Orthodontics that asks: does this smile breathe well?

Eight years of training, seven named specialists

Airway-focused orthodontics isn't a weekend certification. It's a framework that requires learning from the entire team that treats airway disorders — orthodontists, oral surgeons, ENTs, sleep medicine physicians, myofunctional therapists, and frenulum specialists. Most orthodontic continuing education stays within orthodontics. Dr. Andros has spent eight years deliberately training across all of these disciplines.

Specifically, he has trained directly under:

• Dr. Rebecca Bockow (Seattle, WA) — dual-trained periodontist-orthodontist, one of the leading voices in pediatric sleep-disordered breathing and airway-focused orthodontics in the Pacific Northwest. Recurring lecturer in Dr. Andros' OrthoPreneurs RD study group.
• Dr. Audrey Yoon (Stanford-affiliated orthodontist) — pediatric airway, OSA, growth modification, and MARPE complications. Multiple lectures at the 2022 Stanford Sleep and Airway Symposium.
• Dr. Stanley Liu (Stanford-affiliated oral & maxillofacial surgeon) — sleep surgery, the surgical side of airway intervention when orthodontic and medical management aren't enough.
• Dr. Soroush Zaghi (founder, The Breathe Institute, Los Angeles) — world-recognized expert on tongue-tie, frenulum restrictions, and how restricted oral function shapes craniofacial development.
• Dr. Sharon Keenan — sleep medicine specialist; polysomnography (sleep study) interpretation, the diagnostic foundation for airway-related orthodontic decision-making.
• Sarah Hornsby — leading myofunctional therapist; how to retrain tongue posture and oral muscle function in conjunction with orthodontic treatment.
• Dr. Anil Rama (Stanford-affiliated sleep specialist) — adult sleep medicine and the orthodontist's role in coordinated care.

That roster is essentially the multidisciplinary team behind modern airway medicine. Dr. Andros has trained under all of them — not as a passing introduction, but as part of a deliberate eight-year arc that included two Stanford Sleep and Airway Symposiums (2019 and 2022) plus a 2026 sleep-study course with Dr. Rama and a confirmed December 2026 course at the Arizona Biltmore.

Why this matters — the link between airway and craniofacial development

The connection is well-documented in the peer-reviewed orthodontic and sleep medicine literature, even if it isn't yet routine in mainstream orthodontic practice. The simplified version:

Healthy craniofacial development depends on nasal breathing with the tongue resting against the roof of the mouth. The tongue, sitting against the palate, provides the gentle outward force that keeps the upper jaw growing wide enough. The nose, used as the primary breathing route, helps drive vertical and horizontal growth of the midface. Lips closed at rest helps seal the system.

When any of these is disrupted — chronic nasal congestion forcing mouth breathing, enlarged adenoids forcing the tongue to drop, a restricted tongue tie pulling the tongue away from the palate — the craniofacial system develops differently. The palate narrows. The jaw can grow long and narrow. Crowded teeth and a high arched palate are visible markers of an underlying breathing pattern that started years earlier.

By the time a child is in braces or an adult is asking why they snore, the structural pattern is already set. Airway-focused orthodontics treats the structure that contributes to the airway problem — and coordinates with sleep medicine, ENT, and myofunctional therapy to address the rest.

Signs your child might benefit from airway evaluation

The American Association of Orthodontists recommends a general orthodontic screening by age 7. For airway specifically, the right age is case by case. If a child has been diagnosed with pediatric sleep apnea, referred by a pediatrician or ENT, or if parents are concerned about sleep patterns or chronic mouth breathing, earlier evaluation makes sense — even in toddlers and preschoolers. None of the signs below is diagnostic on its own; together they often indicate an underlying airway component that benefits from orthodontic assessment.

• Chronic mouth breathing — during sleep, during concentration, or as a baseline resting state. A child whose lips don't naturally close at rest.
• Snoring at any age, especially if loud or accompanied by pauses
• Restless or non-restorative sleep — frequent waking, thrashing, unusual sleeping positions to keep the airway open, sweating during sleep
• Daytime fatigue or behavioral issues — children with airway-related poor sleep often present with attention difficulties, irritability, or ADHD-like behaviors. The behavior is the visible symptom; the sleep disruption is the cause.
• Dark circles under the eyes — "allergic shiners" caused by venous congestion related to chronic nasal blockage
• Frequent congestion, sinus infections, or ear infections
• Bedwetting past the typical age
• Long, narrow face — a developmental pattern often associated with chronic mouth breathing
• Narrow palate, crowded teeth, or a high-arched palate — visible signs of altered jaw development
• Tongue scalloping — wavy edges along the sides of the tongue from resting against the teeth instead of the palate
• Low tongue posture — a tongue that rests on the floor of the mouth rather than against the roof

Parents are often the first to notice these patterns. Pediatricians and family dentists sometimes flag them. When several of these are present together, an airway-focused orthodontic evaluation is worth scheduling — even if your child isn't yet at the typical "braces age."

Signs an adult might benefit from airway evaluation

Adult presentations are different, but the underlying mechanism is the same — structural narrowing of the upper airway contributing to chronic symptoms that the patient may have lived with for decades. Common patterns:

• Chronic mouth breathing or chronic nasal congestion — including waking with a dry mouth
• Snoring, witnessed pauses in breathing during sleep, or a known diagnosis of sleep apnea
• Morning headaches or non-restorative sleep — feeling tired despite a full night
• Persistent TMJ symptoms not adequately addressed by traditional dental treatment
• Tooth wear or grinding — sometimes a manifestation of airway-related arousals during sleep
• A narrow upper arch with dark corridors at the corners of the smile
• Recessed lower jaw or chin — structural patterns associated with reduced airway volume
• Daytime fatigue not explained by other factors
• A previous CPAP intolerance — patients who couldn't tolerate the mask sometimes benefit from a structural approach as an adjunct

Many adults arrive at airway-focused orthodontics because something else didn't work — a sleep study they ignored, a CPAP they stopped using, TMJ treatment that didn't resolve, or chronic congestion that ENT visits didn't fully fix. The structural component of these problems is often what was missed.

What an airway-focused evaluation includes

The first visit looks different from a standard orthodontic consultation. In addition to the usual orthodontic workup — bite, jaw alignment, tooth crowding — Dr. Andros also evaluates:

CBCT imaging with airway analysis

A cone-beam CT scan provides a three-dimensional view of the nasal cavity, palate, sinuses, and upper airway. Volume measurements and minimum cross-sectional area give an objective starting point. The same scan supports the transverse skeletal analysis used in MARPE/MASPE planning.

Clinical assessment of tongue posture and frenulum

Where the tongue rests, how it functions during swallowing and speech, and whether there's a restrictive frenulum (tongue tie) under it. Dr. Andros' training with Dr. Soroush Zaghi at The Breathe Institute focuses specifically on this assessment.

Palatal width and dental compensation

How wide the palate actually is, and whether the molars are tipped inward to compensate for an underlying skeletal narrowness. The CWRU-style transverse analysis Dr. Andros uses (described on the MARPE page) is specifically designed to detect this compensation pattern.

Nasal breathing assessment

Whether the patient can comfortably breathe through the nose with the mouth closed. Persistent inability often indicates an ENT issue (deviated septum, enlarged turbinates, adenoid hypertrophy) that should be addressed before or alongside orthodontic treatment.

Sleep screening

A structured intake of sleep-related symptoms. When the screening suggests sleep-disordered breathing, the next step is referral for a formal sleep study with a sleep medicine specialist — the orthodontic plan is built around their findings.

Treatments we offer and coordinate

Airway-focused orthodontics rarely uses one tool. Depending on the case, treatment may include any combination of:

• Skeletal palatal expansion — MARPE/MASPE in adults; conventional rapid palatal expansion in growing children. Widening the palate increases nasal cavity volume and creates room for the tongue to rest properly.
• Growth modification in children — using the remaining growth potential to guide jaw development toward a more airway-friendly outcome
• Conventional or self-ligating braces for tooth alignment after the structural foundation is addressed
• Clear aligners (Invisalign) in cases where the skeletal foundation is sound and only tooth movement is needed
• Coordination with ENT for adenoid/tonsil evaluation, septum or turbinate treatment, or chronic congestion management
• Coordination with myofunctional therapy for tongue posture retraining — often before, during, and after orthodontic treatment
• Coordination with frenulum specialists when a restrictive tongue tie is contributing
• Coordination with sleep medicine for sleep studies, CPAP titration, or oral appliance therapy where indicated
• Referral to oral and maxillofacial surgery when surgical advancement of the jaws is the right answer — typically severe adult cases where orthodontic and medical management alone won't address the structural narrowing

What airway-focused orthodontics is not

Honesty matters here. The airway-focused orthodontic community has its share of overpromising, and Dr. Andros doesn't want to be associated with claims the evidence doesn't support. Specifically:

• Orthodontic treatment alone does not cure sleep apnea. Sleep apnea is a medical diagnosis requiring evaluation by a sleep medicine physician. Orthodontic treatment can address structural contributors and meaningfully improve outcomes in coordination with sleep medicine — but it is not a replacement for proper sleep medicine care.
• Not every crowded smile is an airway case. Plenty of patients have orthodontic issues that are purely dental. The airway-focused evaluation determines which category each case actually belongs in.
• Children with attention difficulties don't always have airway problems. Sometimes they do. The airway evaluation helps determine whether structural factors are contributing — but it doesn't replace pediatric or psychological evaluation.
• Treatment results vary. Some patients have dramatic improvements in sleep quality, headaches, and breathing after orthodontic treatment. Others have measurable structural changes without dramatic symptom relief. Realistic expectations matter.

The honest framing: airway-focused orthodontics addresses anatomical contributors to airway function, in coordination with the rest of the medical team, and produces measurable improvements in many — not all — cases. Dr. Andros will tell you which category your case is likely to fall into based on the evaluation.

The case for early evaluation

One of the most important reasons to evaluate children for airway involvement early is the developmental window. The upper jaw and palate are still actively growing through about age 10-12. The midpalatal suture (the seam down the middle of the upper jaw) is more pliable in younger patients, which means palatal expansion is simpler and produces better long-term results.

That doesn't mean every child needs treatment at the first visit. Early evaluation often results in a plan that includes monitoring growth over time, coordinating with pediatricians, ENTs, or sleep specialists, and starting myofunctional therapy long before any braces or expander is placed. The goal of seeing kids early isn't to start treatment before it's needed — it's to put the right team in place and intervene at the right moment.

The contrast matters: the same problem, identified for the first time in adulthood, often requires MARPE/MASPE — a more involved procedure — or in some cases jaw surgery. By contrast, a 7-year-old with a narrow palate, mouth breathing, and chronic congestion can often be expanded with a conventional pediatric expander, treated for the underlying ENT issue, retrained on tongue posture with myofunctional therapy, and sent into adolescence with a wider palate, better breathing, and a more favorable craniofacial pattern.

The economic and quality-of-life math favors early evaluation by a wide margin — even when the conclusion of that evaluation is "monitor for now."

What to expect at your evaluation

An airway-focused consultation typically runs longer than a standard orthodontic visit — generally 45-60 minutes. It includes a detailed intake on sleep and breathing symptoms, the clinical airway assessment described above, a CBCT scan if not already on file, and a discussion of findings and recommendations. If the case has a significant airway component, Dr. Andros will outline which specialists to coordinate with and in what order. If the case is purely dental, he'll tell you that too.

You'll leave the consultation with a clear understanding of what the workup shows, what the realistic options are, and what your next step is — whether that's orthodontic treatment, a sleep study referral, an ENT consult, or a combination.