Subscribe 

Good Morning.

Good Morning,

A patient in his late 60s came into our office recently with a frustration many of us have heard before:

“My front teeth keep breaking… and I’m tired of fixing them one by one.”

At first glance, this might look like a restorative problem.

It wasn’t.

5-minute read👇

The Clinical Story

• The Pattern Behind the Problem

  This patient had a long restorative history:

  • Every tooth has been crowned for over ~45 years

  • Multiple re-treatments

  • Recent fracture of maxillary centrals within weeks

  • Significant wear across PFM restorations (see 3D scans)

  But the real story was not in the teeth.

  It was in the airway.

  The Airway & Systemic Context

  His medical and airway history included:

  • Prior stroke

  • Diagnosed with severe obstructive sleep apnea

  • Intermittent CPAP intolerance

  • History of UPPP with residual soft tissue bulk

  CBCT findings revealed:

  • Compromised nasal valves

  • Inferior turbinate hypertrophy

  • Septal deviation (possible turbinate contact)

  • Maxillary hypoplasia

  • Mandibular retronathia

  • Deep overbite

  This is a classic presentation of structural airway compromise paired with chronic sympathetic activation.

  And the teeth?

  They were collateral damage.

  Why Teeth Break in These Cases

  What we’re seeing is not a random fracture.

  It’s the downstream effect of:

  • Sleep fragmentation

  • Micro-arousals

  • Protective neuromuscular reflexes (bruxism)

  As highlighted in the literature, sleep bruxism is frequently associated with sleep-disordered breathing and may represent a compensatory airway response rather than a primary disorder.

  In other words:

  The body is trying to survive—not destroy teeth.

  Phase-Based Treatment Approach

  Phase 1: Stabilize Airway + Neuromuscular System

  • 3D printed PMA for airway support

  • Lower TMD orthotic

  • Trial bite development using phonetic positioning

  Outcome:

  • Shimbashi increased from ~8 mm → ~16 mm

  • Improved mandibular posture

  • Reduced strain on the system

  This aligns with principles that bite registration and mandibular positioning directly influence airway patency and treatment success.

  Phase 2: Restore Into Stability

  • Bite registration transferred at tested position

  • Virtual wax-up for full-arch rehabilitation

  • Interim EMA appliance during temporization

  Key principle:

  We don’t guess the bite—we test it physiologically first.

  Phase 3: Long-Term Airway Control

  • EMA sleep appliance for ongoing support

  • Nasal optimization protocol:

    • Intake breathing strips

    • “Three-blow method” (Xlear + clearance + support)

  • ENT collaboration for structural nasal concerns

  • Pre/post objective sleep tracking (SleepImage)

  Why This Case Matters

  This isn't just about one patient; it's about changing how we think. Dentists often notice early signs like worn teeth, fractures, failed dental work, and muscle or joint strain. However, many dentists hesitate to screen for these issues because of limited time, unclear roles, and a lack of confidence. While these challenges are known, there are also solutions: better education, integrating screening into daily routines, and having clear referral processes.

  A Clinical Reframe

  Instead of asking:

  “Why do this patient’s teeth keep breaking?”

  Ask:

  “What is the body trying to accomplish during sleep?”

  When you answer that question…

  Everything changes.

Coach Cathy’s Corner (Functional Nutrition Lens) 

Supporting the Airway Through Nutrition

Excess digestive acid and reflux can contribute to nasal congestion and airway resistance, especially at night. A simple starting point is reducing common triggers like late meals, alcohol, caffeine, chocolate, and highly processed foods.

Focus instead on whole, low-inflammatory foods that support digestion and reduce upper airway irritation:

• Lean proteins (fish, poultry)

• Cooked vegetables (zucchini, carrots, leafy greens)

• Low-acid fruits (melon, berries)

• Healthy fats (olive oil, avocado)

To minimize allergic load and mucus production, consider reducing dairy, refined sugar, and ultra-processed foods. These can increase inflammation and contribute to airway reactivity.

Hydration, mindful eating, and finishing meals 2–3 hours before sleep can also improve nighttime breathing.

When the airway is calmer, the body has less need to compensate, helping reduce parafunctional activity such as bruxism.

Selected Peer-Reviewed References with Links

1. Thurtell MJ, Wall M. Idiopathic intracranial hypertension. Neurology, 2013.

2. Sugita Y et al. Sleep apnea and intracranial pressure. Chest, 1985.

3. Pirelli P et al. Rapid maxillary expansion in children with sleep apnea. AJODO, 2004.

4. Villa MP et al. Orthodontic expansion and pediatric sleep-disordered breathing. Sleep Medicine Reviews, 2015.

5. Van Cauter E et al. Sleep and growth hormone regulation. Endocrine Reviews, 2000.

6. Russo MA, Santarelli DM, O’Rourke D. The physiological effects of slow breathing in the healthy human. Breathe (ERS). 2017.

Final Thought

You can replace a crown, but you can't fix a broken system quickly. Airway-focused dentistry is about understanding better, not doing more. For your health and development, focus on the airway. Let sleep work its magic, and growth will come.

If you found this helpful, forward it to a colleague or sleep physician partner. Let’s grow the movement, one documented, approved, and healed patient at a time.

Click here for related podcast topics.

Until next week,
Dr. Michael & Cathy Bennett
More Than Teeth | A Mission for Generational Health