March 9, 2017
by Howard Hindin, DDS, Michael Gelb, DDS
There is an Airway Centric paradigm shift in dentistry. We are excited that this edition of Oral Health is being devoted to Airway Health and Airway in Dentistry. The term AirwayCentric® was created to give healthcare practitioners and consumers and new way of looking at dentistry and healthcare. We invite you to be part of the change.
In 2009, during breakfast together at a diner, we were discussing our TMD /sleep practices and realized how many of the patients treated, we should never have had to see. Their sleep and airway problems were there for years, probably from childhood – maybe even from before birth. Without the airway problem ever being discovered by patient or practitioner, interventions produced only symptomatic and temporary relief. The increased cost of compensating for a restricted airway continued to be expressed and exact its toll as renewed health, function, and performance problems. Here was an issue that was not in search of a cure, but in search of recognition.
This conversation give birth to the creation of AirwayCentric® (philosophy, appliances and education), the American Academy of Physiological Medicine and Dentistry (AAPMD), the Foundation for Airway Health, and the book, GASP: Airway Health; The Hidden Path to Wellness, along with the terms “Hidden Airway”, “Connecting the Dots”, White Flag Event” and “Airway for All”.
Maintaining the airway is the most important physiological function. It trumps everything. Dr. Arthur C. Guyton, MD, physician and physiology text book author states, “All chronic pain, suffering, and diseases are caused by a lack of oxygen at the cell level.”
What is a paradigm shift? A paradigm shift is defined as an important change that happens when the usual way of thinking or doing something is replaced by a new and different way. There is a transformational and fundamental change in the way of thinking and behaving. This change is driven by new information and societal needs. Think digital watches, the germ theory, the brain is plastic, and the world is not flat. Paradigm shifts are characterized by periods of denial, ridicule, attack, growing belief and finally acceptance.
What is the paradigm shift in dentistry? For many years the practice of dentistry was focused on dental health, the care and repair of teeth and supporting structures. We call it the “tooth paradigm”. Dental specialities, the “dontics” such as prosthodontics, endodontics, periodontics, orthodontics, were created to focus on parts of this dental universe. Teeth, their internal and external structures and how they occluded was and for the most part, is still the focus of dental education and practice.
The past few years have seen a meteoric growth in sleep and dental sleep medicine. Today there are over 100 appliances approved for treating sleep apnea. Dentists are increasingly screening for proper nasal breathing and restricted frenums. Integrated medicine physicians and dentists are realizing the sleep / nutrition connection and the need for co-diagnosis and co-treatment. It is said that paradigm shifts are propelled when the current paradigm is not working. The increase of chronic health, learning and performance problems to epidemic levels requires, rather demands a new paradigm.
Researchers continue to show the importance of sleep and airway and it’s effects on growth, development and learning, (Bonuck), memory, (Nedergaard), ADHD, (Gozal and Sheldon) and dementia, (Ancoli-israel). This scientific support provides comfort and courage to look at things differently.
We remember cases presented in the past by Harold Gelb, Brendan Stack, Willie May and others showing dramatic changes in health by dental interventions that could not be explained and therefore were not believable or widely accepted. Now they are are suddenly viewed as plausible and possible when airway function is considered. The AirwayCentric® paradigm expands care past the teeth and the “dontics” to the nose, throat, muscles of the tongue, face, neck – and – beyond to the rest of the body. Suddenly it is all related. We are fixing more than the teeth. We are fixing the person, restoring more optimal health and function.
According to Mark Murphy, DDS, adjunct lecturer at the Pankey Institute, speaking at the Foundation for Airway Health, (FAH), White Flag Event, (WFE) in 2016, “Airway is the Unifying Factor in Dentistry”. Also, as part of the WFE, Barry Raphael, DDS, a leader in the airway orthodontic movement organized a meeting of orthodontic practitioners from across the country, with different and competing philosophies and techniques. On this day, nineteen practitioners were each give seven minutes to speak about how their method contributed to a better airway. At the end of the day, all agreed, in spite of their differences, they could all support a pledge to protect, maintain and restore the airway and to screen all patients for airway disorders. Airway does indeed trump everything in dentistry.
So much has happened in the past few years. Continuing education catalogues are featuring more sleep and airway courses. Medical and dental organizations are holding combined meetings on topics of collaborative care.
The American College of Prosthodontists, in a 2016 position paper states, “prosthodontists should include a mandatory screening for OSA through questionnaires for their patients”. The American Academy of Pediatric Dentistry has issued a similar position statement. The world is changing.
The AirwayCentric Model was created to bring dentists of differing philosophies and practitioners of different modalities together to create methods and protocols for better care solutions.
We are excited about what the future will bring. We look forward to the day where an airway screening will be routine and the standard of care; where there will be no “hidden airway” problems that go unrecognized and treated solely as something else like ADHD, chronic pain, or anxiety; where chronic disease sufferers with airway / sleep problems will be screened and have their airway component acknowledged and treated. We see a future where practices will be airway centric and focused earliest identification, intervention and prevention. OH
About the Authors
Dr. Howard Hindin is celebrating 50 years of practice in all aspects of general dentistry, with an emphasis on cosmetic dentistry, temporomandibular joint disorders, craniofacial pain and sleep dental medicine. An acknowledged pioneer in the relationship between dental issues and whole body health, he was one first dentists to eliminate the use of mercury from his practice.
Dr. Hindin was President (2000-2010) of the Foundation for the Advancement of Innovative Medicine (FAIM). In addition, Dr. Hindin advanced the use of acupuncture in dentistry and general medicine as the Director of the Acupuncture Program for Substance Abuse in Rockland County.
Dr. Hindin is the co-founder and president of the Academy of Physiologic Medicine and Dentistry (AAPMD).
Michael Gelb DDS, MS has created AirwayCentric(R) Dentistry and Orthodontic Philosophy and Curriculums . Drs Gelb and Hindin have written GASP , founded the Foundation for Airway Health and are actively involved in the Airway for All 15/50 by 2020 campaign through the dental team. He is the Director of The Gelb Center in NYC and Westchester, NY.