The ADA Is Embracing Airway Dentistry

It’s become clear to me that the field of myofunctional therapy is in a real growth phase right now. As I say on the homepage of this site, the field is exploding!

Frankly, I think the surge is only just getting started. As more and more patients and medical professionals begin to truly understand the importance of the airway, we’ll see myofunctional therapy become very mainstream and well known.

The American Dental Association (ADA) has recognized that airway health is critical. Earlier this year, there was a new policy statement on the Role of Dentistry in the Treatment of Sleep-Related Breathing Disorders. This statement recommends that dentists screen their patients for sleep disordered breathing, bringing sleep medicine firmly into the dental arena, and not just in the highly specialized way it’s been applied in the past. This is an organizational-level initiative.

Sleep Dentistry is Airway Dentistry

Some readers may wonder how I’m connecting a focus on sleep apnea and other types of sleep disordered breathing with the airway.

Well, sleep dentistry is airway dentistry. You can’t address sleep disordered breathing without addressing the airway. Even if the treatment in question is a mandibular advancement appliance, it’s designed to open the airway.

For example, the SomnoMed website has this to say on the subject of sleep apnea:

“While we sleep, gravity and muscle relaxation allows the tongue and surrounding soft tissue to fall back into the throat area, collapsing the airway and obstructing the air flow.

Continuous Open Airway Therapy (COAT)® is a category of products that treat patients seeking an easy, efficient solution for OSA, or obstructive sleep apnea.”

Regardless of the approach taken to treat sleep disordered breathing, the airway is going to considered one way or another.

Airway Health is Here!

As further confirmation that the ADA is seriously acknowledging the importance of the airway, I noticed the fact that there was an interesting conference recently at ADA Headquarters in Chicago. The conference was titled 2018 Children’s Airway Health – A Practical Conference.

The conference was described as follows:

"The Children's Airway Health – A Practical Conference is a two day event that will impact your ability to recognize compromised airway health in your pediatric patients and give dentists and their team tools for engaging families in the diagnostic and treatment pathways. To be able to make a true difference in the lives of children and families, the dentist needs to recognize children at risk, know what to say, who to work with, and how to get paid for services."

Some of the topics, and the speakers for that matter, would be instantly recognizable to anyone who’s been working in myofunctional therapy for a while.

Dr. Christian Guilleminault, MD is a prolific researcher on the topic of the airway. He spoke about Sleep Disordered Breathing, and Dr. Barry Raphael, DMD spoke about Orthodontics with an Airway Focus.

Other topics included An Airway Focused Approach To Dental Clinical Care by Dr. Mark Cruz, DDS, and it was great to see myofunctional therapy being discussed as well – Kristie Gatto, MA spoke about Myofunctional Therapy and the Airway.

It’s so encouraging to me to see all of these exciting developments in the field. And it definitely isn’t limited to the USA – it’s a global shift.  

I’m leaving in a few days to attend the IAFGG (International Association of Facial Growth Guidance Orthotropics Symposium in London, followed by the AAMS (Academy of Applied Myofunctional Sciences) Congress in Rome.

The list of internationally-based speakers and topics at both events is impressive to say the least. Here’s what will be covered at the AAMS Conference:

• History of Craniofacial Intervention
• Sleep - Pulmonology - Neurology - Psychiatry - Dental Sleep
• Surgery - Sleep Surgery - Oral Surgery - Soft Tissue
• Surgery
• Otolaryngology
• Posture
• Genetics/Epigenetics
• Evolution
• Chewing, Nutrition, and Diet
• Dentistry - Orthodontic - Pediatric Dental - Dental Hygiene
• Psychology of Orofacial Myofunctional Disorders (OMDs)
• Early Intervention, from Pregnancy to Newborn
• Speech-Language Pathology
• Physiotherapy
• Occupational Therapy
• Lactation Consulting
• Public Health
• Research

Click the image below to download the full AAMS Congress flyer.

It’s a sign of things to come – there’s so much research and great work being done around the world, and it will all translate into better outcomes for our patients. Myofunctional therapy is a perfect fit for airway dentistry. There’s no better time to be part of this amazing field!

Sleep Apnea On The High Intensity Health Podcast

As many of you will know, I love being able to spread the message about myofunctional therapy, and all the ways it can be used to help treat and ease so many health conditions. So I was incredibly excited to be asked to appear on Mike Mutzel’s High Intensity Health podcast recently.

Mike's podcast is described as "The Best of Fitness, Nutrition and Functional Medicine", and I think he covers all those topics very well! He's a great interviewer with a real wealth of knowledge. He made me feel very relaxed and comfortable, so I had a lot of fun.

We went over a number of interesting topics that are important to me including sleep apnea, the microbiome and mouth breathing among others, all of which can make a big difference to health and well-being. I hope you enjoy watching this video of the podcast - the interview was professionally filmed, so the production quality is really high.

If you have any questions, comments or other feedback, I'd love to hear from you, so feel free to leave a comment below, or to drop me a note right here

What is a myofunctional therapist’s role when it comes to sleep apnea?

When it comes to sleep apnea, the field of myofunctional therapy seems to be filled with confusion. With so many practitioners from different backgrounds coming together, it’s easy to see why. Myofunctional therapists mostly have degrees in dental hygiene or speech pathology, but we tend to work with specialists ranging from pediatric dentists, orthodontists, and lactation consultants, to chiropractors, massage therapists, cranial osteopaths, and more.

We all have different perspectives on the same part of the body – the mouth – and we all want to do the best we can to provide quality care for our patients. So what makes the topic of sleep apnea so difficult?

I have one word for you, diagnosis.

This one little concept has a lot of fear, liability, protective wording, and general anxiety all wrapped around it, and I’m still not sure why.

As far as I know, the only practitioners who can diagnose sleep apnea are medical doctors. So this means that even a dentist who specializes in sleep dentistry can’t diagnose a patient with sleep apnea.

I’m not a dentist, and I’m definitely not a medical doctor, so this seems pretty cut and dry to me. As a dental hygienist or as a myofunctional therapist, I can’t diagnose a patient with sleep apnea, and neither can the orthodontist who referred the patient to me. Easy right?

What both the orthodontist and I can do however, is to be the best advocate for our patients’ health that we know how to be. As hygienists working in a dental office, we can become familiar with the signs and symptoms of sleep apnea, and discuss these with our patients.

For example, if a patient in your chair tells you that he snores so loudly at night that his wife sleeps in the other room, and that he feels chronically tired and fatigued, and then he falls asleep in the chair while you’re cleaning his teeth, then you can recognize these signs as a potential problem. You can and should ask him about it. These are possible symptoms of sleep apnea, so it’s in the patient’s best interest for you and/or the dentist to recommend that he talk to his medical doctor about them. The dentist can even write a referral to a sleep clinic if your office has one they regularly refer to.

For me, practicing as a myofunctional therapist, I do this exact sort of thing in my own office. If I recognize symptoms that could be related to sleep apnea, I recommend that the patient talk to their doctor about it, and learn more about having a sleep test done.

I’ve linked a great article here from RDH Magazine about our role as hygienists when it comes to sleep apnea.

So what about treating my sleep apnea patients?

I treat them all the time but not specifically for their sleep apnea. I help them with their tongue posture, nasal breathing, chewing and swallowing foods and liquids, and learning new habits – in exactly the same way I work with all my other patients.

My patients who have sleep apnea are much the same as my patients who breathe normally and healthily at night. The only difference is that during their sessions with me, I often ask them about their CPAP machines or sleep appliances, and whether or not they have been wearing them. My goal is to help these patients stay compliant with what their doctors have recommended, and to act as a resource when they have questions.

Sometimes my patients are pretty smart, and they like to research their sleep apnea online. I’ve had a few ask me if the exercises that I teach them will help with their sleep apnea.

I think this is where a lot of myofunctional therapists start to get worried. But there’s no need.

So what do I tell these patients?

“Maybe” is my answer.

I tell my patients that my job is to help them retrain their tongue so that it rests in the proper position inside their mouth. It’s my job to help them learn to breathe through their nose and keep their mouth closed, and it’s my job to help them learn how to swallow without thrusting their tongue forward.

And that’s it!

However, I also tell them that if their sleep apnea symptoms improve by doing exercises, then that’s great. If they don’t improve, then it’s still great that they’ve learned new, healthier habits through working with me.

We are still learning about the benefits of oropharyngeal exercises when it comes to sleep apnea, and several studies, like the one here have been published recently suggesting that exercises may be a good complement to CPAP and sleep appliance use.

But for now, all I know is that it’s my responsibility to be an advocate for my patient’s best health, and that I’m in a really good position to recognize sleep apnea symptoms that may get missed by the patient, or their other practitioners. I’m happy to talk to them about sleep apnea if I recognize the signs and symptoms, because I realize that I may be the first person to catch it early enough to make a difference.

So, for all the other myofunctional therapists out there, and for all the hygienists aspiring to make this field part of your career, I hope this article inspires you to be less stressed and confused when it comes to sleep apnea.

Unless you are diagnosing sleep apnea, or telling patients that you will cure their sleep apnea with your myofunctional therapy exercises, you are on the right track! You’re helping patients by talking to them about it, and that’s the most important thing you can do.

Techie Tips: Three things that have made my life as a therapist and business owner much easier!

It’s a unique time to be a small business owner because of the amount of technology right at our fingertips. It can be overwhelming to know that there is so much out there – where to start? How can it help me?  

When I mentor hygienists and work with my patients, I’m not just a healthcare provider – I need to be “in the know” about the latest and greatest ways to improve what I do and what I teach. In this article, I have highlighted three modern “techie” conveniences that have transformed the way I run my practice and work with my patients. 

SnoreLab App – Snorelab is an App that I like to have my adult patients download to their smartphones or tablets when we get to the sleeping phase of my therapy program. The App is designed to record, measure, and track snoring so that patients can get feedback each morning. It helps them stay in control of their breathing and snoring, and provides me with real data to see when their symptoms improve. As a myofunctional therapist, I want to know if my patients have really changed their habits and health. This App has helped me achieve that when it comes to snoring.

Adobe EchoSign – It’s so important to stay on top of the legal and contractual agreements we enter into with our patients. Adobe EchoSign is an online cloud based system for sending documents, collecting e-signatures, and storing all those important contracts. Making sure I have the right signatures in the right places is very important to me, so I use Adobe EchoSign each time I start a new treatment program with a patient. The patient has full access to all their documents as well, so there is never any confusion about the costs, details, or even whether or not they are alright with their photo being used for educational purposes.

Worktime Tracker App – When you don’t have a boss, and no one is checking whether or not you have “clocked out” for your lunch break, it can be hard to know how much time you actually spend working. That’s why, when I discovered the Worktime Tracker App, I was excited (and a little nervous) to finally be able to track my own hours. Worktime Tracker allows you to track hours spent on specific subjects or projects, which I find very convenient and helpful. I can track how many hours I spend working one-on-one with patients, vs. how much time I spend writing chart entries and doing admin work. It’s a great tool!

These are just a few helpful hints from my bag of tricks. I also use a cloud based accounting system and patient tracking and charting system, so that I can access my data from anywhere and all the security and HIPAA compliance is covered.

What's great is that all of these techie tools are either free or very inexpensive. Part of being a savvy business owner is finding effective ways to do things without breaking the bank. I cover all of these techie tricks and much more in my private and group mentoring programs if you want to find out more.

Snoring In Children Is Making The Mainstream News

Mainstream medicine and dentistry have not always made the link between snoring in children and the harm it can cause, which means that many parents and practitioners have never made the connection either.

As a myofunctional therapist, snoring is one of the first things I screen for in all of my patients - both kids and adults. My job is to look at the airway and find out why my patients breathe through their mouth, or have a tongue thrust or tongue-tie, and to investigate other underlying health issues related to breathing. Snoring in particular, can be an indicator of deeper, more involved airway problems, and the symptoms of airway problems are exactly what I treat.

Research shows that snoring and sleep apnea in children can lead to impaired concentration, poor memory, and difficulty focusing and learning at school. So sleep problems in children are very serious.

As a practicing myofunctional therapist and trainer, I was thrilled to see this subject covered in a current affairs segment on Australia’s high-profile 7 News Network. The program on sleep apnea in young children was called Sleepless Nights. It’s thought provoking stuff for any parent, and for us as hygienists, or for those of you with an interest in myofunctional therapy. 

To watch the video, click the image below.

The lead-in to the segment on the broadcaster’s website has this to say on the topic:

“If your child snores, no matter how quietly, you may have a big problem on your hands. What most parents don’t know is that while they are sleeping, their snoring children could be suffering long-term damage.

More than half of Australian children suffer from a sleeping disorder, and the effects can last a lifetime. Experts know that a lack of sleep leads to reduced IQ, developmental issues and can even stunt a child’s growth.”

I’m happy to see other countries recognizing this problem because it definitely happens in the USA too. I see signs and symptoms related to sleep apnea in my practice all the time, and unfortunately I’m often the first healthcare provider to notice them.

If parents aren't aware of obvious loud snoring, another key thing us hygienists can tell them to watch for in their children is an open mouth. An open mouth during the day can be one of the first signs of trouble with sleep and breathing at night. It’s for this reason that I always recommend that parents and healthcare providers treat an open mouth as soon as they see the signs of it in children. Myofunctional therapy is one of the best ways to address airway issues such as snoring and other related symptoms, and this is covered in detail in my Introductory Mentoring Program.