Patient Education

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.

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.