An ENT's Perspective on Airway & Orthodontic Treatment (w/Dr. David McIntosh) [Ep.75]

Dentists and orthodontists often debate the role we play in the detection and management of airway compromise, especially in children.  I had a fascinating conversation with Dr. David McIntosh, a highly regarded ENT from Australia, who offered his thoughts on the topic from a medical perspective. 

 We discuss:

• How David became passionate about airway and sleep, and why he is passionate about treating children.
• The influence that the 2012 paper by Karen Bonuck, MD about the impact of snoring and mouth breathing on the cognitive development of children had on David.
• The reason why ENTs and dentists should be collaborating more often.
• The fact that 80% of the children presenting to the orthodontist have an airway problem.
• The fact that pediatric sleep-disordered breathing is more common than asthma and diabetes combined.
• The role that cognitive dissonance plays in the resistance of both orthodontists and ENTs to change their approach to the diagnosis and treatment of patients with airway compromise.
• The signs and symptoms of airway compromise that ALL ENTs and dentists should be looking for in their patients.
• Why straightening teeth is great, but saving someone’s life is next-level rewarding.
• How the medical insurance industry is impacting the ability of ENTs to perform adenotonsillectomy on children.
• How the 2019 AAO White Paper got it wrong and the 2017 ADA Position Statement got it right.
• The reason why a sleep study and AHI are NOT reliable indicators of airway compromise in children.
• The AADSM position statement about the efficacy of monotherapies.
• The efficacy of CPAP versus mandibular advancement splint therapy.
• The importance of phenotyping to determine the etiology of airway disease before initiating treatment.
• What David feels about expanding on patients as young as 4 years old.
• Why orthodontists would feel differently about airway-focused treatment if they saw their patients 20-30 years after treatment.
• The importance of early detection and treatment of airway issues.
• Why saying that OSA is analogous to Stage 4 cancer IS appropriate from a medical perspective.
• And much more!!

LINKS:

-Dr. McIntosh’s books: 

>Snored to Death: https://a.co/d/0700GJj

>Don’t Ignore the Snore: https://a.co/d/3P9lpXA 

>A Parent’s Guide to Pediatric Sleep Disordered Breathing: https://a.co/d/7qDRuJS 

-Karen Bonuck paper: https://pmc.ncbi.nlm.nih.gov/articles/PMC3313633/ 

-Chervin paper: https://pubmed.ncbi.nlm.nih.gov/11875140/