Breathing Well with Holistic Dentistry: Exploring Airway Health

Hi, everybody. I'm Dr. Sandhya Moldovan, periodontist and nutritionist. Welcome to the Holistic Dentistry Podcast, the show that gives you the tips and tools to detoxify your mouth for a healthier body as we explore together the root cause of disease. Remember, you're not healthy until your mouth is healthy, so take care of it in the most natural way. Hi, everyone. Welcome to today's show. I'm very excited to talk to Dr. Kevin Schwand. He's a biological airway and reconstructive dentist in Denver, Colorado. We're going to be talking about airway health, how you can sleep better, and some very common misconceptions that you probably didn't know about. So please listen to the whole show. Dr. Kevin, welcome to the show.

Thanks so much for having me, Doc.

Of course. I'm so excited to talk to another fellow dentist that's in the same mindset, and we're really looking at the whole health, not just teeth. So how did you get started in holistic dentistry?

You know, my journey got started with nutrition on a personal level, which I was especially excited to talk to you because you're nutritionist, and I've taken up the opportunity to talk to all of my patients about the nuances of nutrition as it relates to dentistry and oral health and also holistic health. So my journey really started right as I graduated dental school, just diving in on different authors, different books related to nutrition and how it relates to inflammation and chronic health and some of the chronic health diseases that we see in America especially. And then after getting into that, then I really took a strong interest in anthropology and the study of ancient humans and what we learned from studying ancient human skulls. And it's fascinating to learn that humans really didn't experience much for cavities and periodontal disease until the advent of agriculture. So as we started practicing grains and grinding them up before we eat them and all the starchy foods, and then especially with the Europeans love of sugar in the 1500s, then we really saw rampant oral health crises break out.

Yeah, yeah, Very fascinating. You know, and. And the thing is, we don't learn about this in dentistry, which I honestly think it should be part of the curriculum because it's so related. We need to understand, like you said, even anthropology. It's fascinating what we. What conclusions we have from that.

Yep. One of our dentists, Dr. Weston Price, back in the 1930s, he was huge on nutrition and learning from humans across the world and why, especially the European descent individuals, were so plagued with cavities and periodontal disease and tooth loss and crowding. And I'm just kind of surprised that it's not just day one curriculum for dental students that we learn these basic facts about our health. But then we are, there's a lot to cover in dental school, so we'll give people some grace in, in what they choose to teach.

That's true. I think probably we're just so focused on teeth and getting the hand skills right to, you know, cut it too, that probably if we added a whole nother year to dental school would be beneficial. So we can include a lot of those other things that, that we can learn and are so essential for dentistry. After you're done with anthropology studies, where does the journey take you after that?

Yeah, that's a great question. You know, I was always a little bit of a builder, so I loved surgical procedures, learning implants, bone grafting. You would know it as a periodontist, how kind of intricate and exciting some of these types of procedures are. So I really got engaged with implants and wisdom teeth extractions and different types of surgery. And then I started to notice as I took on bigger and bigger cases, healing is just not the same in every patient. And it's very dependent upon medical histories, chronic disease, nutrition. And I just really wanted to get interested and help patients heal better. And that's really where my journey took me next, was really trying to develop nutrition plans and supplement recommendations and talking to medical doctors for consults and trying to figure out how to get someone who's especially getting like all their teeth extracted and put in and bone grafting and they're spending all this money. We really got to make sure that they get to the finish line with a good outcome.

So yes, you're absolutely right. And this is one of the things that I had to do as well. In the start of my journey in nutrition, there was no such thing as nutritional recommendations really for oral surgery. So we kind of have to come up with them and create recalls in order to, to help patients heal better. But I can tell you that I've had patients that have done the traditional way and then maybe the other side of the mouth with nutrition and supplementation. And they saw a world of difference in the way they felt the inflammation. Do you see that?

I've been seeing that a lot and now I've brought on a few adjunctive treatments such as ozone and lasers and, and what I'm finding is that people have less post op pain, better healing, better bone growth, and, you know, more stable implants.

Yeah, that's exactly what I see as well. I mean, ozone is such an essential thing of anybody, any dentist, holistic or not?

Super, absolutely.

Yes. You also do airway dentistry. And this is one of the things that we're gonna dive into deeper in our conversation today. But what started you on the path of airway health?

It was a little bit tied in with my interest in anthropology, learning and discovering that humans, especially before soft diets, the incidence of mouth breathing and nasal congestion and tongue ties, humans just did not struggle with these type of issues as much. And the incidence of sleep apnea is on the rise. So my very first lecture just really blew my mind because I was already interested in nutrition and anthropology and holistic health. And then as I started looking at the nuances of symptoms related to upper airway resistance syndrome, mild sleep apnea, I realized that I had a lot of these symptoms and I needed to get checked out. And then as I went down this journey of seeking out a sleep physician, getting a full in lab polysomnogram, I realized that I had a mild form of REM disturbed sleep apnea where I was just not quite sleeping well, not waking up, feeling rested, dealing with chronic congestion. And then when I took my first coin cone beam 3D x ray of my whole skull, I realized that my whole left maxillary sinus was completely full of mucus and was not draining. And I had the declassic, you know, high voltage pallet, narrow arch, deviated septum that was causing just chronic nasal congestion and I needed to get treated.

And how does someone, let's say, because I'm sure there's people listening, thinking, oh, I have a high vaulted pallet, or I, you know, I have a narrow arch, my sinuses are always chronic. What do you look into? How do you start? What do you recommend for somebody listening that has these problems? Where do they get started?

You know, you can get started with a sleep physician. You could get started with an ent. And then I tend to think the best place to start is actually with an airway dentist. There's a good handful of us now that are very passionate. It's a very fast, rapidly growing field. And the more and more I've developed my protocols in my office, I just think I'm a great spot to start and educate people about it because I can do the full 3D x ray like an ENT can. We can do some basic sleep screening with some at home, basic sleep screening devices. And then as needed, I refer out to ENTs and sleep physicians. And I know There's a good number of dentists across major cities across the country who work with, you know, periodontist, orthodontist, general dentists, sleep physicians, ENTs, osteopaths, massage therapy, myofunctional therapy. There's networks growing, so you could start with any one of these providers. But even starting with a podcast like this really gets you thinking. And I'm excited to talk because I saw on your podcast, you know, there's not too much conversations about airway health just yet. And I wanted to add some value because breathing and sleep are foundational to our health. And it's really fascinating coming from my perspective, having been treated because I breathe better and I sleep better. And it's just, I wanted to kind of create a hopeful picture for your audience because there's some really fascinating treatments going on that are not well known that need some more attention.

Yes, definitely. And how do you feel after treatment? Is your sinus better? Is your sleep better? More energy maybe?

Exactly. I have confirmed now that my sinuses have cleared up. They drained after expansion therapy. I've got numbers to show the nasal floor distance and how essentially through palatal expansion, my whole nasal maxillary complex is open and the nasal airflow is dramatically different. I've done some basic, like left nostal, right nostril breathing just to show that it's way, I mean, I just have increased the airflow dramatically and then with a wide palate tongue tie release. I don't snore anymore. I used to snore probably 15% of the night. I recorded myself all the time through Snore Lab, the app. And I just, you know, you play it back and you listen to it and I would get the classic slight gaspy kind of noises, snoring and just clearly like not comfortable sleep. And I'm excited to see that. I just, I sleep peacefully now. Lips closed, smooth nasal breathing, no problems.

Wow, that's incredible. So what are some common misconceptions about airway dentistry? Because I'm sure there's plenty and I know of some, but I'm curious to know your take on those.

Yeah, I think, you know, I like to start when I'm talking to people about the medical literature because of course, all of medicine and dentistry be were educated that the really gold standard for curing sleep apnea, if there is a possible cure, is full corrective jaw surgery. You know, MMA advancement is the only, like, tried and true, like, corrective treatment for sleep apnea. For those who qualify and hit the certain, you know, parameters for qualifying for the surgery and being good candidates for it. But then the other, the other side of the spectrum is the minimally invasive treatment of. Of mandibular advancement devices. So I like to kind of educate people about how sleep physicians are typically educated in CPAP therapy, mandibular advancement devices, and then depending on their level of education, they might recommend a referral to an oral surgeon to be evaluated for possible jaw surgery. So the misconception, I think, is maybe it's not as much a misconception as it is that people just don't know about these new treatments, because within the last 5, 10, and 15 years, there's a whole world blowing up about palatal expansion through different types of either removable devices or implantable devices like I had. And these types of devices, because they expand the palate, they open the nose, and they improve nasal breathing. And when you expand the pallet, you also tighten the soft pallet, which is the major reason why people snore.

So, yes, makes sense. So this devices, do they have a name or Mar?

Yep. The implantable device is called a MarPy, which is a mini screw assisted rapid palatal expand expander. Maxillary skeletal expander. MSE is another name or another type of one of those implantable devices. And that's the device that I had and that I chose in part because I had a little bit more severe a problem. It's still technically a non surgical treatment, but it's semi surgical in the sense that it's implantable for a short time, you know, six to nine months. And then.

So it actually gets. It gets screwed into the palate. Is that what happens with like, mini screws?

Mini.

Okay. Just like a painful procedure?

Not that painful. It is painful, but two days, two nights. You know how typical oral surgery procedures go. They, they hurt and they ache for two days, two nights with some mild painkillers. Very controllable. And then I was surprised because the entire appliance was extremely comfortable from then on out. You get food stuck and this and that. But I was going through treatment and a lot of friends of friends and people I would meet, they just, they never actually noticed that I was. That I had this big metal thing on my palate.

That's amazing. And then what do you do? Do you actually expand it? Do you turn a little screw in order to expand it? Okay, yep. All right.

It's similar. You know, these are common appliances for children in orthodontics, but often they're most often not implanted in. Usually for children, they're cemented onto the Molars. And then there's a little screw that's turned by the parent or the child. The difference is that when we use a more robust device with six or eight tads, tempor temporary anchorage devices, the mini screws, then you get a really strong grip in adults and you can actually expand adults all the way through the age of 65 to 80. It's really. It used to be thought that the skeletal sutures would form and fuse, that you could never get the sutures to loosen and widen and open. But that's certainly proven to be, you know.

They're not true. Absolutely. Yeah. I, I learned from our. My osteopaths that I work with. Basically they told me, no, the sutures on the top, you can still expand. You can move. They actually move with our breath. So as we take a breath as like a micro movement inside that suture. So they're definitely not. Yeah, yeah.

And I started working with an osteopath recently as well for me and my patients. And it's very fascinating. With the manual therapy that they apply, you can feel sutures moving. And now that I've had that experience, I'm doing more tongue movements between my functional therapy or mewing. If you've heard of Dr. Mike Mew and his father John, the tongue actually happen.

I would love to know more. What. What do they do?

This is really interesting. They, you know, Dr. Mike Mu and his father John have been on. They've been learning more about this for the last, like 40 years. They've been kind of siloed a little bit because mainstream orthodontics and the dental community just doesn't. Didn't know quite know what to think about it and their claims, but essentially their biggest claim and, and, you know, public health advice is to encourage children through adults to do a movement with their tongue that resembles malfunctional therapy, where the tongue is up on the pallet and pushing up and forward. And it's like a posterior tongue rising exercise, which is great for anyone with a tongue tie to keep it loose and to keep the tongue postured up on a pallet. So it's a tongue posture, but also a pallo growth strategy. So it's most likely true that the tongue is supposed to be on the pallet at all times at rest with lips closed and smooth nasal breathing. And then during chewing, it's most likely that the posterior tongue is supposed to be up, keeping the food out into the cheeks. And then when you swallow, you swallow with a rolling motion that's very forceful and very Controlled and all of that pressure up on the palate pushes the palate up and forward and helps those skeletal sutures breathe, just like you're saying. And then it also helps with growth and development in children.

Yeah, so, so important. I'm glad we're discussing this because this starts as a problem early in life and it can be corrected at a young age. However, there's still a lot of people that don't know about this therapy, about myofunctional therapy, about these devices that expand the palette. And as adults, good news is there's still hope. Yep. Yes. So after the expansion, does that change the bite at all dramatically?

Y just like you're saying, you know, when we jump in early with children, we can do minimally invasive expanders and orthodontic treatments that are really gentle, really kind, and help with growth and development. So there's a lot of the whole world of evolving called growth guidance orthodontics, sometimes called interceptive orthodontics. And that's the whole goal, is to avoid the otherwise more invasive options that adults consider. So I like to use myself as an example because I had retractive style braces back when I was 13, 14, 15, and people don't often realize the fact that the skull is almost fully formed by the age of 12, 13. So if you wait to do orthodontics until after that, you pretty much miss the entire period of growth and development of the skull and then you have to play catch up. And for me then I had a more traditional style of braces that was retractive in nature and restrictive and kind of just everything tight and back. And as such, I ended up with a very narrow arch form but perfectly straight teeth. Class 1 occlusion and orthodontically speaking, it looks great. But if you looked at my facial profile, you would see that my, you know, upper and lower jaw is tucked in and narrow and my cheekbones are kind of tucked in narrow and I have a longer face than what is proportional for my body. So sometimes I've said, after this style of orthodontics, you know, I hit age 16, 17, 18, and then of course, I get to age 32 as a dentist, not realizing the impact on my breathing and sleep. And then sometimes I tell people too. I met a seven year old child in my practice, one of my patients, and she had an intermolar distance essentially the size of her pal and the size of her maxillary arch of 33 millimeters, which is exactly where I started before treatment. So I'm a six One male, I should have a maxilla size of about 40 millimeters between my molars. And I was 7 to 8 to 9 millimeters shy of, of what would be considered normal and healthy for my, for my size.

Yeah, yeah. And having so little room now, you know, your tongue has matured. So what happens to the tongue naturally just goes back, correct?

Yep, it goes back and then it doesn't have any space to do its normal functions. I couldn't create a palatal seal. My tongue was tied, so I, my posterior tongue wasn't contacting my soft palate. I had low resting tongue posture. And then together with it was a whole range of just muscle tension, you know, head and neck muscle tension and forward head posture.

How is your head and neck shoulders feeling? Do you feel a difference after this treatment?

It's a lot better. Yeah, more like relaxed. My forehead posture isn't so severe. And then I've been working with massage therapist and an osteopath for fascial release. So when we combine these treatments with also, you know, cranial osteopathy and fascial release, you get the optimal result.

Yeah. That's amazing. What a journey for you. But I bet you, you know, you have so many lessons learned from that journey.

It's true. Yeah, it's fascinating. And I wanted to jump in to treatment because I'm of course a dentist. So part of me felt like it was my professional responsibility to jump in and, and get it done. And I, I really went for gold. You know, I, I tried to do the biggest treatment possible to correct the problem so that I could gain some experience with, with the issues. And that was the other thing I was going to mention with your question about occlusion because of course any dentist, orthodontist will understand that if you expand the palate beyond especially five, six millimeters. And I did about nine and a half millimeters on my palate. So if you that far, you of course can't expand the lower to that degree. And so one of the treatment options that is available that most people don't know about, that I did myself, was phase one expansion for the maximizing the outcome of nasal breathing and the impact on sleep. And then phase two, which I had done in December actually in la, was surgically facilitated orthodontic therapy, which is a periodontal surgery similar to Willics, involves flaps, corticotomies and bone grafting to allow the lower especially to expand further beyond what otherwise is biologically possible and to really push the limit of how far you can grow the jaws as an adult.

So yes, I am familiar with that procedure and it does have downtime. It is a full surgical procedure where we actually basically try to add bone on the lower jaw and also by corticotomies, it allows the teeth to move easier. So good. So you had it in December. And how is that movement going?

I am almost done with this phase, so I'm on tray 33 of 38. We love clear aligners in my practice and I love the clear aligners. The therapy works great. It's very simple, very easy and tied in with the surgery. I was just, I was amazed because I was swapping out trays every two or three days at first and then eventually three or four days and now four or five days. But the amount of movement you can create within a short three or four month period is astounding. And my occlusion is back on track. I've got the appropriate size upper and lower jaw for my, for my size, for my frame and yeah, it just, it looks great.

Now I know a lot of people listening are thinking, oh my God, you know, I want to try this, I want to start. But now I want to talk a little bit about the CT scan technology that you're using in the practice. Do you find that that's necessary for diagnosis?

Absolutely. We do a full diagnostic workup because of course, the more, you know, going into it, the better decisions you can make as a patient. So the essential components of diagnostics is certainly the 3D x ray cone beam CT, full jaws shot where you can see the entirety of the airway from the entrance of the nose to the whole ne nasal cavity and sinuses to the soft palate and then down the throat of course, and tongue. And then everyone should get at least the basics of an at home sleep testing device and then, you know, put the whole picture together. So we do a full myofunctional exam, comprehensive tmj, dental orthodontic exam, and then we do all of the measurements in all three planes of dimension, lateral forward and up and down.

Test. Do you like to use for sleep or what do you recommend?

In our office we have something called sleep sat. It is a high resolution pulse oximeter, so it looks at blood pressure and pulse and draw some conclusions from that. There's another device called the vivo score ring. I don't personally like the diagnostic report as much. Otherwise the next best one is watchpad. That's another one that a lot of sleep physicians will use. And then of course, if a patient really has indications of moderate to severe sleep apnea, especially a full in lab sleep study. Polysomnogram is, is warranted.

So are these devices relatively easy to use? The home use? I remember my mom actually when she got tested, so somebody came to her house and wired her up. Is that still necessary for home use or do we get enough information from this pulse oximeter?

A lot of people will get enough information from the very basic pulse oximeters. Most of them are like a wristwatch with a little device that goes on the finger. Some of them are even easier to wear than that. But those devices are, even though they're basic, the technology's gotten a lot better in recent years and the software is, is improved a lot. So most people, it's a good starting point to start with one of those tools. Otherwise there are some that incorporate a chest strap. Sometimes they'll monitor your nasal breathing with another piece. There's some different options.

So you mentioned that you're working now with, you know, the different physicians and we do have some dentists that are actually listening to our podcast. And how does a dentist even start to look into this? You know, I think pretty much all dentists should have knowledge about this. Even if you don't want to go full force, at least be connected, be in the network. How does, how do they start to, to tackle this?

I think the best starting point, of course there's a lot of lectures that we all can attend and learn more about and there's more and more within the airway dentistry community. Sometimes it can be a little hit or miss on, on the information you're presented with. But another great starting point is just paying attention. You know, we dentists are checking people's mouths every single day of the week and looking for a tongue tie in every single person. Looking at arch form as it relates to the nose and breathing, looking at mal and potty score for just where the soft palate extends to relative to the tongue and starting to kind of screen for sleep and breathing issues. I think that's the best starting point. And knowing, you know, knowing when to refer and who to refer to. And then as you build your network of who you're referring to, you can learn from those people and what they're doing and what they're looking at as you attend more lectures and, and learn more.

So did you start reaching out to like sleep doctors in your area to introduce yourself?

Yes, that's basically started that, that process along with ENTs, massage therapists, cranial sacral therapists, osteopaths, and then I'M starting to do some educational events in my office, just sitting around the round table and having conversations about this so that other providers can learn more.

Yeah, very nice. Regarding oral surgeons that do these devices, do most oral surgeons know how to place these palatal expanders?

Not all necessarily, but at the same time, it's. Anyone from orth, you know, orthodontist can place these devices as well as general dentists and oral surgeons. It's actually a very simple device to insert even with the mini screws. It's not a complicated procedure by any means. So I think anyone with any provider that can place an implant could place this device and get a patient started. What's harder is really the orthodontic planning, but what I tell people and teach people is how to create a network that you can work with where everyone is doing their part from the insertion of the device, monitoring the orthodontic planning, the periodontist when the periodontist is involved, and then of course, the surgeon when the surgeon is involved. So you kind of get a part of the team and you build your network based on everyone doing their part in portion.

So on an average, what is this treatment? Or if you can give me a range of. How long does a treatment for airway health last?

Yeah, that's a great question too. So, you know, depending. I think first, for anyone interested in this type of treatment, starting with the diagnostics is the most important thing. And then understanding the severity of the issue, from upper airway resistance syndrome to mild, moderate or severe sleep apnea. And then as you understand the severity, you can choose the treatment that's best for you. But then essentially you have the minimally invasive removable appliances like the Vios, DNA appliance, homeo block. Orthotropics is another option. And then usually it's phase one is pall expansion. Phase two is clear liner therapy to really maximize upper and lower occlusion. That's kind of the most minimally invasive treatment that usually can last two to three, sometimes even four years. They tend to be a lot slower progressing since they're removable and they apply gentler forces. But again, a lot of times people like the gentle approach compared to the more aggressive approach.

But then good to have options.

As you get into Mary and SFOT like I've done, you can actually quicken the pace and maximize the outcome. So treatment for me is really closer to 18, 20, 24 months, all said and done, with some pretty astounding outcomes.

Yeah, excellent. I mean, it is a complex process. It does Take time. But I highly encourage people to get screened for sleep to start with. A simple sleep test is easy. Physicians can easily order this and least we can start the conversation because what are some statistics there with, with sleep and morbidity?

Yeah, that's a. I was going to, I was hoping to bring that into the, into the conversation because the incidence of sleep apnea is actually rising. And I like to describe it by describing the problem and how we came upon this, and it ties back in with our conversation of anthropology because as the diet has gotten softer and softer, especially since the Industrial revolution, processed foods, you think of like Gerber baby food and children doing applesauce and very basic things where they require almost no chewing at all. There's a dysfunction that forms in an infant and young child's ability to swallow smoothly based on the texture of their foods. And because of that whole problem, it's increased the prevalence of tongue ties and mouth breathing and it's exacerbated the problem. So it's a little hard to know just how far in we are with the issue. But it is really interesting because I, I believe sleep apnea is about 15% of the population. Tongue ties. It's, you know, no one really has a number on it, but I've heard some providers talk about 30, 35% of the population that has definitive tongue ties. And it might be more than that. And then if you look at the prevalence of soft diets today, it's just about 100% of the Western world that consumes a soft diet. So with that, you essentially have one, two and three generations of people on a soft diet that end up with at least some crowding and mal occlusion. And then with some crowding and mal occlusion, there's almost always an incidence of at least some disrupted breathing, at least from. From optimal.

Yeah. Where can people find you? This is such great information. So let us know. What do you do in your practice? Where is your practice? And where can maybe dentists find you to learn?

Yeah. I am located in Denver, Colorado. My practice name is Reclaim Integrative Dentistry. And my whole goal is, especially having gone through these treatments myself, is to raise awareness for them, both to providers and to patients. So if you look on my website, reclaim dentistry.com I'm constantly adding information and refining it. And I'm very, very lucky to have a very competent team of enthusiastic individuals around me that are making big contributions to everything that we do here. But we have, yeah, the whole diagnostic workflow built up along with the whole spectrum of treatments. And then, yeah, I'm starting to do educational events. And as I keep going, we'll, we'll start posting more and more and then we're just, we're getting excited around here because we're just about ready to unveil our Instagram and social media efforts to get more and more of this information out there. So Reclaimed Dentistry is our Instagram handle, of course. And yeah, that's a, it's a good piece of what we do. And then of course, just like, you know, we do a whole range of different treatments around here from mercury filling removals, wisdom teeth extractions and implants, and reconstructive surgery, cosmetics. You know, big focus on biological dentistry.

Yeah, great. Using ozone and prf, which, which I love. But thank you so much for joining us today. This is very important information that you brought forth and I look forward to hopefully seeing you again and chatting with you on a new show.

Thanks, Sanda. I so appreciate it. And keep up the good work with what you're doing.

Thank you so much for joining me this week. Please make sure you check out the show notes for any links mentioned in the show. If you like today's show, please invite your friends, friends to listen as well. That would mean a lot to me. Do you have a question you'd like me to answer? Message me on Instagram. Dr. Sanda, this is Dr. Sandha. And remember, your mouth is the gateway to your health, so take care of it in the most natural and best way possible.