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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.
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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Listen, Subscribe, Earn CPD
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.
Continuing Education Information
This activity may be eligible for continuing education credit through Protrusive Guidance. Participants must complete the associated quiz inside Protrusive Guidance to obtain CPD certification.
Cost:
Access to this CE activity is included with an active Protrusive Guidance membership. Current membership pricing is available at
www.protrusive.app.
Cancellation & Refund Policy:
Memberships may be cancelled at any time. Access to CE activities remains active until the end of the current billing cycle. Subscription charges are non-refundable once processed. Full details are available at
www.protrusive.app.
