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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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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.
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
"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
"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.
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
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.
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.
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.

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
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).
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.
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.
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.
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.
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.

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.
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.
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.

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:
  • Tongue thrusting
  • Articulation issues
  • Chronic mouth breathing
  • Dental malocclusion
  • Temporomandibular joint disorders
  • Tight/restricted frenums
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.
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.
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.

Sleep Hygiene

  • Prepare the bedroom with low-level, warmer-toned lights in the yellow to orange spectrum and avoid blue spectrum lights and blue screens such as computer screens, smartphones, and television one hour prior to sleep.
  • Avoid eating and drinking much 2 hours and preferably 3 hours prior to sleep as this may distend the stomach and pose as a risk factor for “silent” reflux which may perturb sleep. A cup of Chamomile tea or the like is ok.
  • A cup of hot ginger herbal tea with a teaspoon of lemon juice prior to sleep may help with any known reflux and frequent (enigmatic) cough that may occur once you lay down. The ginger is a natural anti-inflammatory and the lemon juice counterintuitively helps neutralize stomach acids.
  • Leave the events of the day mentally behind you or any similar stimulating family interactions in preparation for sleep if possible to minimize adreno-cortical stimulation one hour (preferably longer) prior to sleep.
  • Preferably set your mind toward a contemplative versus a stimulating set by reading versus watching TV if possible, especially with kids.
  • Keep animals out of the bedroom or jump on the bed during the night if possible unless they remain peaceful and quiet throughout the night.
  • The bedroom should be set up as a sanctuary for sleep and amenities such as essential oils and spa-type music will foster an environment for the brain to transition toward its natural sleep cycle releasing the normal sleep neurotransmitters such as GABA.
  • If you are using an oral sleep appliance the use of warm, moist heat 30-60 minutes prior to insertion may be quite helpful. Warm a bowl with hot water (sauna temperature) and dip a couple of wash clothes and wring out excess water and apply to both sides of the face for 15-20 minutes. As the towels cool, re-warm in the hot water. Warm compresses do not have the same beneficial effect of relaxing the masticatory muscles.
  • The use of a natural sleep supplement such as melatonin may be helpful if needed especially for shift workers (2-4 mg) as needed. Natural sleep without this is best once the normal sleep cycle is established. Ironically, sleep medications such as Ambien and Lunesta depress slow wave delta (deep) sleep even though they facilitate initial quick drowsiness. These meds may be helpful on occasion.
  • Keeping a regular sleep cycle with regular sleep hours is best versus changing night to night even on weekends.
  • There are many websites that address sleep hygiene if you wish to learn more. The simplest solutions are often the best and good sleep is typically a conscious choice.
  • Limiting daytime naps to 30 minutes. Napping does not make up for inadequate nighttime sleep. However, a short nap of 20-30 minutes can help to improve mood, alertness, and performance.
  • Avoiding stimulants such as caffeine and nicotine close to bedtime. And when it comes to alcohol, moderation is key. While alcohol is well known to help you fall asleep faster, too close to bedtime can disrupt sleep in the second half of the night as the body metabolizes the alcohol.
  • Exercising to promote good quality sleep. As little as 10 minutes of aerobic exercise, such as walking or cycling, can drastically improve nighttime sleep quality. For the best night’s sleep, most people should avoid strenuous workouts close to bedtime. However, the effect of intense nighttime exercise on sleep differs from person to person, so find out what works best for you.
  • Steering clear of food that can be disruptive right before sleep. Heavy or rich foods, fatty or fried meals, spicy dishes, citrus fruits, and carbonated drinks can trigger indigestion for some people. When this occurs close to bedtime, it can lead to painful heartburn that disrupts sleep.
  • Making sure that the sleep environment is pleasant. The mattress and pillows should be comfortable. The bedroom should be cool – between 60 and 67 degrees – for optimal sleep. Bright light from lamps, cell phones, and TV screens can make it difficult to fall asleep, so turn those lights off or adjust them when possible. Consider using blackout curtains, eye shades, ear plugs, "white noise" machines, humidifiers, fans, and other devices that can make the bedroom more relaxing.
  • Hydration(2-3 ltrs) should be attained by early to mid-afternoon with minimal consumption after dinner.

Do you have other questions?

We are always happy to answer any additional questions you may have. Just call our Dana Point, CA office at (949) 661-1006.