Putting the ENT into dENTistry – PDP272

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.

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:

• Chervin RD, Hedger K, Dillon JE, Pituch KJ. Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. Sleep Medicine, 2000;1(1):21–32. The 22-item PSQ; a score above 0.33 suggests sleep-disordered breathing.

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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.