by Felix Liao
Diagnosis: Impaired Mouth and pinched airway interfering with the start of puberty. His Holistic Mouth Solutions treatment included the following: diet change to ensure nasal breathing full-time, wear an upper oral appliance attached to a face mask to sleep for ten months, tongue-tie release, and oral-facial myofunctional therapy.
“I wake up less tired, and I have more energy during the day compared to before starting oral appliance”, says Todd 3 months later . (He goes to school many states away.) “I am proud of you for doing your part.” I padded him on the shoulder, “But you can do more.” Todd wore his oral appliance only during sleep, i.e. only half the recommended time, but it still worked. Todd agreed that he’d wear his appliance from after dinner to breakfast by signing his name on his chart.
Then I commented to Todd’s mom, “His legs look longer to me.” Yes, and Todd had just gotten bigger shoes and longer pants — evidence that growth spurt is kicking in. Coincidental? Maybe, maybe not. One thing is sure: growth hormones are released during deep sleep. Oral appliance therapy may jump-start delayed puberty through airway development and deeper sleep. A formal study is needed to confirm that opinion.
A positive domino effect starts Todd back on the right track with that referral by his mom’s WholeHealth-oriented doctor. The resulting early intervention can save him many medical, dental, and other troubles throughout life, unlike the cases cited in the preceding chapters.
With training, all health professionals and even some patients can screen for an impaired mouth and recognized Impaired Mouth Syndrome. Dentists who are certified as Holistic Mouth doctors can confirm the presence of impaired mouth, screen for airway and sleep problems, refer for sleep test work with integrative health professionals as needed, and provide Holistic Mouth Solutions to help save teeth, hearts, money, and lives.
A patient’s total health will upgrade itself naturally if a Holistic Mouth checkup is part of the medical and dental diagnostic process that results in treating the anatomical source of Impaired Mouth Syndrome.
A patient’s total health can upgrade itself naturally only if sleep and airway is not blocked by an Impaired Mouth. Living and sleeping with an impaired mouth makes health a difficult and costly quest for patients, employers, insurance carriers, and the government. Improving natural health through sleep upgrade is an effective and sustainable way to reduce the cost of managing Impaired Mouth Syndrome.
More patients will be better served if more health professionals can:
Recognize the need for a Holistic Mouth checkup
Know how to screen for an impaired mouth
Have certified Holistic Mouth doctors to refer to for Holistic Mouth Solutions
Have the support of employers, insurance carriers, and government leaders in these endeavors as they do traditional dental checkups and cleanings
In this book, we have looked solely at the consequences of an impaired mouth on airway-related complications, which are already considerable. Medically, we’ve seen how impaired jaw development leads to obstructive sleep apnea (OSA), which is “a common but under-diagnosed disorder that is associated with excessive sleepiness, poor quality of life, neuro-cognitive deficits, metabolic dysfunction, cardiovascular disease, and early mortality,” as one study in JAMA found.(2)
It is worth looking again at the leading problems stemming from OSA:
Hypertension and heart failure
High blood pressure, stroke, and heart attack
Inflammation and oxidative stress
Obesity-related ailments
Alzheimer’s disease
Each of these conditions is expensive to live with—and to pay for. Unsurprisingly, the more severe the sleep apnea, the higher the medical cost.
Would the cost of disease management go down substantially if we treat impaired mouth as an anatomical root cause of poor sleep and oxygen deficiency? I believe the answer is definitely! Consider just Alzheimer’s disease for a moment.
CDC research spells out just how big this problem is: “One in eight Americans aged 60 and over (12.7 %) say they have experienced worsening confusion or memory loss in the previous 12 months …. Of those experiencing worsening memory problems—known as ‘cognitive decline’—over 80 percent have not talked to a health provider about it; and 1 in 3 says memory loss has interfered with household activities and/or work.”(3)
Linda, age fifty-seven, recognizes her husband on some days, but not others. She had been the manager of a departmental store’s cosmetic counters before she was diagnosed with Alzheimer’s disease. Linda’s first visit with me was a routine six-month cleaning, during which I found a mouthful of gum inflammation, which has been linked to Alzheimer’s as well.(4) In addition, Linda had many fillings and crowns and a narrow V-shaped maxilla.
I sent her for a sleep test because she had never had one done. I told Linda’s family that a 2009 preliminary study had shown that “sustained use of CPAP slows deterioration of cognition, sleep, and mood in Alzheimer’s disease and obstructive sleep apnea.”(5) As basic care, we are now waiting for Linda’s son to arrange for help to supervise her home care to control her gum bleeding.(6)
With Baby Boomers now aging and retiring, says the Alzheimer’s Association, “The rising costs of Alzheimer’s disease are on a path that will cripple state budgets. A comprehensive strategy is needed.”(7) We can no longer afford to ignore choked airways inside impaired mouths.
Supplying the brain with all the oxygen it needs, particularly during sleep, is a sensible start to reviving a brain undergoing cognitive and memory decline. Ruling out airway obstruction inside an impaired mouth is a logical, low-cost first step. “If only we could have had this cleaning with you ten years earlier,” sighed Linda’s husband.
Dentists Trained as Holistic Mouth Doctors Have a Strategic Position to Screen for OSA During Checkups
Given the primarily oral nature of OSA, dental visits make excellent opportunities for screening for OSA, fixing Impaired Mouth, and stopping the many costly related complications.
It’s time to connect medical and dental symptoms with sleep and the airway and therefore impaired mouth structure. As mentioned in the Introduction, this holistic integration of mind-body-mouth is not part of health professionals’ training. The earlier an impaired mouth is diagnosed, the lower the cost of managing obstructive sleep apnea and its related symptoms. Fatigue “since forever” is a recurring theme in my chair-side chats with new patients, as are aches and pains, snoring, and teeth grinding.
Total Health Benefits of a Holistic Mouth Checkup
The body’s innate ability to heal and renew itself can be activated through deeper sleep by redeveloping an impaired mouth into a Holistic Mouth—one that is structurally fit to support total health. This requires a new breed of qualified mouth doctors who are trained on a postgraduate level.
A dentist trained to provide a Holistic Mouth checkup can help patients and their doctors and all health professionals:
Determine if the patient has an impaired mouth that results in a pinched airway
Recognize the signs and symptoms of snoring, teeth grinding, and malocclusion
Screen for sleep-apnea risk during regularly scheduled dental checkups to help reduce OSA-related co-morbidities in, around, and beyond the mouth
Provide oral appliances and Holistic Mouth Solutions
Collaborate with medical (and all health) professionals to treat patients who have mild to moderate OSA or who don’t tolerate continuous positive airway pressure (CPAP) therapy
Identify, mitigate, or resolve oral contributions to chronic pain and fatigue
Educate patients on the need for lifestyle change, taste reform, and stress management
Reclaim Your Fully Potentiated Mouth and Health: Start by Having the Right Conversation with Your Health-Care Providers
If you have any of the signs and symptoms discussed in this book, I encourage you to start conversations with your medical, dental, and integrative health-care provider
s on how to avoid that “unpatched hole” that we have identified as an impaired mouth with a pinched airway.
Holistic Mouth checkups help ensure that you have the right infrastructure to supply oxygen without interruption to your heart, brain, and teeth that may already be starving for it.
The earlier your mouth impairments and airway obstructions are spotted and treated appropriately, the less frustrated you’re likely to be with your health, the less pain you are likely to have, and the lower your health-care costs are likely to be.
The medical and dental worlds currently remain far too segregated for your whole-body health. As a patient, you can start the conversation about your sleep and airway with your doctors and dentists using this book, your Holistic Mouth score, and your Epworth sleepiness scale. I’ve included resources at the end of this book to support you in this endeavor, as well as a special section at HolisticMouthSolutions.com, giving you additional tools and support so that you can take charge of your health like never before.
Holistic Mouth Bites
A Holistic Mouth checkup has one purpose: to help you and your doctors and health professionals determine if your mouth is a built-in stressor contributing to poor sleep, oxygen deficiency, and medical, dental, mental-emotional, and financial troubles.
Dental visits are excellent opportunities to screen for an impaired mouth and OSA, as long as a trained Holistic Mouth Doctor is in.
Natural health upgrade through better sleep and wider airway from Impaired Mouth recognition and Holistic mouth solutions can be an effective and sustainable way to reduce the cost of managing the “unmatched hole” of Impaired Mouth Syndrome.
A Holistic Mouth checkup bridges the gap between the segregated medical and dental worlds. The earlier an impaired mouth and an obstructed airway are recognized and treated appropriately, the less pain the patient suffers and the lower the health-care cost.
Chapter Twenty
From Teeth to Mouth: Dentistry’s Next Paradigm Shift
We are each other’s harvest; we are each other’s business; we are each other’s magnitude and bond.
– Gwendolyn Brooks
At the end of each tooth, there is a whole person. I learned that in dental school.
At the end of each mouth, there is an airway that impacts medical, dental, and life quality, as well as out-of-pocket costs, insurance premiums, competitive edge, and taxes. I learned that from seeing patients as a mouth doctor.
Through these pages, we have seen the whole-body fallouts of an impaired mouth too small for the tongue—a six-foot tiger in a three-foot cage. This diagnosis also suggests its own solution: enlarge the tongue’s habitat, and good sleep and energy will naturally follow.
Now let’s turn to the next challenge: The mouth is still largely missing in American health care today. The waiting rooms of emergency rooms, hospitals, and doctors’ offices are filled with patients suffering from symptoms of impaired mouths yet to be diagnosed. What will it take to turn this awareness into action?
The solution is to make a paradigm shift—a change from one way of thinking to another.(1)
We need to move from teeth to mouth in the minds of not only patients and their doctors, dentists, and all health professionals but also employers, insurers, nonprofits, and governments at all levels.
Toward WholeHealth Integration of Mind-Body-Mouth
Fixing America’s health-care costs requires identifying the root causes first. Managing the symptomatic parts have not worked, judging from America’s health-care costs, as the cases of Avis, Marie, and others in this book have shown us.
Most symptoms and many diseases—heart disease, for instance—that are associated with sleep apnea ultimately have an oral origin. OSA alone is responsible for 49 percent of high-blood-pressure cases and 30 percent of heart attacks.(2) The brain needs oxygen to thrive; when it fails to get enough, health care gets costly. The Alzheimer’s Association reports that Alzheimer’s disease, America’s sixth leading cause of death in 2013, is now “the most expensive disease in the United States.” (3), (4)
A 2013 study found that “dementia represents a substantial financial burden on society, one that is similar to the financial burden of heart disease and cancer …. We found that dementia leads to total annual societal costs of $41,000 to $56,000 per case, with a total cost of $159 billion to $215 billion nationwide in 2010. Medicare paid approximately $11 billion of this cost.”(5)
Such astronomical costs bind us together economically, socially, and politically. It is clearly time we start treating sources and causes. Oxygen deficiency means premature degeneration while sleep without airway obstruction is a bedrock of whole-body health. Screening for an impaired mouth and a pinched airway can only help stem the tide.
Holistic Mouth is a new solution that can resolve or reduce many sleep- and airway-related symptoms naturally at their root.
I believe that when an impaired mouth and a pinched airway are routinely included in medical, dental, and mood evaluations, health care will likely become more effective and less expensive in the long run. “Oral diseases and disorders in and of themselves affect health and well-being throughout life,” states US Surgeon General Dr. David Satcher in Oral Health in America. (6)
As we have seen, the mouth remains left out of medical and dental care today. It is time to drop the medical/dental/mental silo mentality. Impaired Mouth is indeed that gaping “hole in the side walk” that needs patching to stop rampant Impaired Mouth Syndrome, and Holistic Mouth checkup is a start.
Educating patients on mouth-airway-sleep-wellness connections is the first step, and engaging all stakeholders in health care in a creative solution is the next step.
Stopping the domino effect of escalating symptoms and spiraling costs at the source requires training to help all health professionals recognize an impaired mouth as bad equipment for overall health.
Doctors focus on what they know in their areas of expertise. Dentists’ eyes are used to seeing teeth, gums, and smiles. It takes additional training and much practice to see the mouth in the WholeHealth context that all parts in the body are interconnected, and that all systems are seamlessly integrated.
Dentistry’s Next Paradigm Shift: From Teeth to Mouth to Integrated Well-Being
Diagnosing impaired mouths and producing Holistic Mouths across America and throughout the world are the next paradigm shift in dental care. Dentistry’s history began with relief of pain and infections to fixing cavities. With the advent of the digital age, sleep medicine, and nutritional supplements, dentistry is evolving from teeth to mouth and from dental to total health and natural wellness.
In our grandparents’ generation, dentures by the age of fifty were accepted without qustion. Today, parents expect their children to keep all their teeth for life. The dental profession has succeeded brilliantly in actualizing the first paradigm shift from extraction to prevention. One survey by Delta Dental found that “69 percent of Americans brush their teeth twice a day, and those who do are 22% more likely to self-report their oral health as good or better compared with those who brush less frequently.”(7)
This remarkable achievement was made possible by the combination of employer-sponsored dental plans to help cover checkups and cleanings every six months, government-provided tax benefits to employers for providing health plans, and patient education by dentists and hygienists. That level of self-care is a fantastic springboard to upgrade total health with a Holistic Mouth.
Holistic Mouth checkups and solutions can predictably improve overall health just as brushing and flossing can save teeth. What would that do for your individual health and our national treasury?
Can we apply dentistry’s preventive model to overall health to improve life quality and longevity? Can we copy and paste dentistry’s success in saving teeth onto America’s health-care system to save more hearts, brains, joints, and lives with Holistic Mouth Solutions? I believe we can and the numbers say we must, but that requires having new eyes to see th
e mouth’s pivotal roles in total health.
Upgrade Total Health by Attending to Impaired Sleep-Airway-Mouth Connections
Shifting our focus from teeth to mouth can be powerful, benefitting individual patients, business productivity, and our national economy. But we’d have to grow new eyes to see the impaired mouth’s place in our national health. This shift from teeth to mouth begins with patient education and professional recognition and training by health-care providers, and it continues with employers, health insurers, and policy makers to support the science-validated connections between oral and overall health. As US Surgeon General Dr. David Satcher states in Oral Health America:
The broadened meaning of oral health parallels the broadened meaning of health. In 1948 the World Health Organization expanded the definition of health to mean “a complete state of physical, mental, and social well-being, and not just the absence of infirmity.” It follows that oral health must also include well-being …. We must recognize that oral health and general health are inseparable. (8)
Health Insurance: Big Barrier or Beneficial Bridge?
As of this writing, there is not yet an insurance code for diagnosing an impaired mouth. There are codes for under-sized maxilla and mandible, but no benefits are quite possibly because medical and dental insurers have not yet fully understood or embraced the airway-mouth-sleep connections and its consequences. Maybe that is why the mouth is missing from nearly all the minds of doctors, dentists, insurers, and patients.
Dental insurance was instrumental to the success of preventive dentistry. But dental insurance is for tooth care, not airway obstruction, nor craniofacial orthopedic correction of impaired mouths, nor the proactive development of a Holistic Mouth for total health. Since the mouth is much more than teeth, and oral-systemic links are two-way streets, isn’t it time for medical plans to cover Holistic Mouth checkupS, documentation, and treatment?
