The best airway providers aren’t just well-trained. They’re constantly questioning, learning, and observing beyond the protocol.
I suspect every dental student spends most of their academic career and early years in practice asking “how” questions. It is natural to do this since dentistry is a “doing profession” with specific tasks that must be done in a certain way for success. We all want to do our best, so learning the “how” is of great importance to us.
Students and those straight out of school are also more inclined to trust that those who taught us “how” to do something had great evidence to support the “why” of doing something, as well as some form of proof that what we learned was “evidence-based.” My experience in the profession has caused me to believe these assumptions are rarely valid. Having learned what I have about the nature of dental education, I don’t think it’s fair to assume there was good evidence for the “why.”
When my bubble was burst about what I had learned in school and I began to question the entire profession, I began to ask those “why” questions. In reality, this is what “critical thinking” really is. Critical thinking requires questioning EVERYTHING—clear back to basic assumptions. First, I questioned whether the faces I produced with traditional treatments were better or worse esthetically after treatment. Looking at one of my former patients in the choir at our church made me feel totally guilty. Her caved-in mid-face made her look like a woman with no teeth. Coming to such a conclusion comes only after critical thinking—and believe me, I was critical of myself. It is one thing when another person shows such things in a lecture. It is yet another when you realize you were the person who did the treatment and have to sleep with the thought that you made someone look worse.
Looking better or worse is one thing, but having a better airway is quite another since a person’s airway health can easily be correlated to longevity. Most people in the airway arena giving courses today are focused on various types of lateral expansion. Lateral expansion is necessary. There are legitimate unanswered questions about various types of lateral expansion—such as non-surgical or surgically assisted, or using TADs or not using TADs. The jury is still out on these questions. Sadly, most people promoting lateral expansion are suggesting that this is all that is needed to resolve sleep/breathing issues. In reality, lateral expansion is a necessary part of treatment but often fails miserably because the person recommending the treatment has not done the hard work of critical thinking to question why the person has a sleep/breathing problem in the first place. If one asks that critical question and digs deeper, they are likely to conclude, as I did nearly a decade ago, that there is much more to the problem. If we dig deep into the science behind why our faces are different than our ancestors’, we learn that our faces are further back than our ancestors’. This is an anteroposterior problem. Doing treatments which enhance forward development of the face and the teeth is more likely to result in improvements in the airway. My own critical thinking helped me summarize this issue in one simple statement: “You can’t expand your way out of an anteroposterior problem.”
If we don’t all become critical thinkers, we continue to do our best at what is inadequate. What we need now is even more critical thinking to literally innovate ways that may help facilitate forward growth of the entire face. I’ve struggled with these thoughts, laying awake at night thinking about how to answer that question. I need help because my critical thinking hasn’t given me an answer. Perhaps you can come up with something I haven’t. I hope so.
