The Dental Relation to Oral Function, Sleep Apnea and Related Conditions

In dental school, during the process of learning about reconstructing a mouth, that has no teeth, utilizing full dentures, sometimes referred to as upper and lower plates, we learned about the impact of the whole mouth upon the tongue as it relates to “swallowing” and “speaking” and “overall muscle balance and comfort”.

When a mouth is missing these teeth we must determine where to position the jaws: How up/down far apart must they be?

  • What is the backward/forward relation between the top (maxilla) and bottom (mandible)?
  • What is the right/left relation of them?

We also must determine from this:

  • The size and shape to make the teeth
  • How to best position the teeth
  • How to replace and contour (even with different contours (bumps and recesses) the gums and underlying bone that replaces that of the missing jaw bone and gums.

All of this is designed to be in harmony with ease of speaking, swallowing and ease of breathing.

Ease of breathing had not been seen by many dentists as a condition directly impacted by the dental profession.  In Snoring and Obstructive Sleep Apnea, second edition by David N. F. Fairbanks, et al, I note the first reported use of a dental appliance was in 1934 by Pierre Robin to pull the jaw and tongue forward in people with smaller (retruded or receded) lower jaws.

In the mid-1980s this concept got more attention. The dental relationship to obstructive sleep apnea has provided an opportunity to recognize the link between dentistry and airway control of airflow and breathing – our body’s most fundamental need.

As I discussed in prior articles, our knowledge of the basic CPR priority of airway-breathing-circulation (A-B-C) addresses this fundamental need and its impact on life and death.

To manage airflow our body instantly compensates for any degree of obstruction or blockage.  The body adapts to make sure the airway is open and air can flow into our lungs.

Through these compensations, the body robs from “Peter” to pay “Paul” to keep us alive. The immediate and subsequent impact, of this, can be measured physiologically and readily picked up through the eyes of a trained, skilled and focused observer.

As the medical and dental communities address obstructive sleep apnea and all the complications from it, you can see that dentistry plays a major, if not the primary role.

Snoring, Sleep Apnea and Human Health

I have shared in many articles how snoring and sleep apnea are symptoms of round-the-clock airway airflow limitations from impaired oral function as it impacts our ease of swallowing, speaking and breathing.  This is a function of the jaw-tongue-throat relationship, as the size, shape and position of the jaws (including teeth and gums) impacts the posture and position of the tongue in the throat, the dynamic portion of an otherwise static semi-rigid airway.
I have pointed out how we are “wired to survive.” And, I discussed how a perceived threat to our survival triggers our “fight or flight” response with release of adrenaline type “stress hormones” into our bloodstream to facilitate breathing and circulation of oxygen to, and carbon dioxide from our cells, most important, of course, are those most immediately impacting our survival.
Our body survival priority, according to medicine, is that of cardio-pulmonary-resuscitation, referred to as CPR. This must be addressed in the sequence of airway, then breathing, then circulation, which is abbreviated as A-B-C.  Medicine recognizes this in life threatening emergency situations, however, in my opinion, it does not recognize this as the “all the time” priority of our body functioning to keep us alive and manage balance (homeostasis) through our autonomic nervous system (ANS), which controls this “fight or flight” “stress” response.
There may be a critical oversight in our understanding of how the body works. The specialization design of medicine, including dentistry, can lead to a fragmented view of a fully integrated system that, most likely, functions according the ABC of CPR.
From this perspective, we will persistently ask why the body is behaving in this way or that way to keep us alive (survive) and how it impacts our “vital aliveness” our health?
My prior discussions relating to the priority of survival show how the body continually compensates to keep us alive, beginning with airway/airflow management through:
  • Going into a fight or flight state with adrenaline type hormone release,
  • Forward head and other postural changes, and,
  • Clenching and grinding of teeth.
I believe these compensations lead to many unwanted chronic conditions. Minimally, because the intimate relation of the “stress”, which is really the stress hormone sensations we are both conscious and unconscious of and beyond that the impact of this upon the endocrine glands (hormone system) that integrates with (effects and effected by) all other body systems.
Health is thriving, not just surviving. Manage the airway for ease of swallowing, speaking and breathing to minimize the need for compensations.  I believe this is the key to health; this is the focus of Oral Systemic Balance, (OSB).