When Dr. Mark A. Cruz talks about the importance of taking a multi-disciplinary approach to airway problems, he speaks from the heart. He can relate to parents who become concerned when their children have trouble sleeping. He knows firsthand how it feels when the doctor prescribes a diagnosis that does not seem quite right.
Dr. Cruz shared his personal experience with his peers during the first session of his Airway Focused Dentistry Mini-Residency this summer. About five years ago, Dr. Cruz's son, Brendan, was a latent bedwetter. His wife would change the bed five to six times a week. Brendan did not want to have sleepovers because he was embarrassed about wearing pull-ups. Brendan would talk about experiencing "baby barf." Then, the family left town for a family reunion. On the way home, Brendan had an upset stomach and vomited. They put Brendan to bed. At 3 a.m., Dr. Cruz's wife woke him up exclaiming, "Mark, Mark…Brendan's not breathing."
Dr. Cruz replied, "What do you mean he's not breathing? He's sleeping just fine."
"No, no; he's not breathing," his wife insisted.
Dr. Cruz then put his ear up to Brendan's mouth and could tell Brendan was struggling to breathe.
"Needless to say, we were in the ER within 15 minutes," Dr. Cruz recalled.
The ER physician recommended a chest X-ray; however it did not reveal anything. Brendan was diagnosed with asthma. However, Dr. Cruz knew it was an airway problem. Brendan would sleep on his stomach, with his head cranked back, and his mouth wide open. His sheets would be disheveled in the morning.
Dr. Cruz brought Brendan to see Dr. William Hang, an orthodontist in Agoura Hills who is committed to orthodontic approaches that do not retract the teeth regardless of the patient's age. They discussed orthotropics, a specific method of Facial Growth Guidance which changes unfavorable vertical growth to more favorable horizontal growth without surgery.
Then, Mrs. Cruz brought Brendan to another orthodontist for a second opinion. The orthodontist said, "I wouldn't touch him until his baby teeth fell out." Mrs. Cruz concurred. However, Dr. Cruz felt strongly that Brendan should be treated with orthotropics.
Fast forward three months. After orthotropic treatment, there was a remarkable improvement in Brendan's facial growth. However, the most rewarding moment came when Brendan came running in saying, "Daddy, daddy, thank you so much. I can breathe," while hugging his father tightly.
"And right at the moment, about 15 seconds later, I had this big bear hug from behind…It was my wife…She started bawling. And, she said, 'I was wrong,'" Dr. Cruz said.
It turned out orthotropics was the best treatment for Brendan. He no longer had problems with nocturnal enuresis (bedwetting) or acid reflux (what Brendan had described as "baby barf"). Brendan's experience inspired Dr. Cruz to focus on the airway in dentistry and encourage his peers to do the same.
"I found out the hard way," Dr. Cruz said.
It is Dr. Cruz's hope that the medical community, including orthodontists and dentists, will change their approach toward diagnoses and treatments. He hopes there will be more focus on the airway, which has been described as the "keystone" in craniofacial growth and development. Dr. Cruz believes airway problems lead to sleep disordered breathing.
Dr. Cruz has joined with Dr. Barry Raphael, an orthodontist with more than 30 years of experience, to educate physicians from multiple disciplines about the importance of the airway in dentistry. They are co-directors of the Airway Focused Dentistry Mini-Residency, a 2-day course for physicians that kicked off this summer and continues into 2016.