AIRWAY vs. DENTAL SLEEP APNEA TREATMENT

Airway-Centric Dentistry is different than dental sleep medicine. There are a lot of dental providers that offer sleep apnea treatments, namely an oral appliance that positions the lower jaw forward, bringing the tongue with it and hopefully maintaining an open patent airway. While this is a valid treatment option, it is not treating the root cause of sleep apnea. The origin of sleep apnea is often deficiently sized jaws, narrow and dysfunctional nasal passages, dysfunctional tongue and facial muscles, as well as sub-optimal breathing behavior. Airway-Centric Dentistry looks to the anatomical determinants (jaws, tongue-tie, nasal passages), muscle dysfunctions, and breathing etiologies, and gives patients treatment plans to reverse the disease process. The etiology or root cause is multi-faceted and complex; but, with the correct diagnosis and plan of action, wellness is possible!

The “airway” referenced all throughout our website (and ad nauseam by the Drs. Santiago and the AirSync Team) means the upper part of the airway passage, starting behind the nose, extending behind the tongue and down to the fourth vertebrae. An Airway-Centric Dentist is perfectly poised to help make improvements to the 3 dimensions of the upper airway in infants, children, and adults.

TONGUE-TIE

After 8 years of providing laser frenotomies and functional frenuloplasties for infants, children, and adults, we know how to get the best outcomes for the patient based on their age, size, challenge, and tolerance. We want you to have the most successful outcome; the treatment plan is customized to you or your child.

For newborns and young infants, we can often perform the CO2 laser frenotomy the same day as the examination; in some cases some physical therapy/occupational therapy is needed prior to the procedure to have a successful surgery. This pre-habilitation can be missed by many providers who just seek to treat the tongue-tie without regards to restoring the optimal behavior and function of the infant before and after the procedure.

Depending on the circumstances, a different approach altogether may be needed. Depending on baby’s size/weight/strength, whether they have teeth, whether they have begun weaning onto solid foods, and a detailed functional and structural evaluation, we will discuss the best approach for your baby.

For toddlers, children and adults, we follow an integrative and functional model. This method includes evaluating not just the tongue-tie, but the other structures (palate, nose, upper airway, digestion, and more), behaviors, and functions that have been impacted by a tongue that cannot function optimally. The AirSync method is comprehensive and functional. We strive to rehabilitate and give you back the quality of life that you deserve.

TRUTHS ABOUT TONGUE-TIE

1. Tongue-tie (aka ankyloglossia, short lingual frenum, tethered oral tissue) is an embryological tissue leftover present at about 11 weeks of gestation. It can manifest as tissue that extends to the tip of the tongue or it can manifest as a short band of tissue or somewhere in between. Assessment is nuanced.

2. The genetic component of tongue-tie is in the gene(s) that regulates programmed cell death, a natural embryologic process for unneeded cell deletion. In other words, it is not an inherited feature like hair color or eye color.

3. You do not outgrow tongue-ties (this is stated in the literature.)

4. . You “adapt” with compensations and compensations have a price.

5. It is estimated that up to 50% of the population has some level of anatomical restriction of the tongue, limiting movement and optimal function. The incidence is grossly underestimated in older literature cited by medical professionals who denounce the presence of tongue-tie; the studies did not have a standardized assessment/classification tools for either anatomy or function.

6. There is more clinical efficacy to treating a tongue-tie than to circumcising a male baby. Surgical discomfort is minimal in comparison to other early childhood surgeries and the long-term health benefits will be substantial and long reaching for a baby, child, or adult.

7. There are many deleterious effects of not treating a tongue-tie: potential difficulties with breastfeeding, improper swallowing, higher risk of choking, difficulties with speech, underdeveloped jaws, high risk of developing breathing-disordered sleep, potential for headaches/neck pain/poor posture, and more.

8. Tongue-tie assessment and treatment requires proper education, proper positioning, proper training, and surgical skill. To properly assess an infant, the provider has to examine the baby over the top of the head and lift the tongue with two fingers. They need to have optimal lighting (a headlamp). They should know the difference between an anterior and posterior tie and should know that they have to remove not just the anterior but always the posterior connective tissue. Not all medical providers are surgeons. The mouth, especially the underside of the tongue, has a lot of structures that can be damaged by an in-experienced surgeon.

9. Wound healing, no matter the size of the human, takes 30 days. Aftercare is REQUIRED for 30 days post-surgery, as you cannot rush this basic biological process.

BREASTFEEDING

Breastfeeding provides the best, most convenient, most cost-effective, most nutritious meal that your baby needs. And, beyond nutrition, it is the natural trainer of optimal tongue function and posture as well as developer of the upper jaw and dental arches. The longer one can breastfeed, the more optimal it is for your baby. And, if you cannot or choose not to breastfeed, we support your decision.

Breastfeeding should not hurt. If it does, this is not your fault.

Physicians receive minimal breast-feeding education and minimal oral anatomy and oral function education.  If you are receiving conflicting information between the pediatrician and lactation experts, please get your child evaluated by an infant tongue-tie specialist at AirSync Integrative Dentistry.  Listen to the tongue-tie and breastfeeding experts and trust your maternal (or paternal) instinct.

ORTHOPEDIC REMODELING & GROWTH GUIDANCE vs. ORTHODONTICS & PALATAL EXPANSION

To optimally treat a the jaws which are a 3-dimensional system, one must assess and plan treatment for 3 dimensions. What is often overlooked are the vertical dimension and the forward growth/development of the upper jaw. There is no way to alter 3 dimensions with treatment that only targets one dimension. Orthopedic Remodeling looks at changing/growing/remodeling the shape and size of the foundation for the teeth, making a sturdier and larger foundation with ample room for the tongue, teeth, and airway space behind the tongue. Just like building a house, the quality and stability of the house are directly linked to the foundation. At AirSync, we treat the foundation first, develop optimally sized jaws and airways, then look to get the teeth into the right position. Orthopedic means that the treatment is targeting the bone, not the teeth. The goal is to get as much skeletal and bone development (in which the teeth move within the bone) then reassess when all adult teeth are present if limited orthodontics are needed.

Growth guidance is orthopedic treatment in the growing child. It gives the deficient jaw growth (manifested as crowding, history of pediatric sleep apnea, and more) a nudge in the optimal direction to optimize the growth potential for the patient. Coupled with optimizing the muscle function and breathing behavior, longterm stability and naturally straight teeth are possible!

For the adult, foundational change is possible! Whether by turning on bone growth centers or using combined advanced orthopedic and orthodontic techniques. It is an exciting time to be able to help teens and adults get the smiles, sleep and health they deserve.

LESS THAN SIX (LTS)

Dentists were and are educated that all children should referred by the age of 7 to the orthodontist for evaluation. However, the deficiency of space is often present at birth! As mentioned before, the time to refer is when you see the high palate, no space between baby teeth, signs of crowding, presence of thrusts, tooth grinding, history of chronic ear infections/tubes being placed, tonsils and adenoids surgery, diagnosis of sleep apnea, diagnosis of ADHD, and on and on.

An amazing Airway-Centric Pediatric Dentist in Chicago termed a new movement called LTS - Less Than Six — meaning identification, referral, and care for children can and should be younger than 6 years of age. The problems don’t suddenly appear or exacerbate at 7 years of age. A human head (and upper jaw) grows the most rapidly from age 0-2 years, by 4 years of age it is 60% developed and then by age 6 it the jaws are 80% grown. The remaining growth creeps along from 6-12 years of age. Why not help encourage the growth while the growth is at its optimal potential? It is time to think differently and non-conventionally.

At AirSync we are confidant and comfortable with treating the young-ins. We have many options that can be started very early in childhood. And, as long as the child can sit still for a digital impression, the child can move into more customized care. For children ages 8 months - 2 years, we can incorporate the MyoMunchee® into daily routine, guide parents on optimal nutrition to strengthen and grow the jaws, train breathing habits, and more. At 2.5+ years, we can move into Invisalign®, ALF therapy, or other 3-Dimensional growth appliances.

SLEEP

Finding the reasons behind your restless, interrupted sleep is sometimes not as hard as you think it might be. We can find and treat what is keeping you or your child from the rest you need to be your best every day.

SLEEP DISORDERS

There are over 70 different sleep disorders that have been defined and are grouped into 3 general categories: lack of sleep, excessive sleep, or disturbed sleep. Proper diagnosis is key. At AirSync, we treat and manage disturbed sleep, specifically breathing-disordered sleep. What is not widely understood is that how well we breathe and the mode of breathing determines how well we sleep and how restorative and qualitative that sleep will be. If we breathe nasally, with our tongue suctioned against the roof of the mouth, with lips sealed, sleep will generally be well-organized and qualitative. When breathing is other than “invisible” quiet nasal breathing, a person is not breathing as nature intended. There is an entire range of breathing and breathing disordered sleep.

ADHD, DEPRESSION & ANXIETY

There are many children and adults that have been given a diagnosis of ADHD, anxiety, or depression. While these diagnoses are very real, why are they so common? Why are so many of us medicated and still not feeling our best? The answer is more likely tied to quality of sleep and the lack there of. Fundamentally, if we are appropriately clocking the optimal hours of sleep, we should awaken refreshed and ready to take on the day without fatigue. If our sleep quality is compromised, then we are not able to be our best version. If we have sleep that is consistently fragmented (from apnea, pressure change or airway collapse) the perceived threat of danger to our breath activates the fight-or-flight side of our nervous system. The body responds with a flood of stress hormones (adrenaline and cortisol)into the bloodstream to manage the perceived threat. If this happens all night long there will be excess levels of these hormones in our bloodstream in the morning and all day long. And, then the cycle continues.

In children, these excess hormones can result in very active behavior/poor listening skills, aggressive behaviors, inability to fall asleep, inability to organize thoughts, and more.

In adults, this excessive “exercise” of fight or flight often manifests as anxiety and depression. Couple all of these internal stressors with the constant stress of the world we live in, it is difficult lived in a balanced non-stressed way.

AirSync can help.

GROWTH HORMONE & DELAYED GROWTH

Growth hormone is normally released during the first cycle of deep sleep. If a child or adult does not get into deep sleep or deep sleep is interrupted, there will be little to no release of the hormone. In children, this can manifest in a plateau of growth. In adults, this can mean decrease in bone density, difficulty with metabolism and weight loss, the onset of insulin resistance, metabolic syndrome, weakening of the immune system and more.
 

UNEXPLAINED WEIGHT GAIN OR DIFFICULTY LOSING WEIGHT

Studies show that both sleep duration and breathing-disordered sleep significantly and independently increase a child’s risk of becoming overweight.

This is related to (and not limited to) the dysregulation of a hormone named gherlin that stimulates appetite and growth hormone. When one is “sleep deprived” or lacking qualitative sleep, gherlin levels spike and hunger levels increase. Growth hormone does not get released in adequate levels when sleep is lacking or interrupted, and an individual can experience problems with carbohydrate and fat metabolism, as well as insulin production, building of muscle mass, and more. In some cases, no matter how much exercise one may perform or how healthy they eat, if there are interruptions in basic hormone processes due to fragmentation of sleep, losing weight can be an endless battle.

FINGER SUCKING, ORAL HABITS, NAIL-BITING, TONGUE THRUSTS

What is the connection to all of the above? — risk/likelihood of dysfunctional breathing and breathing-disordered sleep, poor oral rest posture (low tongue posture), and likely an underdeveloped airway.

SPEECH

For proper articulation of sounds, the tongue must be able to move in very specific ways. If it is not able to elevate, sounds can certainly be impacted. And it is not just the tip of the tongue, but the middle and back parts of the tongue that need to work and move properly. The most impacted sounds from tongue-tie are the R, S, SH, CH, L, T, and D sounds. A tongue-tie can be one of the causes of difficulties with speech articulation. If you or your child have been in years of speech therapy, it is likely time to see if the structure of the tongue, jaws, or nose are impeding success.

MIGRAINES, HEADACHES & TMJ

How the jaw develops is determined by how the soft tissue and muscles of the tongue and face function or dysfunction, the length of breastfeeding, the diet we eat, and more. Only 5% of how human jaws develop and look is inherited, meaning the other 95% is shaped by how the environment interacts with it. If the tongue muscles cannot move properly, dysfunctional or parafunctional behaviors result for breathing, chewing, swallowing, speech, etc. The consequence of non-optimal function is aberrant jaw development, small jaws, small nasal passages, small upper airway space, mouth-breathing tendencies, enlarged tonsils/adenoids, recurrent ear infections, interruption/fragmentation of sleep, crowded teeth, and ultimately a TMJ / cranium that is not in the most comfortable anatomic and functional position. The bones get locked up and have decreased mobility, muscle tension is increased, strain is placed on all of the structures and pain results. This is treatable and most often reversible without medications and without surgery. Ask AirSync how we can help your TMJ condition or migraines today!

HEART ATTACK & STROKE PREVENTION

Persons with sleep apnea have a 7x increased risk of heart attack and stroke. Reversing or mitigating sleep apnea can improve your heart and brain health as well as lower your risk for dementia.

ORAL MYOFUNCTIONAL THERAPY

It seems as though we should be born with the innate ability to breathe well, but often out of the gate, we are challenged with disadvantaged anatomy and an environment working against us. Many of us over-breathe, breathe too shallowly and too often, and with our mouth’s open. The human will do whatever needs to be done to take the next breath, regardless of whether that is an optimal breath or a maladaptive/dysfunctional breath. With dysfunctional or parafunctional breath, the body compensates in some way to make that effort. With every compensation there is a price. Myofunctional therapy is a non-invasive way of retraining proper oral rest posture, nasal breathing, lip seal, proper swallow, and diaphragmatic breathing. Research has shown, that with myofunctional therapy alone, sleep apnea can be reduced by up to 50% in adults and up to 60% in children without any other treatment. Couple this with a frenuloplasty, airway/jaw development, calming of the nervous system, we can help restore a person to full health.

UPPER AIRWAY RESISTANCE SYNDROME (UARS)

The little sibling of obstructive sleep apnea (OSA), this condition was identified at Stanford University by the same beloved Dr. Christian Guillemenault who defined OSA. It has similar characteristics to OSA, in that the airway is reduced, sleep is disturbed and fragmented which results in subsequent excessive daytime sleepiness. UARS patients may have even more significant daytime symptoms than OSA patients. Patients with UARS often go undetected as they do not meet the criteria of OSA because they do not have blood oxygen changes, but do have constantly interrupted sleep. You may be one of these persons looking for an answer to your chronic daytime fatigue, poor sleep quality and yet your sleep study came back negative and the sleep physician had no treatment to offer you. And, little do you know that as you age, gain weight, and/or a female (experiencing hormone changes with menopause), your condition will worsen. But, you do not have to wait to get a diagnosis of OSA to feel better and sleep well. You do not need a diagnosis of OSA to prove that you are not breathing, sleeping, or resting well. Regardless, you are not breathing or sleeping well and AirSync can help.

FATIGUE WITHOUT EXPLANATION

Many patients arrive at our practice with nowhere else to turn. They had a sleep study that was negative - no sleep apnea present. The physician said you don’t have sleep apnea, there is nothing I can do for you. Blood tests appear normal. What is often not discussed is that there is an entire spectrum of breathing disordered sleep that happens before one gets to end-stage disease/sleep apnea. With age and/or weight gain, your airway and sleep will get worse. If you are a female, this will often speed up once you reach menopause.

You may be also thinking why do I have to wait until I get sleep apnea until I can be helped. You don’t. In the conventional medical model you do have to wait. With the functional approach, we can help! We understand that breathing disordered sleep is not black and white; it is not simply you are healthy or have sleep apnea. There are many shades of gray and subtleties between optimal breathing/sleep and sleep apnea. We are here to address all of those gray areas. We help treat the underlying cause before the disease progresses and you are “sick enough” to get a diagnosis and treatment. The smoke signals are there and we can treat them. You do not have to wait for the fire!

YOU DO NOT HAVE TO LIVE ON A CPAP

You may have been given a few choices for helping you sleep better - a CPAP, an oral appliance that pulls your lower jaw/tongue forward, perhaps a referral to an ENT for nose/sinus surgery, lose weight, or to do nothing at all. What you likely were not told is that you can actually treat the root cause(s) of sleep apnea. You may not have been given the choice because conventional medicine looks at a conventional system of care - a pill, a machine, or a surgery to treat the symptom. When one understands the underpinnings that cause sleep apnea, then one can look for solutions to undo the disease rather than first-aid measures. Conventional treatments look to manage disease; functional therapies look at a solution or cure. A CPAP is fantastic for the patient looking for initially stabilizing and maintaining an airway, but it is not a long-term solution. CPAP is considered the gold standard of care in sleep medicine and it is often the long-term care recommendation by most sleep docs. Something to realize is that you are pumping humidified air into your lungs (maybe your stomach as well) so you can breathe, but it is not treating the source of the problem. Sleep apnea only gets worse with age and/or weight gain, despite the use of a traditional sleep oral appliance or CPAP.  A CPAP or a conventional oral sleep appliance is better than absolutely no treatment. And, despite compliance with a CPAP or an oral device, you may still feel exhausted because your breathing habits/muscle function/airway structure has not been helped and your flight-or-fight system has not been managed. When you have the option of a solution or cure, you can be well and thrive, rather than survive. At AirSync we are here to help get you the treatment and sleep that you deserve.

CPAP INTOLERANCE

Despite having a mask strapped to your face, CPAP intolerance generally arises from the inability to breathe well through the nose, maintain lip seal, and having the tongue suctioned lightly up to the palate. One must know how to breathe through the nose as well as be able to breathe through the nose for air to flow easily through the nasal passages.

If you are destined for a CPAP, you can increase the effectiveness of the machine with nasal hygiene as well as oral myofunctional therapy. Come find out how!