A Comprehensive Guide To Airway Dentistry

What is airway dentistry?

Airway dentistry is a relatively new topic that focuses on the assessment of the structure, function, behaviors of the oral cavity, specifically the bite and palate. These areas are related to the function of chewing, swallowing, speaking and most importantly breathing. 

Airway dentistry addresses a plethora of oral issues that impact breathing. It is popular for addressing sleep disorders such as obstructive sleep apnea, due to its prevalence in the media. Besides correcting sleep disorders, airway dentistry also seeks to improve overall health.

Why do you need an airway dentist?

• If you have temporomandibular joint (TMJ) problems.
• If you have sleep apnea.
• If you are a chest breather
• If you are a mouth breather
• If you have a cracked tooth
• If you don’t have a restful sleep
• If you are tired all the time. 
• If you are removing tonsils and adenoids for the second or third time
• If you are concerned about the wellness of your teeth and health.
• If you have chronic fatigue syndrome.
• If you have difficulties concentrating.
• If you are concerned with peak performance.
• If you want to reduce inflammation in your body.

How is airway dentistry performed?

Airway dentistry employs a range of advanced technologies to assess your oral health and help dentists to decide on a course of treatment based on specific findings. 

Technologies that are used in airway dentistry:

• Cone-beam CT (CBCT) to assess the airway, TMJ and nasal cavity
• Digital Scanning to evaluate the size of the arches in the mouth and the amount of tooth structure lost
• Digital x-ray to evaluate the tooth and supporting areas
• A high-resolution pulse oximeter to evaluate your sleep quality
• Capnometry to evaluate your breathing.
• Salivary genetic testing for pathogens in periodontal disease

Risk Assessment

In airway dentistry you will be examined in the following areas:

1. Periodontal disease: We evaluate the stages of gum disease clinically, with the use of saliva tests such as oral DNA. This helps us relate the stages of gum disease to the risk of cardiovascular disease.

2. Cavities, broken and fractured teeth: Wear and tear in the teeth can show signs of erosion and pathway damage, which are often a direct result of airway issues.

3. Bite and TMJ joints: Your TMJ joints may affect the movement of your jaw, thus it is important to ensure that these are taken into consideration when treatment planning the case. We also examine how the teeth and jaw fit together, including the examination of how Invisalign could also affect your jaw relationship.

4. Esthetics: The size and structure of your teeth can have an impact on the function of your jaw. We look at how teeth fit in the face, as well as the size of the teeth.

5. Airway: We examine how the structure and function in the mouth may affect how you breathe and sleep.

6. Dysfunctional breathing habits: Abnormalities in breathing habits can affect your jaw muscles. We examine whether you breathe through your nose or mouth, and its impact on your health. 

Steps 1 to 4 are usually conducted in general dentistry. 5-6 are the additional assessments that are performed in airway dentistry.

Note: Besides doing an oral exam, many airway dentists perform a comprehensive physical exam as well to look for additional signs of an airway disorder. Your medical history is also essential to the diagnosis as an airway disorder can present itself in different ways. For example, conditions such as high blood pressure, atrial fibrillation, diabetes, gastroesophageal reflux disease, headaches, depression and TMD can be an indicator of an airway disorder.

Why is airway dentistry important?

Airway dentistry has a direct impact on an essential human function – breathing.

Breathing might seem like the main function of the respiratory system, but it is extremely important to dentistry as well. Your oral health has an effect on your breathing, and vice versa.

Breathing, speaking, chewing and swallowing all share the same structures; they all have to work together within a single framework. When there is disharmony, there is dysfunction. Dysfunction within oral structures can cause a whole range of symptoms: headache, fatigue, inability to concentrate, TMJ disorders, tinnitus and sleep-related breathing disorders. 

Additionally, breathing controls moment-to-moment changes in body chemistry. The body chemistry affects the muscles of the jaw, and therefore the teeth. 

Mouth breathing leads to dry mouth, it can lead to enamel damage, making your teeth more vulnerable to the formation of cavities.

The science behind breathing and respiration

Due to the close relationship between breathing and dentistry, airway dentistry is essential to correct breathing disorders to provide proper oral and overall wellness. This begs the question: What is proper breathing? 

Contrary to popular belief, respiration is not equivalent to breathing. Breathing is a physical process, whereas respiration involves a chemical reaction.

Breathing is the movement of air in and out of the lungs.

Respiration is the chemical exchange of carbon dioxide and oxygen in the lungs.

Every breath counts in the respiration process. You could be taking breaths that do not provide a sufficient exchange of carbon dioxide and oxygen in your respiratory system, which does not ultimately benefit the body. Proper breathing is when breathing and respiration are in alignment. 

A lack of alignment can alter the pH value of the body. The body tries to maintain body chemistry in a very narrow range with a pH between 7.35-7.45. Below pH of 7.35, the blood becomes acidic, above 7.45, the blood becomes alkaline. In the brain, there are receptor sites for carbon dioxide and pH, but not for oxygen. Breathing is regulated by the concentration of carbon dioxide and pH.

The regulated breathing can be altered by behaviors, the altered breathing leads to changes in the blood pH making it more acidic or more alkaline.

What happens when breathing and respiration is out of alignment

When there is a lack of alignment between breathing and respiration, there is a shift in body chemistry. Besides having a drastic impact on your oral cavity and sleep quality, this can also lead to various symptoms throughout the entire body.

Here are some symptoms that may arise:

• Nausea, vomiting, cramping and bloatedness in the abdominal area 
• Acute fatigue and chronic fatigue
• Heart problems such as palpitations
• Cognitive problems such as attention deficit disorders, learning deficits, poor memory, brain fog and inability to learn
• Poor mental health, such as feelings of anxiety, anger, fear, panic and phobia
• Dizziness, hallucinations, fainting and diminished coordination and balance
• Muscle pains such as tetany, hyperreflexia, spasm, weakness or fatigue
• Low performance due to sleep apnea, anxiety and fatigue
• Drastic peripheral changes such as sweatiness, tingling, numbness, trembling, and shivering
• Respiratory problems such as shortness of breath, resistance in the airway and asthma-like symptoms
• Changes in sensory reactions such as blurred vision, dry mouth, distant sounds, reduced pain threshold and the feeling of sensory overload

How airway dentistry addresses breathing issues

Breathing issues are related to the structure, function and behavior of the oral cavity. Airway dentists examine these areas to come up with the best course of treatment for different breathing issues 

Structure: Nasal breathing is preferred over mouth breathing. In fact, it is the correct breathing method for a clear airway. With nasal breathing, the inhaled air is moistened, filtered, and flows with proper resistance. With mouth breathing, the air is not filtered, causing inflammation in the adenoid and tonsil tissue and enlarging the tissue potentially blocking the airway. 

Mouth breathing is a classic symptom of sleep disorders caused by airway issues. It is the human body’s way of compensating for airway blockages while sleeping.  

Function: In the normal chewing and swallowing cycle, breathing takes place through the nasal complex, the tongue is normally placed against the upper palate with the lips closed. If nasal breathing is compromised, the mouth breathing takes over. It will be difficult to chew properly while trying to breathe at the same time. During the speech, the breathing and the tongue may interfere to cause speech disorder. Dysfunctional habits will be established to be able to accomplish speaking, chewing and breathing in a compromised way.     

Behaviour: The learned dysfunctional habits will continue to reinforce the behaviour to be able to function but in a compromised way.

What are the behaviors that can alter breathing? 

• Heightened feelings of fear and panic
• Physical exercise
• Interacting in groups

These behaviours can lead to a shift in breathing patterns. For example, anxiety and physical exercise will naturally lead you to take more shallow breaths due to an increase in heart rate, as compared to taking deep breaths when you are relaxed. The depth of your breaths can determine whether you breathe through your mouth or nose.

How airway dentistry solves sleep disorders

Airway dentistry helps to improve the overall wellness of your health by improving the quality of your life through better sleep. A good night’s rest can go a long way – better sleep quality eliminates fatigue in your daily life, allows for optimum body performance and reduces the risk of falling sick.

Airway dentists commonly treat sleep-related breathing disorders (SRBDs). SRBDs lead to difficulties in breathing during sleep, which reduces your blood oxygen levels. This can lead to extremely poor sleep quality as patients are frequently woken up in the middle of the sleep cycle.

Examples of SRBDs are:

• Snoring 
• Obstructive sleep apnea (OSA), which is the repeated partial obstruction in your airway as measured by the AHI score
• Upper airway resistance syndrome (UARS), which is an obstruction in your airway caused by soft tissue but below the threshold AHI score 

They might also be referred by a sleep specialist to treat other sleep disorders such as insomnia, restless limb syndrome, jet lag and narcolepsy.

Treatment for SRBD

1. Naturally, in obstructive sleep apnea(OSA), the lower jaw posture forward and backward to allow the airway to open up. The posturing requires activation of the jaw muscles and changes in the TMJ position.  This leads to pain in the jaw muscles, pain and clicking in the TMJ as well. 
2.  The constant forward and backward posture leads to parafunctional activity, wearing ,and breaking of the tooth structure..  
3. In OSA, mouth breathing may be used, causing inflammation.
4. Airway collapse can be managed by Oral Appliance therapy(OAT) also commonly known as sleep appliance. OAT works by positioning the lower jaw forward, giving the tongue more space and thus opening the collapsed airway. 
5. In young children you can expand the arches to create more oral volume – more room for the tongue with orthodontic treatments such as Invisalign.