Five hundred years ago, caries, malocclusion, and sleep apnea were rare. The prehistoric skull had enough room for wisdom teeth, as well as space behind them. Various stressors led to difficulties in the way humans breathe
, how the face grows, ability to fight infection, the way humans sleep, and neurocognitive problems. Dr. Barry Raphael, an orthodontist in New Jersey, addressed compromises to the human airway during a session of the Airway Focused Dentistry Mini-Residency. It was co-developed by Dr. Raphael and Dr. Mark A. Cruz, a Dana Point dentist, to educate doctors from various disciplines about the critical role the airway plays in dentistry.
Understanding compromises to the human airway
Airway problems change the shape and length of the maxilla
, affecting the way teeth come in and where they fit, as well as the way the soft palate is positioned and its ability to descend in the mouth. Dr. Raphael encouraged dentists and orthodontists to tip patients' heads back and look at the shape of the arches in their mouths. Roman arches are big and broad, whereas Gothic arches are narrow. He then asked the audience, "How do you build an arch?" He responded, "You need a scaffold, a temporary structure used to give shape to the way the blocks are going in."
Learning about the maxilla
The maxilla has a scaffold – the tongue, which must rest on the roof of the mouth. Then, teeth erupt around the tongue forming a jaw of normal shape and size. When the lips are open, the tongue is held away from the mouth and the maxilla no longer has a proper shape. When teeth come in, they have no choice but to fit in a container that does not have enough room.
The maxilla is meant to grow downward, forward, and outward. However, 20-30 years ago, orthodontists focused on treating "buck teeth" and pulling incisors back to match lower teeth. Over time, they understood the lower jaw was at fault, and the mandible needed to be brought forward. In about 80 percent of malocclusion cases, the maxilla was not in the proper position.
"There is nothing in conventional orthodontics that addresses this issue, and it's pretty important," Dr. Raphael said.
It is for this reason, as well as many others, Dr. Raphael and Dr. Cruz are committed to educating their peers about the important role of the airway in dentistry and orthodontics.