More airway tips from Dr. Ben Miraglia

Several months ago, I put together an airway screening tool for CandidPro providers to help them conduct thorough assessments during hygiene screenings. This tool, which I suggest you download for use in your practice, outlines three essential criteria I look for in my patients: Arch form, arch width, and buccolingual inclination.

To help you make the most of this resource, please review the talking points in this article to help your patients understand the deep connections between malocclusion, airway health, and their whole-body health.

Airway disorders are common‍

Many patients living with an airway health concern may not understand the likelihood of having one. An estimated 80% of Americans with obstructive sleep apnea (OSA) and/or sleep-disordered breathing (SDB) are undiagnosed¹. Let your patients know that airway issues are very common and offer them actionable ways to address these concerns.

Not all airway disorders are the same

‍SDB is an umbrella term that describes breathing difficulties or irregularities during sleep. OSA is a type of SDB that occurs when the airway is partially or completely obstructed during sleep. The causes of these disorders may stem from a variety of maxillofacial issues including malocclusion.

Airway disorders can pose a significant risk

‍Interference with breathing during sleep can put your patients at risk for cardiovascular issues, developmental concerns, depression, endocrine disorders, and more². Make sure your patients understand the severity of OSA and SDB if you see signs and symptoms of these conditions during your evaluation.

Upper respiratory space is key to healthy breathing

‍Review the basic biology behind healthy nasal breathing and why it’s important. You might try something like this:

“Maximizing the space in your upper airway is important for your breathing. It makes breathing easier by allowing for an open, unobstructed pathway for air to enter and leave your lungs.”

The shape of the arch matters

‍Explain the importance of arch shape and symmetry to your patients to help them understand its vital role in maximizing upper respiratory space. Use the images in the Airway Screening Guide as a visual aid.

“Your arch form—the curved alignment of your teeth in your upper and lower jaws—should be symmetrical and U-shaped. If your arch is too narrow or misshapen, your tongue won’t have enough space to rest without interfering with your breathing.”

The dangers of a low tongue posture

‍Give further detail about why the position of the tongue is important to healthy breathing. Demonstrate the proper resting tongue position with a visual aid if possible.

“Narrow and misshapen arches can trap the tongue in a low posture, blocking the passage of air and making breathing difficult—especially while you’re asleep. For proper nasal breathing, the tongue should be surrounded by your teeth and placed firmly against the roof of your mouth.”

Healthy occlusion can benefit healthy breathing

‍Once the patient understands the basic principles behind how their arch and occlusion may be impacting their airway health, it’s easy for them to see how an orthodontic intervention could benefit their breathing.

“Aligning your teeth with CandidPro clear aligners could improve the shape of your arch and create more space for your tongue. Ideally, you’ll end treatment with a fuller-looking smile and a more comfortable bite.”

Set the right expectations‍

Remember, CandidPro clear aligner therapy is not indicated for treating SDB, OSA, or anything other than correcting malocclusion. Clear aligners, on their own, do not replace palate expanders, mandibular advancement devices, or other tools clinicians use to develop the mandible and/or maxilla.

If the patient has an extremely narrow arch, CandidPro clear aligner therapy can increase the tongue space via uprighting. However, a comprehensive treatment plan would likely involve expansion first, followed by CandidPro.

I’m thrilled that more clinicians are interested in learning about the connections between occlusal health and the airway. This specialty has been central to my development as a clinician, and it’s incredible to see more dental professionals explore the principles that have helped me deliver healthier airways to my patients.

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1. Chest 2022;161(4):1083-1091

2. https://www.ncbi.nlm.nih.gov/books/NBK459252/