CE Eligible Article AIRWAY FACIAL EPIGENETICS: A A New New Root-Cause Root-Cause Treatment Treatment Category Category Beyond Beyond Clear Clear Aligners Aligners By Felix Liao, MAGD, ABGD, MIABDM, Diplomate ASBA “Pediatric obstructive sleep apnea in non-obese children is a disorder of oral facial growth.” — Huang YS, Guilleminault C. 1 T he critical role of oral facial growth quoted above has not been widely recognized or practiced. Obstructive sleep apnea (OSA) and crowded teeth are outcomes sharing the same origin: b “7-10% narrower maxilla is found in OSA patients,” per Dr. G. Dave Singh and colleagues in 2009. 2 b Two thirds of untreated U.S. adults have clinically mean-ingful malocclusion. 3 b 89.9% of children with OSA have malocclusion. 4 Crowded teeth are rooted in defi-cient oral facial growth. The under-lying cause is underdeveloped jaws. Failing to see this root cause has led to much pain, unnecessary suffer-ing, and high costs, as the cases ahead will show. Figure 1 ᕥ Energy from food and air. ᕦ Sleep with a wide-open airway. This explains the diversity of resulting signs and symptoms, such as crowded teeth, bruxing, TMJ, musculoskeletal pain, escalating fatigue, brain fog, ADHD, irritabil-ity, daytime sleepiness, etc., as shown in Fig. 1. Impaired Mouth’s fallout throughout the body is rarely inte-grated in patient care due to silo mentality separating various special-ties, as shown in Fig. 2. According to Dr. Francisco Eraso, DDS, MS, orthodontist and oral and maxillo-facial radiologist: “… it has become increasingly evident that many common dental and medical complaints—crowded teeth, bruxism, sleep disturbances, chronic fatigue, and airway obstruction—often share a common structural denominator: Impaired Mouth Syndrome Diagnosis is crucial before starting treatment. Impaired Mouth Syndrome is a root cause missing from most medical and dental training. Impaired Mouth Syndrome is a new term coined by this author in 2017 to spotlight a deficient oral structure featuring malocclusion, a narrow airway, and postural misalignment, thereby contributing to many medical, dental, mental, and mood symptoms. 5 An Impaired Mouth can affect six basic physiological functions: ᕡ Alignment against gravity. ᕢ Breathing without obstruction. ᕣ Circulation with oxygen supply. ᕤ Digestion without stress or toxins. inadequate oral-facial development and a constricted airway. The framework by Dr. Felix Liao offers an important perspective on how these structural limitations may contribute to systemic symptoms.” A New Look at Clear Aligners Clear aligners are intended to align teeth, not to widen jaws and the airway. Missed diagnosis prolongs treatment, adds costs, and fuels frustrations. It is wise to distinguish between the following: b Phase I Orthopedics for jaw growth. b Phase II Orthodontics for aligning teeth. Clear aligners work best for Phase II—with a sufficient bony foundation. Straight teeth in Impaired Mouth can create other symptoms and lead to relapse, as cases ahead will show. 8 Summer 2026 JAOS
Journal of the American Orthodontic Society Summer 2026: Page 8
