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32241 Crown Valley Parkway #200
Dana Point, CA 92629 | Directions

Orthodontist highlights compromises to the human airway (Part 3)

Many health conditions can compromise the human airway. Dr. Barry Raphael, an orthodontist with 33 years of experience, discussed hypocapnia and breathing disordered sleep 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.


Think of the body as a bottle of soda, filled with carbon dioxide in the blood. Carbon dioxide gives a person a certain amount of “fizz.” Imagine if the bottle of soda was left open overnight. It becomes flat. Likewise, when a person leaves his or her mouth open all night, the base level of carbon dioxide lowers. Hypocapnia involves having less than an optimal level of carbon dioxide in the body.

This condition causes spasms of smooth muscle tubes in an attempt to reduce the loss of carbon dioxide. A person experiences shortness of breath as is experienced with asthma. Hypocapnia also causes spasms in all other smooth muscle tubes in the body.

When carbon dioxide levels are low, oxygen is not distributed to the tissues properly. This can lead to rapid fatigue in the muscles, poor memory, headaches, and many other issues. It is just as dangerous to over-breathe as it is to overeat, Dr. Raphael said.

Breathing Disordered Sleep

Breathing disordered sleep includes snoring, Upper Airway Resistance Syndrome (UARS) and Obstructive Sleep Apnea Syndrome (OSAS). Daytime symptoms include hyperactivity, behavior and learning difficulties, and compromised somatic growth. Risk factors of breathing disordered sleep include swollen tonsils and adenoids, crossbite (narrow palate), and a convex facial profile.

Symptoms and signs of OSAS include:

    • Frequent snoring • Sleeping in a seated position with the neck hyperextended • Headaches upon awakening • Daytime sleepiness • Learning problems
A physical examination will reveal the person is underweight or overweight, tonsillar hypertrophy, a high-arched palate, failure to thrive, hypertension, a narrow face, or short jaws. Risk factors of sleep disordered breathing and OSAS include the size and condition of the airway and the flow of air through the airway. Sleep apnea occurs due to craniofacial morphology and obesity.


Bruxism is tooth grinding and clenching during sleep. It is associated with caffeine, heavy alcohol use, anxiety and psychological stress, sleep apnea, and reflux. Its secondary effects include tooth wear and fracture, hypersensitivity, and temporomandibular derangement and pain.

Understanding these conditions can better help dentists, as well as orthodontists, treat patients. Drs. Cruz and Raphael are committed to educating doctors of multiple disciplines in hopes of improving medicine.

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