by Felix Liao
Failing to recognize habitual mouth breathing has serious developmental consequences. “All children who are habitual mouth-breathers will have a malocclusion,” says Dr. John Flutter, a general dentist who practices orthodontics and orofacial orthopedics full-time in Brisbane, Australia. “Establishing nasal breathing in growing children must be a priority to prevent abnormal growth and development of the face and jaws. Establishing a lip seal in growing children must be the second priority.” (12) I heartily agree.
There’s plenty of evidence supporting this view, such as:
A study published in American Journal of Orthodontics titled Mouth Breathing in Allergic Children reported: “mouth breathers’ maxillas and mandibles were more retrognathic [retruded]. Palatal height was higher, overjet was greater in mouth breathers. Overall, mouth breathers had longer faces, with narrower maxillae and retrognathic jaws.” (13)
Earlier research in that same journal found that “all experimental animals [with artificially induced nasal obstruction or interference with lip seal] gradually acquired a facial appearance and dental occlusion different from those of the control animals.” (14)
A CHEST Journal study observed that “nasal congestion from any cause predisposes to sleep-disordered breathing.” (15)
Optimal dental-facial form develops naturally through normal oral functions such as suckling, swallowing, chewing, and lip seal. As mentioned in chapter 13, “According to Moss, the form of the facial skeleton is largely secondary and adaptive to surrounding soft tissues and functional spaces.” As the baby’s brain grows, the cranial sutures respond to the subtle stretch by expanding the brain case.
Similarly, a perfectly suited functional space, for the tongue comes from normal soft-tissue actions of the tongue and the throat muscles on the inside, and lips and cheeks on the outside. This is how the genetic potential unfolds.
Would this child perform better at school from having a more open airway? Yes, I believe.
Mouth breathing, like tongue-tie, interferes with the full expression of genetic potential. It can also lead to undesirable craniofacial changes. “The [breathing] impaired group demonstrate characteristic combinations of craniofacial deformities and malocclusions, with the younger individuals demonstrating a lesser expression of malocclusion progression and morphologic deformities,” reports one 1988 study out of Case School of Dental Medicine. “This suggests that early recognition of such facial patterns may be utilized to identify those breathing compromised individuals who have a likely tendency to develop certain types of malocclusion.” (16)
It’s time to look beyond cavities and smiles in dental checkups. It’s time for Holistic Mouth Checkups to uncover Impaired Mouth Syndrome early on to head off its devastating consequences later in life.
How Parents Can Monitor Their Children’s Dental-Facial Development
Why do jaws become underdeveloped? Beyond tongue-tie, improper weaning, nasal congestion, and habitual mouth breathing, additional epigenetic factors can include prolonged bottle-feeding, pacifiers, thumb-sucking, a pro-inflammatory diet, exposure to industrial pollutants, maternal health and pelvic form, birth trauma to the skull, and accidental falls. (17), (18), (19), (20), (21), (22)
Why do teeth crowd up in children so frequently these days? It’s not entirely the fault of the mom’s or dad’s genes. As Dr. Pottenger’s famous studies of cats showed, a diet of processed foods can result in dental-skeletal malformation injuries that are passed down to offspring. “If proper nutrition and exercise are absent when facial structures are developing,” he wrote, “dentition always suffers. The kitten kept on a deficient diet for 10 months has an inadequate jaw with crowded, irregular, and poorly aligned teeth.” (23)
If nutritional injuries can lead to malocclusion and scoliosis, then can children with impaired mouth development be recipients of cumulative epigenetic patterns passed down from their family trees?
Ancestral diet has helped all ethnic groups survive to this day, but convenient food may be de-evolving the human dental-facial structures. This may explain the rise of malocclusion in children and the prevalence of sleep apnea and Alzheimer’s disease in adults in Westernized countries. Much research is needed.
The mother and grandmothers of these newborn kittens were fed a diet of cooked instead of raw meat; the kittens have dental-skeletal malformation.
Before all the studies are completed, there are constructive steps parents can take to guide their children’s orofacial development onto the right track.
As always, parents should seek advice from their own doctors and dentists, as the information provided here does not constitute medical or dental advice.
Left undetected, impaired mouth development can lead to costly consequences later in adult life just on the dental side alone. Dentists trained in sleep medicine and certified to provide Holistic Mouth checkups can be a great asset to the cause of optimal orofacial development.
A Holistic Mouth checkup in early childhood is the best prevention of OSA and its complications. This requires integrative collaboration by all health professionals, parental awareness of Holistic Mouth connections, and additional training for interested dentists to see the whole mouth instead of just the teeth and gums.
A Parents’ Guide to Holistic Mouth Development and other resources are available in the back of this book and at HolisticMouthSolutions.com.
Holistic Mouth Bites
Tongue-tie, improper weaning, food sensitivities that can cause nasal congestion, and habitual mouth breathing are four commonly overlooked epigenetic blockers to normal dental-facial development, in my experience.
The tongue inside the mouth, the nasal airway, and other soft tissues around the mouth shape the oral-facial structures. Poor soft-tissue function is the origin of impaired mouth development, airway obstruction and related consequences.
Every newborn should be checked for tongue-tie, and a child should have a Holistic Mouth checkup as soon as they can cooperate with an evaluation, but no later than age eight.
Crowded teeth, absence of lip seal, and habitual mouth breathing are signs of impaired mouth developing during childhood, and contributors to Impaired Mouth Syndrome in adult years.
Chapter Eighteen
The High Cost of Impaired Mouth: Two Cases and a Contrast
You see only what you know.
– Dr. Richard Beistle, DDS
One Dental Trouble After Another: The Case of Avis
“I have all conditions in that slide except high blood pressure,” said 63-year old Avis, pointing at the image below. She had come in for an initial consultation regarding two other dental treatment plans totaling $29,000 and $19,000, respectively. Let’s see if her dental troubles are connected to her medical symptoms through her impaired mouth.
Avis kept her teeth and gums spotlessly clean. “But each time I go the dentist,” she said, “there’s something else wrong.” Daily, she walked 5 to 7 miles for exercise, and she had lost weight since changing her diet. She had been doing her part, yet her teeth keeping having costly troubles. How could that be?
Our Chair Side Investigation revealed an important clue: Avis seldom woke up feeling refreshed – “less than twice a week since forever,” she said. A 3D CT scan revealed an airway the width of angel hair (pasta). I gave her an overview of impaired mouth as a problem and Holistic Mouth as a solution. Then I asked her, “Would you mind telling me what you learned from coming to see me?”
“First, having a six-foot tiger in a three-foot den creates an airway issue. Secondly, airway comes before dental work.”
“You’ve got it. Airway dictates, and the rest of the body adapts to a pinched airway by paying a price.”
“I’ve been dealing with my teeth since my 20s. Even as they complimented me on my home care, I kept getting cavities, broken and root canal pain just the same.”
“Poor dental hygiene is not your problem. Sleeping with a normal size tongue inside a half-sized mouth is. Each time you sleep, your body ex
periences an oxygen deficiency that threatens life. Oxygen deficiency results in higher acidity. To neutralize that acid, your body robs calcium from wherever it can, mainly bones and teeth. Another reaction to airway obstruction is teeth grinding, which can damage natural teeth and loosen dental work.”
Avis’s airway is off-the-scale deficient and susceptible to sleep apnea, thus hazardous to dental health.
“Really?! That’d explain why I kept getting cavities over the past 30 years, even after I stopped all sweets. Apples and baked potatoes are the only treats I get. So where do I start?”
“You should still get your cavities treated to keep your teeth in good repair. But before your next dental reconstruction, let’s fix your airway to avoid further damage from the same old pattern.”
Avis frowned. “How come I never heard about Holistic Mouth before?”
“Dentists’ eyes are trained to see teeth and gums. A mouth doctor looks at the airway, the neck, the jaw joints, the tongue space between the jaws. Airway blockage by the tongue starts as a mouth problem that creates teeth problems later. Here’s the good new: you still have enough good teeth in the right places, and redeveloping your airway costs much less than a third of dental reconstruction.”
“I can’t wait to wake up feeling great for once in my life!”
The anatomical choke zones behind Avis’ jaws is the source of her dental problem was also her medical problem, and Medicare’s, and therefore all Americans’. What have her health insurance premiums and coverage gotten her? The patient has done her part, but has America’s healthcare system?
The earlier the recognition and correction of impaired mouth, the lower the cost to individuals, employers, and Medicare.
The sensible sequence in building a house is to lay a foundation and frame the walls and floors before finishing the rooms and moving the furniture in. In the Old World mentality of dentists focusing on teeth, the furniture gets a makeover while the bad infrastructure is ignored and stays in trouble.
It is time to break out of the tunnel vision and see the airway as the starting point of dental care.
Having to Come Out of Retirement To Pay For Her Teeth: The Case of Marie
“The single greatest expense I have had for my health has been for my teeth.” Marie was 62 one-retired but applying to go back to work when she came to see me. “I am here for a third opinion regarding my dental makeover. The price tags are $90,000 from one dentist, and $42,000 from another, and I cannot afford either.”
Marie’s presenting complaints included one dental problem after another since age 7, food sensitivity and gut inflammation, overweight, snoring, and her memory getting fuzzier. She had all the signs of an impaired mouth, including an extremely deep overbite, 10 crowns, 6 implants, and severe wear on her remaining teeth.
“I’ve been stationed all over the world, and I have seen at least 50 dentists in my life,” Marie said. “None has ever told me why I grind my teeth or that my airway is a problem.”
I referred Marie for a sleep test, and the medical diagnosis was moderate obstructive sleep apnea (AHI =18). Her lowest oxygen concentration dropped to 68%, whereas “healthy” is considered 95% or more. Left untreated, this has serious implications on brain function and memory.
“How’s your adrenal function?” I asked.
“Oh, yes, my doctors are trying to fix that too.”
“Sleeping with the tongue occupying your airway is like burning the candle from both ends. You’re struggling to stay alive during sleep when you should be resting and renewing yourself.”
“I can feel that first hand, but you’re the first doctor who’s ever said that to me.”
“My work focuses on providing a more compatible space for your tongue so it’s not forced into the throat. In building a house, the foundation and the framework should be in place before moving the furniture in, right?”
“Right. But all I’m getting so far is furniture replacement at an astronomical price, and it doesn’t even address the root cause.” Marie shook her head.
In my view, Marie’s very deep overbite was a surface sign of her impaired mouth and pinched airway that was an anatomical source of nearly all her medical and dental troubles.
The dental diagnosis in Marie’s case was Class I malocclusion with a strong deep bite tendency. But it said nothing about the cause and the logical treatment. So the dentists kept fixing the dental wear and tear, while her mouth had gone missing in her medical and dental care.
“You have a case of six-foot tiger inside a three-foot den with a very low ceiling and shallow depth front-to-back.,” I explained to her, “The solution depends on your choice: Sleep with a CPAP machine or redevelop your jaws with oral appliances to free your lower jaw from its entrapment and liberate your tongue from the airway?”
“I don’t want to sleep with forced air. I want to fix the cause, “ Marie said.
“In that case, airway comes before teeth. Before we can start, however, your case is complicated by pre-existing bridgework perpetuating your narrow airway.”
“I see that now. So how do we start fixing my problems?”
“The size of your airway is determined by the combination of soft tissues excess (over-weight and nose-throat inflammation), and hard tissues (jaw size, position, and deep overbite). So the logical order for treating your case is to start with ensuring nasal breathing full-time and oral appliances to redevelop both jaws. You will still need to reconstruct your old bridgework, but only after your airway problem is solved.”
“Now I definitely have to un-retire and go back to work!” she said with a smile.
Once patients know the cause of their troubles, most want to fix it. My heart goes out to Marie – and all patients who have had extensive dental work done while their OSA has gone undiagnosed. Until sleep and airway issues routinely turn up on a dentist’s radar screen, healthcare costs will be high for patients stuck with undiagnosed impaired mouths, as well as their employers and our national treasury.
The Joys – and Cost Savings – of Childhood Holistic Mouth Development: The Case of S.B.
S.B. is the oldest of five children whose parents are members of the Weston A. Price Foundation and follow the Nourishing Traditions Diet. S.B. came in at age 11 with no cavities, strong teeth, and a good face. His mom was concerned with crowded teeth, cross bite in one tooth, and fang-like canines that did not fit into his upper arch.
A few months of oral appliance therapy amplified S.B.’s good genes and diet so that he did not need braces. His parents used the savings on oral appliance therapy for the younger siblings.
It does not take a rocket scientist to predict that S.B. will likely have much lower lifetime dental and medical care costs than either Avis or Marie. Wouldn’t it be nice to make Holistic Mouth happen for as many Americans as possible?
Holistic Mouth Bites
The pattern of “one dental trouble after another” is a red flag for an impaired mouth. Very high dental and medical bills happen when the impaired mouth goes missing in medical care and the pinched airway goes missing in dental care.
Airway before Teeth: redevelop impaired mouth as a root cause before spending lots of money rebuilding teeth damaged by acid reflux, teeth grinding, and oxygen deficiency.
The U-turn back to sound form and function begins with a holistic mouth checkup and a more integrative health insurance plan.
Chapter Nineteen
The Holistic Mouth Checkup: Integrating Mind, Body, and Mouth
That it is important to correct perpetuating factors is illustrated by the apocryphal story of the man who stepped into a hole in the sidewalk and broke his leg. He was treated and the bones of his leg healed, but two months later he stepped in the same hole, and again broke the leg. No one had patched the hole.
– Myofascial Pain and Dysfunction:
The Trigger Point Manual(1)
Impaired mouth is an unseen “hole in the sidewalk” in American health care today, and the vastly under-r
ecognized Impaired Mouth Syndrome is costing every American medically, dental, and financially.
When all the research is done eventually, an impaired mouth is either an initiating or contributing factor in snoring, sleep apnea, nagging aches and pains, chronic fatigue, moodiness, lingering illness, and the puzzling and yet costly pattern of one dental problem after another. That’s because the mouth belongs in the body’s control tower, where it participates in essential functions such as breathing, sleep, energy, digestion, speech, socializing, relationship building, life quality, and longevity.
The whole body suffers when the mouth is structurally impaired, and so does the pocketbook. It’s time to put Holistic Mouth Checkup to uncover Impaired Mouth as a handicap and reverse the Impaired Mouth domino with Holistic Mouth Solutions.
Impaired Mouth: Hugely Expensive, Hugely Preventable
A Holistic Mouth Checkup has one purpose: to help you and your doctors determine if impaired mouth is a built-in stressor contributing to pain, fatigue, early degeneration, and to help parents prevent impaired mouth’s systemic consequences for their children.
Todd, age 14, was referred by his mom’s natural hormone doctor who suspected tongue-tie and its effects on airway and sleep. Mom’s concerns included “slow to reach puberty, a lot of teeth grinding, and some ADHD. Otherwise he has been really healthy.” Chair Side Investigation confirm the presence of tongue-tie, partial nasal obstruction, enlarged tonsils and adnoids, and a narrow airway in the red zone behind his palate.