Airway-Conscious Orthodontics

Airway-conscious orthodontic treatment incorporates analysis of airway health into traditional orthodontic treatment. The objectives are to achieve a beautiful smile and align your teeth, jaws, and airway for the highest level of long-term health.

A New Approach to Orthodontics

Nothing is more central to healthy human life than the act of breathing. That’s why airway-conscious treatment is so important.

At Leland Orthodontics, we consider the health of your airway when planning your treatment to give you the best results.

What Makes Up Our Airway?

There are two main parts of your airway:

  • The nasal airway: This is the passageway through the nose. Hard tissues outline the nasal airway, including nasal cartilage, nasal bones, and nose floor.
  • The pharyngeal airway: This is the passageway down the throat and into the lungs. Soft tissues line the pharyngeal airway, including the back surface of the tongue and the back of the throat.

What Happens During Sleep? How Are Sleep and Breathing Connected?

You may wonder why doctors assess your quality of sleep while discussing breathing. This is because your airways are in their most vulnerable positions when you sleep.

As you sleep, you lose muscle tone throughout your body, so when you’re lying down, your airway is more likely to close due to gravity. This can interrupt your sleep, causing you to wake up when you should be able to recharge.

Simply put, your muscles are at their weakest when you sleep, so if you have healthy breathing patterns while sleeping, you most likely breathe well when you’re awake.

invisalign reno nv

The Problem with Snoring

Contrary to popular belief, snoring isn’t normal and indicates a compromised airway. The sounds of snoring are the result of the airway collapsing during sleep.

Snoring indicates that the brain isn’t getting the oxygen it needs to become fully rested. Because of these reasons, improper breathing is a serious health condition that requires treatment.

The Proper Way to Breathe

While you can certainly breathe through your mouth and nose, the best way to breathe is nasal. Nasal breathing offers numerous health benefits, including:

  • Breathing with your mouth closed allows the proper resting posture of the tongue braced against the roof of the mouth, which encourages proper jaw development.
  • Air filtration and humidification.
  • Increased resistance promotes deeper breathing, increasing oxygen intake and distribution.
  • Nitric oxide mixes with the air, which improves the lungs’ ability to absorb oxygen.
reno family orthodontist

Side Effects of Mouth Breathing

We learned about the health benefits of nasal breathing in the last section, so let’s see the effects of mouth breathing:

  • Breathing unfiltered air
  • Nitric oxide is not added to inspired air, which decreases the lungs’ ability to absorb oxygen
  • Shallow breathing reduces the amount of oxygen transferred into the body
  • Underdeveloped upper jaw bones

These are the most direct adverse effects of mouth breathing. Unfortunately, there are also indirect adverse effects of chronic mouth breathing, which stem from getting inadequate oxygen to the brain.

These adverse effects include:

  • A constant lethargic feeling
  • ADD or ADHD
  • Bedwetting
  • Difficulty focusing on tasks
  • Getting labeled as a “problem child”
  • Irritability
  • Non-restful sleep
  • Poor performance at school or work
  • Increased risk for cavities and periodontal disease

Timing Is Everything

Orthodontists like Dr. Leland do more than straighten teeth—they spend a great deal of time focusing on the growth and development of the jaws and how to make sure things are growing and developing properly.

Timing is everything when it comes to orthodontic treatment to change the relationship of the jaw bones.

We identify the Golden Period of a child’s orthodontic development between the ages of 7 and 9. During this time, we can modify the jaws to create space for erupting teeth, create ideal alignment, and make changes that will benefit a child’s smile for life without invasive treatment.

Two-Phase Treatment

Phase 1

Phase 1 occurs between the ages of 7 and 9 when there are enough permanent teeth for treatment to be effective, but there are still primary (baby) teeth in the mouth.

The main objective of Phase 1 treatment is to properly align the jaws and put the airway in the best possible position.

Although we always strive to achieve an esthetic outcome, the main goal of Phase 1 is NOT cosmetic, and we often use appliances like expanders and facemasks.

Phase 2

Phase 2 can occur as early as 11 years old and includes all patients older than this.

By the end of Phase 2, all permanent teeth have erupted and are properly aligned. The goals of Phase 2 are to get the best results regarding your smile esthetics, tooth alignment, bite, and airway.

Orthodontic Treatment for Airways

Let’s explore several treatments we use in our office to correct an improper jaw bone relationship.

Rapid Palatal Expander

Rapid Palatal Expander (RPE)

To expand a palate, we attach a rapid palatal expander (RPE) to the upper molars, one on the right and one on the left. To activate the expander, you’ll turn a screw joint to widen the expander. After the final turn of the expander screw, we’ll leave the appliance in place for four to six months to ensure the bone has fully back-filled in the space created.

Timing for maxillary expansion: On average, we can expand the maxilla (the upper jaw bone) any time before age 12. At 12 years old, the mid-palatal suture “fuses,” which means that the gap turns into solid bone.  After this happens, expansion doesn’t work because there is no “weak point” we can use to expand the maxilla.


A facemask is an appliance that is worn outside the mouth, on the face, also known as an “extra-oral appliance.” It attaches to a metal orthodontic appliance fixed inside the mouth to one molar on each side of the upper jaw, similar to an expander.

Timing: TIMING IS EVERYTHING, especially with facemasks! It is extremely important that children visit an orthodontist soon after their 7th birthday.  Many kids do not need treatment at this age, but for those who do, it is critical to be completed before their jaws finish growing!

Mara Appliance

The MARA appliance is an intra-oral appliance with two pieces; one attaches to the upper jaw, and one attaches to the lower jaw. The purpose of this appliance is to move a mandible (lower jaw) forward, in cases where it is too small, or set too far back.  When the patient bites down, the MARA appliance shifts the mandible forward and holds it there for six to nine months, allowing it to grow into the proper position.

Timing: The forward growth of the mandible is the last dimension of jaw growth to finish. The most effective time to use a MARA is at the beginning of Phase 2, approximately 11½ years old.

Mara Appliance