slightly open mouth, tired-looking eyes, and a dull expression because they’re not sleeping properly at night.

In my son’s case, we started treatment with an airway-focused approach. We used a combination of myofunctional therapy, orthodontic expansion, and nasal breathing retraining. We didn’t just straighten teeth; we worked to develop his facial structure forward to create more space for the tongue and airway.

Within a few months, the results were dramatic. His bedwetting stopped. His reflux went away. He started participating more in physical activities, and his teachers reported better attention and behavior in class. That’s when it really hit me—this wasn’t just about teeth. It was about the child’s total health.

If you think about it, how can we expect a child to concentrate in school when their brain isn’t getting enough oxygen at night? Imagine waking up ten times an hour without realizing it. That’s what happens with sleep-disordered breathing. The body keeps waking up just enough to restart breathing, but not enough for the child to remember it. They wake up exhausted, and the teacher calls it an attention problem.

Now, let’s talk about how this connects to academic performance. Dr. Karen Bonuck at Albert Einstein College of Medicine followed children from infancy to age seven. She found that kids with early breathing and sleep problems were 40% to 60% more likely to have behavioral and learning difficulties later in life. These problems didn’t just go away—they persisted and compounded.

Sleep is when the brain consolidates memory, regulates hormones, and grows. If we deprive children of quality sleep, we interfere with every aspect of development. Growth hormone is released during deep sleep, so if a child doesn’t sleep deeply, they literally can’t grow properly.

We also know that chronic mouth breathing can change the way the skull develops. A normal, nasal-breathing child develops a wide face and forward jaw growth. A mouth breather develops a narrow face, retruded jaw, and smaller airway. This isn’t genetics—it’s function driving form.

That’s why we are seeing an epidemic of kids needing braces, extractions, and even sleep studies. This is a modern problem created by lifestyle changes—soft diets, bottle feeding, pacifiers, allergies, and poor oral posture.

Here’s something else to understand: the position of the tongue determines the position of the jaw, and the position of the jaw determines the size of the airway. The airway is the most important real estate in your body. If the tongue is low, the jaw is back, the airway is small, and the body is in constant fight-or-flight mode trying to breathe.

Children like this often clench or grind their teeth at night because their bodies are trying to open the airway. Grinding is not just a bad habit—it’s a survival reflex. The brain senses oxygen deprivation and tells the jaw muscles to move to reopen the airway.

So, when I see a child grinding their teeth, I don’t just make them a night guard. I ask why they are grinding. What’s driving it? Because if I don’t address the cause, I’m just putting a Band-Aid on a much deeper problem.

When you fix the airway, you often fix everything else—the sleep, the behavior, the attention, even the emotional regulation. These kids go from struggling in school to thriving, just by being able to breathe properly at night.

This is why I keep saying: this is not a small problem. It’s not just about crooked teeth or snoring. This is a public health issue. We are raising a generation of children with compromised airways, poor sleep, and impaired development, and we’re calling it normal.

We have the data. We know the mechanisms. What we need now is awareness, early screening, and collaboration between medicine, dentistry, and education. Every pediatrician, teacher, and parent needs to know the signs of airway dysfunction—mouth breathing, dark circles, restless sleep, speech issues, or chronic fatigue. These are not behavioral problems. They are red flags.

Now, let’s talk about solutions and the larger implications of this problem. Once we begin recognizing that airway and sleep issues are not isolated dental problems but whole-body problems, we can start addressing them in a multidisciplinary way.

We have to start by screening children early. That means identifying airway issues in toddlers, not waiting until middle school when they already need braces or CPAP. Pediatricians, dentists, orthodontists, and even teachers need to be aware of the warning signs.

Here’s something I tell parents all the time: if your child snores, that is not normal. Snoring in a child is never normal. It’s a sign that the airway is compromised. If your child is grinding, mouth breathing, wetting the bed, struggling in school, or waking up tired, these are all signs of airway dysfunction.

When we begin to treat airway problems early, we can change a child’s entire trajectory. We can literally change the shape of their face and the health of their brain. We can prevent chronic disease before it starts.

A big part of the solution involves what we call airway orthodontics. Instead of waiting until all the permanent teeth are in and then extracting teeth to make space, we start early expansion and development of the jaws. By creating space for the tongue and promoting nasal breathing, we can guide the face to grow forward, not downward.

This can be done with removable or fixed appliances, myofunctional therapy, and breathing retraining. It’s not about making teeth straight—it’s about making airways healthy. When the airway is healthy, the teeth naturally align because the tongue, lips, and cheeks are balanced.

Now, I know what you might be thinking—this sounds like a lot. But what’s amazing is that the body responds beautifully when you restore normal function. Kids adapt quickly. Within weeks, parents start saying things like, “My child wakes up happy now,” or “They’re not snoring anymore,” or “Their teacher says they’re paying attention again.”

We see measurable changes in brainwave activity and oxygen saturation. The data is clear: restoring nasal breathing and proper tongue posture changes everything.

We also have to look at public health policy. This problem can’t be fixed one child at a time in dental offices. We need school-based screening programs and cross-collaboration with pediatricians, ENTs, and sleep physicians.

In some places, dentists are working directly with schools to screen for mouth breathing and facial growth patterns, just like we screen for vision and hearing. Imagine if we could catch these problems in kindergarten instead of high school.

The economic impact alone would be huge. Children with untreated sleep-disordered breathing cost the healthcare system billions through behavioral interventions, medication for ADHD, poor academic performance, and chronic illness later in life. Prevention is not only better medicine—it’s better economics.

We also need to look at the medical education system. Medical and dental students receive almost no training in airway development, facial growth, or sleep physiology. This must change. We have the science, but if professionals don’t learn it, the cycle continues.

In my own practice, I collaborate with ENTs, pediatricians, and speech therapists. It’s about working together for the child, not protecting our professional turf. When we align our focus on health instead of symptoms, everything gets better.

Parents, you play a huge role. If you suspect something is wrong with your child’s sleep or breathing, don’t let anyone tell you “they’ll grow out of it.” They won’t. Early intervention works.

We need to move away from the idea that crooked teeth or snoring are cosmetic issues. They are medical issues. They are signs of a developmental problem that, if left untreated, will become a lifelong condition.

When I lecture around the world, I often say this: if we don’t fix the airway, nothing else matters. You can’t have wellness without breathing well. You can’t learn, grow, or heal without oxygen.

It’s time for a paradigm shift. We need to connect the dots between dentistry, medicine, and education. It’s not enough to treat symptoms—we must treat causes.

I often tell my patients that the greatest gift you can give your child is the ability to breathe through their nose, sleep soundly, and wake up refreshed. It’s that simple, and it’s that profound.

So, as we move forward, my challenge to all of you—parents, educators, and healthcare providers—is to look deeper. When you see a tired child, don’t just assume they’re lazy or inattentive. Ask, “Are they sleeping well? Are they breathing well?”

When you see a child struggling in school, think beyond learning disabilities. Think oxygen. Think airway.

This is how we begin to change the future of children’s health—not with more medication or labels, but with understanding, prevention, and collaboration.

At this point in the lecture, Dr. Cruz paused and invited the audience to begin asking questions. What followed was a thoughtful and detailed Q&A session focused on real-world concerns from parents, educators, and medical professionals.

The first question came from a parent who asked how to tell if their child might have airway issues.

Dr. Cruz explained that parents are the first line of defense. “Look for mouth breathing, snoring, grinding teeth at night, bedwetting beyond age five, dark circles under the eyes, frequent waking, or excessive tiredness in the morning,” he said. “If your child sleeps with their mouth open or tosses and turns a lot, those are red flags. Sleep should be peaceful and quiet.”

Another attendee asked whether removing tonsils and adenoids always solves the problem. Dr. Cruz clarified that while tonsil and adenoid removal can help, it doesn’t always address the underlying issue. “If the jaw and facial structure are underdeveloped, the airway may still be too small,” he said. “The goal is to promote proper facial growth so the airway stays open naturally.”

He emphasized that surgery should be part of a comprehensive plan, not a standalone fix. “It’s like widening a tunnel—you can’t just remove a few obstacles and expect perfect airflow if the tunnel itself is too narrow,” he said.

A teacher in the audience then asked how sleep and breathing issues affect learning and behavior in the classroom.

Dr. Cruz responded, “Children with airway dysfunction often look inattentive or hyperactive because their brains are in constant survival mode. They’re not getting enough oxygen during sleep, so their nervous systems stay on alert. These kids can’t focus because they’re exhausted. It’s not bad behavior—it’s biology.”

He added that many of these children are misdiagnosed with ADHD and placed on medication when what they really need is better sleep. “You can’t medicate away oxygen deprivation,” he said. “Fix the breathing first. Often, the behavior problems disappear.”

A pediatrician asked how dentists and physicians can collaborate more effectively.

Dr. Cruz said, “The key is communication. Dentists see structural issues—narrow arches, high palates, mouth breathing—but often don’t share that information with physicians. Likewise, pediatricians see behavioral or developmental problems but don’t think about airway anatomy. We have to talk to each other.”

He recommended creating interdisciplinary teams where dentists, ENTs, pediatricians, and orthodontists review cases together. “We should be co-managing patients, not working in isolation,” he said.

Another parent asked if pacifier use or bottle feeding could cause airway problems. Dr. Cruz nodded. “Yes, those can contribute. When a baby uses a pacifier or bottle for too long, it changes tongue posture and weakens oral muscles. The tongue doesn’t press against the palate as it should, which can affect jaw development. Breastfeeding, when possible, supports nasal breathing and proper facial growth.”

He also mentioned that diet plays a role. “Soft modern diets require very little chewing. Our ancestors had wide jaws and straight teeth because they chewed tough food,” he said. “We’re seeing smaller jaws and more crooked teeth today because our kids don’t use their jaws the way nature intended.”

A high school counselor asked about adolescents who seem chronically fatigued despite sleeping eight or nine hours.

Dr. Cruz explained that quantity of sleep isn’t the same as quality. “They might be asleep for nine hours, but if their oxygen drops all night, that’s not restorative sleep. They’ll still wake up tired,” he said. “That’s why it’s critical to look at the airway, not just the number of hours in bed.”

Another question came from a dentist in the audience who asked how to incorporate airway evaluation into a routine dental exam.

Dr. Cruz answered, “Start by observing facial structure—long faces, dark circles, dry lips, scalloped tongues, and narrow arches. Ask parents if their child snores or grinds. You don’t have to diagnose sleep apnea to identify risk. Just start the conversation and refer appropriately.”

He added that tools like cone beam CT scans and sleep questionnaires can help with screening, but most of the information comes from simply listening to the parent and looking carefully at the child.

A parent asked about treatment options for adults who never received help as children.

Dr. Cruz acknowledged that adult treatment is more complex because bones have stopped growing. “But we can still make a big difference,” he said. “We can use expansion appliances, myofunctional therapy, and sometimes surgery. The goal is to optimize airway space and retrain breathing patterns. It’s never too late to improve.”

He shared several success stories of adult patients who went from chronic fatigue and snoring to sleeping peacefully and feeling decades younger. “When you breathe better, everything improves—your energy, your mood, even your posture,” he said.

As the Q&A continued, Dr. Cruz returned to the theme of prevention and awareness. “We can change the future if we start now,” he said. “The research is clear. The earlier we intervene, the better the outcomes. Every parent, teacher, and doctor should know the basics of airway health.”

He closed with a powerful statement: “We cannot separate the mouth from the body. Dentistry is medicine. The airway connects them both. If we work together—parents, doctors, educators—we can raise a generation of healthier, happier kids.”

After Dr. Cruz’s final remarks, the audience applauded warmly. Parents lined up to speak with him personally, sharing stories and gratitude. Several local educators and healthcare professionals discussed ways to collaborate on community-based screening programs.

The event ended with a sense of inspiration and determination to bring greater awareness to airway health and childhood sleep issues.

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What is a healthy and functioning airway?

Optimal breathing patterns occur through the nose. That way, the air is "conditioned" before entering the lungs. Then, it is powered by the diaphragm. So, the entire lung is filled with minimal effort and at precisely the correct rate and volume for the body's needs.

Healthy nasal breathing is not labored and is relatively "silent." If breathing stops abruptly, our brains go into survival mode. They activate our sympathetic nervous system. Our bodies are susceptible to blood oxygenation and react urgently to protect us if breathing falters. If our airway narrows, "fight or flight" behaviors kick in. For instance, among individuals with obstructive sleep apnea, the body abruptly arouses itself to restart breathing.

What conditions interfere with a healthy, functioning airway?

Commonly, there may be chronic threats to airway health and function. They may not rise to the level where immediate survival instincts kick in; however, they do challenge healthy blood oxygenation on a chronic basis. These threats are characterized mainly by a narrowing of the airway, which affects airflow and leads to effortful breathing.

These threats start a cycle of patterns or behaviors that inhibit oxygenation over the long haul. Such "suboptimal" behaviors are called "compensations." They successfully overcome chronic barriers. But, since they are used habitually, undesirable compensations have many side effects and unintended consequences. The resulting habits themselves become chronic conditions. The root causes of airflow obstruction and narrowed airways are generally divided into three categories:

Structural
Functional
Behavioral

What are structural threats to airway health?

"Structure" refers to anatomical characteristics, specifically the airway's size, shape, and contours. It can take a great deal of effort to push air through a narrowed spot when structural malformations are present. These structural distortions include:

Narrow or collapsed nostrils
Deviated nasal septum
Narrow nasal aperture
Constricted pharynx

What functional deficiencies lead to poor airway health?

"Function" refers to the airway's physiology. Any time the soft tissues become enlarged or swollen due to inflammation or fatty tissue, the airway narrows. Conditions such as allergies, food sensitivities, and regular colds and infections are associated with swelling and obstruction of airflow. Furthermore, acid reflux disease irritates the throat, nose, and sinuses, which results in problematic swelling. Anything that leads to obstruction is a risk factor for impaired airflow and poor airway health.

What are the behavioral causes of airway dysfunction?

Notably, "behavior" represents the most overlooked and misunderstood factors responsible for airway obstruction. As airway-focused practitioners, we understand that the behaviors and resulting compensations reside at the root of chronic breathing irregularities. They must be factored in when establishing an effective treatment plan. If the compensations that result from poor behaviors are allowed to flourish, the undesirable consequences can also thrive.

We've isolated a few of the common behavioral threats and compensatory behaviors:

Breathing through the mouth instead of the nose
Rapid breathing
Heavy respiration
Poor tongue posture
Poor sleep posture (stomach-sleeping)
Snoring
Noisy breathing

What are the consequences of poor airway health and dysfunction?

Myriad problems can arise that affect overall health, wellbeing, and quality of life. When our airway's structure, function, and behavior and, accordingly, airflow is jeopardized, sufferers may experience frequent awakenings, nightmares, and poor sleep quality. Additionally, dysfunctional airways can distort the facial shape. The "adenoid face" is characterized by flat features, a narrow palate, elevated nostrils, a small lower jaw, and a short upper lip. These developmental and structural issues make airway function even worse. Poor structural form is also associated with malocclusion or misalignment of the teeth and bite problems; for instance, "open bite" when the opposing teeth don't touch each other when a patient closes their mouth.

Additionally, airway deficiencies can lead to chronic, irregular "hypoxia," when the body is starved of oxygen. The lack of oxygen stresses organs and systems throughout the body, and it can damage a growing brain and interfere with proper development and cognition. Airway distress leads to a vicious cycle of compensation and comorbidities and chronic pain and dysfunction among adults.

How can airway-focused dentists break this destructive cycle?

There are undoubtedly genetic influences; however, modern airway-focused practitioners appreciate how genes are "expressed" depending on the broader environment. We account for the various effects – genes, environment, and otherwise – that are at work and interfere with healthy, functional airway flow. We can intervene at just the right time to optimize facial growth and minimize the risk of chronic compensations that result in unhealthy consequences and make deficiencies worse.

We recommend and facilitate behaviors that stimulate growth and can, in turn, change the way that the face develops over time. Notably, understand that crowded or crooked teeth are complications of the unhealthy cycle associated with untreated airway problems and the behaviors that arise to compensate for these chronic problems. How the teeth are ultimately positioned depends on the form that the jaws take, and the jaws take shape due to poor function and labored breathing patterns often developed early in life. We must interrupt this cycle of form, function, and behavior. To do so, the form must be addressed by reshaping a patient's airway. The function must also be addressed by improving airway physiology and behaviors.

To encourage the development of optimal airway physiology and breathing patterns, we partner with patients to:

Reduce constriction of the airway anatomy
Prevent or lessen the risk of developing harmful physiologic/functional changes
Demonstrate and educate on proper behaviors
Support optimal behaviors and wellness to address malocclusion and for sustained good health

So, efforts that support healthy structure are about much more than straightening the teeth and achieving a beautiful smile and attractive facial contours; getting to the root of the problem (deficient structures) promotes excellent health for life. Teeth that have been straightened with orthodontic appliances, for example, tend to relapse if structural deficiencies are not interrupted and adequately resolved. Straightened teeth that function within dysfunctional environments, where structural issues linger, often cannot be maintained. There is a strong foundation for orthodontic treatments focused on repositioning the teeth by creating optimal airway health and function. Optimal airflow also supports facial balance and not just "balanced" or evenly-spaced teeth.

As clinicians focused on airway health, we see the face and associated structures not as "static" but rather as "dynamic." Among developing patients, these structures are evolving. We appreciate that interventions can be undertaken now to prevent future problems and the need for restorative or therapeutic intervention. We know that consequences from airflow problems are not a foregone conclusion.

Great! How do we start the process?

We encourage you to contact Mark A. Cruz, DDS, today to schedule your consultation. Call (949) 661-1006. Dr. Cruz starts with getting to the bottom of the cause of your or your loved one's troublesome symptoms. With accurate knowledge of the nature and extent of these symptoms, we can recommend techniques, appliances, and therapies to resolve the root cause for symptom relief, lasting health, and optimal function.

Airway-focused dental practice answers common questions about diagnosing and treating airflow problems

At Mark A. Cruz, DDS, we distinguish ourselves from other dental practices in and around Dana Point, California, with airway-focused dentistry. Our dentist, Dr. Cruz, is a pioneer in this approach, which supports patient health, quality of life, and beautiful smiles. He founded the Airway Collaborative, the oldest and highest-regarded airway curriculum in the United States. A nod to our team’s considerable expertise, Dr. Cruz is a respected authority in the field who teaches other dental professionals about airflow conditions and how to treat them effectively.

Fittingly, our team values education and empowering patients with credible information that they can trust. We welcome your specific questions but, in the meantime, we’ve answered some of the most frequently asked questions about airway health and the advanced, multi-faceted diagnostics and treatments available at our practice.

How do airway problems arise?

Optimal, healthy breathing is done through the nose. This “nasal breathing” is easy and generally “silent” (no snoring or noisy breathing). Air flows unimpeded through the airway. However, there may be chronic threats to healthy nasal breathing, which leads to a persistent lack of healthy blood oxygenation throughout the body. They also result in the sufferer compensating with “suboptimal” behaviors or breathing patterns. These compensations can become chronic conditions themselves or make airflow function worse.

Airway-focused practitioners generally divide these threats to good airway health into three categories:

Structural distortions; for example, a deviated nasal septum
Functional or physiological deficiencies, such as swelling of the soft tissues in the throat in response to allergies or food sensitivities
Behavioral factors; for instance, mouth-breathing and poor sleep and tongue posture

Why is it essential to treat airway dysfunction?

Numerous conditions arise due to poor airway health and the resulting lack of proper oxygenation. These consequences can affect every aspect of our lives and a child’s proper development. Facial appearance can be affected by structural issues associated with poor airway health. These structural deficiencies are also related to misaligned teeth and bite problems. Of course, ongoing bouts of hypoxia (oxygen-starvation) stress the organs and your entire “system” (body).

How do you diagnose structural airway problems?

Advanced diagnostics such as cone beam computed tomography (CBCT) scanners have been tremendously helpful. We can see nasal structures from front to back and obstructions that may be present. Anatomical features, such as the shape and size of the airway, are now visible. Information about the entire maxilla (upper jaw) is now available to us and can inform treatment options.

Formerly, practitioners may have focused just on the narrow palate. But this is only one factor to consider when evaluating airway collapse. We may find deformities that affect the entire jaw and not just the palate. Similarly, we are keenly aware of accounting for overall facial shape. We can now compare the patient’s face to samples of their peers, to earlier skeletal models (before there was considerable misalignment in the population), and those children who naturally develop straight teeth. We can take a bigger-picture view of deficiencies affecting the lower portion of the face.

How do you confirm that functional problems are at fault?

We account for the fact that airway collapse most often occurs at night. That necessitates diagnostics such as pulse oximetry (to measure sleeping irregularities), snore recordings (to track noisy breathing), and “sleep inventory” (a way of monitoring the effects of airway dysfunction on the patient’s “experience” both during the day and at night).

Furthermore, we don’t just assume that the child has issues with nasal breathing. We can use pressure sensors to measure the function of the tongue and how the lips, chin, and cheeks are used for swallowing. From there, we assess the relationship and balance among these forces. We don’t just consider the upper and lower jawbones, but all 22 skull bones. The idea is to evaluate how these bones work together to support optimal development.

What steps do you take to confirm behavioral causes?

If we suspect that behavioral issues are playing a role, we are adept at both spotting and measuring these causes and the outcomes from treatment. We do not think of outcomes and results in just the teeth. By looking at the big picture, we assess factors that contribute to the patient’s quality of life; for instance, we evaluate and measure how well patients are breathing, feeling, sleeping, and performing socially and at school.

True wellness is about more than resolving symptoms. We use specialized tools to track breathing at night and during the day. We also factor in the behavioral compensations that have been adopted. It is essential to understand why behaviors such as open-mouth breathing were introduced and, as needed, to know why such compensations may persist. Also, soft tissue and tongue function are factored in; tongue movement, for example, is analyzed. So, we can then train and guide the tongue’s development. In this manner, the tongue is encouraged to better guard and support the airway and proper respiration, as intended.

What treatment is best?

There is no special treatment appropriate for such complex, multi-faceted conditions. Likewise, it is not sufficient to fall back strictly on orthodontics and extractions and limit one’s diagnostics and therapies to the teeth and malocclusion. We correct the behaviors that cause airway problems. So, we can adequately treat them. We offer an expanded view to support optimal airway physiology/function and breathing behaviors/patterns. Our wide-ranging services and expertise consider the role that structure, function, and behavior play in airway health and airflow. We must address airflow limitations. Due to our considerable knowledge in specialized areas, airway-focused dentists can better treat patients with complex airflow problems than most other clinicians.

Depending on your needs, therapies may include myofunctional training protocols to correct tongue posture. Or a mix of upper jaw expansion techniques and aligners may be appropriate to address a narrow maxilla, snoring, and airway construction. Such diverse methodologies promptly break the destructive cycle, stop the suffering patients face, and restore renewed vigor, health, and quality of life.

That sounds great! How do we get started?

It’s simple! Contact Mark A. Cruz, DDS, to schedule your consultation. Call (949) 661-1006. Dr. Cruz applies a range of diagnostic and treatment technologies to achieve sustained symptom relief, health, optimal function, and wellbeing.

Dental Alveolar Problems

Certain conditions can cause the loss of bone in the jaw and along the ridge of the gums. This is normally referred to as alveolar bone loss. Alveolar bone loss can significantly impact the way your teeth look and function. In some cases, it can lead to tooth loss. Dr. Mark A. Cruz of Dana Point, California, can help you understand this condition and what can be done.

What Is Dental Alveolar Bone Loss?

Our dentists describe dental alveolar bone loss as the loss of bone around the teeth. This results in loose and lost teeth, as the bone can no longer support the teeth in the mouth.

What Causes Alveolar Bone Loss?

There are a variety of different conditions that might cause alveolar bone loss. These include:

Periodontitis: This is a severe gum infection that destroys the tissues and bones that support your teeth.
Orthodontic treatment: This can sometimes put pressure on the bones in your jaw, leading to bone loss.
Trauma: An injury to the mouth or face can damage the bones in the jaw, which can lead to bone loss.

If you are experiencing any symptoms of alveolar bone loss, it's essential to see our dentists as soon as you can. They will be able to diagnose the cause of the problem and recommend the best course of treatment. In most cases, bone grafting is often performed to rebuild the bone in the area and maintain the natural teeth. Bone grafting uses donor bone or materials to add to the jaw.

How Do I Learn More About the Treatment for Dental Alveolar Problems?

If you reside in the Dana Point, California area and deal with bone loss in the jaw, it is time to connect with Dr. Mark Cruz to learn about the various treatment options available to rebuild the bone and maintain the natural smile whenever possible. Call (949) 661-1006 to request an appointment at our facility, conveniently located at 32241 Crown Valley Parkway, Suite #200. We are open to both new and established patients.

Orofacial Myofunctional Disorder

Dana Point, California area patients who need oral health care, can work with our team, including Dr. Mark Cruz. They work with patients to help them with general, cosmetic, and restorative dentistry needs. This includes the diagnosis and treatment of Orofacial Myofunctional Disorder.

What Is Orofacial Myofunctional Disorder?

Our team describes Orofacial Myofunctional Disorder as patterns of poor development, growth, and function of the orofacial structures. This can occur to patients at any age, including children, teenagers, and adults. Also known as OMD, these conditions can be combined with swallowing and speech disorders. Some of the more common orofacial myofunctional disorders include:

What Can Cause Orofacial Myofunctional Disorders?

In most situations, the cause of these disorders can often be multifactorial. There is typically more than one concern happening that can contribute to the poor development of the oral structures. Patients of all ages must be thoroughly evaluated by their dental team to look for signs of problems that may contribute to abnormalities and improper formation of the mouth and its structures.

How are Orofacial Myofunctional Disorders Treated?

The condition and the cause will help our dental team determine the best course of action for treatment. For example, patients who have a temporomandibular joint disorder, or TMD, may need to wear a special mouthguard to realign the jaw and reduce clenching and grinding of the teeth. Other patients with malocclusion may benefit from orthodontic treatments. Our dentists can recommend the best course of action to treat the issue and ensure proper oral health with a complete evaluation. We also work with dental insurance plans to help reduce the cost of treatments whenever possible.

How Do I Learn More About the Treatment for Orofacial Myofunctional Disorder?

If you reside in the Dana Point area and are concerned about orofacial myofunctional disorder, it is a great idea to connect with a dental team that has experience in providing the diagnosis and treatment of this condition. Call the office at (949) 661-1006 to request an appointment at 32241 Crown Valley Parkway, Suite #200.

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