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.