The Truth About Airway Dentistry No One Talks About

Most people believe healthcare starts when something goes wrong, symptoms show up, you get treated, and you move on.

But what if that entire model is flawed?

In this episode, we break down why modern healthcare often focuses on treating symptoms instead of addressing the root cause, and how airway-focused dentistry is changing that conversation. From breathing dysfunction and sleep issues to anxiety, addiction, and chronic disease, this discussion reveals how deeply connected your body systems really are.

We explore why many patients feel “treated” but never truly better, the role of the autonomic nervous system, and how something as basic as breathing can influence your energy, mental health, and long-term wellness.

This isn’t just about dentistry, it’s about rethinking how we approach health entirely.

If you’ve ever felt like something is missing in your health journey, this might be the perspective shift you’ve been looking for.

#airwaydentistry #functionalmedicine #healthoptimization #sleephealth

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

Care Quality Over Access

SPEAKER_02 0:00

It's not who can afford and have insurance to pay for it. It's the kind of care that we're getting that needs to be radically changed.

SPEAKER_00 0:10

At the intersection of airway, sleep, dentistry, and whole body health, three leading experts come together for one evidence-driven conversation. Dr. Barry Raphael, integrative orthodontist, and co-founder of the Airway Collaborative. Dr. Richard Stevenson, award-winning educator, author, and authority in restorative dentistry. Dr. Mark Cruz, respected lecturer, clinician, and contributor to national dental research, where science meets clinical insight. This is Airway Nexus.

Defining Airway-Focused Dentistry

SPEAKER_01 0:45

Hey Rich, how you doing?

SPEAKER_03 0:47

I'm doing great, hi Mark.

SPEAKER_01 0:48

Good to see you, bud. Good to see you as well.

SPEAKER_03 0:50

I'm saying I'm sorry, I'm a little horse. I'm just getting over a little cold my wife gave me.

SPEAKER_02 0:55

Well, it's a lot better than being a little donkey.

SPEAKER_03 0:58

That's right.

SPEAKER_02 1:01

Anyway, um, you know, Richard, I I think that maybe something that we could talk about. Um, and and we've really touched upon these in different uh podcasts, but you know, maybe kind of circle back and talk a little bit more about what airway-focused dentistry is, and because it's like such a hot topic, right? I mean, you're getting these weekend courses that we've been talking about, that people are going to, but yet at the same time, it's a little bit of business as usual. And uh so I'd like to talk about that. And I I think pursuant to um going to breakfast this morning with my good friend uh Peter Lichfield, who is a world-renowned um physiologist. And let me just say a couple things. One of the things that we talked about uh this morning is um so Dr. Uma Katwa, who's the head of the pediatric sleep lab at Harvard, who's gone to the AMR and and uh we're you know, we were talking about uh the data of uh one of our studies that we're gonna be publishing. It's an uh uh IRB study that we're uh gonna be publishing, that we're in the process of writing up right now. And during that uh meeting uh a few weeks back, he said, Hey uh Mark, um can you put me in contact uh with Peter Litchfield, who he had heard uh before at the AMR uh in New Jersey, probably, I don't know, five, six years ago. And uh essentially he's kind of frustrated with the um institutional approach to sleep and breathing at Harvard. And I can also tell you that Stephen Park, um who also uh spoke at and uh has been at the AMR, who wrote the book Sleep Interrupted, as a CPNT, who's one of the um uh one of the pro the directors there at Mana Fior uh at NYU, he left there, had the same exact experience um at a different time, where he said, you know, I see all these these problems with these kiddos uh or these patients, but um they just don't get when you get out of the system, you know, some of the concepts that we talk about in airway um dentistry. And Dr. Park totally gets it because he had this problem with his own kids, right? They they he actually had them treated with bio block, and so he totally gets it. So here's some two examples of academic physicians in sleep medicine as an ENT

When Academic Medicine Pushes Back

SPEAKER_02 3:50

and as a pediatrician with a pulmonology background. So he went through a pulmonology certificate, so they really get the breathing in the sleep. And Uma was saying how that he totally gets the breathing part of it, but you almost can't talk too much about breathing because it's just assumed you're doing it. And they're not so much getting into a lot of the details that I'm gonna get into um next week during the Arrow Mini Residency, the physiology. And so he's gonna go through the full program curriculum that I went through with uh Peter Litchfield that gets into acid-base um uh balance and talks about what's going on with the disordered breathing without getting leaving it, uh uh leaving it at that. And so um going back to Peter, so Peter has this uh program, you know, as um uh that's recognized by the U.S. Department of Education, but also as I've said, he's got these big contracts with the Department of Defense and the CIA, and and now he's got this big, big right. He was telling me he's kind of stressed because this thing is just blown up worldwide on the breathing and the capnometer and gamers and athletic performance, having to do with breathing. The very, very basic thing of be uh breathing. And Peter was telling me that he two weeks ago was in this international conference uh about an organization that's been around about a dozen years on uh focused on wellness. Um, and it was in Riyadh, uh in Riyadh, uh um uh Saudi Arabia, and he was one of the speakers, he did it remotely. And there was a pulmonologist, C physician, that was also speaking, and they were on a panel. And Peter was just kind of you know, chuckling a little bit, how the moderator was asking them the same question, but the answers are so different to where they were each talking past each other. And the pulmonologist, sea physicians kind of talking about the autonomic nervous system and you know how you have to treat the autonomic nervous system and how um, you know, all the different strategies and all the issues from a physiologic, just purely physiologic approach, but not ever really asking the question why. Whereas Peter was actually focusing more on what the underlying problem is and the behavior of breathing and how the uh breathing is really a response to the input, the environment that you're in. Because you know, you breathe differently when you're resting, when you're on a treadmill, when you're angry, when you're um uh meditating. It's under our control. And and the problem is that so many people, well-documented, hijack their own breathing based on uh they override their chemoreceptors, based on some trigger. You know, they get emotional and then they have an outburst, and then they're angry, and then they get in trouble, and then they they uh have to see a counselor, and the counselor is all about anger management. So they're kind of focusing on okay, the problem is you don't know how to control your anger. Whereas it may be, as he was saying, you have to find out maybe what the trigger is uh that might have stimulated an adrenaline response, and in a particular personality, this this behavior that we call anger that may have been, you know, a physiologic problem, but we always assign it maybe it's just purely psychological, or maybe you need to take Paxel, or maybe you're just depressed, or maybe you're you need to take a chill pill. And so it's kind of talking about how the symptom tends to be treated with counseling or psychiatry or psychology, which helps, but everyone's still missing root cause and the physiology, and and going back to mammals, really being at their best when we're in parasympathetic coherence, where we're designed to be super efficient in our energy use based on being in this state of rest and digest. But many of us get really keyed up uh from our response to the stress. So, as Peter was saying, it's not so much the stress where you st where you treat the autonomic nervous system, it's your body's response to the stress that we should be addressing. So, you know, the the stressor isn't necessarily that crazy person who's yelling at you who, if you didn't know any better, you would yell back and get all upset. It's more really understanding, huh? That's kind of interesting. I wonder what's going on with that guy that he's really that upset. I'm not gonna let you know that affect you know my state. So I think the point I'm making is he was saying that it's we have to think about allopathic healthcare differently to where we're really dealing more with root cause, we're really dealing more with the patient's, you know, tangible problems versus what we in the white coat think should be treated. You know, is it really the anger that should be treated, or is it the patient's coping mechanism that stimulates a stress response that should be treated? And we're in this allopathic system

Breathing Physiology And Root Causes

SPEAKER_02 9:40

that we take a pill. It's the same thing with weight gain. You know, um, you could take a GLP1, um, and you know, don't worry, it's not your fault, it's maybe not the behavior. Um, maybe you change um your what you eat, maybe eat fewer Cheetos and maybe, but then no one ever asks the question, well, why am I eating that? Even though the availability of the junk food and the bad food is everywhere, it's ubiquitous, and it's very easy to explain that. But maybe if you're not in parasympathetic coherence, where you're burning up your energy stores, your brain wants that ATP now, quick access, carbohydrates, and and of course, industry's kind of fed that that this is what you need to do, and this is how you'll be healthier, and this is um that we should maybe start stepping back and asking more about uh is it really impulse control, or is it really that our bodies are in this chronic fight or flight that's requiring uh um this energy source that we're feeding right away with the carbs, and then we have coffee to stay awake and that stimulates insulin, and then you want more. This is vicious cycle. And then at the end, at happy hour, you're all amped up and kind of, and now you want to go ahead and have happy hour to kind of calm you off the ledge, and and now you're a little bit, and then we go through these cycles. It's not a right or a wrong, it's just our response to our environment, our response to the stress is how I'm summarizing it in kind of simple terms. And our allopathic healthcare system is all about us thinking in this way, such that if you're a dentist that wants to get into airway-focused dentistry, it's much easier to understand if someone tells you that if you have a narrow palate, that it should be wider for your tongue, and that if you use this widget, you could accomplish that. That's very easy to incorporate into your practice, sure, and that you can monetize it, and then you talk to the patient, say, hey, your net your palate's too narrow, let's make it wider. And never really talking about all the physiologic effects and benefits of that, the cognitive effect.

SPEAKER_03 12:10

If I could say a few things, I mean so interesting. We're we're we we become uh a profession of a lot of referrals, you know. The referral is gonna solve the problem, and then when the referring provider gets the gets the patient, they're expected to have a solution. And if the referral is because somebody is uh got let's say, for example, uh a person is drinking too much alcohol, um, the referral might be to a psychologist, a counselor, therapist, maybe psychiatrist, and depending on who the healthcare provider is, they're either going to recommend a 12-step program, or uh or they'll recommend maybe a medication to to help them with the anxiety and sleep, and a 12-step program. Others, uh uh, other counselors may say, Oh, it's about willpower, it's uh 12-step programs are not very successful, and but nobody is actually looking underneath and seeing could there be something more explainable than just you're a weak human or you have lack of willpower or you were born with a gene of addiction or whatever the case may be. And I don't want to go down the rabbit hole of addiction, but it's a it's a huge industry. I mean, and it it is a multi-billion dollar industry, and a lot of people find themselves in those kinds of situations, and there may be something else at play. And I'm just you know, that's one of many, many, many things. Um, you know, I I have patients that uh are clearly airway patients, clearly suffering. Um, and I render a diagnosis based off of a more holistic or let's just say uh taking a broader perspective of how they're doing and uh present uh I mean a treatment plan for them that incorporates everything that we talk about in the airway mini residency, etc. And that patient may actually leave for second opinion. And the second opinions, as these patients have been coming back and telling me, are very uh widget-based and very uh restoration, race to restoration based. They're like, oh, you just need crowns, or oh, you need and these are coming from high-level

Stress Response Drives Poor Health

SPEAKER_03 14:45

prostodontists here in Southern California, that you know, and they're doing the best they can do with what the knowledge that they have to choose from. I mean, they may in fact be quite exquisite in what they do, but but they're missing a larger sort of perspective. And so the the the patient comes back and says, this is what I was told, and it didn't make sense to be because they were missing the why. And I really appreciate you getting into how things ended up the way they ended up. And um it it's it's I think it's just really interesting that um we do the best we can with what we got, and so we refer, we refer a lot of people for a lot of different reasons to healthcare providers, expecting some great high-level, you know, you know, so it's just an appropriate perspective of what's going on, and and yet a lot of it's just formula, you know, it's it's a it's a list of pills, it's uh check the boxes, and and it and what we and and that I guess we've sort of taken care of it from our perspective, but has a patient really been truly helped, really, in the level that they could be helped? And I think the answer that we have, you and I have, is clearly no, they haven't been helped. And you know, I don't want to generalize, but it's just just a we should have a different approach to health care where we're where we're seeking to understand the why. And we're not comfortable with the um you have three options, here they are, and we don't know why, but here's the treatment. Um yeah, it's like and that's one of the greatest things for me that the revelation for me in the whole airway journey that I've had is that we can actually get the story behind the story. We can get the story behind the story, behind the story. You know, and I think that that to me is just is just really cool. Um so you know, carry on. But I I wanted to just perspective that I had that was really kind of fits in.

SPEAKER_02 16:50

No, it's so so and and as I'm listening to you, I can and I've encountered this more often than not, where uh docs who don't know they eye roll and go, give me a break. This is a fact because they really don't they they really aren't allowing themselves to be intellectually uh uh available to the concept of the vulnerable and open, what a concept. Yeah, I mean again the distinction between being well and not being sick, right?

SPEAKER_03 17:26

Right.

SPEAKER_02 17:26

So we're we're we know that the right way to do it is if if they're not complaining and they're no uh and you check the organs A-G-E-N-T and review of systems, ROS, and uh everything must be okay, or maybe they've got some blood blood work that's off a little bit, but we can you know put you on some medication to help that. I mean, that's just the way we're trained. I argue that the problem and the crisis in the American healthcare system is not access to care, it's not who can afford and have insurance to pay for it, it's the kind of care that we're getting that needs to be radically changed. And you brought up an example, and I've had this occur a number of times, but I'm thinking of this very specific situation with the patient that got referred to me some years ago. Young, attractive, uh female in like her mid-20s. And uh she got referred to me uh by a colleague from Texas, and she came in and uh for an airway, airway. Um, gosh, this had to have been at this point eight to ten years ago. And um, and I I looked at her and I did my my typical workup, and uh she had uh gone through uh addiction counseling, she had been in rehab and had problems with alcohol and pills and all that, and so she was uh clean, and this is one of the steps for her to kind of move on, uh, is to kind of fix a lot of the the issues that that she was having. And there were some uh provided that knew that that there was something there, referred her to me. And fast forward, I went ahead and got uh and and uh treated her. Details aren't important, but she comes back um one of the follow-up appointments, and she's in a really good mood, kind of skipping to to you know, to the operatory, sits down, I said, How are you doing? She goes, Oh my god, I am doing fantastic. And I said, You know, Dr. Cruz, I have to tell you, I, you know, I am sleeping amazing. And um, thank you very much. And I have to tell you, I just feel all the time, I feel I'm euphoric. And I said to her, I said, Well, that's really interesting that you say that. But I'm gonna argue that you don't feel euphoric. I'm gonna argue that you're feeling the way you should have always felt, but relative to how bad you felt before, it's euphoric, to where the way you were feeling is you were trying to um chemically address that feeling that led to your addiction. And I'm gonna say a lot of people suffer from that. They're not getting the answers from the healthcare system, and so they find that maybe, you know, um whatever uh drug of choice gets them to where their autonomic nervous system is telling them everything is okay, at least short term. And then there's this vicious cycle that leads to addiction.

Widget Dentistry Versus Systems Thinking

SPEAKER_02 20:40

What's addiction? Addiction is when you're chasing the dopamine and you can't release any more and you hit the wall. That's called that's the definition of addiction, right? It's a dopamine-driven response. And so now you've gone through recovery and now you're more in your organic state. And so that's very interesting. I've had that happen a number of times. Different people do it differently. Some people will do it by just being a workout junkie. They're in the gym all the time.

SPEAKER_03 21:03

Oh, sure.

SPEAKER_02 21:04

You know, they're getting their oxygen-faced, they're getting back into homeostasis. And so um, we're in this era now where the public at large understands the obesity crisis and all the metabolic problems that are out there, all the anxiety and depression that is at the highest that it's ever been. So they're trying to um do telemetry on themselves with wearables, right? How they're sleeping, how they're breathing, their heart rate, glucose monitoring. They're trying to get data to figure out how their body's working. That's because our healthcare systems failed, right? They they that when you really start understanding how we're supposed to function like a mammal, very efficient, parasympathetic coherence, it becomes very, very clear. And so when we're talking to our patients and you know how to talk to them, they connect the dots and go, of course, this is it. No, it's just that no one's ever talked to me about this. First thing they say is, you know, you're feeling this. Here's this medication. Are you willing to take it? Or you've got this condition, let's, let's, let's do this. And so this is the way we're also trained. You know, there's a lot of you got you've got a cavity, let's fill it, right? Aesthetics, here's another cavity. It's a doc, every time I come in, there's another, well, you got decay, man. Let's go ahead and replace that crown and fill it. And they go through 20 years of every tooth in their body is in their and their mouth is drilled and filled without stopping and saying, wait, you know, what's really going on? We're not treating a disease. We're treating the effects of a disease when we're doing that. And we did that starting in the 50s and the 60s when it was rampant because of the advent of, you know, refined carbohydrates. We didn't understand a lot of the problems, which by the way also led to type 2 diabetes. These are environmental inputs that we kind of quickly figured out some of the things, if you will, that we could change. So it's just that line of thinking that this is the way we were trained. You got tooth decay, this is the solution, right? And you tell the patient, patient sees you in a white coat, of course. Doc says I need to have this filling, we do that. Okay. It's not to say that they may not need that restoration, but the um dentist's responsibility is also to mitigate the risk for future disease. And you know, the reality is the third-party payer doesn't pay for that. So in a busy office, why would you spend time going through, say, Canberra, what we know now? Why would you spend time trying to mitigate that? And besides that, the patient doesn't want to hear it. They're in, they're out. So these are all uh day-to-day real-world scenarios. Well, it's the same thing in medicine. I'm not going to get paid to uh help this patient breathe better because they're breathing, right? Um, um, but we can maybe put them on a CPAP if they've got C. And so the hamster that the hamster wheel continues, and and yet when you start getting off of that hamster wheel and start really thinking differently, which ultimately was what the airway meeting residency is about. It's not a right or wrong. It's not telling you this is the way it is, because no, that's an allopathic model. You've got this condition, this is the medication. No, it's not that. It's more like think about it differently, communicate with the patient differently, and it'll start making sense. When you kind of go back to the basics, and I think this will maybe lead to our learning moment that we're talking about a little bit in the green movement that you were telling me is that you talk to your patients every day. I'm emotionally detached as to whether they accept my recommendation. My feelings aren't hurt. My job as the provider is to gather data, put it together, explain it to the patient, and then let them own it or not own it. My feelings aren't hurt if they don't, and if they want to get a second and third opinion, so be it. But what I find is they go and get the second and third opinion, and what if two things happen? Either they never come back, I never see them, or more often than not, they circle back.

SPEAKER_03 25:25

Yeah.

SPEAKER_02 25:26

And and oftentimes, either after they've had a bunch of treatment that didn't change it, and now they get that what I said made sense to them, or they were recommended some intervention, some widget that didn't settle with them, and they want to come back and learn more. And I think that's really what airway focused dentistry is about, is really um respecting the host response. It's not an on-off switch, it's a process, and that they're the most important part and variable in the outcome, but that those that are motivated um want to really take more control of the health. You can have a great outcome with all the things we can do in dentistry. There's so many things in our tool chest to address the deficient facial skeleton that goes beyond just treating the teeth and the joints and the muscles. That's the exciting part as a provider because we do want to do that. But I think the biggest part that the provider doesn't get that's maybe an AGD master that's heard every lecture and knows how to make veneers and what materials and chemical strategies and what good margins are like and bonding techniques and how to make it look good.

Patient Stories That Change Perspectives

SPEAKER_02 26:40

That's what they feel that they're getting paid for. But really, is the patient any healthier after you do that full mouth rehab? And then they have a heart attack because they were snoring while you were doing, you know, your your rehab, and then they didn't wear their CPAP and they have a heart attack. What good was it? Under your watch, you didn't recognize really what was going on with that patient. It was very easy to wash your hands. That's not part of my job. That's a C physician's. And the C physicians may have talked to the patient, say you got to wear the CPAP, and the patient said, I'm not gonna wear it. But there's no one really to work with the patient and explain what why you have to do it. Yeah, so I'll I'll leave it maybe our our topic here um regarding that, and maybe end it with your comments on the learning moment that maybe underscores what we've been talking about, what the issues and problems are with airway education and airway.

SPEAKER_03 27:40

Yeah, I mean, I it the learning moment definitely is that you know we can we can have the conversations with the patients in in a in a customized way that helps them better understand where they are on the health spectrum and what kinds of interventions might be available to them in our office and you know how we might approach things. And um they they may say yes or they may say no, and they may seek care elsewhere. Um I have a really it's kind of a sad story. Um the the patient has not died, but the patient is very sick. Uh I saw a patient and I diagnosed that uh you know there was significant airway issues. And um I told the patient, I you know, and he says, you know, I wear I used to wear a CPAP. And I said, Okay, and used to, what does that mean? He says, Well, you know, I just forgot it a few times. I woke up in the morning, I felt okay, so I just figured it was fine. I grew out of it. So a seven-year-old guy, he's been wearing a CPAP for 15 years, he just says I've grown out of it. And I said, Well, okay, but now you haven't been wearing the device um for all these years. Uh, what what's happening now? He says, Well, I have a completely different problem now. I said, Oh, what is your completely different problem? He says, Oh, I I have uh just really uncontrollable ner neuropathies and uh very, very, very severe anxiety and depression. But I'm I'm going through, don't worry, Rich, I'm going through all the medical testing required. The neurologists and the neuropsychiatrist uh system, everyone's got a hold of me, and they're they're gonna get me fixed. And I said, Can you do me a favor at least would you bring up to your primary care physician the next time you're in, because you're going in like every week for something, just just bring up this notion that you know you haven't been wearing your CPAP and and there may be an issue with with breathing and etc. And so he says, Oh, okay, I'll do that. And I called him and I said, You know, how'd it go? And he says, Oh, yeah, they rolled their eyes. They gave me an eye roll, and said, Your problems have nothing to do with airway. Nothing to do. These are you know, the board double-boarded neurophysiologist, uh the neurologist, uh, neuro radiologist, the whole team just roll their eyes and push it aside. And then on a on a more favorable outcome, and I mentioned it earlier, and it has happened me more than once, and it's happening to you many times, Mark, is that you basically have this wonderful conversation, they may go and seek second opinions, and then they come back, and then when they come back, they're ready.

CPAP, Accountability, And Closing Thoughts

SPEAKER_03 30:50

And so I think that that's just something that's part of the this type of I think that'll change probably when when the word is finally out and everyone gets gets this at least a little bit better. Um, what's going on? Where the patient will return to you and seek the care that you've originally recommended.

SPEAKER_01 31:13

Yeah, you know, it yeah, last uh closing.

SPEAKER_03 31:18

A lot to unpack, I know.

SPEAKER_01 31:19

Well, no, but let me maybe uh button it up here with this comment and listening to you.

SPEAKER_02 31:25

Um to be trite, I'll say at the end of the day, um we have clearly a broken healthcare system. Everyone knows that. And again, it's not just access to care, it's a kind of dentist or our healthcare that we're getting. Okay, no question about it. Look at the statistics. As a nation, we're getting sicker and sicker, more chronic disease. Yet we're in this brilliant um system that you have very smart people. The problem is just what you just described, is they have these symptom-driven answers that have obviated their ability to step back and really look at uh more of the global view beyond uh, you know, um, we have to look at the problem through the human systems theory, which by the way, that's the airway-focused uh approach, is kind of looking at it as a system. So that's our challenge. So we're butted up against a healthcare system that pays a certain way, and the pharmaceutical industry is getting, and then that device industry is getting rich doing that, but our patients are getting sicker. We're getting sicker, and so that's just a manifestation, and all I could say is is of what I found with my practice is it's so exciting because at least the earlier adopter early adopters are really appreciating um a new lease on life, if you will, getting them off of the CPAP, um, getting them off of their medications. And so that's what's available. And um I think it's gonna radically change in the next number of years. Uh, but the answer isn't going in and just taking uh a course, weekend course, and learning about the widget de jure and arguing about which widget A or B or C is the best. Um, so I think with that said, um, this is a deep philosophical problem. And uh Rich, I'm glad we were able to uh discuss it, talk about in this podcast, and uh look forward to seeing you at the next podcast. Thank you.

SPEAKER_03 33:39

Yeah, I do too, Mark. Thanks. Always great to chat with you, but