AI Just Confirmed What Airway Dentists Have Been Saying for Years

AI and machine learning analyzed over 585,000 hours of sleep data from 65,000 patients and the findings were alarming.

In this episode, Dr. Mark Cruz and Richard Stevenson break down a groundbreaking Nature Medicine study linking sleep dysfunction to chronic diseases like Alzheimer’s, stroke, heart failure, kidney disease, anxiety, brain fog, and more.

But the conversation goes far beyond sleep.

They explain why many of these health problems may actually begin with breathing dysfunction, flow limitation, and chronic stress on the autonomic nervous system long before symptoms become severe.

From airway-focused dentistry and preventative healthcare to AI diagnostics and deep sleep science, this episode uncovers the hidden connection between breathing, sleep, and long-term health.

If you’ve ever wondered whether poor sleep is really a sign of something deeper, this episode is for you.

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

Why Sleep Data Points To Breathing

SPEAKER_01 0:00

The common problem or the common factor in all of this is it's really not a complete problem. It's a breathing problem.

SPEAKER_00 0:09

Right. 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.

The Nature Medicine AI Study

SPEAKER_01 0:45

Rich, how are you doing?

SPEAKER_02 0:47

Hey Mark, I'm doing great. So uh what are we talking about today?

SPEAKER_01 0:52

Yeah, you know, so uh I thought we would talk about this this study, interesting study that uh actually was sent to me by my son. Um and he thought it was really very interesting because he's really into AI. Sure. And uh he saw this, and of course in healthcare, and so he saw this, and it was published in Nature Medicine. Yep, and it was uh uh uh published in February, so just a few months ago. And the title is A Multimodal Sleep Foundation Model for Disease Prediction. And the whole study is really about uh using AI and machine learning and looking at uh data from uh a significant uh amount of data from 585,000 hours of sleep data from 65,000 patients. So it's really large data. And so they were implementing uh some uh a model, they they called it the um the sleep foundation model, applying it to the various channels of a PSG or polysonogram to pick up on patterns as it relates to disease incidence or risk for uh for uh medical morbidities. I and I thought it was pretty interesting. I don't know what your thoughts were.

SPEAKER_02 2:21

No, I I mean I I I thought it was pretty interesting too. I mean, you got about half a million, more than half a million hours of data from a huge cohort, 65,000 participants. So I'm kind of doing the math. They all slept for at least eight hours. That alone is pretty remarkable, uh, particularly if it's uh a night of polysomnog uh polysomnographia. So, you know, it's that's pretty amazing, but you know, the thing that's incredible was that um you know they they were really strongly correlating in dementia, heart, heart failure, stroke, you know, kidney disease, uh, things that um you know uh affect us all. And um very, very interesting. I thought it was also kind of interesting that they made the point about that normally you would be looking at MRI for this same data set, and yet they could do it in a less evasive, invasive, uh more cost-effective manner. And that was pretty cool. Um I think it's pretty strong, pretty strong paper, but at the same time, um it's kind of also about what they didn't say, you know. Uh, and so when we when we look at this kind of stuff, Mark, and we we see these things all the time, um we're we're thinking, oh my gosh, who's asking the why? Uh what's really happening behind the the the sleep information itself? Let's let's let's try to unpack that a little bit better. And I think we all know, and and we know that they're they're I don't know if that you would say that necessarily they missed it, but let's just say that it wasn't there wasn't clarity in terms of how um the airway is directly involved in this whole process. What do you think about that?

SPEAKER_01 4:28

Yeah, I mean it's I think it's uh uh an example of the old saying, don't let your education get in the way that you're learning. That orthodoxy is so skeletal, you know, where they are seeing the problem the way it's been seen so orthodox. And I in the introduction, uh, one of the things that grabbed me right away is as they start introducing how you know sleep is related to you know all these chronic diseases and conditions and these medical comorbidities, and that it's kind of equivocal, this association between sleep and disease. And I'm kind of going, really? Um I don't think so. There are really good, good studies showing causation with all of these chronic conditions, whether it's cardiovascular, metabolic, you're looking at cognitive, neurocognitive. There's there's so much data out there. So I was a little puzzled about it. So when I read a paper and I'm hearing it in that context, I'm already a little bit, I don't want to say cynical about um the authors and what they're gonna say, but I'm I'm I'm gonna maybe be a little bit more jaundiced, if you will, in reading through the details. So that's one thing. Um yeah, when they talked about uh MRIs, um first of all, an MRI is not really uh a diagnostic test that the um the uh provider would normally use, right? It's not like you go in there and say, here's a functional MRI. So um a polysomagram is a study that can be prescribed by the physician, the insurance recognizes. But medical insurance, it's it's a it's another thing to say you need a functional MRI or diffusion tensor imaging, which is what a lot of the studies are based on that are academic, that look at damage to different parts of the brain,

Big Predictions Across Major Diseases

SPEAKER_01 6:40

that are associated with chronic intermittent hypoxia. But those were not studies that were meant necessarily to um uh assess an individual patient as much as the pathophysiology of the condition of sleep apnea. So I thought that was kind of interesting that they brought that up, because that would never even enter as a decision anyway, I don't think, in the average C physician's mind to say, oh, I'm gonna send you an MRI, let alone say functional MRI.

SPEAKER_02 7:11

Yeah. I agree. You know, I wanted to ask you, um, because you know, the amount of amount of experience and knowledge you have in this area is is is is huge. Um these are the kinds of things that uh we're we're sort of trying to prevent uh by recognizing them earlier in life, you know. And somehow people are missing this, that this is this is a you know, we talk about this a lot. We're talking about kind of the end stage of a disease, actually, right, Mark? And so just even the fact that we say that implies that there's an arc, there's a trajectory that can be predicted much, much earlier, and uh we can intervene, intervene. And in and this is exactly what we do. Exactly what we do. We have tangible results, medical metrics that prove outcomes uh are you know are better, uh happier patients. We see we see we move the needle pretty drastically in some patients in a positive way, uh, without waiting until the very end. Um and and um that's one of the things that kind of resonates with me is that I'm looking at this going, yeah, it's it's not it's really not it's great, I I get it, but at the same time it's it's not that surprising. Um if if I have patients that have um problems with respiration while they're sleeping and they're not saturated well, and they're they've got a lot of breathing effort and high arousal events. Um if that's all happening while they're sleeping, uh that's no surprise to me. Um that you know that they're that they're I mean, why were they even prescribed this PSG in the first place? So I don't know. I I think it well let me jump in. Oh, I mean this is not the this is not the cohort anyway that we normally even spend much time treating. We try to get them into treatment with the uh the medical community, but uh sometimes it'll circle back and we'll we'll help them as well. But a lot of that can be can be looked at way in advance before these things happen.

SPEAKER_01 9:48

Well, that's it that that's exactly right. And this is exactly what this podcast is about, and what we're about is you know, let's not be waiting until the end stage. I mean, the the again, going back to the studies, uh it's very well documented what's gonna happen to the brain due to many years, oftentimes decades, of chronic intermittent hypoxia. You're gonna have damage to different areas of the brain that end up in end stage disease. Why would we wait to that? And yet in this study, they're using studies that are prescribed to a selected population, which one of the comments that was made in the discussion was the weakness of the study was uh uh there was a selection bias. Well, of course, because they're actually looking at disease that's already end stage, it's not even beginning for they didn't really get into the details of the study other than that they did use that they did use uh American Academy of Seat Medicine studies and they use different criteria to kind of have uniformity across the the four uh centers from which they got gathered the PSGs. But I think the bigger issue is to me, is the the elephant in the room is this is a reflection of the problems with our healthcare system that were focused on the problem once it's already happened, you know, all all these all these uh problems, metabolic problems, obesity, I mean even cancer. I mean, they talked about the uh

What The Paper Skips About Airway

SPEAKER_01 11:25

what was okay, sidebar, what was really to me very important in the paper is is the statistical analysis that they made in the machine learning uh correlating the data from the different channels of the study with the different medical comorbidities, and they broke it down looking at uh area under the curve. So they looked at rock curves, and almost all of the correlations were 0.8 or above, meaning that the sensitivity and the specificity were so high that um that it is another way of saying it's very accurate, right? So it's it's so when you get to one, that means area under the curve, which doesn't happen 100%, uh, that means that you've got um a condition that really doesn't occur where sensitivity and specificity are very, very high. So few false negatives, few false positives. So the data that you get, it's very strong. Another way of saying it's very strong. So to me, that was like, wow, well, we already know that, but they actually were acknowledging that with the the with the um uh the the um analysis and the machine learning. The other thing that I think was really interesting from an AI point of view is and that what AI can do, uh, and that I will predict in the future that it will be malpractice if the provider is not using AI as a as an aid in diagnostics, in that it could look at very uh big data sets and pick up patterns that are very difficult for even a very seasoned clinician to look at. And some of the things that I thought to me that were compelling were excuse me, is that we're looking at the association of the different stages of sleep with the different morbidities. Like for instance, Alzheimer's, they were looking at the uh correlation with those that cohort that that sample had less N3 sleep or slow wave delta sleep, the deep, deep sleep right before REM. And of course, we already know that, and why is that? And the reason is is that during slow wave sleep, you have what's called the lymphatic system, and that's where the glial cells or the brain cells um shrink, where the blood-brain barrier opens and all the metabolic waste from the brain gets to spill out and cleanse. So all the reactive oxygen species from the metabolic work, uh, that the glial cells, as every cell, will go through their metabolic byproducts that if they they're they're it's like you're swimming in your own poop, right? So you want to it it's gotta get rid of it. And and so the brain doesn't have its own lymphatic system like the rest of the uh the body. And so what they found some years ago is that during slow uh slow wave sleep, deep, deep sleep, right before RAM, um, those cells really shrink, and what happens is the uh cerebral spinal fluid can cleanse and go through the nuts and crannies and pick up all the metabolic product and cleanse it. Well, in those individuals that aren't in slow wave delta sleep for very long, they're not able to have that cleansing effect, if you will. And so what happens is it stimulates uh the deposition of tau beta amyloid, which is what we know essentially causes Alzheimer's. So I thought that was really interesting. They they also uh talked a little bit about what happens when you have REM versus just slow sleep. So I thought that part of the machine learning from the AI was really, really uh very interesting.

SPEAKER_02 15:33

Yeah, I will things, but yeah, I mean that's absolutely fascinating to me. And um I just I get excited about the role that we can play as dentists in in keeping patients from even being in this e you know my my goal is that a patient

End Stage Care Versus Early Prevention

SPEAKER_02 16:00

never has to have a PSG ordered, you know? Right, right, right, yeah, right. I mean, and so it's it's and I think that that's it's gonna take some time before that message gets out for sure. I I think so. Um if we're just looking at this cohort that has uh a sleep study was ordered, um they they were able to make all of these amazingly accurate correlations, what 130 different diseases uh were correlated, uh it's it's it's pretty it's pretty cool. Um but at the same time I'm thinking that's great, but how did these people end up here to begin with? And no one seems to talk about that. Uh there's really not a discussion about what can be done about this. Uh so and and I and I think like you said about you know modern medicine, we get kind of so excited about these sort of things, but does it really now what? I you know, sort of like a now what, you know?

SPEAKER_01 17:09

I call that disease management, right? Because that's how we get paid to manage disease, not so much to obviate or cure it, if you will. Um here's the problem the common problem, or the common factor in all of this is it's really not a sleep problem, it's a breathing problem. You know, for the channels in a sleep study are actually looking specifically at flow limitation, whether it's looking at the chest belt or the effort from the abdomen, um uh flow limitation in the um through the um you know oral or oral pharyngeal complex through the nose, um, and and um and so uh that's where our role as dentists come in. If you understand that the problem really starts with flow limitation, and and why is that a problem? It's because if you have flow limitation, that gets the brain very excited. So the autonomic nervous system upregulates, and it's really what causes a lot of the chronic problems. So when it's end stage, most of these patients that have these diseases that are end stage, it's because they've already been hammered from chronic intermane hypoxia. Um, so it's kind of like what I remember Ron Harper from the U CLE Brain Research Institute, one of the most published researchers on seep apnea, would say it's it's really not so much the chronic intermane hypoxia or the hypoxia per se that's gonna kill the person. It's the brain's uh or it's the autonomic service system's response to it.

SPEAKER_02 18:49

Response to it.

SPEAKER_01 18:50

And that's what we're looking for when we do our screenings with the high-resolution pulse oximetry, it's like we're looking at that heart rate going up because there's a dump of adrenaline. And if it doesn't, that means that there's a lot of damage to the brain. Then we won't get into the weeds about all that, but uh, I I think for those patients that are supersymptomatic, but you do a seep study and they have no apneas and hypopneas, it's this idiosyncratic, paradoxical condition that you're thinking, well, they don't have any apneas or hypopneas, but they're super symptomatic. Why are they? Well, they don't have any apnes and hypoxics because their autonomic nervous system is really healthy. It's preventing them from having that pro that chronic intermediate hypoxia that causes the end stage disease.

SPEAKER_02 19:43

And we and by the way, we in our daily airway practice can see that, we can measure that with highly sophisticated, non-invasive methodology. And we do it all the time. Yeah, all the time. And and and there's just there are so many people out there that are suffering before they get to this stage that have been trying to find answers, uh, and they're doing all kinds of things, uh, as you know. And I think that it's just you know, this is um such a great opportunity for us because we we we we intervene before people get to this point. But let's let's face it, um it's it's gonna take a lot of time for enough airway dentists and orthodontists and airway focused clinicians to to really learn how to recognize these things, to understand how to treat our patients. And unfortunately, you know, it a lot of people are gonna end up in the PSG sleep lab because they're being told they're not breathing at night, and then they end up in this situation, and then we're looking at these strong correlations to all of these horrible, horrible uh chronic conditions that affect so many of us. And so, you know, it's just mmm. I um I'm excited about the fact that a paper like this is out and people are reading it and people are getting excited, and maybe that's just one part of uh the medical community starting to become more informed that um sleep is causing all these issues, and we believe that it's more than sleep. And I I don't think it's a belief, as much as it is we have the documentation to prove that it's all uh really stemming from in most cases. I mean there are some you know outliers, but most of the time if you're not you're not getting properly. Oxygenated and uh while you're sleeping, even if it doesn't show up as an aptic event or hypoxia, you're you're you are dealing with an autonomic nervous system that is stressed, as Harper said. It's what the autonomic nervous system does to try to fix things that causes so many downstream problems.

SPEAKER_01 22:26

So another way of saying that is sleeping is secondary to breathing, moment to moment. Yeah, to breathe. Can we I mean we should just be saying that a lot, you know, because it's I say it's breathing disordered sleep, right? So if you have disordered breathing during the day, uh, and a lot of people do, and they don't know it, but that's why they go to yoga

Flow Limitation And Autonomic Stress

SPEAKER_01 22:50

class, right? Of course, is they kind of order their breathing by either a workout, yeah, uh meditation, um uh yoga, in some cases, happy hour, you know, it's disordered, and then that kind of calms you down to be where you're finally feeling like you should all the all the time at the end of the day. Well, you should be like that throughout the day. I mean, athletes that are performing at that at their peak, you know, they're optimizing their breathing function for the high metabolic demands of their activity better than maybe the next the next guy. And so um it's again, it's about breathing. And what I find in my practice is the people that are coming in, yes, it's gonna take a while for the healthcare system to change because it's so complicated, there's so many stakeholders and and yada yada yada people involved that don't understand this, you know, the beam counters and all that. But it's the patient that knows their searching and go, I know this isn't right with my kid or with myself, I know the snoring, and people are hearing more and more about it. Um, you know, you hear on the internet about taping the nose and and natty pots and um you know, all these things that we didn't hear that much about before. That's so that's a beginning of an understanding. And then when you start treating those individuals, even if it's a colleague that comes to a course and they go, Oh my gosh, that's my wife, that's my husband, that's my daughter, that's they start you know seeking treatment for themselves, and then they start telling other people because it changes their life. It's not just something like you go ahead and and do a set of veneers and boy, that's nice, and then it just becomes part of your background. No, this actually changes the way you function and walk through the world, and it's pretty remarkable. Um, and I think it's a grassroots effort in my mind and in what I my experience that that we're starting to understand. And again, when I was talking about this 15, 17 years ago, it was all about sleep and making appliances. And people thought I was crazy because I was talking about these, and not everyone's doing it, and now they're doing Marpe's and they're doing these these things, but they're still not even talking about the breathing, they're just saying I can make your palate wider, but they're not really saying and understanding why that is and how that affects the sleep beyond maybe citing that you can breathe better through your nose. Well, what does that mean? Well, as a provider, you have to measure, and that's what we do for our patients. And what we're measuring is the autonomic nervous system. They're getting into parasympathetic coherence, and therefore, the anxiety, the depression, the mood swings, the irritability starts melting away. You start brain fog, brain fog, forgetful hands and feet, all those things.

SPEAKER_02 25:54

Explain, you know, I mean, I don't want to eczema, you know, and just uh bags under your eyes and things like this. I'll just it goes on and on. There's so many, so many things.

SPEAKER_01 26:08

Uh but that's the problem, is because there's so many things, how can it all be connected, right? It's it's and that's why you know we talk about human systems theory. We talk about the body not working as seven different organ systems, right? It's integrated, and we're trained in a system that looks at separate seven separate organ systems as if they're functioning in isolation, and reality they're uh they're integrated. And we in dentistry we look at the temporary mandibular joints as maybe somewhat loosely related to you know the teeth and to the gums, and um not much having to do with the tongue, right? And the cheeks, and yet it's all interconnected, and so uh, and the most important part is the breathing part, because that's part of the breathing, the the error, right? You know, oral cavity. You know, I have to tell you this morning I had a meeting with um Craig Pickerell, who's in principal of patient safety, uh, that makes the high-resolution pulse oximeters really exciting, the new oximeter that they have, the Bluetooth that you put it on the forehead, that takes care of a lot of the problems that a finger probe uh has. But we were talking about the this um study that we're ready to publish looking at how you read oxymetry, and he's really frustrated as a sleep tech that's uh that really understands flow limitation. He says, you know, they don't really understand a lot, a lot of these sea physicians, they're really looking at apnes and hypotenuse, but they're not really looking at the arousability, if you will, from the autonomic nervous system. And uh one of the authors uh from Harvard that's in this study actually had a conversation with him, is super excited because he's now saying, you know what? We've been kind of looking at the wrong thing. It really kind of comes down to you know the autonomic nervous system's response to any perturbation in gas exchange. In other words, you have flow limitation, and that can cause a kill to manifest as, as they say, ADD ADHD. It could be what causes the bed wedding. It's not some bad habit because he didn't go to the bathroom before. So so I I think it's so complicated in many ways, and yet I see it's very simple when you really kind of I was gonna say the same thing.

SPEAKER_02 28:45

It's like you know, you you said basically how can all of this have one common origin? And and you could also say how can it not in some respects, because the uh the fact that so many of these things can be explained so clearly with all these pathways that you're talking, you know, that that you know so well, Mark. Um for for me, I just think um you know, I mean if we can circle back to this paper, this study, I mean I think it's it's it's great. Um and it's it's not really preventative medicine, is it, Mark? I mean, it's it's sort of we're just finding out a way to maybe save some healthcare dollars by looking at sleep studies to make some predictions, but in terms of really changing the um trajectory of someone's health, we can be involved in preventing a lot of these things so much earlier.

SPEAKER_01 29:55

Okay, so can I ask you, having said that, knowing what you know about airway, uh how many did uh how many of the diseases that were on the list do you see in your own practice as downstream uh they came into you maybe for a tooth problem, a dental problem. Right, now do you find with this airway focus, if you will, that you're looking at the patient differently when you see that erosion or the wear patterns and the reports that really you end up finding out that they have all these end stage problems uh along with the type 2 diabetes and the obesity. I mean, how with knowing this as a data provider, um how has this affected you and how you see the patients and how you treat them?

SPEAKER_02 30:44

But you know, it every I mean it it's almost like the majority of patients that I see, once they reach a certain age, they're gonna have they're gonna be on some kind of medication for diabetes. Uh, they're gonna be on some kind of statin, they're gonna be on a blood pressure medication

Breathing As A Whole Body System

SPEAKER_02 31:05

of one kind or another. Um there are gonna be other health care issues that they have. They come in to see to see me in the practice, and I can tell you how I used to used to respond to those patients, how I respond now. I used to think, oh gosh, that's really a bummer. Uh that's just something that happens with people that get older. Um, you know, aging, you know, it kind of sucks. Uh now I don't think that way at all. Uh I start to look at the correlations between all of those systemic conditions that are being treated by well-meaning, excellent medical doctors. It's not their fault. Um and I'm looking at other factors, other signs and symptoms that they have that I used to just blow off and say, Oh, you're a grinder. Um, and they say, Oh, why do I grind? And my common response was, Oh, uh, most likely stress. Like, yeah, yeah, I'm under a lot of stress. And and then uh so we would treat them with either new restorations or some kind of a guard of some kind, and you kind of shrug your shoulders, what more can you do? And the patients played along with it as much as we did, too, because you know what else could it be?

SPEAKER_01 32:29

Well, you know, you you what you know, you you just know about teeth, right? You know, absolutely. Um when I my the the my patients now they come to me more and more now are asking me because uh so many times when I'm asking them the questions of all those things that you just listed, I'm just thinking, this person doesn't sleep well. I start talking to them about their sleep. Absolutely when you start having all these systems and these medications. So let's go back in time when we're in dental school. All of us, when we're in dental school, I remember we're all excited, we put our white coat on and we went into the clinic, and then we were supposed to do our medical history, uh, review of systems, ROS, A G E N T, right? All those systems, and we'd go through an ascetter medication, and so we're just, I think, looking back, playing doctor, okay. I checked all the boxes, okay. Not that I could do anything about that complicated medical history, other than just denote it, as if it had anything to do with me as a dentist. I'm just making sure I don't get myself in trouble and use a vasoconstrictor on a patient that's about to have a heart attack, okay? So we kind of would do that, and then as you get into clinical practice, you kind of almost, you know, you kind of blow it off. I mean, how many of your patients do you routinely take your blood pressure every time you do a procedure? I think most dentists do that less and less and less. Okay, we're supposed to, but now for me, knowing what I know, and you know, is when I I see that medical history, I'm going straight to how are you sleeping? And what happens invariably? Oh, I sleep great, I snore, but my wife doesn't like it, or I haven't slept well in in years. And then as you know how we train them to ask the screening questions, it starts taking you down this road that the patient starts saying, hmm, yeah, how'd you know that? And and then you ask another question, and you go, Wow, no one's ever really asked me that. They go into their physician, they have all these medications. Let's see, uh, well, let's put your glucophage uh uh dose up a little bit. Looks like you're having problems collecting, not even thinking about asking whether they've got a sleep problem, right? Sleep apnea or whatever the case. So I think you know that's where it's very exciting to be a dentist when you start using that airway focus because it doesn't uh uh doesn't replace us doing our dentistry. It just gives you a better context to understand the etiology of the problem, right? Whether it's wear, looseness of the teeth, loss of bone, you know, bleeding because they're mouth breathing and they're they've got that chronic gym, all those things that um I I think gives a different different context. So I think patients appreciate that. So it's different, right? For you now?

SPEAKER_02 35:33

Totally, completely different. It makes sense. Pardon? It makes sense, right? It's not a yeah, and you know. I I in my my my chair side discussions with patients are so so different now. Yeah, and uh it's fascinating because they they they they have hope now, and they they have finally found something that is gonna put them on the path to wellness, and um they're excited about it. And so I I'm I I love it. I I wish I were younger so I could practice longer. I mean it because I now finally after 40 years, you know, we both are celebrating our 40th years as as dentists. It seemed like it's we just started. I was just supposed to say that.

SPEAKER_01 36:31

I've been practicing 10 years, man. It's it it is it is um you know exciting, but don't you also find that it's more rewarding the conversations I have with my patients, that they they really, you know, what I find is that the physician is caught up in a system that's broken, and you talk to them and they know that they're frustrated, and they're saying, uh, I just kind of have to get through and take care of this symptom de jure. And the and the patients start saying, Yeah, you know, they're putting me on this thing, they can't figure it out. And I've gone to three or four different specialists, and no one can figure it out. And the physics and the patient's frustrated to where when you start engaging them in a conversation like that, like you say they have hope, they go, wait a second, so who's actually trying to figure it out in a comprehensive diagnostic way? And for me, I have found that my referrals to my physician counterparts is a lot more effective on saying, okay, maybe we should start talking about this, and and and then I find those conversations with my colleagues, medical colleagues, are uh

How Airway Thinking Changes Dentistry

SPEAKER_01 37:50

more collegial as a result of it as well, versus like, you know, you know, stick the teeth, buddy. It's it's more like, well, tell me a little bit about you did that high-resolution pulse-up symmetry, and you had noticed yada yada yada yada. Uh, that makes a lot of sense. Uh, what do you think? So then I start getting referrals from them. And I think that's just the way it should be. It's just more collegial. And again, coming down to how we breathe. And that's our role because as Dennis, we're dealing with the facial skeleton, right? That I mean, more than anyone, and that's where the kinks in the hose are the back of the tongue and the nose. Right. And the nose is just the second floor of a two-story home of which the palate is the first floor, is the the ceiling of the first floor.

SPEAKER_02 38:42

Ceiling of the third floor, right.

SPEAKER_01 38:44

Right. And so when you start thinking about it, and you start talking to the patients about it, and you start understanding that, you know, I could deal with that wear and that tear and stop the bruxism instead of giving you a piece of acrylic to wear at night, we can actually stop that by improving that flow. And the patients come back and go, wow, I just feel so much better, I'm sick of better. Um, and the restorations aren't breaking all the time. Joint symptoms are ameliorated or they go away, and and so, yeah. So, yeah, going back to the paper, I think it was really interesting. Large data sets in summary, AI machine learning, um, pattern recognition, the house of provider. And uh, we're all in this together in healthcare, and it's really about the patient. And I think it is exciting um to really start looking at this, uh, our patients with a different set of eyes. So maybe we conclude our podcast um with that, and and and if you have maybe a learning moment of the week, I know you were gone last week um uh teaching a course up north, but uh any learning learning moments that you want to share?

SPEAKER_02 39:57

Um basically that in in my, you know, I teach these general dentistry fundamentals courses, right? And so we start off with you know diagnosis and and then we get into things like preparation designs, adhesion, posterior work, anterior work, uh we have occlusion in there, we talk about implant restorative connections and the full mouth rehabilitation approach, and and the so this is kind of seven-part series. Um it's a lot of hands-on. But since becoming, I would say, enlightened, quite frankly, um, and have a deeper understanding of the the human body and how our role is so important to the trajectory of people's health, um, I started implementing Mark airway related of uh of kind of a I would say a modifier or uh a deeper understanding level to every single course we have. So airway aware. Airway aware. So the if you look at there's four points on the on the diamond where you have periodontal and you have biomechanical, you have functional, and you have aesthetics or dental facial uh analysis, you look at these four areas, airway impacts them all, and it cannot be dissected out as a fifth area, which would be so convenient to do. Oh, we have fives now.

SPEAKER_01 41:37

No, it's not the foundation, yeah.

SPEAKER_02 41:40

It's totally, it's interwoven everywhere, and so uh my learning moment was I started to incorporate this in my lecture, and the response from everybody was very positive. People are just getting excited, like, okay, okay, how do I learn more? How do where do I where do I go to be able to start to see the things that you're seeing and you're talking about? So that was it was great. There were 26 dentists from all over uh the United States that came to this course for three days, and um, you know, they're waiting for for for for some kind of a program they can join, something that we have um that basically that we have we have we have designed, you know, and so that's kind of my learning moment.

SPEAKER_01 42:34

Nice segue. That's my learning moment. You know what my learning moment was? You and I um coming up with um the airway nexus fell fellowship. I mean, I'm so excited about that, Rich. This happened this last week.

SPEAKER_02 42:50

I can't I can't, I can hardly dedicate. I can hardly sleep. I'm so excited.

SPEAKER_01 42:57

It's yeah, so we'll dedicate the next podcast or series of podcasts to talk a little bit more about that because I agree, I think we should.

SPEAKER_02 43:05

Because any dentist hearing this is gonna want gonna

Airway Aware Training And Fellowship

SPEAKER_02 43:10

want to want to learn more about what what it's all about for sure.

SPEAKER_01 43:13

And I'm confident it's gonna change dentistry. Uh those are big words, but uh the reason is that we've finally figured out um how really to package it in a way, first of all, as you said, dentists need a system. Um, otherwise, you get overwhelmed with a lot of information, but you don't know how to use it. Um because at the end of the day, on Monday, you've got to treat a patient. So, number one, is a system that works for you in working through the entire timeline of the airway from you know from formative years all the way through maturity. Okay, so that's one thing, and then the the other thing that's exciting is that our um residents, if you will, because it's More like a residency, actually, we provide patients for them.

SPEAKER_02 44:04

Oh, I know.

SPEAKER_01 44:05

And like in a residency in a hospital or a dental school, um, they're gonna be able to actually do the procedures in the context after they learn, right? Yeah, so I'm excited. What I learned this week is our conversation going back and forth that yes, we finally have the answer. I cannot wait to get the word out, and I think that's what we'll do over the course of the next few podcasts is talk about how both of us have come together with Barry and our faculty, world-class faculty, both physicians and dentists, to really really provide a system that really makes sense beyond just a widget. So I look forward to that. Rich, again, thanks for a great podcast. And and um I'll look forward to uh our next podcast next week.

SPEAKER_02 44:55

Yeah, me too, Mark. It was great, great talking with you and Kay Wit to talk more about the airway nexus.

SPEAKER_01 45:00

Yeah, sounds great. Good. All right, talk to you later, Rich. Take care.

SPEAKER_02 45:03

Bye, Mark.