Show Notes
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. https://youtu.be/QVEc0ocxTCc Watch PDP272 on YouTube 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 airw
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