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Sleep, Airway and Mouth Breathing: An ENT’s Guide for Dentists
Could a “normal” sleep study still be missing your patient’s airway problem?
Why do women and children with real symptoms keep scoring “mild”?
Should a mouth-breathing child see a myofunctional therapist — or an ENT first?
And which four questions screen a child for sleep problems in under a minute?
The roof of the mouth is the floor of the nose — so ENT and dentistry should be in constant dialogue. In practice, they rarely are. In this one, Dr David McIntosh— an Australian ear, nose and throat surgeon with a deep niche in sleep-disordered breathing — makes the case for why that has to change, and gives dentists practical ways to screen and refer. He is direct, analogy-rich and doesn’t mince words; expect a few positions that cut against the grain of how sleep apnoea is usually handled.
https://youtu.be/QVEc0ocxTCc
Protrusive Dental Pearl: When the Numbers Mislead
Dentists love data — the AHI, the cut-offs (over 5 is mild, over 30 is severe). But take those numbers with a pinch of salt: the thresholds are arbitrary, and a single score tells you nothing about why a patient has the problem.
They don’t account for individual variability — especially in women and children, where a mild score can sit right alongside significant symptoms. Read the number with the anatomy and the phenotype — the clinical signs and the airway assessment — never instead of them.
What You’ll Take From This Episode
This conversation reframes sleep-disordered breathing from a number on a report into something you can localise and refer.
- A sleep study tells you IF, not WHY — sleep-disordered breathing is the whole spectrum; a normal study doesn’t mean normal breathing.
- Phenotyping the airway — map the individual anatomical causes instead of trusting a single score.
- Why women get missed — the gender bias built into standard adult screening tools, and what to ask instead.
- The four-question filter for children — snore, mouth breathe, stop breathing, wake up tired: any ‘yes’ means refer.
- Treat the cause before the function — why myofunctional therapy comes after the obstruction is cleared, not before, and how expansion and surgery are matched to the anatomy.
Highlights of This Episode
- 00:00 Teaser
- 01:00 Why ENT and Dentistry Should Be Talking
- 02:51 Protrusive Dental Pearl: When Sleep Data Misleads You
- 03:46 Meet the ENT Who Works With Dentists
- 06:00 Sleep Physician, ENT or Dentist: Who Should Lead?
- 07:26 Why Children and Adults Are Completely Different
- 08:58 Sleep-Disordered Breathing Is Not the Same as Sleep Apnoea
- 09:39 Why a Normal Sleep Study Doesn’t Mean Normal Breathing
- 10:01 Same AHI, Different Cause: A Tale of Two Patients
- 12:54 Why One Night’s Sleep Study Isn’t Enough
- 13:44 Where the AHI Cut-Off Numbers Really Came From
- 15:27 CPAP Explained: A Bridge, Not a Cure
- 18:27 When Snoring Hides Something Serious
- 19:10 What Phenotyping the Airway Actually Means
- 20:27 Splint, CPAP, or Both?
- 21:33 Why a CBCT Can Miss a Deviated Septum
- 25:32 Is STOP-Bang Enough to Screen for Sleep Apnoea?
- 26:06 Why the Epworth Sleepiness Scale Is a Blunt Tool
- 26:50 Why STOP-Bang Is Biased Against Women
- 31:17 Sleep Apnoea in Women: Mild on Paper, Severe in Life
- 32:05 Midroll
- 36:56 The Triad: Airway, TMD and Orthodontics
- 37:12 The Three Most Common Causes of Night-Time Grinding
- 39:41 The Four Questions That Screen a Child for Sleep Problems
- 41:03 Tired vs Not Tired: The Sign That Changes Everything
- 43:36 Should You Refer to Myofunctional Therapy Before an ENT?
- 45:58 The Hidden Dangers of Forcing Nasal Breathing
- 52:28 Maxillary Expansion vs Surgery: Which One Fixes It?
- 54:51 How Dentists Can Assess Adenoids
- 56:25 Save the Child First: The Drowning Analogy
- 57:56 Where Dentistry and ENT Go From Here
- 1:00:05 Outro – New-Look Premium Notes & CPD Outro
From the Guest
Dr David McIntosh is an ear, nose and throat surgeon (MBBS, FRACS, PhD) with a special interest in sleep-disordered breathing and airway obstruction. A self-described compulsive educator, he is the author of several books on Amazon — including dENTal health, on the connection between ENT and dental disease, and Snored to Death, on the lesser-recognised causes of obstructive sleep apnoea in adults.
References & Further Reading
Sources discussed in this episode:
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Airway Dentistry with Jeff Rouse – PDP229
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This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.
This episode meets GDC Outcomes C
AGD Subject Code: 730 – Oral Medicine, Oral Diagnosis, Oral Pathology (Sleep medicine)
#PDPMainEpisodes #OralSurgeryandOralMedicine
Aim & Learning Outcomes
Aim: To help dental practitioners recognise sleep-disordered breathing across the whole airway, screen adults and children appropriately, and refer at the right time and to the right clinician.
Learning Outcomes — by the end of this episode, dentists will be able to:
- Differentiate sleep-disordered breathing from obstructive sleep apnoea, and explain why a normal sleep study does not exclude clinically significant breathing problems.
- Apply a structured screening approach for adults and children, including recognising why standard adult tools under-detect sleep-disordered breathing in women and children.
- Evaluate when to refer for specialist airway assessment, and articulate why addressing anatomical obstruction should precede functional (myofunctional) therapy.
