Episode #312: Could It Be Airway?, with Dr. Tracey Nguyễn

Airway isn't just appliance therapy — it’s about reducing the risk of sleep-related disorders for overall health. And today’s guest, who didn’t like or start out with sleep dentistry, is here to explain why all dentists should be thinking about airway in their practice. Kirk Behrendt and Dr. Tracey Nguyễn talk about focusing beyond just patients’ teeth, and how airway is connected to everything. To learn how to get started, listen to Episode 312 of The Best Practices Show!

Main Takeaways:

• Disorders we see in children are related to airway issues.
• Dentists are as important as sleep physicians in managing sleep-related disorders.  
• Other physicians need to know that dentists can help treat patients.
• Patients trust dentists. They spend more time with dentists than primary care physicians.
• Start with the medical history. Get to know patients before looking in their mouth.
• Reach out to different specialists for support.
• Airway is connected to everything!

Quotes:

• “What's going on right now with all these diseases, especially with children, all the neurocognitive issues, the ADHD, I kind of realized that, ‘Wow. Could this all be airway issues?’ And the best person to manage the face is a dentist. And so, I didn't understand why we were not equally as important as a sleep physician. The first person that a child should get a referral to is the dentist.” (07:11—07:39)
• “I think the profession that has the most influence in change is dentistry. I mean, medicine is really all about management. I had a five-year-old on a CPAP, and I talked to the physician. I was like, ‘Okay. What's the endgame of this? What do I need to do to get this child off of CPAP?’ And the sleep physician said, ‘What do you mean?’ I was like, ‘What do you mean, you don't understand what I mean?’ I was like, ‘What is the endgame?’ And for them, they didn't even understand that, because medicine is about management.” (08:08—08:47)
• “You see [issues] in all ages. And the question you have to ask is, ‘Could it be airway, and could my dentistry impact the airway positively or negatively?’ So, I think that's a very important conversation to have. Patients trust the dentist. They spend more time at the dentist than they do at their primary care. And we connect the dots.” (10:54—11:20)
• “The way dentistry is working is, we’re trying to get beyond just looking at pictures of teeth and be like, ‘Well, let's start with the medical history. What's going on? Who is this patient?’ Your first class in treatment planning should be understanding the medical history. We kind of skip that. As physicians, we forget the medical history and we go straight to taking pictures of teeth. So, I'd like us to slow down. I think that when you slow down, you get to know the patient, then you develop that trust.” (12:01—12:35)
• “With airway dentistry, it’s no different than restorative dentistry. You're going to need your orthodontists. You're going to need your oral surgeons. You're going to need your specialists. So, it’s just a different way of managing it. And you're managing it from a health’s perspective now.” (14:27—14:43)
• “With kids, all the neurocognitive [consequences appear] before you see the malocclusion. So, when they come into your office for that first dental cleaning, that’s so important. You’ve got to recognize the sleep problems before you send them to the orthodontist. And the adult world is obviously a little bit different. But it always goes back to screening and understanding the signs and symptoms.” (15:06—15:35)
• “Before, I was just focused on the esthetics. But now, when you come from a health perspective, a perspective where you actually care about the patients’ well-being and things that you can do for them, your case acceptance for your treatment skyrockets. Because now, the communication is, ‘Wow, this person really cares about how I feel, how I look. And my dentistry could actually improve how I feel outside of how it makes me smile and the esthetics. I actually can feel better.’” (16:54—17:27)
• “I would say for new dentists, I get it, you're trying to make the money. You're trying to pay the bills. But you want to develop a loyalty, a trust. When the patient trusts you, they will pay whatever you tell them — they will accept whatever you think that they need. And that's the bottom line. And for them to trust you, they have to know that you care. And to know that you care, you have to know who they are.” (18:25—18:56)
• “Any time the patient sits down, the first thing we do is, ‘Who are you? Where have you been? How has your life been? What's your health?’ before I even look at your mouth. So, it’s a different relationship. So, I would say for new docs, slow it down. In this field, what I'm finding is you're going to have two classes. You're going to be the top or the bottom. The middle class, you're not going to survive.” (19:04—19:37)
• “I didn't jump into sleep dentistry. I didn't like sleep dentistry. I didn't like it because it was oral appliances. I was like, ‘Is this the best that I can do, just make an oral appliance and just be like, the teeth are going to be wherever they need to be, because that's where you need to be to live?’ And it was funny because that was what a lot of people told me, like, ‘Tracey, would you rather have them dead or alive?’ I was like, ‘Yeah, but can they be alive with good teeth too?’” (21:53—22:17)
• “I hope that we become a field that is more integrated in medicine. My hope is that if a medical doctor does a quick exam, they can look at risk factors and refer to the dentist, and vice versa. So, I hope there will be more communication with the dental community and the medical community because it’s all related.” (25:44—26:07)
• “As you get into this rabbit hole, I call it a rabbit hole, you start to think, ‘Oh my gosh, all the dentistry that I have been doing, there's an airway component.’ TND, airway component. Bruxism, airway component. Broken front teeth, airway component. We’re like, ‘Crap, how did I miss all of this?’ And so, with kids, you look at all this malocclusion, and it’s interesting because people are like, ‘Well, it’s a genetic component.’ I was like, ‘Yeah. But if the parents have airway issues, then that's an airway component.’ So, you see airway in everything.” (29:06—29:45)
• “One of the things I love about John Kois is he breaks everything down as risk management. And so, that's kind of how I see airway. I don't see us as fixing everybody. I see us as, through dentistry, how can we reduce everybody’s risk of developing airway problems.” (33:19—33:40)

Snippets:

• Dr. Nguyễn’s background. (03:50—06:33)
• Why this is an important conversation. (07:05—10:11)
• Dentists connect the dots. (10:30—12:39)
• Is CE coming together on this topic? (14:05—15:35)
• How to implement this into a restorative practice. (16:46—19:38)
• Reach out to specialists for support. (20:23—23:16)
• What dentists get wrong about airway. (23:36—24:54)
• The future of airway. (25:38—26:58)
• Dr. Nguyễn’s online educational program. (27:20—29:50)
• Dr. Nguyễn’s AACD presentation. (30:49—31:28)
• ASAP Pathway and Dr. Nguyễn’s contact information. (32:06—34:54)

Reach Out to Dr. Nguyễn:

Dr. Nguyễn’s Instagram: @drtraceynguyen https://www.instagram.com/drtraceynguyen/?hl=en

Dr. Nguyễn’s Facebook: https://www.facebook.com/tracey.nguyen.9085

ASAP Pathway: https://www.asappathway.com/

Dr. Tracey Nguyễn, DDS, FAGD, AAACD Bio:

Dr. Tracey Nguyễn, aka, “Dr. Tracey,” received her DDS, Magna Cum Laude at the Virginia Commonwealth University, Medical College of Virginia. Dr. Nguyễn pledges to treat each patient with the highest standard of oral health care.

Dr. Nguyễn is very involved in the local, state, and regional organizations, i.e., Loudoun County Dental Study Group, Northern Virginia Dental Association, Virginia Dental Association, and the American Dental Association.

She is a member of the American Academy of Laser Dentistry, the World Clinical Laser Institute, and the International Congress of Implantologists (ICOI). Dr. Nguyễn understands the importance of lasers in dentistry. She was one of the first doctors that introduced the hard tissue laser dentistry in Loudoun County.

Dr. Nguyễn is also a Fellow of the American Academy of General Dentistry. She thus understands that providing great smiles and excellent oral health are the result of going above and beyond basic requirements. Dr. Nguyễn serves as an editor for the AGD peer-reviewed research manuscripts. She also has continued to advance her dental and clinical expertise by completing thousands of hours of advanced training at the most prestigious dental institutions across the country.