• Preamble
• Objectives
• Concepts that will be covered
• Teaching Modules

The infant child is born as an obligate nasal breather which fosters proper craniofacial development via a natural feeding and breathing pattern. The most important and immediate physiologic function at birth is the maintenance of breathing which is driven at the level of the brain stem. This necessary function trumps all other non-autonomic physiologic functions as it is the CNS’ (central nervous system) drive to keep the individual alive from one second to the next with less concern for all other physiologic functions occurring from one moment to the next. This reality does not change for the lifetime of the individual and all physiologic systems are influenced accordingly. With that said, proper craniofacial growth and development is initially driven by brain development in the first 2 years of life followed by facial development in the following several years. The development of the airway is the “keystone” for facial development (Enlow) and is the major factor in determining gnathologic function and development as well as proper physiologic sleep and diurnal breathing function. These events are not solely driven by genetics as was previously believed and in fact are strongly influenced by epigenetic (“above the genes”) factors (environment).

This premise provides the context for the curriculum described below. It is a sea-change in how we see the role of the dentist, orthodontist and all related healthcare providers. Sleep disordered breathing, Temporomandibular Disorders (TMD), dental crowding, bruxism/clenching, craniofacial distortions, ADHD (Attention Deficit Hyperactivity Disorder), ARCD (Airway Related Craniofacial Dysfunction) and many other medical sequelae are considered signs and symptoms of the deficient airway in the vast majority of case.

It is our goal to provide a foundation to provide a wellness approach to dental health and development versus disease management of the various associated signs and symptoms. It is much more than about teeth, gums, muscles and joints. This approach does not obviate traditional dental intervention, but rather enhances its delivery and clinical outcomes by taking a global approach to the many problems we manage on a daily basis.

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At the conclusion of the curriculum, the participant will be able to:

1. Understand the concept of Airway-related Craniofacial Dysfunctions (ARCD)
2. Provide adult orthopedic arch development to improve airway function
3. Receive certification for the delivery and management of the Homeoblock orthopedic appliance
4. Deliver and objectively titrate jaw repositioning devices
5. Understand how to provide pharyngometry and rhinometry services to assess airway function
6. Assess patients for relevant Airway-related Signs and Symptoms
7. Use a variety of objective instruments and interpret the findings
8. Manage cases with Airway-Related Craniofacial Dysfunction
9. Collaborate with other dental and medical professionals in a very meaningful capacity for the patient’s well-being
10. Implement business protocols in your practice for these services and to enhance dental restorative services
11. Provide a foundation from which to further your education toward more specialized focus ie, the pediatric patient, sleep medicine focusing on OSA versus UARS, non-retractive orthodontics
12. Transform your role as a healthcare provider into a more meaningful role for the patient’s quality of life and well-being as well as personal reward that will set you apart in your healthcare community

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• Sleep disordered breathing goes well beyond obstructive sleep apnea.
• Appliance therapy is not sufficient because this condition goes well beyond reestablishing normal sleep patterns.
• Deficient and aberrant craniofacial developments are not typically just genetic disorders.
• The deficient airway has many dental and medical sequelae.
• Optimal physiologic management of sleep disordered breathing goes beyond the use of a device, CPAP, BiPAP, jaw repositioning devices etc.
• The worn dentition (posterior and anterior) can be associated with the “constricted airway” versus a “constricted envelope of function.”
• There is a relationship between ADHD (child/adult) and the deficient airway/SDB.
• The dentist can enhance the patient’s well-being beyond dental health.
• There are benefits to a wellness model of care in dentistry.
• The risk of SDB often begins at birth.
• Genetics versus epigenetics in craniofacial development and function.
• Aberrant craniofacial development poses as a major risk factor for TMD (Temporomandibular disorders).
• Physiologic, organic occlusion is related more to proper airway function than centric relation.
• Quantify excessive vertical growth tendencies and how to mitigate in the growing child.
• Why SDB is so prevalent worldwide.
• Sleep medicine is more about re-establishing proper nasal breathing function than the use of devices in most cases.
• There is a difference between disease management versus wellness long-term.
• Long-term risks of CPAP, jaw repositioning devices’ and the various surgical interventions.
• How to properly titrate jaw repositioning devices objectively.
• The role of the ANS (Autonomic Nervous System) in SDB and overall health.
• How to intelligently collaborate with the ENT, pulmonologist, cardiologist and family physician/Internist.
• Evaluation of airway function is a global diagnostic consideration in determining comprehensive dental well-being and optimal function.

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• “The Great Leap Forward”
• Craniofacial/airway development: ontogeny
• Epigenetics
  • A view of facial morphology as a primary risk factor
• SDB: UARS versus OSA
• The clinical airway exam
  • HRPO
  • Cardiopulmonary Coupling
  • Pharyngometry/rhinometry
  • CBCT
  • The physical exam and interview
  • End Tidal CO2 and breathing dynamics
  • Effects of SDB and CNS function
• Multidisciplinary intervention
  • CPAP
  • Appliance therapy
  • Orthotropics
  • Orthognathic surgery
  • ENT (hygiene, medical, surgery)
  • Expansion orthodontics (surgically assisted)
  • Cranial sacral intervention
  • Myofunctional Therapy
  • Cardiovascular ramifications
  • Ortho-Postural Training (Breathing, Posture, Nutrition, Sleep)
  • Facial pain and TM dysfunction
• Early Intervention: Orthotropics
  • Prenatal
  • Postnatal
  • Early Feeding
  • Early Breathing
  • Early Posture
  • Early Sleep
• The important role of orthodontics in airway development & management
  • Undoing the damage
  • Expansion
  • Myofunctional Orthodontics
  • Airway-conscious orthodontics
• Habit control and lifestyle changes
  • Orofacial Myofunctional Therapy
  • Breathing Dynamics
  • Posture and bodywork
  • Nutrition as an underlying foundation
  • Sleep hygiene
• Real-world implementation of Airway Focused Dentistry: The "wellness model"
  • Setting up office systems
  • Establishing a referral team
  • Medical insurance billing
  • Patient education
• Presenting and reviewing clinical cases: a “hands-on” experience

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