Part 2: Rethinking the Mouth: How Airway‑Focused Dentistry Challenges Traditional Care

Healthcare loves silos, but breathing does not care what your job title is. We dig into why integrative teamwork in airway health still feels harder than it should be and what has to change for patients to actually benefit from airway-focused dentistry and better interdisciplinary care.

We talk about the biggest barrier on the dental side: education. Airway-focused dentistry is not a replacement for general dentistry, it is an added lens that helps us screen earlier and connect patterns that often get missed. We also unpack why focusing only on obstructive sleep apnea sets the bar too low, since sleep apnea can be an end-stage diagnosis while disordered breathing may show up first as nasal obstruction, mouth breathing, low energy, and poor sleep quality. From there, we connect airway health to real dental findings clinicians see every day, including tooth wear, fractures, mobility, reflux-related erosion, and TMJ strain. 
 
Then we zoom out to the systemic barriers on the medical side: hyper-specialization, limited time, and reimbursement rules that reward narrow disease management instead of root-cause prevention. We share what it takes to bridge the gap in real practice, why reading beyond the dental literature matters, and how building protocols can turn “once you see it, you can’t unsee it” into care that actually helps families breathe, sleep, and live better. Subscribe, share this with a colleague, and leave a review telling us what healthcare silo you most want to see broken.

To learn more about Dr. Mark A. Cruz, DDS. visit:
https://www.MarkACruzdds.com
Dr. Mark A. Cruz, DDS. 
32241 Crown Valley Pkwy #200  
Dana Point, CA 92629  
949-661-1006 

Transcript

Welcome And Episode Setup

SPEAKER_00 0:03

Welcome to Airway Focused Dentistry with Dr. Mark A. Cruz, the show where better breathing leads to better living. If your nights sound like a lawnmower chorus or your energy's stuck on low battery, you're in the right place. Hosted by Dr. Mark A. Cruz, we explore how the airway impacts your sleep, your health, and your smile. So you can breathe, sleep, and be well. Take a deep breath, and let's get started.

Why Teamwork Still Feels Hard

SPEAKER_02 0:32

Let's take a look at why integrative teamwork in airway health is still harder than it should be and what needs to change. Welcome everyone. I'm producer and co-host Julie Schwenzer with Dr. Mark A. Cruz. Dr. Cruz, it's a pleasure to chat with you again.

SPEAKER_01 0:46

Good morning, Julie. Thank you so much.

SPEAKER_02 0:48

Yeah, we're excited to dive into part two from our last episode of how airway dentistry challenges traditional dentistry. And specifically, can you discuss what barriers, whether it's like cultural, educational, or systemic, make it difficult to collaborate with healthcare providers in different fields?

Dental Training Gaps In Airway Care

SPEAKER_01 1:08

Yeah, so that's you know, that's a little bit of a multi-upart question. I'll just say the difficulty for, let's say, dental providers at this point is really an educational barrier, really understanding what it means to practice with an airway focus. It's not in lieu of um traditional general dentistry, it's actually in addition to. So it's a way of looking at the patient. The other part is really um the integration across or that transcends dentistry across uh disciplines in healthcare, like with our medical counterparts of various specialties. So that creates its own challenge just in and of itself because dentistry's been somewhat siloed away from uh our medical professions, um, which was which is somewhat artificial. It it used to not be like that decades ago, but then it became almost its old specialty within healthcare. And that those barriers are starting to be broken down with the advent and understanding of uh of an airway-focused approach to treating the patient. So, you know, two sides to that. So, talking about the dental provider, right now, we're just in the throes of almost hitting the tipping point where the discussion and understanding of what it is to practice airway-focused dentistry is really uh come of age.

Beyond Sleep Apnea Toward Breathing

SPEAKER_01 2:42

Uh a number of things, the American Dental Association some uh a few years ago actually passing the resolution saying that we must start screening for um obstructive sleep apnea, which is really very a low bar, but it's a start because this goes way beyond obstructive sleep apnea, which is an end-stage diagnosis. Um moreover, I argue with an every focused approach to dentistry, we're really talking about breathing versus sleep. Disorder breathing during the day and during the night. So if you can't breathe well, either because your nose is clogged up or congested or has some kind of obstruction, then it's going to also affect your sleep. And those dots oftentimes are not connected.

Growth And The Root Cause Lens

SPEAKER_01 3:28

And why it's important to the dental provider is that more often than not, is has to do with craniofacure growth and development. So how the child grew into an adult with a very constricted uh underdeveloped midface that gets treated with, you know, nasal steroids and surgeries and things like that, over treating the wrong problem. That really falls into the domain of dentistry to a large part, because the palate and the oral cavity is a structure that we see and treat every day. And when we expand, say on a child, what we say expand, meaning that we widen it, we're actually addressing the the nose, the nasal fossa, because it's two sides of the same coin. It's the second story of this two-story home called the nasomaxillaric complex. So once you start understanding that and the effect, excuse me, low limitation on the dental structures like accelerated wear on the teeth, fractured teeth, mobility, erosion from reflux, um all these things that we treat that lead to also problems with temporomanibular joint function and the like. Um when you start understanding what it means, then you could start really treating root cause. Okay, so that's for the dental provider.

Medical Silos And Payment Incentives

SPEAKER_01 4:59

For the medical provider, it is so siloed uh that, you know, the cardiologist doesn't really talk very much to the pulmonologist, it doesn't really talk to the urologist, and it's just really a hyper-specialized siloed disease management healthcare system. So it's difficult to break through those silos in large part because it's been baked into the cake, meaning that the way that uh provider gets paid is governed by the rules of engagement, if you will, financially from the third-party payer. You know, the uh blue shield, blue cross, Medicare. And Medicare is the tail that's wagging the dog. It pretty much sets the table where the rules that most third-party indemnity insurances or HMOs follow. And so it's not really based on patients' health and wellness. It's just based more on a way that the provider gets paid. The rules are this is the way it is, and it it prevents you from looking beyond the very restrictive view that the physician they have of the patient, where they have limited time and it's very pharmaceutically driven. It really makes it very difficult to change that or convince a provider because they're family people as well, right? They have families to go home to and deal with and and uh beyond their patients, and they can't be fighting hour to hour with a system that um gets in the way of uh of their job,

Why The Health System Feels Broken

SPEAKER_01 6:36

if you will. So it's just a real, uh, real big problem. The system is broken, no question about it. We've talked about that. And I don't how can we say that? Well, just look at the health of the American public. It's uh we're not we're not getting healthier and the cost is going way up. More chronic disease, if our kids are getting sicker, they're not gonna live as long as their parents now. And so if the healthcare system is really doing a good job, it actually would be getting better, the cost would be going down, and that's just not what's happening. So, to answer your question in a kind of a two-part um dyad, if you will, the medical provider and the dental provider, the challenges that are brought in practicing with an airway focus, those are the two uh two general um explanations. And I hope that makes sense.

SPEAKER_02 7:35

Yeah, absolutely. And you're a great example of somebody who went beyond his traditional practice and expanded and also faced systemic issues, but you still did it.

SPEAKER_01 7:46

Yes.

SPEAKER_02 7:46

So, my question to you is what advice you have for clinicians who want to bridge that gap because you've done it and you know, you didn't let yourself be siloed as you know, you mentioned

Advice For Clinicians Who Want Change

SPEAKER_02 7:56

that word. So, what can they do? What's your advice?

SPEAKER_01 7:58

Yeah, so when I started uh 15 years ago, it, you know, the the discussion of airway just didn't exist. I mean, there are one or two different groups that were just starting um to talk about it, uh, one in the East Coast. And and the focus at that point had been on obstructive sleep apnea, sleep dentistry, sleep medicine. That's different than aeroweight focus. So I never was really that interested in dealing with sleep problems as a dentist because I didn't really quite understand it. Moreover, I knew that it really went beyond that. So I started, as I started connecting the dots and giving courses and training colleagues, what I noticed and experienced is all these colleagues would be at the end of the course or at the end of the day in a particular um uh course or session would say, Wow, why didn't I hear about this before? It makes so much sense. And jokingly, almost everyone would say, once you see the airway problem, you can't unsee it. Even patients are telling me that. Once you see something where your eyes have changed in how you see it, it becomes very, very obvious. And yet getting from there to actually translating into real world practice is no small matter because you're really going up against a system that's already been set up with all the workflow and the um the way you get remunerated for your services, et cetera, et cetera. Well, I lived through that with many arrows in my path, where it was like there was no evidence and this doesn't make sense, because it really challenged the orthodoxy.

Learning From Medical Literature

SPEAKER_01 9:46

And I think what happened for me is I really delved into the medical literature versus just the dental literature. Whereas at that point, it was mostly the dentists staying within their own silo of the dental literature. So they'd say, well, there's no evidence. Well, there's no evidence, perhaps, as you see it in the silo that you're looking, but we need to understand that there's a huge knowledge base that we need to transcend beyond our silos. And so um I went through out of necessity developing different services protocols and curriculum to make it today something that is fairly straightforward in learning and uh and translating it to where you can actually benefit your community, your practice, your team, your patients. And so that's its own discussion. Um, but it came with a lot of, I have to say it came with a lot of pain. And even today, now, the um people who are saying that there was no evidence now, they're becoming quote unquote airway focused gurus. Um it's kind of a funny thing that uh what happens is, no, what you're saying isn't uh isn't true until you see it, and then, oh, I've been doing this from the very beginning. It's just kind of, you know, it it is what it is, it's human behavior. But I think that um we're in a very exciting place right now in healthcare and certainly uh in in in dentistry. So I hope that answers the question, even if it's not in a direct way.

SPEAKER_02 11:15

Yes, it does. And I wish we had more time to discuss this, but thank you for breaking down these barriers so quickly. What you're facing as a medical, you know, dental and I would say medical, you know, medical professional, and explaining this. I think it's gonna help a lot of people. So thank you.

SPEAKER_01 11:32

Thank you, Julie. Appreciate it.

Closing Thoughts And How To Share

SPEAKER_00 11:38

That's today's breath of fresh insight from airway focused dentistry with Dr. Mark A. Cruz. Remember, small changes in your airway can spark big changes in your life. Breathe, sleep, and be well. For more information, visit markacruzdds.com or call 949 661 1006. If this helped you, share the episode and maybe give your pillow a quieter night. See you next time.