Dana Point dentist kicks off Airway Focused Dentistry Mini-Residency
Dr. Mark A. Cruz is committed to taking a multi-disciplinary approach
toward airway problems such as sleep disordered breathing. Dr. Cruz and
his colleagues strive to improve the way dental health conditions
related to the teeth, muscles, and the TMJ (temporomandibular joint) are
addressed. Providing an approach to patients’ dental health that is
grounded in global wellness is the goal of the course he co-developed
with orthodontist Dr. Barry Raphael. The course is called Airway Focused
Dentistry Mini-Residency. Together, Dr. Cruz and Dr. Raphael are
educating doctors on the West and East coasts about the relationship
between the structure and function of the human airway and facial
development. Dr. Cruz kicked off the 2-day course in July at the
Renaissance Club Resort in Aliso Viejo, CA.
‘The Great Leap Forward’
To highlight the importance of the airway and upper respiratory
evolution, Dr. Cruz provided history about the evolution of humans. The
evolutionary changes in the human’s upper respiratory tract to
facilitate speech led to a phenomenon UCLA physiologist Jared Diamond
calls “The Great Leap Forward.”
During the Paleolithic Period, also known as The Stone Age, Homo
sapiens had sizable brains and made tools. It is well-documented that
Homo sapiens lived in small bands of 6 to 10 people. This made sense in
regards to hunting and sharing food.
About 40,000 years ago, the vocal tube anatomy and the necessary
neuro connections that allowed Homo sapiens to have speech were
completed, and they were able to create language. The other major
evolutionary change was bipedal locomotion that freed up their hands to
have precise work. Speech facilitated the Dawn of Civilization 10,000 to
12,000 years ago. The ability to control the food supply allowed them
to move from small clans to full civilizations. Bipedal movement and the
ability to communicate with speech separated man from the rest of the
animal kingdom and permitted the human race to evolve to advanced
civilization.
Unlike other mammals, Home sapiens are brachycephalic; meaning
they have flat faces. The English bulldog has problems breathing which
is called brachycephalic syndrome, a condition that leads to severe
respiratory distress. When humans became bipedal, the airway became
restricted. Airway dysfunction, including sleep disordered breathing, is
an adverse consequence of the human upper respiratory evolution. The
development of speech contributed to this dysfunction.
The human is the only mammal that has a descended larynx, which is
located between the third and fourth vertebrae in a child and descends
at about six months. We are born as obligate nasal breathers because we
do not have the neuro connections necessary to breathe through the
mouth. Therefore, sleep disordered breathing is an anatomic illness, Dr.
Cruz said.
Craniofacial growth and development
The largest increase in craniofacial growth occurs in the first
four years of our lives. From an infant to an adult, there is a
difference in the angle of growth; which can constrict the airway.
Dr. Cruz shared the following statistics regarding craniofacial growth:
- It is 90 percent complete by age 12.
- Eighty-nine percent of youth, ages 12-17, have some occlusal disharmony.
- Sixteen percent of youth have severe handicapping malocclusion that requires mandatory treatment.
“Let’s not focus on the teeth. Let’s focus on the face and, more
importantly, the airway. The airway is what actually drives facial
growth,” Dr. Cruz said.
Malocclusion (poor bite) is not an aesthetic issue that needs to
be corrected by braces. It is due to improper growth, he said.
“The first and most important area of craniofacial growth and
development are the individual’s breathing habits. Our entire character
and physiology is set up to protect this function first and foremost.
And, it’s driven by the most primitive part of the brain,” Dr. Cruz
said.
There is no question that there is a direct relationship between
the growth and lack of growth of the upper and lower airway with nasal
respiratory function, Dr. Cruz said, before concluding his presentation
with a quote from well-known orthodontist Dr. Robert Rickett.
“From the environmental standpoint, total respiratory function has
been the most overlooked factor in clinical orthodontics. The influence
of the beliefs in the 30s and the 40s, the concepts of genetic
dominance and the conviction of limited skeletal alterations as a
possibility in therapy, led to the concept of treating just the teeth
instead of the face or the patient as a whole. Biologically, the
functions of mastication and respiration have been connected with the
same set of muscles and the same set of nerve paths. We cannot separate
them.”