Our Approach
Airway
Friendly
Beyond just straightening teeth, our airway friendly approach considers how the airway, jaws, tongue posture, and bite work together to support a patient's overall health
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What Makes A Beautiful Smile?
Airway Friendly Approach in Encinitas
Healthy Airway
Natural Results
Tongue Space
Functional Bite
Facial Harmony
Long-Term Stability
Early Orthodontics & Airway Development
A child's ability to nasal breathe can influence sleep, focus, mood, and the way the face and jaws develop, yet airway restriction can go undetected for years. At Haven Orthodontics in Encinitas, Dr. Brittany Fischer makes airway screening a routine part of patients' care, using low-radiation 3D cone beam (CBCT) imaging to provide a detailed view of the airway, nasal passages, and developing jaws. When signs of airway restriction are present, interceptive or Phase I orthodontic treatment may guide jaw development, expand the palate, and create space for erupting permanent teeth while supporting a healthier airway. Because airway health is complex and there is not a single solution to multifactorial problems, Dr. Fischer often coordinates care with a child's pediatrician, ENT, allergist, and myofunctional therapist to address the full picture. Early identification and management can have a significant impact on a patient’s quality of life.
When a child under 12 shows signs of airway restriction, Dr. Fischer may recommend early, or Phase I, orthodontic treatment. Starting at this stage takes advantage of a child's natural growth to guide healthy jaw development, gently widen the palate, and open space for incoming permanent teeth, all while supporting easier, healthier breathing. Because airway health is complex and rarely traces to a single cause, Dr. Fischer often coordinates with a child's pediatrician, ENT, or sleep physician so that care addresses the full picture. Identifying and managing these concerns early can help lower the likelihood of later challenges such as chronic mouth breathing, disrupted sleep, and factors associated with obstructive sleep apnea.
Signs Your Child May Have a Constricted or Underdeveloped Airway
- Snoring or noisy breathing during sleep
- Breathing through the mouth during the day or while asleep
- Teeth grinding (bruxism)
- Bedwetting beyond the expected age
- Trouble focusing or staying on task
- Frequent irritability, mood swings, or behavioral changes
Creating Space for Healthy Growth, Breathing, and Confident Smiles
At Haven Orthodontics, Dr. Fischer believes that well-timed treatment can play an important role in healthy jaw and facial development. When a narrow upper jaw is associated with airway concerns, treatment is tailored to each patient's age, growth, and skeletal maturity. For growing children, this may include a traditional palatal expander to guide upper-jaw development and create additional space. For patients who are more skeletally mature, treatment options may include MARPE or, when indicated, orthognathic jaw surgery. By carefully selecting the appropriate approach, Dr. Fischer works to improve jaw development, support healthy nasal breathing, and create a stable foundation for long-term oral health and facial balance.
A palatal expander is a custom 3D-printed metal appliance designed to gradually widen the upper jaw. It is most effective in young children and pre-teens, when the jaws are still developing and responsive to growth guidance. By widening the upper jaw, an expander can create space for erupting teeth, relieve crowding, and improve the coordination between the upper and lower jaws. In many patients, expansion can also support improved nasal breathing and more balanced facial development, helping create a healthy foundation for a confident smile.
MARPE, short for Miniscrew-Assisted Rapid Palatal Expansion, is an advanced treatment option for teens and adults whose jaws may no longer respond to a traditional expander. It uses small temporary anchorage devices (TADs) to direct expansion forces toward the mid-palatal suture, allowing the upper jaw to be widened even after natural growth has slowed. Dr. Fischer may recommend MARPE for patients with a narrow upper jaw, limited expansion potential due to age, or airway-related concerns such as mouth breathing or snoring. Treatment is offered in coordination with a periodontist or oral surgeon and may include a midline corticotomy to help facilitate expansion. For many patients, MARPE can provide an effective alternative to more invasive jaw surgery while improving alignment, supporting healthier breathing, and promoting long-term stability and comfort.
Myofunctional therapy retrains the muscles of the face, tongue, lips, and airway to support healthy function, including proper tongue posture and nasal breathing. Because these patterns can influence facial growth, airway health, and orthodontic stability, Dr. Fischer evaluates functional habits such as mouth breathing and low tongue posture as part of airway-focused care. When needed, she collaborates with trusted myofunctional therapists before, during, or after orthodontic treatment to support each patient's long-term results.
Orthognathic surgery, or corrective jaw surgery, is a treatment used to reposition the upper and/or lower jaws when skeletal growth differences cannot be fully corrected with orthodontics alone. From an airway-focused perspective, treatment may involve widening and/or advancing the jaws to improve bite alignment, facial balance, and the space available for the airway. For appropriately selected patients, these changes can improve nasal and oral airway dimensions and may help reduce the severity of obstructive sleep apnea. At Haven Orthodontics, Dr. Fischer coordinates orthodontic treatment with an experienced oral and maxillofacial surgeon to carefully plan jaw position, bite function, facial aesthetics, and airway health as part of a comprehensive treatment approach.
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Airway-Focused Expansion
Much of healthy breathing begins with the upper jaw. When the palate is narrow, the nasal airway above it is often restricted as well, which is why expansion sits at the center of the airway-focused care at Haven Orthodontics. Dr. Brittany Fischer evaluates each young patient's airway, nasal passages, and jaw structure in three dimensions using low-radiation 3D cone beam (CBCT) imaging, giving her a clear view of how a child is actually growing. When a child under 12 shows signs of airway restriction, she may recommend early, or Phase I, treatment that gently widens the palate, guides balanced jaw development, and opens space for incoming permanent teeth, all while supporting easier breathing. Recognizing and guiding these patterns early can help lower the risk of later concerns such as chronic mouth breathing, disrupted sleep, and factors associated with obstructive sleep apnea.
Not every jaw responds to expansion the same way, and the right method depends largely on age and how mature the palate has become. Rapid Palatal Expansion (RPE) is typically used in younger patients whose mid-palatal suture is still open and naturally responsive to widening. MARPE (Mini-Implant Assisted Rapid Palatal Expansion) is designed for more skeletally mature adolescents and adults, whose suture has grown resistant to conventional expansion. By anchoring to small temporary screws, MARPE directs the force into genuine skeletal widening with fewer of the unwanted dental side effects that can occur once growth has slowed, making it a strong option for patients past their peak growth years.
An airway evaluation at Haven Orthodontics is built to understand the full picture of how a child breathes and grows. It generally includes:
A review of breathing patterns and sleep-related symptoms
An assessment of growth and jaw development
3D cone beam (CBCT) imaging when appropriate
Personalized recommendations for expansion or early (Phase I) treatment
Myofunctional therapy retrains the muscles of the face, tongue, lips, and airway so they function the way they are meant to. It helps establish healthy habits such as proper tongue posture, consistent nasal breathing, and a balanced swallow, each of which plays a meaningful role in facial growth, airway health, and how well orthodontic results hold over time. Because airway- and growth-focused orthodontics looks beyond straight teeth, Dr. Fischer pays close attention to muscle patterns like mouth breathing, a low resting tongue position, or an improper swallow, since these can quietly influence jaw development, sleep quality, and the long-term stability of treatment. When these functional patterns need support, she collaborates with trusted myofunctional therapists who share her airway-centered, growth-guided philosophy, coordinating care before, during, or after treatment so each patient's plan stays individualized and connected.
Airway-Focused Orthodontics at Haven Orthodontics
At Haven Orthodontics, Dr. Fischer believes a truly healthy smile begins with healthy breathing. Her airway-focused approach gives special attention to children and growing patients, recognizing the signs of airway concerns early so treatment can do more than straighten teeth. The goal is care that supports balanced facial development, more restful sleep, and lasting overall wellness, designed around each child's individual growth.
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