Airway Orthodontics

Airway-focused orthodontics is a clinical approach that looks at how the position of the upper and lower jaws, the shape of the palate, and the way the tongue rests in the mouth affect breathing, sleep, and craniofacial development. A narrow palate, a recessed lower jaw, or chronic mouth breathing can change the way air moves through the nose and throat. At McComb Orthodontics, airway-focused care means treating the orthodontic problem and also identifying when the patient should see an ear-nose-and-throat specialist, a sleep physician, or an oral surgeon alongside us. We treat patients of all ages at our West Hollywood, Culver City, and Santa Monica offices.

Regular orthodontics focuses on the position of the teeth. Airway orthodontics adds the position of the jaws and the shape of the palate to the picture, because both affect how a patient breathes. A patient can have straight teeth and a constricted airway. A patient can also have crooked teeth and a wide-open airway. Airway orthodontics asks both questions at the consultation. At McComb Orthodontics, every consultation includes a panoramic X-ray, a 3D iTero scan, and a brief look at the palate width, jaw position, and tongue posture, even when the patient comes in asking only about straightening their teeth.

The signs include chronic mouth breathing during the day and at night, snoring, restless sleep with frequent position changes, bedwetting past the typical age, dark circles under the eyes, daytime tiredness, behavioral problems sometimes mistaken for attention disorders, a narrow high palate, dental crowding, and forward head posture. Occasional mouth breathing during a cold is not a sign of an airway problem. Chronic, daily mouth breathing combined with one or more of the other signs is. McComb Orthodontics asks parents about these signs at every pediatric consultation and refers to an ENT or pediatric sleep specialist when the picture suggests sleep-disordered breathing.

Sometimes. Palatal expansion in children ages 7 to 10 widens the upper jaw and lowers the nasal floor, which often improves nasal breathing in children whose airway is restricted by a narrow palate. When the snoring or mouth breathing is driven by the shape of the upper jaw, expansion can resolve it on its own. When the cause is enlarged tonsils, enlarged adenoids, allergies, or a more complex airway issue, expansion alone will not be enough. McComb Orthodontics evaluates the palate width and refers to an ENT in parallel when the symptoms suggest a non-orthodontic cause. The right answer for any child is the honest one, not the most optimistic one.

Sometimes. When the symptoms suggest obstructive sleep apnea, which is a clinical diagnosis distinct from simple snoring, a sleep study called a polysomnography is the right first step. A sleep study is ordered by a pediatric sleep physician and shows how often the child stops breathing during sleep and how oxygen levels behave. McComb Orthodontics does not order or interpret sleep studies. We coordinate with the sleep physician and the ENT when one is needed and use their findings to plan orthodontic treatment around the airway picture they document. For mild mouth breathing without other sleep symptoms, a sleep study is usually not needed.

Before, when tonsils or adenoids look obviously enlarged, when the child has documented sleep apnea, when there is severe snoring with pauses in breathing, or when chronic allergies are clearly driving the mouth breathing. An ENT can evaluate the upper airway directly and address the tonsils, adenoids, or nasal blockage. A sleep physician can quantify sleep-disordered breathing through a sleep study. McComb Orthodontics treats in parallel with these specialists rather than instead of them. In some cases, the right sequence is ENT treatment first, then orthodontic expansion. In others, expansion happens first to widen the nasal passage. Dr. Ryan McComb will tell you which sequence is right for your child.

Tongue ties matter, but they are over-treated in many practices. A short or restrictive lingual frenulum can affect tongue posture, palate development, and breathing. It can also be inconsequential. Routine frenectomies done without a coordinated evaluation by a feeding specialist, a myofunctional therapist, and an orthodontist can produce worse outcomes than no treatment, especially in infants with a small or recessed lower jaw. McComb Orthodontics evaluates tongue posture at every airway-focused consultation and refers to a qualified tongue tie evaluation team only when there is a clear functional reason. We do not recommend frenectomies as a routine first step.

Adults can still expand the palate. The approach depends on how fused the palate has become. Children ages 7 to 10 use a simple rapid palatal expander. Teens and adults with a fused suture use MARPE, a mini-implant assisted expander that widens the jaw without surgery. Fully fused adult palates may need surgical SARPE, a coordinated procedure with an oral surgeon. For how adult MARPE works, who is a candidate, and what it costs, see our MARPE page.

MARPE, mini-implant assisted rapid palatal expansion, widens a fused adult palate at the bone without surgery. SARPE is the surgical version, used when the palate is fully fused and an oral surgeon releases the bone first. Both are ways to widen an adult jaw that a childhood expander can no longer move. We cover how MARPE works, who is a candidate, and exactly what it costs on our MARPE page.

Sometimes for mild cases, rarely for severe cases without help from other specialists. Adult obstructive sleep apnea, or OSA, is classified by severity using a sleep study. Mild OSA driven by a narrow upper jaw can sometimes resolve with palatal expansion, mandibular advancement, or a combination. Moderate OSA may improve significantly with airway orthodontic treatment but may still require ongoing care from a sleep physician. Severe OSA almost always requires CPAP, an oral appliance prescribed by a sleep medicine specialist, or jaw advancement surgery. McComb Orthodontics does not market airway orthodontic treatment as a cure for sleep apnea. We treat the orthodontic and skeletal contributors to the airway and coordinate with the sleep physician who manages the diagnosis.

For some patients with mild obstructive sleep apnea, yes. For most patients with moderate or severe sleep apnea, no. The American Academy of Sleep Medicine guidelines recommend CPAP as the first-line treatment for moderate-to-severe OSA. Oral appliances and orthodontic expansion are recognized alternatives for patients who cannot tolerate CPAP or who have mild disease. Any decision to discontinue CPAP must be made by the sleep physician who originally prescribed it, with a follow-up sleep study to confirm the airway is stable without the machine. McComb Orthodontics will not advise a patient to stop CPAP on its own authority.

The sleep physician diagnoses sleep apnea and other sleep-disordered breathing using a sleep study and manages the overall airway diagnosis. The orthodontist treats the orthodontic and skeletal contributors to the airway, including a narrow palate, a recessed lower jaw, or a constricted airway shape that responds to expansion or mandibular advancement. The two coordinate. McComb Orthodontics will share scans, X-rays, and treatment progress with your sleep physician so the airway picture stays current throughout treatment. After treatment ends, a follow-up sleep study confirms whether the airway improvement is enough to change your sleep medicine plan.

Myofunctional therapy is a set of exercises that retrain the tongue, lips, and facial muscles to rest and function in positions that support nasal breathing and proper swallowing. The exercises are performed daily over several months under the guidance of a certified myofunctional therapist. The evidence base for myofunctional therapy is growing. Recent clinical research supports it as an adjunct for mild and moderate sleep-disordered breathing, particularly in patients who also undergo palatal expansion or mandibular advancement. It is not a standalone treatment for severe sleep apnea. McComb Orthodontics refers patients to qualified myofunctional therapists when the case calls for it.

OrthoPulse is a small device that uses safe near-infrared light to stimulate the bone and soft tissue around the teeth. The stimulation helps teeth move more predictably during orthodontic treatment. McComb Orthodontics uses OrthoPulse mainly as a compliance buffer for patients who know they will not be able to wear their Invisalign trays the full 20 to 22 hours a day. Patients who can commit to full wear-time usually do not need it. The device is sold to patients at cost, around $500, because the goal is treatment outcome rather than device margin. Dr. Ryan McComb will tell you honestly whether OrthoPulse will help your specific case.

Jaw surgery, called orthognathic surgery, is needed when the skeletal position of the upper or lower jaw is significantly off and orthodontic appliances alone cannot reach the airway result the patient needs. The most common procedure for airway-driven cases is maxillomandibular advancement, where both the upper and lower jaws are moved forward to open the airway. McComb Orthodontics aligns the teeth before surgery, the oral and maxillofacial surgeon repositions the bones, and McComb finishes the bite afterward. The practice coordinates 15 or more orthognathic surgery cases per year with oral surgery partners across LA. Surgical cases are reserved for patients whose airway, jaw position, or bite cannot be corrected with non-surgical orthodontics.

Pediatric airway treatment with a rapid palatal expander, sometimes combined with partial braces or Invisalign First, ranges from $2,500 to $4,500 at McComb Orthodontics. Adult MARPE has its own pricing, which we break down in full on our MARPE page. Comprehensive airway orthodontic treatment that combines expansion, full alignment, and coordination with a sleep physician or ENT typically falls in the $6,000 to $8,000 range. The exact quote depends on the appliances used and the length of treatment. The free consultation includes a personal cost review with the treatment coordinator.

Sometimes for orthodontic appliances, rarely for the airway diagnosis itself. The orthodontic portion, including expansion appliances, braces, and Invisalign, may be covered under your orthodontic insurance benefit if your plan includes one. The sleep apnea diagnosis and any oral appliance prescribed for sleep apnea is usually covered under medical insurance, not dental, and requires a sleep physician's involvement. Some patients can use FSA or HSA funds for both the orthodontic treatment and adjunct services like myofunctional therapy. McComb Orthodontics is in-network with every major PPO carrier including Delta Dental, MetLife, Cigna, Aetna, Guardian, Anthem, BlueCross BlueShield, and United Healthcare. The treatment coordinator will verify your specific plan's coverage before treatment begins.