by Tom Colquitt, DDS
The early focus of “Dental Sleep Medicine”, thanks to Dr. Thornton’s development of the first TAP appliance, was to bring the mandible and tongue up and forward to provide a passive pharynx and a patent airway during sleep. During that era we were thinking more about providing “air in – air out” as the goal, and not considering how to maximize the efficiency of gas exchange during breathing.
Now we know that if we open the airway with an appliance which still permits oral breathing, we are missing out on the opportunity to provide the maximum benefits for our patients.
Nasal inhalation cleans, humidifies, and warms the inspired air.
Oral inhalation does not.
Nasal inhalation mixes Nitric Oxide, secreted by the paranasal sinuses, with the air before it encounters the tonsils, adenoids, and oropharyngeal airway on its way to the lungs. The NO kills invasive pathogenic microorganisms before they can reach these structures, minimizing the risk of inflamed T&A and respiratory tract infections. It is also a potent vasodilator which enhances the transference of O2 from the alveoli to the hemoglobin in the erythrocytes, maximizing the O2 saturation potential of the brain and organs.
Oral inhalation does not.
Nasal breathing should be driven by the diaphragm to fully fill and empty the lungs, and which is also the pump for the lymphatic system.
Oral breathing typically is from the top 1/3 of the lungs using the intercostal muscles, diminishing the body’s attempt to ward off and deal with infection and inflammation.
Nasal exhalation keeps the nasal airway moist and warm and limits the overbreathing of CO2 to maintain blood pH.
Oral breathing dries out the mouth and nasal passages and can expel too much CO2, creating the crisis of hypocapnia.
The blood becomes acidic, bodily systems which include tubes constrict to compensate (often causing nasal congestion), and the O2 that actually makes it to the hemoglobin does not get released to the tissues due to the Bohr Effect. The SPO2 may look great on oximetry, but the entire body is undergoing hypoxic inflammation.
Once we understand this, the need to not only provide airway patency but to help our patients develop nasodiaphragmatic breathing to improve their health 24/7/365 – not just during the third of their lives they spend sleeping – becomes obvious and should be included in any dental airway improvement protocol.
This requires patient education and behavior modification for the patient to self-regulate their breathing from their previous dysfunctional breathing behavior so that their impaired physiology can correct itself.
In our practice, once the patient understands these things, we begin a regimen of having them clear their nose before bedtime and then seal their lips with tape (Buteyko Snorless Strips, 3m gentle paper tape) before they go to bed and sleep with the tape in place, assuming they are able to inhale and exhale without obstruction in their nasal airways. This is for patients who do not require nocturnal protrusion with a MAD.
For those patients who need mandibular stabilization or protrusion to provide nocturnal airway patency, Dr. Thornton has produced the new MyTap with a bent post which helps provide more tongue room with minimal protrusion and the oral obturator which now accompanies the MyTap. The soft obturator fits over the end of the appliance post. Instead of sealing the lips from without using tape, the soft flange of the obturator fits comfortably (can be trimmed with scissors) in the anterior vestibule, sealing the oral airway from within to maximize proper gas exchange and keep the mouth moist during sleep.
Tape can leak around the edges during sleep, minimizing its effect. The obturator is probably more predictably efficient in encouraging nocturnal nasodiaphragmatic breathing than the tape.
Score another one in the win column for Dr. Thornton.
Married to Virginia Newell Colquitt since 1967
Two grown daughters and 4 grandchildren.
BS in English from Centenary College of Louisiana
DDS from Baylor College of Dentistry
Practice of General Dentistry in Shreveport, LA since 1970
Former Trustee of Baylor Dental College
Fellow, American College of Dentists
Past President of Baylor Century Club, Northwest Louisiana Dental Association, Ark-La-Tex Dental Congress, Southwest Academy of Restorative Dentistry, American Academy of Restorative Dentistry, International Academy of Gnathology, American Section. Recipient of the IAG’s McCollum Award.
Fellow, American College of Dentists.
Co-originator of the “Through the Eyes of the Master” Educational video series of AARD.
Visiting faculty teaching prosthodontic residents at Wilford Hall AFB and UTHSCSA Dental School during Dr. Cronin’s tenure at both institutions.
Three articles published in Journal of Prosthetic Dentistry.
Lectured nationally and internationally on Bruxism and Restorative Dentistry since the 1980s., and on Airway-Centered Dentistry since 2006.
Adjunct professor, Sleep Fellowship Program, LSUHSC medical school in Shreveport, LA, since 2007. Present airway from dental prospective to departments of Sleep, Neurology, and Pediatrics annually.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of Airway Management.