By: DeWitt Wilkerson, DMD
The article originally appeared on The Dawson Academyย
Have you ever wondered why some peopleโs teeth are perfectly straight while others are crowded or misaligned? Or why you might be waking up with a sore jaw and headaches despite wearing a night guard? Could your acid reflux be the reason for your crumbling teeth?
The answer to all of these questions may lie not in your mouth, but in your airway.
Countless patients struggle with dental issues that seem to defy explanation. However, recent research has shed light on a crucial connection that many in the dental field have overlooked: the role of airway obstruction and sleep-breathing disorders in dental health and the practice of airway dentistry. What is even more surprising is the impact these issues can have on overall well-being and quality of life.
Letโs dive a bit deeper into a few of the key ways in which airway obstruction and sleep-breathing disorders can affect dental health โ and the steps we can take to address them.
Is Airway Obstruction Linked To Dental Malocclusion?
Imagine if you couldnโt breathe through your nose and had to rely on mouth breathing day and night. Over time, this would alter the position of your tongue, jaw, and facial muscles, changing the way your teeth and bones develop. Thatโs exactly what researchers have found in both animal and human studies.
In a fascinating experiment at the University of Michigan, scientists plugged the noses of young monkeys, forcing them to breathe through their mouths. The result? The monkeys developed longer, narrower faces and dental arches, with teeth that were more crowded and misaligned.
These findings align with the โneutral zoneโ concept proposed by the renowned dentist Dr. Pete Dawson. He explained that the teeth naturally erupt into a balance between the outward forces of the tongue and the inward pressure of the lips and cheeks.
But when the tongue rests low in the mouth due to mouth breathing, this delicate balance is disrupted, often leading to a narrowed upper arch and crowded teeth. Correcting a breathing issue early on through orthodontics, oral appliances, or even surgery may be the key to achieving a healthy, beautiful smile.
The Surprising Connection Between TMD and Sleep Breathing Disorders
Another aspect of airway dentistry & oral health that is often overlooked is the link between temporomandibular joint (TMJ) disorders and sleep-breathing disorders. Patients with TMD often report symptoms like jaw soreness, clicking or popping sounds, headaches, and difficulty chewing. While dentists have traditionally focused on factors like bite misalignment and teeth grinding as potential causes, a growing body of research suggests that sleep-breathing disorders may be the missing link.
Dr. Christian Guilleminault, a pioneer in sleep medicine, coined the term โupper airway resistance syndromeโ (UARS) to describe a condition where patients experience frequent arousals from sleep due to increased effort to breathe, leading to fragmented sleep and daytime fatigue.
This connection makes sense when considering the jaw and airway anatomy. When the airway is partially obstructed during sleep, the body may unconsciously clench the jaw and grind the teeth to open the airway. Over time, this repeated strain on the jaw muscles and joints can lead to the classic symptoms of TMD.
As dentists, we need to consider the possibility of an underlying sleep-breathing disorder in every patient who presents with TMD. Instead of just prescribing a night guard or adjusting the bite, we should screen for signs of UARS or sleep apnea, such as snoring, daytime sleepiness, and a narrow upper arch. Collaborating with sleep medicine specialists to diagnose and treat any airway dentistry issues may be the key to providing lasting relief for our TMD patients.
Is Bruxism A Protective Reflex Against Airway Collapse?
Teeth grinding, or bruxism is another common dental problem that may have its roots in the airway. While bruxism is often attributed to stress or bite issues, recent studies suggest that it may actually be a protective mechanism to maintain airway patency during sleep.
Several studies have found a strong link between sleep bruxism and enlarged tonsils or adenoids in children, which can obstruct the airway. Adult bruxism has also been associated with obstructive sleep apnea (OSA), where the airway repeatedly collapses during sleep, leading to pauses in breathing and reduced oxygen levels. Researchers propose that bruxism is a compensatory mechanism to reopen the airway by activating the jaw muscles and bringing the tongue forward.
This theory is supported by studies showing that when OSA patients are treated with continuous positive airway pressure (CPAP) therapy, which maintains an open airway during sleep, their bruxism often resolves. In one study, patients with severe OSA who were treated with CPAP had an 80% reduction in bruxism episodes.
These findings have important implications for how we as dentists approach bruxism in our patients. Instead of just prescribing a night guard to protect the teeth, we should be screening for signs of sleep apnea or airway obstruction, such as snoring, daytime fatigue, and a large neck circumference.
Referring patients with suspected sleep breathing disorders for a sleep study and collaborating with physicians on treatment may not only save their teeth but also improve their overall health and quality of life.
Airway Dentistry Tips For Moving Ahead With Targeted Treatments
From crooked teeth and jaw pain to eroded enamel and more, a compromised airway can contribute to a wide range of issues in the mouth. The question remains โ how can we better address this underlying airway dentistry issue for our patients?
Itโs clear that we need to expand our focus beyond the teeth and jaws to consider the airway as a potential contributor to dental problems.
By screening for sleep breathing disorders, collaborating with physicians, and providing comprehensive treatment, we can not only improve our patientsโ dental health but also enhance their overall quality of life.
- Educating ourselves on the links between airway disorders and dental health
- Incorporating airway screenings into our routine exams
- Referring patients with suspected sleep breathing disorders for further evaluation
- Working with sleep medicine specialists, ENTs, and orthodontists to provide coordinated care
- Considering airway-focused treatments like oral appliances, orthodontics, or myofunctional therapy
Itโs Time To Assess How We Approach Our Treatments
The connection between airway health and dental problems is a paradigm shift that has the potential to revolutionize the way we practice dentistry. By recognizing the mouth as a window into the bodyโs overall health, we can provide more comprehensive, effective care for our patients.
If youโre a patient struggling with TMD, bruxism, GERD, or unexplained dental issues, donโt suffer in silence. Talk to your dentist about the possibility of an underlying airway problem, and work together to find a solution that addresses the root cause.
As dentists, we have a unique opportunity to change lives by identifying and treating airway disorders in our patients. By embracing this challenge and working collaboratively with our medical colleagues, we can help our patients breathe better, sleep better, and smile better.
So letโs open our minds, ask the right questions, and take charge of improving the health and well-being of our patients. The future of dentistry is airway-focused, and the time to act is now.
Learn more about airway dentistry & dental sleep courses at Dawson here.
