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GOOD MORNING

Welcome back to More Than Teeth, where we help you design smarter, healthier, more personalized airway care.

Last week, we showed you how to measure airway improvement before you fabricate a device. This week, we’re closing the loop—with a powerful follow-up that shows how Xlear nasal spray, Dr. Bennett’s 3-Blow Method, and a muscle-aware bite registration protocol can turn a good appliance into a great one.

Let’s talk about real-world impact, innovation, and the nose’s quiet power to help the brain keep the airway open.

IN TODAY’S EDITION

• Case Study Update – How a 2mm bite change + Xlear led to airway success

• Dr. Bennett’s 5-Step Protocol for building better appliances with better data

• Why the Nose Triggers the Throat – A reflex-based approach to airway support [Clinical Study]

• CBCT + Xlear = Predictability – How nasal hygiene impacts scan outcomes

• Cathy’s Corner – Buteyko Breathing Tips enhanced by using Xlear Nasal Spray

• Evidence Spotlight – Why nasal airflow is the brain’s cue to protect your airway

5-minute read👇

Clinical Corner

🥼Use the clinical corner as your secret weapon to impress your colleagues and patients!

Key Takeaways🔑

CASE STUDY FOLLOW-UP

From Stuffy to Stable: Nasal Patency Is a KEY Part of the Solution

We revisited the patient from last week’s scan—the one whose first CBCT with trimmed bite and nasal valve supports showed some improvement, but not the dramatic volume increase we were hoping for. The patient’s gag reflex wasn’t completely comfortable with the tongue extension.

So we did what any airway-aware team would do:

• We increased the vertical by 1mm by adding occlusal acrylic and changed from 21 to 20 EMA bands.

• Added a daily Xlear nasal spray routine morning and night

• Coached tongue posture and myo drills (suctions, lip purses)

• Used the 3-Blow Method to address nasal congestion as needed.

2 weeks later, we re-scanned with the same bite but better nasal patency.

The result? A 36% increase in the minimum cross-sectional area, a visible drop in soft palate collapse, and—most importantly—a patient who slept through the night for the first time in years. The titration HST verified breathing function improvement from AHI 61 to AHI 23. With nose breathing improved the patient could tolerate the tongue extension without any problems.

5-Step Appliance Prep With Nasal Protocol

1. Baseline CBCT

   • Take in a neutral head posture, teeth in occlusion, and don’t say anything about how the patient should hold their tongue.

   • Look at volume AND shape: Is the soft palate thickened? Is the tongue in a low posture position?

2. Trimmed Bite + Tongue Test

   • Make sure the patient can suction their tongue to the roof of the mouth

   • Leave the anterior space free

3. Nasal Patency Preparation Pre-Scan Protocol

   • Do the 3-Blow Method [see pdf link below] 5 minutes before CBCT.

   • Add nasal valve supports (e.g., Intake™ or Mute®) if the Cottle maneuver is positive. [Watch Cottle Maneuver below]

4. Scan Again

   • Compare baseline CBCT with bite reg CBCT tongue positioning, minimum area, nasopharyngeal total volume (PNS to C3 inferior border)

   • Watch the autonomic effect: the nose triggers the throat to stay open

5. Refine, Then Fabricate

   • If volume improves: finalize bite, scan, fabricate mandibular advancement device

   • If not: adjust vertical/protrusion 1mm, add myo drills, repeat CBCT

   • Patient commitment to nasal breathing matters. Give some buyers comfort by showing how their airway may improve with your help, by showing the before and after CBCT airways.

EVIDENCE SPOTLIGHT

Your Nose Knows: Why Nasal Breathing is Nature’s Design

A 1985 clinical study in the American Review of Respiratory Disease looked at what happens when healthy men had their noses numbed with lidocaine before sleep. The result? A 400% increase in disordered breathing events, many of which were true apneas. No congestion. Just the numbed signal from the nose shut down the normal rhythm of sleep breathing.

This tells us something profound: The nose isn’t just a passage, it’s a sensor. The brain needs nasal airflow to regulate breathing during sleep.

When your nose is blocked, dry, or inflamed, your body often defaults to mouth breathing, especially when lying down. And mouth breathing at night doesn’t just dry your throat, it can lead to:

• Poor sleep quality

• Snoring and sleep apnea

• Changes in facial growth in children

• Impaired immune function and gut health

That’s why airway-focused dental teams, and now our partners at Xlear, are working to restore nasal dominance for children and adults alike.

 CATHY’S CORNER

Buteyko Basics + Xlear: Your Nasal Breathing Reset

Whether you’re healing from a cold, dealing with allergies, or just trying to get better sleep, your nose needs to be clear to do its job. That’s where Xlear (pronounced CLEAR) comes in.

Buteyko breathing teaches us that quiet, nasal, diaphragmatic breathing helps reduce inflammation, improve oxygen uptake, and calm the nervous system. But here’s the catch: You can’t breathe through a nose that’s blocked.

That’s why I recommend adding Xlear to your daily breathing routine. It’s gentle, effective, and safe enough for kids and adults. (Mike and I have been using Xlear in our home for years!)

Try This Simple Routine

Step 1: Clear the Way
Use Xlear nasal spray – 2 sprays per nostril, morning and evening for two days then as needed for mild to moderate congestion.

Step 2: Do These Buteyko Basics

Nasal Breathing Only

• Practice keeping lips closed throughout the day

• Use a sticky note reminder: "Nose Only."

The Control Pause

• After a normal exhale, hold your breath

• Time until you feel the first urge to breathe

• Goal: 20+ seconds = improving function

Something Sweet

🍭Stuff so sweet you might get a cavity..

CE Opportunities / Events

Have an event you would like to post? [ click here ]

Miscellaneous

😅P.S. … THE XLEAR DIFFERENCE

Breathe Better. Sleep Deeper. Heal Naturally.

We’re proud to announce our new partnership with Xlear, makers of xylitol-based nasal sprays that hydrate and protect the nose while clearing mucus and allergens.

— Dr. Michael & Cathy Bennett
More Than Teeth | A Mission for Generational Health