Airway-Focused Dentistry

The Airway-Dental Connection: A Paradigm Shift in Oral Health

Traditional dentistry has long focused primarily on teeth and gums—treating cavities, performing cleanings, straightening teeth, and addressing obvious oral problems. While these services remain essential, they represent only part of the picture. Airway-focused dentistry takes a broader, more comprehensive view, recognizing that your oral structures play a crucial role in how well you breathe—both during the day and especially during sleep.

At Aloha Sleep Apnea & Airway Center, we specialize in the intersection of dental health and breathing, particularly as it relates to sleep-disordered breathing. Our approach recognizes that the mouth is not an isolated system—it’s the gateway to your airway and intimately connected to your overall health and well-being.

The Hidden Epidemic of Breathing-Related Problems

Breathing dysfunction is far more common than most people realize:

• 25 million Americans have obstructive sleep apnea, with 80% of moderate to severe cases undiagnosed
• 90 million Americans snore regularly, indicating some degree of airway compromise
• 50-75% of children with ADHD symptoms may actually have sleep-disordered breathing
• 40-50% of adults habitually breathe through their mouth rather than their nose
• 20-30% of children are chronic mouth breathers, affecting their development

These statistics represent real people whose quality of life, health, and longevity are affected by airway problems that often go unrecognized and untreated.

Understanding How Your Mouth Affects Your Breathing

Your oral cavity is the entryway to your airway. The structures within and around your mouth—your jaw, tongue, palate, tonsils, and soft tissues—directly determine how freely air can flow to and from your lungs. When these structures are malformed, malpositioned, or malfunctioning, breathing suffers.

Jaw Position and Size

The size and position of your jaws profoundly impact your airway:

Recessed Lower Jaw (Retrognathia):

• Pushes the tongue backward toward the throat
• Reduces space in the pharynx (throat)
• Creates the appearance of a “weak chin”
• Strongly associated with obstructive sleep apnea
• Often develops due to mouth breathing during childhood

Narrow Upper Jaw (Maxillary Hypoplasia):

• Limits space for the tongue, which rests on the palate
• Forces the tongue into a lower, more posterior position
• Associated with high, narrow palate
• Correlates with nasal obstruction and mouth breathing
• Often presents with dental crowding

Bite Misalignment (Malocclusion):

• Can affect jaw position during sleep
• May contribute to jaw muscle strain
• Often indicates underlying skeletal issues
• Can worsen over time without treatment

Soft Tissue Considerations

The soft tissues of your mouth and throat affect airflow:

Tongue Size and Position (Macroglossia):

• A large tongue is more likely to obstruct the airway
• Low tongue posture pushes the tongue toward the throat
• Tongue tie (ankyloglossia) restricts proper tongue placement
• Weak tongue muscles may allow backward collapse during sleep

Soft Palate and Uvula:

• Elongated soft palate can partially block the throat
• Thickened tissue narrows the airway
• These structures vibrate during snoring
• Can collapse during sleep apnea events

Tonsils and Adenoids:

• Enlarged tonsils narrow the oral airway
• Enlarged adenoids obstruct nasal breathing
• Particularly important in children
• Common cause of pediatric sleep apnea

Tongue Posture and Function

Where your tongue rests and how it functions matters enormously:

Proper Tongue Posture:

• Tongue should rest against the palate
• Lips should be sealed at rest
• Breathing should occur through the nose
• This posture helps maintain airway patency and guides proper jaw development

Improper Tongue Posture:

• Low, forward tongue position
• Open-mouth posture
• Associated with mouth breathing
• Contributes to airway collapse during sleep
• In children, leads to altered facial development

Tongue Tie (Ankyloglossia):

• Restricted lingual frenulum limits tongue movement
• Prevents proper tongue-to-palate resting posture
• May contribute to mouth breathing and airway issues
• Can be released with simple procedure if indicated

Signs of Airway-Related Issues

Recognizing the signs of airway problems is the first step toward addressing them. Many people have adapted to these issues and consider them “normal” when they’re actually indicators of dysfunction.

Signs in Adults

Sleep-Related Symptoms:

• Snoring (any amount is abnormal)
• Gasping or choking during sleep
• Witnessed breathing pauses
• Waking unrefreshed despite adequate sleep time
• Frequent nighttime urination
• Night sweats
• Vivid dreams or nightmares (related to oxygen desaturation)

Daytime Symptoms:

• Excessive daytime sleepiness
• Morning headaches
• Difficulty concentrating or “brain fog”
• Memory problems
• Irritability or mood changes
• Fatigue despite “enough” sleep

Oral and Dental Signs:

• Dry mouth, especially upon waking
• Teeth grinding (bruxism)—often a sign of airway protection
• TMJ pain and dysfunction
• Crowded teeth or narrow dental arches
• Mouth breathing
• Scalloped tongue (indentations from pressing against teeth)
• Tongue tie visible upon examination

Physical Characteristics:

• Forward head posture (head in front of shoulders)
• Large neck circumference
• Recessed chin or small jaw
• Long, narrow face
• High, narrow palate

Signs in Children

Pediatric airway issues are particularly important to recognize because intervention during growth can permanently improve development:

Sleep Observations:

• Snoring or noisy breathing during sleep (not normal in children)
• Mouth breathing while sleeping
• Restless sleep, frequent position changes
• Sleeping in unusual positions (neck hyperextended)
• Bedwetting beyond age 5 (strongly linked to sleep apnea)
• Excessive sweating during sleep
• Difficulty waking in the morning

Behavioral and Cognitive Signs:

• ADHD-like symptoms (hyperactivity, inattention)
• Behavioral problems at school or home
• Difficulty concentrating
• Poor academic performance
• Mood swings and irritability
• Aggressive behavior

Physical Signs:

• Mouth breathing during day
• Dark circles under eyes (“allergic shiners”)
• Crowded teeth or bite problems
• Long, narrow face
• Visible tonsils
• Speech difficulties (particularly with certain sounds)
• Frequent ear infections
• Chronic nasal congestion

Growth and Development:

• Failure to thrive
• Short stature (growth hormone is released during deep sleep)
• Delayed development

The Science Behind Airway-Focused Dentistry

The connection between oral anatomy and breathing is increasingly supported by research:

Craniofacial Development

How your face and jaws develop during childhood largely determines your adult airway size:

• Nasal breathing promotes proper midface growth and palatal width
• Mouth breathing leads to long, narrow facial development with reduced airway space
• Tongue posture influences how the palate develops
• Early intervention during growth can permanently improve airway dimensions

This is why identifying airway issues in children is so critical—the window for influencing growth eventually closes.

The Bruxism-Airway Connection

Teeth grinding is often a protective mechanism:

• When the airway becomes obstructed during sleep, the brain triggers jaw clenching
• This muscular action pulls the jaw forward, opening the airway
• While this saves the airway, it damages teeth and overworks jaw muscles
• Treating the underlying airway issue often reduces bruxism

Systemic Health Connections

Airway dysfunction affects far more than sleep:

• Cardiovascular: Obstructive sleep apnea increases risk of hypertension, heart attack, stroke, and arrhythmias
• Metabolic: Links to insulin resistance, type 2 diabetes, and weight gain
• Cognitive: Memory impairment, dementia risk, difficulty concentrating
• Mental Health: Depression, anxiety, mood disorders
• Inflammation: Chronic inflammation affecting multiple organ systems
• Immune Function: Impaired immune response and increased infection susceptibility

Professional Recognition

The importance of airway-focused care is recognized by major organizations:

• American Academy of Dental Sleep Medicine (AADSM) provides guidelines for dental treatment of sleep-disordered breathing
• American Academy of Sleep Medicine (AASM) recognizes oral appliances as first-line treatment for mild-moderate OSA
• American Dental Association (ADA) acknowledges dentistry’s role in screening for and treating sleep apnea
• American Academy of Pediatrics recommends screening children for sleep-disordered breathing

Our Airway-Focused Approach

While we specialize specifically in oral appliance therapy for sleep apnea and snoring in adults, our entire approach is informed by airway-focused principles.

Comprehensive Evaluation

Every patient receives a thorough assessment including:

Airway and Breathing Assessment:

• Mallampati classification (visibility of throat structures)
• Tongue size, position, and mobility evaluation
• Tonsil assessment (if visible)
• Nasal breathing evaluation
• Signs of mouth breathing
• Neck circumference measurement
• Facial profile analysis

Dental and Skeletal Evaluation:

• Jaw size and position
• Bite alignment
• Dental arch width
• Tooth crowding or spacing
• Signs of bruxism (wear facets, cracked teeth)
• Gum recession patterns

TMJ and Muscle Assessment:

• Jaw joint function
• Muscle tenderness
• Range of motion
• Clicking, popping, or crepitus
• Signs of clenching or grinding

Sleep History:

• Sleep quality and patterns
• Snoring and witnessed apneas
• Daytime symptoms
• Previous sleep studies
• Current treatments

Integrated Treatment Approach

Based on your evaluation, we develop an appropriate treatment plan:

Oral Appliance Therapy: Our primary treatment for adults with obstructive sleep apnea and snoring. Custom devices reposition the jaw to open the airway during sleep, addressing the mechanical cause of obstruction.

TMJ Considerations: We evaluate and address jaw joint health as part of comprehensive treatment, recognizing the connection between airway issues and TMD.

Coordination with Specialists: We work collaboratively with:

• Sleep medicine physicians for diagnosis, treatment authorization, and efficacy verification
• ENT specialists when nasal obstruction, enlarged tonsils, or throat issues require evaluation
• Orthodontists when palatal expansion or jaw development could improve the airway
• Myofunctional therapists for muscle retraining and proper tongue posture
• Oral surgeons when surgical intervention may be appropriate
• Primary care physicians for overall health coordination

What We Treat

Primary Focus: Sleep-Disordered Breathing

Our expertise centers on treating diagnosed sleep apnea with oral appliance therapy:

• Mild to moderate obstructive sleep apnea (AHI 5-30)—oral appliances are first-line treatment
• Severe OSA in CPAP-intolerant patients—when CPAP isn’t tolerated
• Primary snoring—after ruling out underlying sleep apnea
• Upper airway resistance syndrome—when present

Screening and Coordination

While we don’t diagnose sleep apnea (that requires physician-ordered testing), we:

• Screen for airway issues during all evaluations
• Identify patients who should be tested for sleep apnea
• Recognize signs of breathing dysfunction that warrant further evaluation
• Coordinate testing with sleep medicine physicians
• Refer appropriately when other specialists are needed

The Impact of Airway-Focused Care

Patients who receive proper airway assessment and treatment often experience:

Sleep Quality Improvements

• Reduced or eliminated snoring
• Fewer nighttime awakenings
• More restful, restorative sleep
• Waking feeling refreshed

Daytime Function Benefits

• Increased energy and alertness
• Improved concentration and memory
• Better mood and emotional regulation
• Enhanced work performance

Health Improvements

• Better blood pressure control
• Improved blood sugar regulation
• Reduced cardiovascular risk
• Decreased inflammation

Relationship Benefits

• Restored bed partner’s sleep
• Improved intimacy
• Reduced tension from snoring-related frustration

Beyond Sleep Apnea Treatment

While oral appliance therapy for diagnosed sleep apnea is our specialty, our airway-focused perspective informs everything we do:

Comprehensive Screening

We look for signs of breathing dysfunction in every patient, not just those with obvious sleep complaints.

Patient Education

We help patients understand how their oral anatomy affects their breathing and overall health, empowering informed decisions.

Early Identification

We identify adults and children who may benefit from specialist referral for airway issues beyond our treatment scope.

Whole-Person Care

We consider how treatment decisions affect not just teeth, but breathing, sleep, and systemic health.

Taking an Airway-Conscious Approach to Your Health

If you’re concerned about how your breathing might be affecting your health, or if you’ve been told you snore, grind your teeth, or may have sleep apnea, an airway-focused evaluation can help identify issues and solutions.

At Aloha Sleep Apnea & Airway Center, we provide thorough assessment and, where appropriate, effective oral appliance therapy to address sleep-disordered breathing. We serve patients throughout Aloha, Hillsboro, Beaverton, Portland, and the greater Oregon metro area.

Note: Home sleep apnea testing (HSAT) is ordered and interpreted by a physician. We coordinate testing and provide oral appliance therapy as a CPAP alternative in collaboration with the patient’s sleep physician.

Schedule a consultation to learn how airway-focused care can improve your breathing, your sleep, and your life.