Hooray For Airway Palooza!

People with properly developed faces will always have straight teeth, room for wisdom teeth, and superior beauty. Sadly, most of us have some level of crowding and lack of jaw space for wisdom teeth today, meaning almost all of us to have deficient jaws. Since most of us have underdeveloped faces, this epidemic has gone primarily unnoticed by us, including most physicians and dentists. This needs to change because it is one of the major contributing factors to many, if not most, of our modern health problems; most of which originate in poor breathing from small airways.

I am writing this post as I fly back home from an amazing conference called Airway Palooza. It was hosted by Airway Health Solutions, an outfit dedicated to teaching dentists and other professionals about the importance of good breathing and how to fix it if the airway is compromised. Founder and CEO Lauren Gueits did an amazing job putting together a world-class lineup of experts. For those of you not familiar with the small jaw health epidemic, see this post. I want to share some pearls of wisdom that can help you recognize if you have an airway problem and ways it can be addressed.

Dr. Kevin Boyd was the first and most prominent speaker. I was recently on a panel with him and James Nestor, whom I will discuss later. You can see it here. He coined the term craniofacial respiratory complex to define the areas of the head and neck that define the airway. He presented numerous papers on facial growth and development, paying special attention to developmental benchmarks. You may be shocked to learn that the jaws are already over 50% developed by age 2, and most rapid jaw growth is done by age seven. For this reason, Dr. Boyd urges dentists to treat growth deficiencies when diagnosed if the parent and child are ready. Sadly, most dentists do not take action in time, and treatment becomes more difficult while the child needlessly suffers until they receive proper treatment, if ever.

Dr. Ben Miraglia, the cofounder of Airway Health Solutions, spoke next. He presented a few cases where he corrected severely deficient jaws. His results were stunning. He stressed that breathing problems may remain if the upper arch is not expanded to a minimum of 40 millimeters between the upper molars. This measurement is called the intermolar distance. Sadly, most of my patients measure less than 35, meaning they are much more predisposed to breathing issues.

Karese Laguerre and Brittny Scierra Murphy spoke about the importance of myofunctional therapy. Every speaker at the event agrees that it should be a part of most dental treatments. Essentially myofunctional therapy is physical therapy for the muscles associated with the craniofacial respiratory complex. Since the position and movement of the facial muscles, the tongue being the most prominent, affect the shape of the face, myofunctional therapy is critical. Brittny is local at CT orofacial Myology, and I am blessed that my patients can receive her exceptional care. You can read her guest post here.

Dr. Scott Siegel, a prominent oral surgeon, based in New York City and Long Island, presented on relieving tethered oral tissues, sometimes known as tongue ties. The cheeks and tongue are sometimes limited in movement because their attachments to the jaws are too tight. A simple laser procedure frees up restrictions. Myofunctional therapy is critical before and after release because the tongue needs to learn how to move after it is freed. Dr. Siegel has helped my patients and family members with his skills. See this post for more information.

Dr. Brett Christensen presented an orthodontic case study where he was able to eliminate severe apnea in a patient by expanding their dental arches. Although nobody can promise these results, dentists often see large improvements in breathing, sleep, and overall health with such treatments. Dr. Christensen has data on hundreds of patients showing measurable improvements in the size of the airway with expansion orthodontics. He uses a special device called a rhynometer/pharyngometer to measure the airways sonically. Most definitely, adults can be expanded orthodontically; most orthodontists are taught that this can't be done, so they don't even attempt it.

Dr. Lauren Ballinger, a western Massachusetts-based pediatric dentist, reiterated the need for early treatment of facial growth deficiencies. She stated that 3-5 years of age is ideal for such treatments,  6-8 years is already middle-aged, and over ten is geriatric when treating facial growth discrepancies. She also highly recommended a book called Sleep Wrecked Kids by Sharon Moore, which covers the tragic consequences of poor jaw growth.

Dr. Darius Loghmanee is a super compassionate pediatric sleep physician out of Chicago who wants to change the world by creating groups of like-minded individuals locally. He recognizes that the most interesting people are the most interested, and everyone has something to offer. He is creating the Optimal Airway Network to build capacity, engage in conversations, think and act systematically, and increase access to reciprocal learning.

Dr. Susan Maples, the author of Brave Parent, put the big picture together by linking the numerous detrimental changes to children's health due to poor airways. She thinks very much like me, and I am glad to be copresenting with her at a pediatric dental meeting in February of 2023.

Jerald Simmons is a triple-board-certified sleep doctor. During sleep tests, the jaw muscles are monitored for activity; thus, grinding can be measured. He spoke about the connection between apnea and tooth grinding, called bruxism. He presented data from numerous sleep studies he has conducted and other research that demonstrates that bruxism is a protective measure against apnea. For instance, children grind much less after tonsil and adenoid removal because it makes breathing easier. He presented a study that the major jaw muscle called the masseter functions like a respiratory muscle and that a CPAP machine decreases its tension. He also mentioned that when patients stop grinding, apneas can begin, so the relationship is not linear. He also stated the need to standardize sleep test interpretation and that arousal from sleep, not decrease in blood oxygen saturation, is a much better standard. Lastly, arousals usually occur before tooth-grinding episodes.

Dovetailing into Dr. Simmons's talk, Dr. Michael Gelb, a longtime dentist in New York City and White Plains, spoke about bruxism being the first sign there is a breathing problem. He also quipped that all dentists are airway dentists, but sadly, most shrink the airway. He showed how some simple appliances (some bear his name) can help immensely, making it appear as if years have been erased from our faces. In fact, in some ways, dentists can make a larger difference than cosmetic surgeons. Lastly, he discussed that sleep tests should be performed before making a grinding appliance because missing sleep apnea is tantamount to malpractice. I wholeheartedly agree.

Dr. Scotty Bolding, an immensely talented oral maxillofacial surgeon, presented surgical cases he performed on people with severe jaw growth restrictions. The surgery, called maxillomandibular advancement, or MMA, transforms lives. I often recommend it to patients, but most refuse to consider it because it sounds dangerous and painful. The surgery has been around for decades, and complications are uncommon. Dr. Bolding uses the correct airway size to guide where to move the bones, unlike when they used facial measurements without regard to the airway. Today, with most dental offices equipped with  CAT scans and digital three-D scanners, highly accurate software can help design the surgery for precise movement of facial bones. The hardware that holds the bones in place is also designed and milled specifically for each case. Luckily, the recovery is not very painful because the nerves take time to recover their ability to feel. Finally, the jaw no longer has to be wired shut for six weeks like it used to be. I have never seen a patient regret their decision to have MMA surgery, and I wish more people would consider it to improve their looks and health, especially because it is potentially the only real cure for sleep apnea. I am lucky to have Dr. Giovanni Ibrahim in my office, who does the same surgery at Yale as Dr. Bolding does elsewhere.

Dr. Steve Carstensen started treating sleep problems in 1998 and is a prominent figure in sleep dentistry. His talk focused on the negative pressure generated during apneic events and the damage it causes to the GI, heart, lungs, and more. Some of the problems it causes are GERD (heartburn), enlarged hearts, high blood pressure, ear problems, lung issues, brain damage, and more. Lastly, he recommends renaming dentists as PRIMARY CARE DENTAL SURGEONS to better define their roles in the collaborative effort to treat facial growth, apnea, and sleep.

My friend Dr. Scott Province gave a heartwarming presentation about his recent journey in airway dentistry. He spoke about how he recently found out about sleep dentistry. His curiosity led him to take some courses to learn more about it. He eventually hung signs in his office asking parents to check if their children had any signs of breathing disorders. His once adult-oriented practice is now full of children he is helping to transform. He did this in one year! He truly inspires me.

To close the conference, author and speaker James Nestor gave the keynote address. His book Breath is an international best-seller. Because of the success of his book, he is probably the one person who has done the most to bring the tragedy of sleep-disordered breathing to the masses. I highly recommend you read it. It will probably change your life for the better.

I could have filled volumes with what I learned at Airway Palooza, but I will stop here. I hope you learned something that can help you. If you did, please tell your friends and family. You can help add years to their lives and help end the massive suffering from poor breathing and lack of restful sleep!