Healthcare from an Airway Perspective
You may have read some of my articles on sleep apnea, snoring, breathing, airway issues and nutrition. These issues are interrelated. Keep in mind that our most basic and most important nutrient is air. We can live with other depleted nutrients but not without air. It is the most essential nutrient. In an abbreviated way let me explain how various healthcare providers can work together to address interrelated healthcare from an airway perspective.
Typically, airway problems are noticed by the patient or a primary care doctor like a general physician, pediatrician or general dentist. Recognition may happen in a discussion about current health, a questionnaire or through clinical findings.
Below are some simplified scenarios of how detection and treatment may progress for a new born, a child, a teenager and an adult patient.
A mother experiences painful breast feeding and her baby is unable to latch on properly. This newborn should be evaluated for tongue and lip ties as these will interfere with breast feeding and nasal breathing. Breast feeding is extremely important for growth and development of the structures of the face and upper airway to allow appropriate nasal breathing, well developed dental arches and correct swallowing. If these basic functions are lacking the baby may have growth and development impairment both physically and neurologically. Release of tongue and lip ties is an easy procedure and is often done at the pediatric dentist’s office. Sometimes a myofunctional therapist is also needed to assist in training the baby and mother to develop proper latch, breathing and swallowing. Proper development of the face is dependent on the appropriate use of the tongue, facial muscles and nasal breathing. When it is time to transition from breast feeding to solids parents should avoid soft processed baby foods because they do not allow for proper muscle and jaw development.
A 3 to 7 year old patient has a visit with their pediatrician and the parent reports some or all of the following: unrestful sleep (hard to wake, toss and turn a lot), snoring, night teeth grinding, mouth breathing, bedwetting and daytime symptoms of hyperactivity. Before a child is put on medications for sleep or hyperactivity he or she should be checked for airway problems. This evaluation can be done with a pediatric sleep physician to check for apnea, a pediatric sleep ENT physician who will check for tonsil and adenoid obstructions and tongue and lip ties, or a pediatric sleep dentist who can check for proper growth and development of the face and jaws, address tongue and lip ties and assess proper nasal breathing. This is an age where early intervention orthodontic treatment can easily expand the airway. This will correct some narrow, long faces allowing for proper jaw and airway growth. Early intervention treatment is essential for correcting airway problems which will allow for proper physical and neurocognitive growth and development. A myofunctional therapist is very important when a tongue and/or lip tie is released so the muscles can be trained to go to the right places to develop proper nasal breathing and swallow patterns which will assist in the facial growth and development.
A teenager presents to their general dentist with narrow, crowded dental arches and a long face. They have or have had some of the same symptoms of the 3 to 7 year old listed above and may be experiencing some behavior problems and academic challenges. They may be on ADHD (Attention Deficit Hyperactivity Disorder) medications, sleep aids, antidepressants and/or antianxiety medications. The dentist can see that intervention is needed to improve the airway, develop nasal breathing and stabilize the patient. A team of doctors is needed to determine what should be done. A pediatric sleep physician may be needed to rule out sleep apnea. If there are suspected enlarged tonsils and/or adenoids a pediatric sleep ENT should be consulted. A myofunctional therapist may be needed if a tongue and/or lip tie is going to be released by either the dentist or ENT. At this age most of the growth of the face and airway structures are complete so orthodontic expansion is helpful but sometimes surgical intervention is needed. An orthodontist should evaluate for expansion of the dental arches. If expansion cannot get enough correction of the small airway and crowded dental arches an oral surgeon may work with the orthodontist.
An adult patient reports fatigue, acid reflux and lack of desire for intimacy and/or their healthcare provider discovers hypertension and atrial fibrillation during the patient visit. If sleep apnea is suspected the patient should have further testing. A team of doctors is needed to determine what should be done. A diagnosis of sleep apnea is usually made by a sleep physician after a polysomnogram (sleep study). If it is unclear if sleep apnea is the issue or sleep apnea has been ruled out and the findings are suspicious of a nasal or oral obstruction then an ENT or dentist familiar with airway issues should be consulted. The ENT will evaluate the nasal-pharyngeal airway and the dentist will evaluate the oral-pharyngeal airway to determine if any obstructions or other issues are present. The common treatment of the symptoms of sleep apnea is a CPAP (Continuous Positive Airway Pressure) or a similar machine worn during sleep. This is not a cure but a part-time symptomatic treatment which can help make the patient healthier. To cure the problem the cause needs to be addressed. There may be a need for expansion with an orthodontist or more expansion with the aid of a periodontist surgically assisting the orthodontic treatment. If the airway is very small and the dental arches short an oral surgeon and orthodontist will work together to treat to a cure.
At each stage of life there are various factors that need to be evaluated and one or more airway trained healthcare providers may need to be involved. The earlier in life the problems are addressed the healthier the individual will be for the rest of their lifetime.
The following are some excellent resources:
- GASP: A book by Dr. Howard Hindin and Dr. Michael Gelb. Airway Health: The hidden path to wellness.
- The Oxygen Advantage: A book by Patrick McKeown. Simple, scientifically proven breathing techniques to help you become healthier, slimmer, faster, and fitter.
- Sleep, Interrupted: A book by Dr. Steven Y. Park. A physician reveals the #1 reason why so many of us are sick and tired.
- The Dental Diet: A book by Dr. Steven Lin. The surprising link between your teeth, real food, and life-changing natural health.
Dr. Robert A. Gallegos is a Fellow in the Academy of General Dentistry, visiting faculty at Spear Education, alumnus of Pankey Institute, a member the American Academy of Cosmetic Dentistry, the American Academy of Dental Sleep Medicine and the American Dental Association. Dr. Gallegos practices dentistry in Middleburg, VA. www.MiddleburgSmiles.com.