Dr. Mark A. Cruz Discusses Common Misconceptions And Facts About Clear Aligners

Clear aligners are everywhere, but the biggest questions rarely get asked: What are they really doing to your face, your tongue space, and your airway? In this episode, I break down the myths that keep patients confused and clinicians stuck in default planning, then we rebuild the conversation around health, stability, and breathing.

We start with the basics of orthodontic tooth movement and why “Invisalign” is like saying “Kleenex” it is a brand name that people use for the entire category. From there, we talk about how aligners spread from specialists to general dentists and then to direct-to-consumer models, and why skipping a real diagnosis created predictable problems. Straightening teeth without evaluating bite, bone support, and function can lead to unstable results and disappointed patients.

Then we get to the airway-focused dentistry lens: crowding often signals limited facial development, and many aligner and braces plans retract teeth by default. Retraction can trade a cosmetic win for a bigger loss by shrinking tongue space, which matters because the tongue helps keep the airway open during sleep. We explain why we aim to create space, support forward facial balance, and often coordinate clear aligners with skeletal expansion and better oral posture so “smile design” becomes function-first facial design.

If you’re considering clear aligners or you already started treatment, listen closely, share this with someone weighing Invisalign, and subscribe and leave a review so more people learn what questions to ask before they move a single tooth.

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 Show Purpose

SPEAKER_01 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 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.

What Clear Aligners Really Do

SPEAKER_02 0:32

Clear aligners are everywhere, but with popularity comes confusion. Today we separate myth from reality so patients and clinicians can make informed decisions. Welcome. I'm Julie Schwenzer, co-host and producer with Dr. Mark A. Cruz. Dr. Cruz is so good to be back with you.

SPEAKER_00 0:48

Thank you. Thanks for having me.

SPEAKER_02 0:50

Yeah, we we need your help here on this one. Clear aligners, they've become such a go-to option for so many patients out there, and there's a lot of misunderstandings. Can you break down some of the misconceptions and then some of the facts about clear aligners?

SPEAKER_00 1:05

Yeah, let's first talk about what clear aligners are and how they work. So clear aligners are an alternative to what's called fixed mechanics, like traditional way of moving teeth using brackets, braces, and hardware with very specific mechanics that stimulate an inflammatory response through light pressure on the tooth that causes the bone to remodel and move it in the direction that the force is moving the tooth to. And so that's been around now almost 100 years, say there they're about to say there's a long history of the use of that when we learn to do that. And uh more recently than that last uh few decades, there's been the advent of which everyone knows Invisalign. It's kind of like saying a facial tissue and you say Kleenex. What a Kleenex is, or do you have a Kleenex? Well, Kleenex is just uh branded facial tissue. So we're gonna talk about clear liners, like we're talking about facial tissue, of which Kleenex is the Invisalign brand. It's the biggest one. They've exploded to where it started off with just the orthodontist, and then you have what I call the orthodentist, which is the general dentist that's gotten into that space to uh to use the software in the company's um software to plan tooth movement.

Direct-To-Consumer Aligner Pitfalls

SPEAKER_00 2:32

And then it moved some years ago, a few years ago, to where it went directly to the consumer, where you'd hear commercial on TV at home saying, just uh send uh, you know, you send me this information, we'll give you a package and you know, yeah, like a clay, you take an impression, send it back, and they would actually go directly and bypass the provider. And of course, that was very controversial. Um, and there were problems with that because of diagnosis. Um, people want their teeth straight, but it wouldn't be stable, and there were lawsuits, and that's been set from now to where it really essentially doesn't exist anymore. It's kind of like tooth whitening. Um, when it first started, it was you'd only get it at the dentist and you could do it over the counter. And now you could even get it um in the drugstore. And that's another area where we have to be very careful. I'm always about open source, but you also have to be very informed. Some of those whitening um uh devices or toothpaste are just very abrasive toothpaste that actually will take away enamel as well as sustain, and over time it creates a problem. So it has its place, but let's just be informed, right? And that's what this podcast is about. So going back to clearlighters, we know it's a multi-multi-billion dollar industry worldwide. And whereas Invisalign was the foundational company that started it, you have now very large uh companies that have jumped into the space and bought um the you know, the the uh manufacturing capacity and the planning capacity um to do this. Um I was working with the Clearliners very early on with a colleague or two orthodontists uh colleagues that I introduced the concept of airway to, and he actually bought into it said, hey, this really makes a lot of sense. Whereas most orthodontists they don't want to hear. They they just want to treat and move the teeth. Um they don't want to really, they they they they don't really link that connection of how the teeth are to overall health and wellness.

Crowding As A Breathing Clue

SPEAKER_00 4:47

And of course, we know the evidence is very clear. But dental crowding is a manifestation of not enough facial development, not a problem necessarily to fix uh to straighten teeth. And then typically when you do try to straighten those teeth out in that situation, as an orthodontist, oftentimes the controversy of removing teeth to create space and then now put the teeth in, straighten them out. So you straighten the teeth out, but now you've taken away tongue space. And uh the tongue is very involved, it's an airway dilator muscle, and so it starts compensating, and so then now the dentition are unstable. And so you can glue a retainer in, but over time it does create some problems. The nice thing about clear aligners is that it's more gentle, it doesn't have the force or can't deliver the force that races can, but that's a good thing. Um things can go uh uh uh uh a little bit more gently, if you will. So there are less risks with losing roots, uh root structure because of the movement. And um, and so everyone's kind of jumped into it. But the problem is essentially all clear liners like braces, by definition, are retracted. You put a wire on or you put a clear liner, the way the technicians plan in moving teeth and straining them out is you're retracting invariably. And and it solves one problem, but creates a bigger problem that's not recognized, which is what this podcast is all about airway. We don't want to subtract, we actually want to add. And that means we create spaces. And so most orthodontists are trying to close spaces, we want to actually open

Retraction Versus Creating Tongue Space

SPEAKER_00 6:40

spaces. Why? Because we want to have more tongue space. So then, as we have more tongue space, then you have more space to move the teeth uh with that extra space being closed in a non-retractive way. It goes beyond the um this podcast, uh, the details of that. But um, and so most planning centers in orthodontic um companies that make Clearliners don't understand that. And in fact, that's how um I started. Um I I founded with a couple other colleagues, uh, Clearliner company with a planning center in Europe that really did understand and worked with us in that we trained their orthodontic team on how to protract and create space with various protocols that now is going crazy. You know, everyone's doing it now. But um, so that was uh an S uh corporation that I started and that is um uh is doing well, but I'm not so quick to really um be like an Invisalign because that's all about the money. I'm more about actually correcting the problem and why you do it. So it requires a little bit more from the provider and understanding when you use it, how you use it. So we're careful on you know who's using it and how they understand it. But um it it requires a plan and a simulation to create more tongue space. And that Cleverliner um uh protocol makes it more efficient to be able to deliver the care uh to the to the patient with more predictable outcomes and addressing changes in the structure. And of course, we've talked about it before. We also have to address the function, the constant problem to begin with, the tongue function, the tongue posture, if you will. So I I think as time goes on, um this is going to become a bigger and bigger thing with the cleared liners, because the other aspect of it is that I'm not about treating the teeth per se. I'm actually about treating the airway, and then treating the airway or actually treating the face. So when someone talks about smile design, it's not about straight teeth, which has traditionally been what smile design is. It's how you arrange the teeth, the display, the proportion. Um it's really more about the bone that supports those teeth and making them wider and in the right place in three dimensions of space, uh, in a more forward position. Most of us are too far back. Um, our chins are weak, we don't have what we call the Paleolithic face, which is the high cheekbones, a big square jaw,

Smile Design Starts With The Face

SPEAKER_00 9:27

or that actually means you've got a larger caliber airway, it functions better. And um, and so in order to do that, you have to move the the bone, and we use the teeth that are in the bone to do that. And with our clear liner protocols, we have very specific mechanics in conjunction, oftentimes, not always, but most of the time, with skeletal expand, which has also blown up to that actually expands the facial skeleton for the the main reason being for breathing, not for tooth alignment. I always say that's the icing on the cake. Form follows function. If it functions well, it probably looks good. So um we want the pace to have real a patient to have really good facial balance with the teeth arranged uh properly, with enough tongue space and a good oral posture. And that's where clearliners are an uh an invaluable tool in being able to do that. But again, the discussion on the details of that goes way beyond the scope of this this particular podcast. But I hope that gives a little bit of understanding on uh clearliners.

Next Steps And Where To Learn

SPEAKER_02 10:40

Yes, absolutely. And you know, if it's okay with you, we could continue discussing this in the next episode because I do have some questions about, you know, taking that uh course of action as you're an adult compared to, you know, the traditional way that it used to be. You take care of it when you're a kid. What's the physical impact?

SPEAKER_00 11:00

Excellent. Excellent point.

SPEAKER_02 11:02

Yeah, so I I can't wait to chat with you again about it. Dr. Cruz, you're always so helpful. We appreciate you.

SPEAKER_00 11:07

Thank you. Thank you. I look forward to the conversation continuing.

SPEAKER_02 11:11

Absolutely.

SPEAKER_01 11:16

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 markaruzdds.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.