Part 2: Airway Diagnostics Upgrades: How The Latest Innovations Can Protect Your Airway

If your nights sound like a lawnmower and your days feel like a low battery, the problem might not be “just sleep” or “just stress” it may be your airway and how you breathe when no one is watching. We dig into the fast-changing world of airway-focused dentistry and why the field has to move beyond provider-only measurements like bite changes, jaw position, or palate width and toward outcomes patients can actually feel and track.

Dr. Mark A. Cruz explains why symptoms like sleep bruxism often show up in the mouth but start as a sleep and breathing issue, driven by arousals and autonomic stress responses. We talk about sleep-disordered breathing as a spectrum, including flow limitation and upper airway resistance syndrome, and why common metrics can miss what matters most to patients: sleep quality, mood, energy, and long-term health risk.

You’ll hear how high-resolution pulse oximetry can help measure night-time physiology, why different tools like SleepImage aim to quantify sleep in new ways, and how “measure twice, cut once” applies before any intervention. We also explore the overlooked role of breathing behavior, including end-tidal CO2 tracking with capnometry, plus heart rate variability and the rise of wearables that are pushing healthcare toward patient-driven wellness and better questions at the chair.

If you found this useful, subscribe, share it with someone who snores or grinds, and leave a review. What’s the one health metric you wish your provider could explain in plain English?

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 Why Airway Matters

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 course 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.

SPEAKER_02 0:32

In this continuation of our airway diagnostics discussion, emerging technologies are revealing even deeper insights into how patients breathe in real-world conditions. Welcome. I'm Julie Schwenzer, co-host and producer with Dr. Mark A. Cruz. Dr. Cruz, it's always great to talk to you and hear your expertise.

SPEAKER_00 0:51

Thank you, Julie, as well.

SPEAKER_02 0:54

So, Dr. Cruz, you've been at the forefront of airway-focused dentistry for a while now, and the field keeps advancing. What's on your mind with some of the latest innovations?

Patient Centered Outcomes Over Measurements

SPEAKER_00 1:05

Yeah, you know, I think that it's just coincidental that we're talking about diagnostics and technology in that domain. Because my concern with airway as you get more and more people jumping into the space is really measuring an outcome. And that largely has not been done in our profession. It's not been done in a tangible way to the patient. It's been done in a tangible way for the provider. So the outcomes being the position of the jaw relative to uh the other jaw or of the teeth relative to each other, or you know, the width of the palate as examples, right? So um that's really not tangible to the patient. I mean, they may connect some dots because you're hearing more and more about this. But what's tangible to the patient is the outcome of mitigating or ameliorating or eliminating uh any particular medical symptoms, whether it's tooth grinding, what we call sleep bruxism. That really is a medical symptom that has a dental manifestation. It's an arousal response during sleep, the literature would suggest, coming from the brainstem as a result of a perturbation in gas exchange or problems of bleeding, right? So you'll see the damage as a dentist, and then you want to go in and repair the damage, which you know has definitely its um uh its benefit. But if you don't really address what causes it to begin with, then it it's it's gonna continue, right? So uh the success of your restoration long term will be a function of really addressing the cause. Or let's say anxiety um as a result of an upregulated sympathetic drive, also for the same reason because it's there's flow limitation in in your breathing that behind the scenes through the autonomic nervous system u-regulates it. Um depression. Depression is very highly correlated to sleep fragmentation or sleep disorder breathing in throughout that entire spectrum. So if your brain is not able to really recover, it does affect the um affect, if you will, during the day of how you're feeling. So, yes, there are other causes, but certainly that's a major cause that I would want to address as a provider and actually measure it.

Pulse Oximetry Beyond Sleep Apnea

SPEAKER_00 3:48

And so how we measure it is through technology like high-resolution pulse oximetry. I've been using that for, you know, almost 20 years, you know, uh going on now. Um, really specifically, kind of initially off-label, which was designed the this particular algorithm, was really looking at obstructive sleep apnea. And I've gone way beyond looking at the end stage diagnosis of sleep apnea because the problems, uh much bigger problem having to do with just um sleep fragmentation or what we call upper air resistance syndrome, super common. And so um I'm really looking at the autonomic response to that versus some provider-defined outcome of what we call the apnea hypopnea index, which really doesn't mean that much to the patient, but it kind of counts the number of baby events an hour, like when you stop your breathing for more than 10 seconds, it's accompanied with a drop in oxygen saturation that the patient is completely unaware of. Um, but that the physician or the dentist may discuss with the patient about how it's correlated to heart disease, cardiovascular remodeling, hypertension, metabolic dysregulation, waking, type 2 diabetes, inflammatory markers, et cetera, et cetera. Um, again, for me, why I would address any structural deficit as a dentist, like widening the palate skeletally or moving the jaws forward, is because uh I want to ameliorate the end stage disease that hammers all the organ systems, the set organ systems. And so that's something I'm gonna measure. Uh and from a technology point of view, because that's the question. High resolution pulse oxymetry is one. There, there are others uh called sleep image. It's been around for a long time. I've known the uh developer of that out of Harvard. Um uh now, some some 15 years when he was just developing it. We had conversations back in the day. Um, in fact, I used to have a um what we're not calling podcasts back then with a colleague calling spree casts early on. And I had him as one of the um the um people that were interviewing, and I was asking him about you know what he thought about high-resolution pulse oximetry in comparison to his technology, um, which gave a what he calls a sleep quotient that looks at sleep efficiency and uh sleep quality, but measures it very differently. And very differently than a polysomic or sleep study, a gold standard sleep study that has 12 leads with leads when you're you know doing this level one study in a lab versus a home sleep test, which um actually uses fewer leads, so that's accurate. But he said, yeah, it measures things uh differently. And so we have to understand all these this emerging technology of what it actually means tangibly to the patient. Because at the end of the day, what is it that we do with the information? And it well, for me, it's diagnostic. I always say measure twice, cut once. Before I make a regular uh a recommendation or an intervention to a patient, I really want to understand what we're measuring and how it benefits the patient, how predictable it is. And so we use our technology. So these are some of the things that we look at.

CO2 Breathing Behavior And Capnometry

SPEAKER_00 7:24

Also emergent, what people have largely ignored is the actual breathing behavior. And I've been talking about that along with Peter Litchfield, uh who's a well-known physiologist, uh, now for decades. He's been talking about that for decades, but it's really integrated into what I've been teaching now for some time, which is really measuring what's called entitled CO2. It's the amount of CO2 in your lungs that actually affects the blood pH moment to moment that affects every organ system without getting into all the details. So how we breathe, which is a behavior, um, can be measured with a capnometer, behavior capnometry. And so you can actually alter that behavior with the patient through this technology. So that's one. And now I had breakfast with uh Peter uh about a month and a half ago. He was telling me about the most uh recent developments that now uh companies like Apple that make hardware and wearables, that's where it's going now. People want more

Wearables HRV And The Wellness Shift

SPEAKER_00 8:31

control of their own health. You know, they they will wear um glucose monitors, you know, even though they don't have type 2 diabetes, they'll actually have, you know, monitors, Fitbits, and things that are giving them telemetry, not only on their sleep, but also their moment-to-moment function, their heart rate. So they're starting to understand and educate themselves on that. And I think that's really exciting, but it's also really a reflection of, I believe, of an allopathic disease management healthcare system that's largely failed our population in really addressing wellness. We're really good at addressing disease, but not really good at really understanding what wellness is. And I'm not talking about prevention per se, because that's also a misused or overused word. What does it mean to prevent? Um it's really taking more control. So this technology is really helping so uh the technometers now become aware of. So when you're in the gym or you're walking in your power walks, you can kind of monitor your that one gas that we ignore, which is CO2. Um, your oximeter during the day isn't going to really change that much if you're healthy, unless you're unhealthy, but it will durate the night. And that's really when I use it. Um there are um other technologies that have been around that people are starting to also understand, uh, measuring what's called heart rate variability, which also is a measure of wellness. The more variability you have from the um low heart rate to the high heart rate, the spikes, the more healthy you are, the less variability you have, the less healthy you are, meaning that the system's been damaged. So now it can't really respond, in which case it results in a number of different medical conditions that uh are dangerous, like stroke and heart attack and um neurologic, neurocognitive problems. So um, so in summary, um I'm excited that we're actually getting into better and better technology, more accessible to the public, um, and really measuring very, very basic functions that we've ignored for so long, which is breathing and sleep. So that's what this podcast is all about is really, you know, understanding how that really relates to your overall health and your dental health. So I hope that makes sense. I know it's a lot of information packed in a very small segment here, but uh hopefully um it's not too contusing.

SPEAKER_02 11:08

So I appreciate your clarity, Dr. Cruz.

Why Tracking Breath Improves Performance

SPEAKER_02 11:12

And I had a quick question for you. We just have uh a minute here left, but do you think these wearable technologies are really helping um the long-term health for airways and sleep quality?

SPEAKER_00 11:26

Yeah, no, no question. Uh, before you address it, you first have to understand what you don't understand. So at the past, people wouldn't understand about breathing. So the first step is the public at large, because that's really what drives healthcare. Really, it's the public sentiment, um, is really understanding that breathing is important. And it's not just a matter of going to the gym and doing yoga or literally m-hof breathing or you know, being connected to your diaphragm. Um, but I think it's part of a very big movement, part of um what's called the Maha movement that's gonna go way beyond just what's in our food. So I think it's the first step. There are also large studies um involving catinometry having to do with human performance, whether you're a jet pilot, whether you're an FBI or CIA operative, um, having to make very, very quick decisions or world-class athlete. How we breathe moment to moment at a time of stress, say athletic uh stress, will really determine um what ball goes into the hoop or whether it ends up in your hands to score the touchdown. And so athletics have already known that at some level, but now it's becoming more consciously uh visible. Um, whereas we would say that guy choked, right? Because he missed the free throw to win the game. Well, that all had to do with airway. But at the time, I don't think people were consciously aware of, well, what does that mean? Well, you stopped your breathing, and that stimulated stress response, and you don't function as well. So, yeah, I think um we're turning the page in uh an era that I think a year from now, five years from now, um the physician, the dentist provider, it's gonna be really forced to go beyond something that's tangible just to the provider, but that's actually tangible to the patient itself. So hopefully, my my hope will be an ending on this segment is that the patient would be asking, well, what do you measure? Don't tell me how wide my palate is. What does that mean to me tangibly? What are the things and how are you measuring it? Well, that currently is something that's really not being done. I've I've been teaching that for a long time. Everything's been very mechanical. You know, trust a guy in the white coat. He says this is the measurement, and it's not based on good data, as it turns out. So um, I'm excited about where we're heading right now.

SPEAKER_02 14:00

Well, thank you, Dr. Cruz. It's always enlightening to hear how the field is advancing and hear

What Patients Should Ask Providers

SPEAKER_02 14:05

your advice. Thank you so much.

SPEAKER_00 14:07

It's my pleasure.

SPEAKER_01 14:11

That's today's breath of fresh insight from airway

Closing And How To Learn More

SPEAKER_01 14:15

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 fellow a quieter night. See you next time.