Airway Dentistry: Looking Beyond Teeth to Improve Breathing, Sleep and Overall Health

When most people think about dentistry, they think about cavities, cleanings, and straight teeth. Airway dentistry takes a broader approach by evaluating how the structures of the mouth, jaws, tongue, and airway work together to support healthy breathing, quality sleep, and long-term oral health.

Many common dental problems—such as tooth wear, clenching, grinding, gum inflammation, and even crowded teeth—can be signs of underlying airway issues. By identifying these signs early, we can help patients understand how their oral health may be connected to the way they breathe both day and night.

What We Evaluate During an Airway Assessment

An airway-focused dental examination looks at much more than just the teeth.

Teeth

The teeth often provide some of the earliest clues that breathing or airway concerns may be present. During an evaluation, we look for:

· Signs of clenching and grinding

· Excessive tooth wear

· Notching at the gumline (abfraction lesions)

· Tooth position and alignment

· Spacing versus crowding

· The width and shape of the palate (roof of the mouth)

A narrow palate, significant tooth wear, or chronic grinding may suggest that the body is compensating for airway restriction, particularly during sleep.

Tongue

The tongue plays a critical role in proper breathing and facial development. We evaluate:

· Tongue size

· Indentations or scalloping along the sides of the tongue

· Tongue mobility

· Tongue-tie restrictions, including both anterior and posterior tongue ties

The tongue should naturally rest against the roof of the mouth. When it cannot do so because of restricted mobility or poor function, it can contribute to mouth breathing, improper jaw development, and airway narrowing.

Throat

The throat provides important information about airway health. We assess:

· Tonsil size

· Signs of chronic inflammation

· Redness associated with open-mouth breathing

Enlarged tonsils or ongoing inflammation can reduce airway space and make breathing more difficult, especially during sleep.

Gums

The condition of the gums can also reveal breathing patterns. We look for:

· Redness or inflammation associated with mouth breathing

· Excessive plaque or tartar buildup, particularly on the lower front teeth

Mouth breathing can dry out the oral tissues, making them more susceptible to irritation, gum disease, and cavities.

Sinuses and Nasal Breathing

Healthy nasal breathing is essential for a healthy airway. During an evaluation, we look for:

· Signs of poor nasal breathing

· Enlarged nasal turbinates

· Tonsil size and condition

· Indicators of chronic sinus congestion

Restricted nasal breathing often leads to mouth breathing, which can negatively affect oral health, sleep quality, and facial development over time.

How We Address Airway Issues

There is no one-size-fits-all solution for airway concerns. Treatment recommendations are highly individualized and depend on the specific causes and severity of each patient's condition.

Palatal Expansion and Skeletal Development

For some patients, the underlying issue involves narrowing of the palate, jaws, or nasal cavity. In these cases, treatment may include:

· MARPE (Mini-Screw Assisted Rapid Palatal Expansion)

· SFOT (Surgically Facilitated Orthodontic Therapy)

· Orthodontics combined with orthognathic (jaw) surgery

These treatments can help widen the palate, expand the sinus cavity, improve nasal airflow, and create more room for the tongue and airway.

Jaw Repositioning Appliances

For patients with airway obstruction during sleep, oral appliances may help maintain an open airway by positioning the lower jaw forward.

These appliances may include:

· Mandibular advancement devices (MADs)

· Snore guards

· Custom sleep appliances

By moving the lower jaw forward, these devices help keep the tongue and surrounding soft tissues from collapsing into the airway during sleep.

Myofunctional Therapy and Tongue-Tie Release

Approximately 3–5% of patients have a significant tissue restriction beneath the tongue that limits normal tongue movement and function.

For these individuals, treatment may include:

· Myofunctional therapy

· Tongue exercises and stretching

· Laser tongue-tie release when appropriate

Think of myofunctional therapy as physical therapy for the tongue. These exercises help strengthen and retrain the muscles involved in breathing, swallowing, and tongue posture. When a restrictive tongue tie is present, releasing that tissue can allow the tongue to properly rest against the roof of the mouth, supporting healthier nasal breathing and improved airway function.

Protecting Oral Health

Airway issues often go hand-in-hand with dry mouth, mouth breathing, snoring, sinus problems, increased cavity risk, and gum disease.

To help support oral health, we may recommend products that promote a healthy oral environment and tissue health, including pH-balanced formulations containing ingredients such as:

· Echinacea

· Arnica

· Calendula

These products can help soothe tissues while supporting healthier gums and reducing the effects of chronic oral dryness.

Custom Nightguards

Not every patient is looking for comprehensive airway treatment. For patients who want to maintain their current condition and prevent further damage, custom-designed nightguards can be an excellent option.

These appliances help protect teeth from:

· Clenching

· Grinding

· Excessive wear

· Fractures and chipping

While a nightguard does not correct the underlying airway issue, it can significantly reduce damage caused by airway-related grinding and clenching.

What Causes Airway Issues?

Research increasingly suggests that airway problems are influenced by a combination of environmental, developmental, genetic, and lifestyle factors.

One factor that has received significant attention is the modern Western diet. Compared to the diets of previous generations, many people now consume softer, highly processed foods that require far less chewing.

Historically, chewing tougher foods required greater tongue movement and stronger jaw function. These forces helped support broader jaw development and proper facial growth.

When the tongue rests low in the mouth and chewing demands are reduced, facial growth may trend toward a longer, narrower pattern rather than a broader, more forward-developed structure. This can contribute to reduced airway space and breathing difficulties later in life.

Genetics and family history also play an important role. Children whose parents experience conditions such as:

· Sleep apnea

· Chronic snoring

· Enlarged tonsils

· Airway restrictions

may be more likely to develop similar issues themselves. Environmental and developmental influences can sometimes cause these conditions to present even more severely in subsequent generations.

Why Airway Health Matters

Airway health affects much more than breathing. It can influence:

· Sleep quality

· Energy levels

· Oral health

· Facial development

· Clenching and grinding

· Gum health

· Overall quality of life

By identifying airway concerns early, we can help patients better understand the connection between breathing, sleep, and oral health and explore treatment options that support long-term wellness.

Schedule an Airway Evaluation

If you experience chronic snoring, grinding, mouth breathing, poor sleep, jaw discomfort, or recurring dental problems, an airway evaluation may provide valuable answers.

Our goal is to listen to your concerns, perform a comprehensive assessment, and explain everything we see. Together, we can discuss treatment options that may improve your airway, support better oral health, and enhance your overall quality of life. We welcome the opportunity to help you better understand your airway health and the role it plays in your daily well-being.

Dr. Thorn is an Ambassador for the Breathe Institute and has completed additional airway training the Dawson Academy, SPEAR and more.