In this presentation Dr. Bill Hang, an orthodontist and member of the American Academy of Physiological Medicine and Dentistry (AAPMD), argues that orthodontics should be centered on airway health and facial development to prevent and treat obstructive sleep apnea (OSA) and its downstream systemic diseases. He cites leading sleep‑medicine researchers (John Remmers, David Gozal, Brendan Stack Jr., James O'Brien) to illustrate the high prevalence, under‑diagnosis, and severe health impacts of OSA, including stroke, heart disease, reduced IQ, and shortened lifespan. Hang explains that traditional retractive orthodontic techniques often pull the jaws backward, narrowing the airway and contributing to these risks. He contrasts this with the AAPMD‑endorsed BioBlock Orthotropics and myofunctional therapy, which aim to advance the jaws and widen the airway, citing his own peer‑reviewed study showing 31% increase at the soft palate, 23% behind the tongue, and 9% at the hypopharynx. The talk includes multiple patient testimonies—adults with chronic headaches, snoring, and choking dreams who experienced relief after non‑surgical or surgical jaw advancement, and a child whose mouth‑breathing signaled future airway problems. Hang emphasizes that early intervention can improve facial balance, airway size, and long‑term health, and that the AAPMD will offer courses worldwide to train clinicians in these preventive and corrective approaches.
Chapters
I'm Bill Hang, an orthodontist from outside Los Angeles, California, and proud to be part of the American Academy of Physiological Medicine and Dentistry. Let me tell you why I'm so passionate about the AAPMD. The AAPMD is an organization started by 2 very committed dentists who were frustrated treating people with advanced TMJ and/or obstructive sleep apnea problems. They decided it made more sense to bring medicine and dentistry together to prevent the problems in the first place rather than to treat them after they occurred. Over the next few minutes, I'm going to talk to you about what I believe we should all care about: orthodontics, airway, facial development, health, and longevity. I never thought I'd be talking about dentistry and saving lives in the same breath, but here I am. What I'm about to share with you might sound a bit over the top, But hear me out. My experience has convinced me that dentistry is the first line of defense in the battle against heart disease, head and face pain, Parkinson's, stroke, dementia, diabetes, cancer, and many other diseases that I believe can be tied to obstructive sleep apnea. If you think that's a stretch from a way-out Southern California guy, I understand. But let's look at some statistics. John Remmers, a Harvard-trained physician, is world-renowned for his knowledge of sleep apnea. Among the quotes that I have from him are, sleep apnea will be the most common chronic disease in all industrialized countries. Sadly, 65 to 80% of stroke patients have sleep apnea. He further states that 17% of the US population suffers from sleep apnea. And this is the real kicker, 95% of those who have sleep apnea are undiagnosed. Another eminent researcher in the sleep arena is Dr. David Gozal from Chicago. One of the things he says is that snoring is not normal, and snoring should never occur. He further notes that 7 to 13% of all preschool children snore, and sleep apnea is present in 2 to 3% of those preschool kids. OSA may be responsible for a 10-point drop in IQ, he says. As a father and grandfather, that's a pretty chilling statistic. Finally, Gozales says, if you do not address the OSA problem in children, You may not be able to later reverse the cardiovascular problems which will occur. Another well-respected name in the sleep apnea arena is Dr. Brendan Stack Jr., who is an ENT specialist. He says that 60 to 80% of snorers test positive for sleep apnea. He further states that untreated sleep apnea results in a 20% reduction in life expectancy. Think about that. Your ride on planet Earth could be 20% shorter if you have sleep apnea. Scary stuff! Another quote that I really like is from James O'Brien, who's a sleep physician from Boston. He said that everyone who snores will develop sleep apnea eventually if they live long enough. You know, I used to laugh at people who snored, just like you might. What I know now is that there's really nothing funny about it. John Remmers says that in most, if not all, cases, it is a structural narrowing of the airway which causes OSA. The first time I heard him say this, it really hit me hard. I asked him to elaborate, and he stated that OSA would not exist if the jaws were properly placed forward in the face. What I take this to mean is that the primary focus of my profession should be about the position of the jaws if we want to promote health and longevity, which I definitely do. Let's simplify this with a diagram. All the conditions I've just described according to those experts, can be caused by jaws that are positioned too far down and back in the face. I believe that many orthodontic treatments can accelerate this process. Here's what can happen. Watch as the jaws move to the right on your screen. Obviously, this growth process does not create the best-looking face. That's unfortunate, but what I care the most about is how it affects the airway. Here's another example. Traditional orthodontics can produce an airway like the one on the right. It's narrower than it was before treatment. On the other hand, BioBlock Orthotropics, or even better, BioBlock Orthotropics along with myofunctional therapy, can widen the airway. I believe that wider is better. The AAPMD is all about creating airways like the one on the right of your screen. That's why I'm such a strong advocate of the work they're doing. Facial balance does matter to all of us. Watch the 2 faces on your screen. It's kind of hard to ignore the contrast in facial balance, isn't it? I don't know about you, but I'd like my child to look more like the patient on the right than the young man on the left. Promoting the kind of facial balance that you see in the young woman on the right of your screen and preventing what you see in the young man on the left is what the AAPMD is all about. We've grown accustomed to seeing facial changes like the one here. This boy had 4 bicuspid teeth removed and braces that pulled the teeth backward into his face starting at about age 10. The changes in his face started during treatment and actually accelerated after the braces came off. I'm sure you're noticing that his nose appears larger as he gets older and his upper and lower jaws continue to fall back. I don't have x-rays on this patient, What do you think has happened to his airway? Now think about how that might impact his life from this point on based on what we've already shown you. This article is from what we call the refereed literature. In other words, articles like these carry significant weight and meaning in my profession. You can read all the fancy language if you want, but what it says in essence is this: the airway has now been shown to get smaller when braces are used to retract the teeth back into the face That's why I refuse to retract, no matter what. Here's another article from the refereed literature. I'm actually one of the authors. My article is also full of fancy language, but what it shows is that BioBlock orthotropic treatment can increase the size of the airway 31% at the level of the soft palate, 23% behind the tongue, and even 9% at the level of the hypopharynx. That means more air and easier breathing for your child. These 2 boys are typical examples of the kind of facial development that can be accomplished with BioBlock Orthotropics if the patient is willing to follow the protocol. It is what we call a compliance-dependent treatment. That means that the child has to do a little bit of work if he or she wants the result. In my opinion, that's a very small price to pay for a better-looking face and a potentially larger airway. Now, there are millions of people around the world who've had retractive orthodontic care. Not all of them have suffered consequences, but some have. If you're one of them, there may well be a solution for you too. This patient had 10 years of retractive orthodontic treatment. She had frequent headaches which severely impacted her life. Her husband reported that she snored loudly, and she herself told me that she had dreams about drowning or choking to death. We reopened her extraction spaces for her, and she is now symptom-free. This is yet another reason why I'm excited about the AAPMD. They will be sponsoring courses to teach orthodontists and dentists around the world how to reverse the effects of retractive orthodontic care.
Just really, the last year was the very most terrifying part of it, when you're just knowing you're choking to death and having these drowning kind of dreams. You know, I'd go on to work, but many days I'd have to leave work because I had too bad a headache. You know, every doctor I went to said, you know, well, take this or take that, or— and I just didn't want to keep taking medicines. I don't like to take medicine. So I just had— I knew there was a reason, but I never figured it out until I met Dr. Hang. 3 months after Dr. Hang's treatment began, the snoring ended, and the headache pattern subsided. Today, I barely ever get a headache. Very, very infrequent.
Nobody ever likes to hear the word surgery, and it's always the treatment of last resort for me. But sometimes it's the only viable option left. This patient's wife is a registered nurse, and recognized his sleep apnea. He couldn't stand wearing his CPAP machine, which is not uncommon in my experience. When he came to me, he'd been seeking a solution for his OSA for more than 15 years. We recommended surgery to advance his upper and lower jaws. To his credit, and I know that having surgery isn't easy for anyone, he followed our advice. He's now free of symptoms and living a normal life Enjoying his grandchildren.
My concern was saying, hey, I know people die from sleep apnea, and if in fact, if I didn't start breathing again, if my heart didn't react properly, I could— it could stop, and that could be the end.
I was an RN almost 40 years ago, but I had all that training, and I just was worried about the stress on his heart because Every time you start breathing again, it jolts your heart. And I knew he doesn't— he didn't have any of the classic symptoms. He wasn't overweight, he didn't have high blood pressure, and so I figured all of that was for the positive. But it was just the fact that I knew that the stress on his heart every time he started breathing again was not good.
He sent me off to have the sleep study done, and it was, and as they said, I performed like a star. It was amazing. I was stopping breathing anywhere between 40 to 50 times an hour and having episodes as long as 90 seconds. And in fact, my oxygen saturation level got down to almost 0.7, which is very dangerous, so they actually woke me up and stopped the study. I was sleep deprived. At work in the afternoons in particular, if I wasn't actually moving or doing something, I'd have a tendency almost to fall I'd be in a hallway talking with people and actually standing up and literally fall asleep on my feet and have to fight to keep awake. So I knew I was sleep deprived and I needed to do something about it, but I'd never really heard of any way other than the CPAP machine that was going to be helpful. To me, it was so worthwhile just to know that when I did that and made that decision and that surgery was completed, that I'd have a clean bill of health. And I went back and had that sleep study done, and it was so reassuring to get that sleep study doctor tell me, you know, you don't have sleep apnea anymore. We can't guarantee it won't come back, and we can't ever say that you'll never be bothered with it again, but clinically you're cured. And to me, that was like, wow. And I've never felt better about anything. And I would do it again, as I say, in a flash. And I would just pass on to other people, you know, the experience I've had and tell to them or say to them, here's a choice that you can make, and I'd go with it.
Although an untrained eye may not be alarmed by how this little boy is breathing with his mouth wide open, I am. This is where it all begins for many children. Mouth breathing and poor Poor oral posture can lead to all the conditions I've described to you in this program. The AAPMD is focused on giving parents what they need to put their kids on the path to better facial balance and healthier airways. I believe that earlier treatment means healthier kids. But we operate in the real world where many of these problems are running rampant. So the AAPMD offers potential solutions to all of the airway-related problems that I've discussed with you today, no matter the patient's age. I spend most of my time treating problems that could have been prevented. My hope is that by the time my grandchildren have children, doctors like me will no longer be necessary.
