Putting the ENT into dENTistry – PDP272

Sleep, Airway and Mouth Breathing: An ENT’s Guide for DentistsCould 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 YouTubeProtrusive Dental Pearl: When the Numbers MisleadDentists 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 EpisodeThis 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 Episode00:00  Teaser01:00  Why ENT and Dentistry Should Be Talking02:51  Protrusive Dental Pearl: When Sleep Data Misleads You03:46  Meet the ENT Who Works With Dentists06:00  Sleep Physician, ENT or Dentist: Who Should Lead?07:26  Why Children and Adults Are Completely Different08:58  Sleep-Disordered Breathing Is Not the Same as Sleep Apnoea09:39  Why a Normal Sleep Study Doesn’t Mean Normal Breathing10:01  Same AHI, Different Cause: A Tale of Two Patients12:54  Why One Night’s Sleep Study Isn’t Enough13:44  Where the AHI Cut-Off Numbers Really Came From15:27  CPAP Explained: A Bridge, Not a Cure18:27  When Snoring Hides Something Serious19:10  What Phenotyping the Airway Actually Means20:27  Splint, CPAP, or Both?21:33  Why a CBCT Can Miss a Deviated Septum25:32  Is STOP-Bang Enough to Screen for Sleep Apnoea?26:06  Why the Epworth Sleepiness Scale Is a Blunt Tool26:50  Why STOP-Bang Is Biased Against Women31:17  Sleep Apnoea in Women: Mild on Paper, Severe in Life32:05  Midroll36:56  The Triad: Airway, TMD and Orthodontics37:12  The Three Most Common Causes of Night-Time Grinding39:41  The Four Questions That Screen a Child for Sleep Problems41:03  Tired vs Not Tired: The Sign That Changes Everything43:36  Should You Refer to Myofunctional Therapy Before an ENT?45:58  The Hidden Dangers of Forcing Nasal Breathing52:28  Maxillary Expansion vs Surgery: Which One Fixes It?54:51  How Dentists Can Assess Adenoids56:25  Save the Child First: The Drowning Analogy57:56  Where Dentistry and ENT Go From Here1:00:05  Outro – New-Look Premium Notes & CPD OutroFrom the GuestDr 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 ReadingSources 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.Loved This Episode? Try NextAirway Dentistry with Jeff Rouse – PDP229Listen, Subscribe, Earn CPDThis episode is eligible for 1 CE credit via the quiz on Protrusive Guidance.This episode meets GDC Outcomes CAGD Subject Code: 730 – Oral Medicine, Oral Diagnosis, Oral Pathology (Sleep medicine)#PDPMainEpisodes #OralSurgeryandOralMedicineAim & Learning OutcomesAim: 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.