A quiet revolution is starting in medicine and dentistry: Chronic pain, fatigue, and overall health can be improved without drugs. Oral sleep appliances can activate stem cells around natural tooth roots to widen both the jaws and the airway, as I describe in Six-Foot Tiger, Three-Foot Cage and Early Sirens.

“What you write in your books is exactly me!” many readers and new patients have commented since these books were first published two years ago. Now I divide my time between seeing patients and training traditional dentists to become airway-centered mouth doctors (AMDs).

My message to all of these groups – patients, doctors, and dentists alike – is simple yet critical: Alignment, Breathing, and Circulation before Dentistry — or ABC before D.

  • Alignment: Connecting the dots: sleep – airway – pain – fatigue – bad bite. (1)
  • Breathing: Oxygen is not optional. Airway rules. Sleep apnea is defined as the absence of breathing for 10 seconds or longer. (2)
  • Circulation:Cardiovascular disease leads the parade of symptoms stemming from obstructive sleep apnea. (3)
  • Dentistry: Jaw alignment comes before the bite, braces, or implants.



Teeth Grinders Suffers

Obstructive Sleep Apnea Symptoms

ABC before D is a rule as unforgiving as gravity. Any deviation comes with a steep price.

It also means breakthrough health outcomes are possible when AMDs and all healthcare professionals work together.

Every part of the body requires structural alignment to resist gravity, breathing to take in oxygen, and circulation to deliver nutrients and remove wastes — including those from root canals and the gums and bone around every tooth.

Yet all too often, braces and cosmetic/implant dentistry are done without seeing ABC as the basic prerequisite for good health.

Putting D before ABC can create unnecessary complications and higher costs.

My heart always sinks whenever a new patient comes with a mouthful of new dental work and signs of a structurally impaired mouth, as was the case with CS. Her dental work is very nice: straight white teeth in a full-mouth reconstruction beautifully done with considerable care and expertise. But CS still suffers from chronic pain and unrefreshing sleep.


clinical findings

Clinical Findings


So what’s wrong? Significant points in her case history include 4 adult teeth extracted for braces, asymmetry in upper jaw with a much narrower left palate, and crowded lower front teeth despite attempts at straightening them with clear trays.

3D Jaw Diagnostics ™ is a proprietary way to assess the “3 foot cage” in terms of the width, depth, and height of the tongue space between the two jaws. It shows that

  • Both jaws are narrow, and the upper jaw is much smaller than lower (the shoe is too small for the foot), which I have consistently observed contributes to back and leg pain.
  • Upper jaw retrusion (sunken into the face) and lower jaw entrapment, which in turn drives the tongue into the throat to create sleep apnea risk. (4)
  • Her airway is in the red (narrow and dangerous) zone, which can contribute to sleep apnea, chronic fatigue, jaw clenching, and teeth grinding.


3D Jaw Diagnotsitcs

The good news: ABC can be redeveloped in adults, regardless of age.

The bad news: Half or more of CS’ dental work may need makeover because D came before ABC. Her existing implant may not respond favorably to oral appliances, and teeth grinding is associated with 3.3 times as many implants failures. (5)

In my opinion, a smarter sequence of treatment could have been

  1. Diagnosis of her impaired mouth, followed by treatment planning using 3D Jaw Diagnostics.
  2. Oral appliance therapy to redevelop the jaw(s) in 3D to support ABC.
  3. Dentistry (braces, cosmetic, or implants) to reinforce ABC.

Following this simple “ABC before D” rule can help save you teeth, simplify treatment, and reduce costs. Who wouldn’t want that?


  1. Myiao E, et al. The role of malocclusion in non-obese patients with obstructive sleep apnea syndrome. Int Med. 2008;47(18):1573–1578.
  2. American Academy of Sleep Medicine. Obstructive Sleep Apnea.
  3. Dement W. It’s time to wake up America. JAMA. 1993;269(12):1548-1550.
  4. Chang ET, Shiao GM. Craniofacial abnormalities in Chinese patients with obstructive and positional sleep apnea. Sleep Med. 2008;9(4):403-410.
  5. Chrcanonic, BR, et al. Bruxism and dental implant failures: A multilevel mixed effects parametric survival analysis approach. J Oral Rehabil. 2016;43(11):813-823.
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