My Doctor Doesn’t Treat Airway – But I Still Do: The Hygienist’s Guide to Saving Breaths (and Lives)

 

by Katrina Sanders, RDH, BSDH, MEd, RF 

The Epidemic You Can’t See  

Airway disorders are everywhere — and yet almost no one is talking about them. As dental hygienists, we spend our careers with a front-row seat to the changes of the mouth, the muscles of the oropharynx, and subsequently the breath — but how often are we encouraged to look beyond the prophy and into the passageways of the airway itself?  

It’s estimated that 1 in 5 adults has some form of sleep-disordered breathing, and most of them don’t even know it. They’re undiagnosed, untreated, and unfortunately, deteriorating. 

What begins as loud snoring or mouth breathing can evolve into fragmented sleep, chronic fatigue, and systemic inflammation — all of which are intimately linked to various systemic conditions such as hypertension, myocardial infarction, cerebrovascular accident, Type 2 diabetes, and even Alzheimer’s Disease. While these patients may not be rushing to their physicians complaining about tired jaws or scalloped tongues, they are sipping triple-shot lattes just to make it through their day.  

Tired Nation, Tired Mouths: Why Sleep is the New Vital Sign 

We live in a world that glorifies the grind and caffeinates the crash. Our patients fall asleep at the wheel — literally and figuratively — struggling to concentrate at work, failing to achieve in school with diagnoses of “ADHD,” and slowly surrendering to a chronic health crisis that’s masquerading as “just tired.” 

Most medical doctors receive less than two hours of education on sleep medicine in the entirety of their medical training despite what we know about the importance of proper sleep.  After all, poor sleepers become poor healers. When patients finally mention fatigue or brain fog, they often leave with a prescription for a sleep aid instead of a root-cause investigation. 

Dental hygienists: where we come in! 

As dental hygienists, we are trained and effective preventive professionals. We do not wait for pathology to show up — we screen for risk, we educate, and we act accordingly. We are trained to assess not just for disease, but for the deep-rooted underlying causes of it. This makes us uniquely positioned to recognize the signs of airway dysfunction in our patients long before a diagnosis ever comes. 

What to Look For: Spotting Airway Risk for the Dental Hygienist 

If your doctor is not currently screening for or actively treating airway, that does not mean you cannot. Here is how to begin assessing risk through four primary lenses:  

Medical History Indicators 

• High blood pressure, especially if poorly controlled 
• Type 2 diabetes or insulin resistance 
• History of GERD or acid reflux 
• ADHD (especially in children), depression, or anxiety 
• TMD or frequent migraines 
• Frequent nighttime urination (nocturia)

Vital Sign Irregularities 

• Elevated blood pressure or pulse 
• Low oxygen saturation (if using pulse oximetry) 
• Obesity or high BMI 
• Large neck circumference (>17” in men, >16” in women) 

Head and Neck Observations 

• “Allergic Shiners” of bags or dark circles under the eyes indicating poor oxygenation during sleep 
• Droopy eyelids and poor skin tone 
• Mouth-breathing or open lip posture 
• Scalloped tongue or noted tongue thrust 
• Enlarged tonsils or ankyloglossia (restricted tongue movement) 
• Forward head posture and curvature of the spine  
• High, narrow palate or visible malocclusion 
• Bruxism, wear facets or fractured restorations 

Patient-Reported Symptoms 

• Chronic fatigue or excessive daytime sleepiness 
• Snoring (self or reported by partner) 
• Waking up gasping or choking 
• Dry mouth in the morning 
• Trouble falling or staying asleep 
• Poor concentration, memory lapses, or irritability 

Many dental hygienists are surprised to realize they’re already gathering much of the information needed to screen for airway issues without even thinking about it. From reviewing medical histories and taking vital signs to observing oral posture, scalloped tongues, and dried oral tissues, these findings are often already part of a standard hygiene assessment.  

Adding airway awareness does not typically require a complete overhaul of your existing workflow — it’s simply a matter of connecting the dots. When you begin listening differently, looking with intention, and asking focused questions, airway screening becomes a natural extension of what you are already doing. The goal is not to diagnose or treat — it is to identify red flags early, educate your patients, and advocate for the care they may not even know they need. 

Tools You Can Use: Quick-Reference Screening 

You do not need a full sleep lab in your op to start airway conversations. These simple screening tools help identify patients at risk: 

STOP-BANG Questionnaire 

A quick and validated screening tool for obstructive sleep apnea (OSA), using eight yes/no questions. A score of 3 or more suggests moderate to high risk for OSA.  

• S – Snoring: Do you snore loudly (louder than talking or loud enough to be heard through closed doors)? 
• T – Tiredness: Do you often feel tired, fatigued, or sleepy during the daytime? 
• O – Observed Apnea: Has anyone observed you stop breathing or choking/gasping during your sleep? 
• P – Pressure: Do you have or are you being treated for high blood pressure? 
• B – BMI: Is your Body Mass Index over 35? 
• A – Age: Are you over 50 years old? 
• N – Neck Circumference: Is your neck circumference greater than 17 inches (men) or 16 inches (women)? 
• G – Gender: Are you male? (Men are at higher risk for sleep apnea.) 

Score of 3 or more = further evaluation is recommended.  

Mallampati Score 

This is a visual assessment of airway space using tongue position (see figure 1). For an accurate Mallampati Score assessment, the patient should be positioned as follows:  

• Seated upright with the head in a neutral position (not tilted). 
• Mouth fully open as wide as possible. 
• Tongue maximally protruded without phonating (no speaking or saying “ahh”). 
• Patient should be breathing quietly during the assessment. 
• Class III or IV may suggest compromised airway space.

In today’s tech-savvy world, many patients are already wearing devices like the Oura Ring, Apple Watch, or Fitbit that track sleep quality, oxygen saturation, heart rate variability, and even breathing patterns during the night. These wearable technologies often give early insight into disrupted sleep or signs of potential airway issues — sometimes before the patient even realizes there’s a problem. By opening up a conversation about their sleep data or wearable insights, we may discover that patients have already noticed concerns like frequent waking, low sleep scores, or restless nights. These conversations not only validate the importance of airway screening but also position us as collaborative partners in our patients’ overall wellness.  

When the Doctor Doesn’t Treat Airway: How to Still Show Up for Your Patients 

What do you do when your doctor isn’t interested in sleep or airway treatment? You advocate anyway. 

• Screen and Educate: Start the conversation. Patients trust you. Your role is to inform, not diagnose. 
• Refer with Purpose: Collaborate with airway-aware providers: sleep dentists, ENTs, myofunctional therapists, or sleep physicians. 
• Champion Myo: Consider myofunctional therapy referrals for children and adults with oral habit concerns, poor posture, or tongue dysfunction. 
• Document It: Note clinical findings in the chart — especially risk factors or observations that may require future follow-up. 
• Build a Network: Connect with professionals who do treat airway, so you have a go-to referral source when your patient needs help beyond your scope.

There are many educational opportunities available to help interested professionals explore airway management and help empower themselves to success such as: 

• Free Podcasts: A few of my favorites include Beauty of Breathing with Renata Nehme and Airway, Sleep & TMD Podcast with Jamison Spencer 
• Free Educational Programs: Educational organizations like Airway Health Solutions offer content through their “AHS Conversations” platform. 
• Deep Dive Programs: Institutions like The Vivos Institute have created comprehensive and immersive programs designed for a comprehensive approach to airway management. 
• Certifications: Consider pursuing a certification in Myofunctional Therapy. Organizations like the Academy of Orofacial Myofunctional Therapy (AOMT) or the International Association of Orofacial Myology (IAOM) offer in-depth training programs that can transform how you evaluate and co-manage oral function and structure.

The Bottom Line: You Don’t Need Permission to Care 

You do not need your dentist’s buy-in to start noticing. You do not need a prescription pad to educate. And you do not need a CPAP machine to save a life. 

You just need the confidence to trust your clinical intuition and the courage to ask one simple question: “Are you breathing well while you sleep?” 

Because your patient’s next breath may depend on it. 

This article is dedicated to my mother, Linda Marie Sanders, whose beautiful life was taken too quickly from an airway obstructive disorder that remained untreated despite visiting her ENT the day she tragically collapsed. May her story transform from tragedy to legacy in the ways her preventable death inspires others to rise above and serve their suffering patients with excellence. We miss you, Mom.