Sleep apnea and sleep breathing disorders

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"I am a terrible sleeper."

"My child is so grouchy when he wakes up and is hyperactive during the day."

"My wife says I snore."

"My daughter grinds her teeth."

"I am fatigued and stressed out"

What do these statements have to do with dentistry?  These statements point to poor quality breathing.   Your breathing isn't only causing problems when you are asleep, but 24 hours per day.  Chronic stress and inflammation, anatomical changes, and diseases are things that your body experiences because it is not breathing well.  A part of your routine dental exam at Life Smiles Family Dentistry includes questions and thoughts into breathing.  I have focused my continuing education to be accessing what is going on with your airway, and not just your teeth.  While you come in for just a routine check-up and cleaning,  you may leave with some answers to your health concerns that no one has figured out yet.  Dr. Geisler has a passion for helping babies, children, adolescents and adults with their overall health.  The first step in detective work is asking questions about your health, listening and asking more in depth questions.  We take photos, measurements, films to document what we see.  Is it possible that what a general dentist visulaizes could be related to how you breathe?  For instance, we may find that your teeth are worn and flat.  Or maybe you know you clench or grind your teeth during the day or night.  While that is easy for any dentist to see, not everyone knows why it is happening.  I used to like to show people their intra-oral photos and show the flat spots to prove they were clenching and grinding.  While I still love to show photos and discuss what I see, I am taking a step back from recommending a night guard immediately.   For most people, worn and cracked teeth are a sign that we need to delve into the etiology (the cause).  A night guard may be the best approach, but a diagnosis must proceed the cure.

Everyday I see areas by the gum-line that looked "scooped out."  They are often sensitive to touch and cold, sometimes are not aesthetically pleasing and accompanied with gingival recession . Recession and these concave spots are not a natural progression of teeth and gums as we age.  Worn teeth, recession, concave spots near the gum-line, and broken teeth are all signs that something is amiss.  Open wide and say "Aaahhhh."  As a part of your oral cancer screening, I see huge and inflamed tonsils red throats, post nasal drip and tonsilloliths everyday.  You may have missed a lot of work this year due to colds and sinus infections, ear aches.   Why do some people get Strep throat or colds often and others don't?  Why do you get sinus infection after sinus infection?   Is this the new "normal?"

In addition, I find other signs such as frequent new cavities and gum bleeding that doesn't respond to good therapy and home care.  While it's true that Mountain Dew may be a factor for some people getting cavities, what about those who haven't had a cavity in a really long time and eat really healthy foods?  Contrary to popular opinion, I find most people are honest about their brushing and flossing.   Why is it that some people never have bleeding gums, brush only one time per day and visit a dentist once per decade?  And others have periodontal disease that is more aggressive.  While a great number of disease processes are multi-factorial, I believe that healthy teeth and gums begins with the next breath you take.  Every 10 seconds you have an opportunity to take in air in a way to promote health or disease. 

 I am a doctor who knows and considers your airway, not just a tooth doctor.  I know what proper anatomy should look like for good airflow.  Everyday I see air passages that are very challenging.   When you close your mouth and take a large breath through your nose, do your nostrils collapse?  The tissue that hangs down off your palate can be part of a soft tissue problem, along with enlarged tonsils and adenoids that often create an obstruction.  Often physicians will report that a patient has a large tongue.  Dentists agree that most of these tongues are really normal sized, but just living inside a small space.   When I look at your profile, I will be able to see if your upper jaw or lower jaw are set back.   When your jaw isn't out as forward as it should be, your airway become compromised.  Did you have four premolars removed due to crowding when you had orthodontics?  Often teeth are retracted back, which makes the volume in your mouth smaller.  A smaller volume of your nasal or oral space will limit your breathing.  Through continued education after dental school, I know the signs and questions to ask about health, breathing, sleeping, stress, fatigue and habits.

It is rare that a child will admit that they cannot breathe well.  We adapt to survive and kids really adapt well.  They will find a way to breathe even if that means leaning their heads way forward in their awake posture, or sleeping with their heads cranked far back.  While, I have had some kids know that they are tired a lot or snore, many do not.  Parents are advised to video their kids sleeping for 5 + minutes so we can see what they are doing while sleeping.  I also recommend filling out some paperwork over the period of a few weeks to observe awake and sleeping behaviors.  I know that kids don't just "grow out of it" when they grind their teeth.  Kids actually grow into their grinding problems (they worsen).  I know that 95% of bad bites (malocclusion) is not caused by genes, but by how you grew when you were really young due to eating and breathing patterns.  I know better than to tell the parents of a six year old with a bad bite to "just start saving for braces now."  We can address the problems now.  We can improve health and change your child's anatomy of their airway now.  Grinding teeth can stop, growth delays and headaches can stop.  Sleep can improve and many times ADHD meds can be stopped.  When breathing is an issue, sleep is a problem.  When breathing is an issue, the shape of your face changes.  When breathing is an issue, your whole health is affected.  And the detective work starts when we review your health questionnaire and continues through a thorough exam. 

I am educated in and have a special interest in preventing childhood breathing disorders.  Why do so many kids now have ADHD, wet the bed, and are not able to sleep soundly through the night?  Did you know that 50% of children diagnosed with ADHD have sleep disordered breathing?   Improve their sleep, and many of the questions you checked "yes" to on the questionnaire about ADHD is now a "no."  My interest really peaked since seeing so many newborns with tongue ties.  I release the tongue and lip ties with a laser for correct functioning during swallowing, speaking, breathing.  While it effects feeding tremendously, it is just the tip of the ice berg.  Consequences of unreleased tongues actually affect the anatomy, or shape, of your face.  A long narrow face equals tight nasal airways.   A tongue tie leads to needing a lot of braces.   A tongue tie leads to mouth breathing which is the prime culprit causing asthma, frequent sinus infections, inflamed tonsils and adenoids.   You don't have to have a tongue tie to be a mouth breather.  It can be a life-long habit learned after having a really bad cold with a stuffy nose.   Did you break your nose playing football?  A deviated septum forces people to breathe through their mouth,  negatively impacting every aspect of health.

I also have a special interest in Upper Airway Respiratory Syndrome (UARS).  When you know you aren't sleeping well, but you don't snore, does that mean you are imagining it?  Is your job and busy life style to blame for your stressed-out feelings?  What if your sleep study doesn't show you stop breathing much?  Does that mean you are O.K.?   Why do you feel so stressed out when you wake up and why do you have extreme fatigue day after day?  It is very possible that little changes in your upper pharygeal anatomy caused some small restrictions to air flow.  You don't stop breathing, but your body may be working really hard, making little adjustments to let the air flow.  You were clenching and grinding and moving a lot.  This chronic managing of your airway prevented you from getting a good nights rest (for your body, brain, and emotions).   Lack of deep sleep leads to body aches and pains.  Lack of REM sleep leads to stressed emotions.  Night after night of poor sleep leads to chronic fatigue and can be given a diagnosis of insomnia ADHD, fibromyalgia, anxiety and depression.  Let's say you are a pre-menopausal woman, who really doesn't sleep well.  You likely are fatigued day after day, and may take anti-depressants or anxiety medications.   You have a hard time falling asleep and are a light sleeper, often waking at 3 am and cannot get back to sleep. When you go through menopause, your progesterone drops and you may gain ten pounds.  When your muscles aren't as toned with age,   sleep problems at night symptoms change from clenching at night to snoring.  The unhealthy yet eventual progression of UARS leads to obstructive sleep apnea (OSA).  You didn't just get OSA overnight, it happened progressively over many years.  You didn't just get high blood pressure overnight either.  The video below gives a general view of sleep apnea, which is very different than UARS when a sleep study is done.  A sleep physician may say that your REM is altered with UARS but don't have any moments where your oxygen dips greater that 4% for greater than ten seconds.   This sleep problem is often not known or diagnosed.  If physicians have to offer only medication, CPAP, weight-loss or sleep hygiene recommendations only as tools, often their investigation doesn't go any further to reach a diagnosis.  Obstructive sleep apnea gets all the press, but is not a sudden condition. Stopping breathing and then arousing to take a deep breath happens when your body has discontinued doing little "fixes" like it did when you were younger.  Your body has, in a sort, given up on fixing the problem independent of the brain.  In sleep apnea, your brain takes over and arouses you out of sleep to gasp for air, which leads to more deep gasping for air and high blood pressure all night.  For years before obstructive sleep apnea is diagnosed, you were breathing poorly.   Wouldn't you like to know that now, and prevent yourself from having the morbidities associated with sleep apnea?  OSA increases the risk for dealthly motor vehicle accidents, high blood pressure, pulmonary vascular disease, cerebral vascular disease, ischemic heart disease , congestive heart disease and arryhthmias.  Let's rewind and prevent these horrible health problems.  Perhaps all the breathing problems started when you were a baby.   My current career passion is to prevent babies and kids from turning into the poor breathers that the adults of this day and age are.  When I look at my team, my family, my friends and even myself, I recognize the health problems that already exist and will lead to a diagnosis of UARS and OSA.   Let's pay attention, and fix breathing to improve health.  So here I am, a general dentist who never would have predicted this the day I graduated from dental school.  My job is bigger than just treating the teeth, it's helping the person.  Let's start breathing through our noses and feeling better.

Dental Anxiety and Dental Phobia- Explained

 Dental

Going to the dentist isn't just a schedule interruption for many people. Whether adults, teens, or children, many Americans become anxious even thinking about dental visits. In these situations, we tend to hear the terms dental phobia or dental anxiety. Surprisingly, though, the two are not interchangeable and are separate conditions.

In an article published by dental supply company Colgate, it's been estimated that between 9% to 15% of Americans ( approximately 30 to 40 million people, by the way!) are so overwhelmed by the dentist's office that they just don't go. The British Dental Health Foundation found that 36% of those that don't regularly see a dentist won't go because of their intense levels of fear.

With so many people are at such unease about the dentist, let's discuss the differences between dental phobia and dental anxiety.

Dental Anxiety

Of the two, dental anxiety is less severe. Dental anxiety is still tricky, despite not being as intense. Those with this issue feel uneasy when it comes to appointments, whether scheduling, attending, or anything dentistry-related that's in between. For those with dental anxiety, dental visits or anything related to being in a dentist's office is stressful and usually causes high levels of stress. Many sufferers of dental anxiety are notorious for rescheduling appointments.

Dental Phobia

Dental phobia is more severe than dental anxiety. In the case of dental phobia, sufferers aren't just anxious but genuinely fearful of any activities revolving around the dentist or dental office. This tremendous fear can be so intense that those with dental phobia may not see a dentist for years, even if they have infections, broken teeth, or worse. Often, this strong fear can cause unintentional degradation of dental health.

TIPS : 5 DENTAL CARE TIPS FOR HEALTHY TEETH AND GUMS BY LIFE SMILES

What Causes Dental Anxiety and Dental Phobia?

Both forms of dental displeasure can arise from varying factors. Here are the most common:

●     Loss of control: Patients may feel as if they don't have control over their situation and can become anxious or panic. They can't directly see what's going on inside their mouth but are on edge anticipating the possibility of pain.

●     Pain: This is probably the number one fear-inducer of dental anxieties and phobias. If a previous incident has left a patient in tremendous pain, or even any pain at all, even if they've recovered from that pain quickly, they still remember and fear a repeat situation.

●     Less than desirable past dental experiences: Much like pain, and even often caused by past pain, patients remember when we've been wronged or hurt. Whether they've had a traumatic encounter with an outrageous bill or a dentist that was far less than kind, patients tend to protect themselves by using fear as a mechanism to prevent these uncomfortable types of events from recurring.

●     Embarrassing dental situations: Sometimes, patients are embarrassed to have their teeth seen, even by professionals. They may think they haven't taken good enough care of their teeth; they expect there will be judgmental or laughing staff or are maybe even embarrassed that they haven't been in a dental office in years.

Do I Have Dental Anxiety or Dental Phobia?

Here are some of the signs that you may experience if you have dental anxiety or dental phobia:

●     You don't sleep or function as well as you usually when a dental exam is upcoming

●     You feel physically sick when you contemplate dental visits

●     You feel panicky or feel as if you can't breathe right when dental objects are used in your mouth during an appointment

●     Being in the waiting room of a dental office makes you feel incredibly nervous

●     The idea of dental staff or dental instruments make you feel like you might break down crying at any moment


If any of these explain how you feel about even the idea of a dentist office, you likely suffer from some degree of dental anxiety or dental phobia.
Don't worry. We can help.

ALSO READ : WHY IS ACID BAD FOR YOUR TEETH?

How We Can Make Dental Unease Better

If you're unsure about how you could feel better about your dental stresses, give us a call and talk to one of our warm-hearted, experienced staff members. If you tell us what about dentistry leaves you feeling the most fearful or upset, we can inform and provide you with the many options our clinic offers to make your dental experience safer and more pleasant. When you're in our office, our main priority isn't just the health of your teeth, but your comfort.

Whether you need a routine checkup or you're in need of emergency dental services in Plymouth, Minnesota, we at Life Smiles provide a wide array of options for all ages, including dental implants in our Plymouth location.

Remember that most of all, we want to help ease the unfortunate and sometimes exhausting discomfort of dental fear. We're here for you. Contact us today!

5 Dental Care Tips For Healthy Teeth and Gums by Life Smiles

Who doesn’t love the toothless smile of a baby? There is something about those first smiles that melts our heart and goes straight to our soul. However, no one wants to grow old with a gummy smile. Luckily, you can enjoy a lifetime of terrific teeth when you follow these five dental care tips.

Do you dread going to the dentist because you tremble with anxiety that the dentist will tell you that you need lots of dental work? Maybe you’re a little bit dental phobic? Don’t worry, these dental tips are easy to follow and will reduce your stress when you’re sitting in the dental chair.

 5 Dental Care Tips For Healthy Teeth and Gums by Life Smiles

Brushing

The number one dental tip is to brush your teeth. The American Dental Association recommends that you brush your teeth at least twice a day. It suggests using a soft bristled brush on your teeth for at least two minutes at a time. The ADA also stresses that you should use a pea-sized amount of fluoride toothpaste.

Many people mistakenly brush too hard and in the wrong direction. Improper brushing doesn't work and can lead to gum damage. Instead of vigorous brushing, gently move the brush side to side at a 45-degree angle to the gums.

Flossing

Brushing alone does not keep your teeth clean. Food gets stuck between teeth and leads to decay and gum disease if not removed. The easiest way to clean the tight spaces between your teeth is to floss every day. Flossing is an essential weapon in the ongoing fight against plaque. Plaque is that sticky stuff on your teeth that trap food and results in painful mouth problems like cavities and gum disease. People can floss with traditional floss or use a water flosser like Waterpik.

Does it matter when you floss? It does not matter if you floss before or after you brush your teeth. Pick the most convenient time to floss and keep it part of your routine. Flossing is one of the surest ways to ensure a pleasant dental visit. 

Rinse

While not a substitute for brushing and flossing, swishing some dental rinse around your mouth each day is an easy dental tip that reaps lots of benefits. Studies show that dental rinses prevent cavities and minimize the chance of gum disease when used as part of an overall dental hygiene plan.

All dental rinses are not the same. Some mouthwashes include fluoride to target cavities. Other gargles are designed to attack plaque. Still others fight plaque, dental caries, and bad breath. It’s a good idea to purchase products with an ADA Seal of Acceptance. The seal indicates that the American Dental Association believes the product is safe and effective. Your dentist can recommend the best dental rinse for you.

Diet

It is impossible to overestimate the importance of a proper diet in taking care of your teeth. Too much sugar in your diet contributes to tooth decay and gum disease.

Let’s be honest, most of us know that we consume too many sugary foods and drinks. It’s easy to cut down on eating candy, desserts, and sugar-rich sodas and fruit drinks. However, food doesn’t need to taste sweet to be loaded with sugar. Indeed, many processed foods contain vast amounts of hidden sugar.

What is the best way to fuel your body and protect your teeth? Dentists encourage you to try some of these strategies:

Drink water instead of soda and fruit juice

Limit sugar consumption

Select foods from all the food groups

Choose healthy snacks such as fruit and cheese

In addition to choosing healthy snacks, it’s beneficial to reduce your overall snacking. Research shows that the food you eat during a full-meal causes less damage to your teeth than when you snack. Your mouth makes more saliva during a meal, and the saliva washes your teeth free of much of the food particles. Snacking initiates less saliva production, so your teeth are less protected.

Also Read : Why do my teeth feel fuzzy?

Dental Visit

The last critical dental tip is to visit your dentist twice a year for a check-up and cleaning. Too many people avoid going to their dentist until they’re in pain. Delaying treatment is such a shame because much of the pain is avoidable if you make going to the dentist a regular part of your healthcare routine. Your dentist can discover potential problems before they flare into a painful crisis.

Along with keeping your teeth healthy, your dentist plays a significant role in making your smile shine. A thorough cleaning will take lots of that yucky sticky plaque off your teeth.

Finally, everyone wants a beautiful smile. Your smile says hello to the world. Fortunately, a beautiful smile is not challenging to maintain if you follow a proper dental care regimen. A consistent routine of brushing, flossing, rinsing, healthy eating, and visiting the dentist will help ensure that your smile lasts a lifetime.  

Smile!

Specialized room for care of infants

After opening my practice from scratch 7 years ago, it has been one of my babies.  I never anticipated being a dentist who treats newborns, it's been a journey since I graduated in 2002.  The path started a long time ago when I was trained using a WaterLase as an associate at another practice.  Looking back at 2009 when my first daughter was born, we spent more than our fair share of appointments with a pediatric ENT doctor.  Jump to five years later when my second child was born with a restricted lingual frenulum. "Hard to do" doesn't begin to describe what it was like to release my own child.  But I did it, and cried with happy tears after, since it improved our nursing dramatically.  Jump forward almost 3 years when I started opening my mind to the idea that I could be the provider for people with tethered oral tissues for others.  What a journey I have been on, a very exciting journey at that.   Well, my baby (practice) has just had a new development!   I am super happy to announce that I remodeled my office to open a infant frenectomy specialized room.  It's the perfect space for examining and treating the young ones.  Afterward, mom and dad can privately take their time feeding and soothing their little child without being rushed.   In addition, it is allowing us to accommodate more patients every week.   An investment in the part of my practice that has become a passion for me, well worth it!

Also Read : A day of learning with tongue tie professionals

HSA, dental insurance and benefits

                                         End of year approaching too quickly?

                                        End of year approaching too quickly?

The end of the year rush filling your calendar has begun.  We recommend you give yourself the gift of good oral health and ring in the new year with a great smile. Many people have realized they haven't used their dental insurance from their employer to maximize their benefit.  Others haven't used any of their dental insurance.  Is this you?  And, can we still see you?  We are saving space for new patients to enter our practice. Research by the National Association of Dental Plans, only 2.8% of people with PPO dental plan participants reached or exceeded their plans annual maximum.   That leaves a lot of money that the dental insurance company get to keep and is a waste for you.  Dental insurance companies count on making millions of dollars off of patients who never use their insurance benefits because many of these plans provide coverage up to a certain dollar amount annually.  We know insurance companies do not encourage customers to use benefits, and most patients are too busy to sift through their policies to determine what might remain on them. 

We can explain how your insurance works once we gather the specifics.  Dental insurance almost always has a maximum benefit per year.  It doesn't cover everything you need, but acts more like a coupon.  For instance, many plans cover two cleanings and exams per year and is covered at 100%.  The least expensive dentistry is always preventative.  Every plan is different so we call to verify specifics.  Pre-tax dollars in the form of an HSA or FSA card can be used to pay for treatment and to purchase electric toothbrushes and Waterpik flossers.

Also Read : 5 Dental Care Tips For Healthy Teeth and Gums by Life Smiles

Traveled to learn from the best

I am so thankful that Dr. Mikel Newman in Indianapolis allowed me to shadow him for a day recently.   He and his team treat infants, children and adolescents, and boy were they busy!  For the frenectomies they release, the dentist has been using the Light Scalpel CO2 laser longer than I have (even though I have quite a few more grey hairs).  I took more away from the visit than I expected and really appreciate how he truly cares for the little ones.  He has done a tremendous job learning about breastfeeding and it shows in the counseling his gives his families.  Integrating this very specialized service within a general dentistry practice was something his practice has done very well.  As for my team, we are ironing out the wrinkles and making systems flow better since I am not a pediatric dentist.  It makes me giggle when a parent of a little one asks me if I see adults, and then in the afternoon an adult may ask if I see kids.  My adult patients are adapting to seeing many babies, car seats and nursing mothers when they arrive for their dental cleaning.  So many comment after learning about tongue-ties "I didn't know that was a thing."   Since implementing the small changes I learned, I have became a more well rounded tethered oral tissue practitioner.  

My goal to educate myself led me to start having conversations with local pediatric ENT's.  I traveled all the way to Eagan (much quicker than Indianapolis) to pick a local children's Ear, Nose, Throat Physician's brain.  Being an MD gives him a different perspective on the tongue tie and airway patients.  I am continuing to seek providers in the Twin Cities who will give excellent care to little children.

On a similar note, Life Smiles hosted the third meeting of the Twin Cities Tongue Tie Professionals Group last week in Plymouth.  Our focus was on the importance of body work, specifically chiropractic care and cranial sacral therapy (CST). I find it extremely helpful to spend face to face time with the people that I refer to. Knowing these women who care so much, gives me confidence in how families will be related to and the babies cared for.  Investing time into relationships also builds a true team, because ankyloglossia is not a snip or clip and you're done type of problem.   Unfortunately, many healthcare professionals don't have that same viewpoint of the complexity of frenulums impact on overall health and wellness.  Scissors releases in the hospital that are incomplete may resolve some symptoms early on.  When that occurs, parents are confused as to why they are struggling so much.   As I have opened my dental practice to laser frenulum releases, I have committed to learning as much as I possibly can, and not getting comfortable with what I know right now.  There will always be more I can learn and people to learn from which will benefit my patients.   The coming year presents more awesome learning experiences which I cannot wait to attend!  In January a local meeting regarding pediatric airways is on my calendar.  In April I will be joining a symposium on laser dentistry in Florida (who can complain about Orlando?).  The coming summer has me booked to an international conference in Canada.  Cool, eh?

Also Read : Interceptive orthodontics for children

A day of learning with tongue tie professionals

This year has a been a year of great professional growth through education for me.   I had the opportunity today to shadow two IBCLC (board certified lactation consultants) while they worked with clients.  I have been on the receiving end in my personal life of help from professionals, but today I was viewing as a healthcare provider.  My goal is to learn more about nursing, to expand my knowledge beyond a few books read and personal experience.  Thanks to Liz and Gigi Lull with Enlightened Mama for the time.  

The second meeting of a group of healthcare providers in the Twin Cities with direct "ties" to infants with tongue tie met at Minnetonka Pediatric Therapy.  We discussed wound healing, protocols for stretches and findings of a study from Woodwinds Hospital in Woodbury.  The prevalence of tongue and lip tie appears to be increasing, necessitating greater awareness from nurses, lactation professionals, chiropractors, dentists, speech therapists, physical therapists, doulas and midwives of the problems.    

Learning everyday and loving it!

Also Read : Why do my teeth feel fuzzy?

Interceptive orthodontics for children

Have you ever thought you got the same crowded teeth your mom or dad had?  

Or have you thought you have "too many teeth for the size of my mouth"?  

Does your child breath noisily or snore?

Who in your family grinds their teeth at night?

Is your six year old still wetting the bed?

What am I doing asking these weird questions, as if they are related to each other?  Aren't I a general dentist?  Yes,  and I am also a proponent for healthy breathing and healthy people.  I would be the first person your child would see who would ask questions like these and recognize the connection between poor sleeping, deep bite, tongue tie, grinding, gagging and ADHD.  The cause of most bad bites can be blamed for these symptoms and many more. My blog is a general article and I am not saying every health problem discussed is caused by an airway problem.  Not every person with ADHD has a bad bite and not all poor sleeping is caused by this.  However, research has been done to support how widespread breathing disorders are and how they contribute to health problems. I am learning from experts about what causes a bad bite, called a malocclusion.  Anthropologists have proven that approximately 95% of bad bites are not caused by genetics.  Wow, that was news to me!   I hear every day that "Johnie" got his dad's crowded teeth.  In the past I was guilty of evaluating a child's bite, and would suggest saving money for future orthodontics.  How little did I know that early interceptive orthodontics can not only prevent and solve malocclusions, but can improve the health of my patients. 

Anthropologists have studied thousands upon thousands of skulls of many different cultures across the world and over time and found malocclusions to be very rare except for recent times.   Has a genetic change happened that quickly from one hundred years ago?   Other than a rapid change in genetics across the world and across all cultures, what could be the cause?  The working theory of the rapid increase in malocclusion across the world is not only which foods we eat, but literally how we eat.  Different muscle strengths, or weaknesses, along with our more processed diet, do not promote strength of tongue and jaw muscles.  Tongue strength and the motion of swallowing can have an imbalance with lip strength. Our families may be at fault, but by how and what we are fed as babies and children, not because of genes passed down.

The following is a concept that may take a couple of reads to comprehend.  The proper growth of our upper and lower jaw, occurs primarily when we are very young.  Our upper jaw is supposed to grow almost entirely forward, with the help of the tongue living against the roof of our mouths.  When our tongue doesn't live there and flatten out our palate, but rather on the floor of our mouth, we develop a narrow upper arch and a high palate.  Our face looks longer when the upper jaw grows more downwards than forward.

 One consequence of this is crowded teeth, which often leads to an extraction orthodontic plan and retraction of the front teeth to close the missing teeth gaps on the side. If you are an adult, you may have had teeth removed for braces.  Others who didn't have braces live with crowded teeth.  Many people have a deep bite or big overbite.  Others have the same source of the problem but present with an open bite (front or side teeth cannot touch). In addition, an underdeveloped lower jaw decreases the space the tongue has to lift in.   The big deal about narrow dental arches is it creates a restricted airway in the nasal, oral and laryngeal (throat) airways.  What is the one thing our bodies need most urgently every single minute?  No, it's not chocolate.  The answer is air.  Did you know that it is never OK for a child to snore?  Loud noisy breathing and snoring is a sign that there is an obstruction.

The implications of a compromised airway are huge! A small nasal airway leads to mouth breathing and vice versa.  Mouth breathing doesn't filter the air we breath, doesn't humidify the air well, doesn't warm the air well and doesn't stimulate the release of a very important chemical compound called nitric oxide.  Nasal breathing does this all!  In addition, mouth breathers actually take in too much air and release too much carbon dioxide.  The driver for our breathing is interestingly not our need for oxygen, but our need to get rid of our waste gas, carbon dioxide.  When we expel more carbon dioxide than we should, we enter into a negative loop of chronic hyperventilating.   Have you woken up with a dry mouth?  You were mouth breathing.   Are your tonsils inflamed?  That may be caused by irritation by drawing in air.  Do you have dark circles under your eyes?  Venous stasis is the official term and is caused by mouth breathing.  Do you have asthma?   Mouth breathers only exchange only the top 2/3 air in the lungs, leaving one third of the air un-exchanged, leading to many cases of asthma.  An interested book I have read recently is called "Close your Mouth" by Patrick Mckeown.

What does this all have to do with dentistry?  Great question, I am so glad you are wondering!  I used to recommend all children see a dentist by the age of 1.  That is still the case, except for when I see babies to do a laser tongue tie release.    I am connecting all the dots of airway, sleep disordered breathing, malocclusion and general health.  Let's say for example, that you were born with a tongue tie.  Your mom likely couldn't nurse you for long and switched to a bottle.  I have nothing against bottles since both of my children had them since I work outside the home.  However, the significance of a tongue tie, is that the tongue cannot live on the roof of the mouth, creating a wide and normal height of the palate.  When a pacifier (I have used them for my children so no judging here) or a bottle is introduced, something foreign is between the tongue and it's natural habitat, the palate. When the tongue is tied, the upper arch becomes narrow, and since the roof of the mouth is also the floor of the nose, the nasal space is reduced.  The palate can often be so high as to deviate a septum in the future.  So this child grows up breathing through their mouth.  Fast forward to age 2 or 3 or 4 when they are getting so many ear infections and their tonsils/adenoids are so large that they need surgery.  Perhaps the ear infections were contributed to by inflammation of adenoids which blocks the drainage of the ears, the Eustachian tubes.  Also the posterior part of the tongue is supposed to make a seal with the palate when swallowing.  This proper swallow creates a small vacuum which can open the Eustachian tubes.   Eating slowly, having difficulty swallowing, grinding teeth, hyperactivity, difficulty waking in the morning, night terrors, a gag reflex, snoring, sleepiness during the day are a few of the many symptoms that may point to a mouth breathing problem.  A current theory of why people grind their teeth at night is that our brain wants to improve the air quality while we sleep.  When grinding the jaw around, our airway is opened by the jaw moving forward.

Also Read : What is a posterior tongue tie?

And what do you do about it?  My job is not only to give you information on the current health of your mouth, but also suggestions for optimum health.  It is possible to train your mouth to be closed, and become nose breathers.  How is that possible when a nose is always stuffy?  I recommend people see an ENT and an allergist to diagnose contributing problems to nose breathing.  Many people will have a referral to a sleep doctor and an Oral Facial Myologist.  We recommend nasal strips, nasal sprays, breathing exercises and sometimes bite splints or orthodontics.  Chiropractors are often a part of the team by releasing restrictions that interfere with your bodies natural ability to heal and function optimally. Each person is an individual and a plan is made that makes sense for the patient (and their family if a child).    There is no formula that fits all, so careful thought is given to each person.  Some children are really good candidates for a system called Myobrace

The big picture for me as a general dentist, is that I am in a great position to spot health problems.  There is a saying that goes like this "the more you know, the more you see."  A great reward for me is really seeing my patients, and being able to help in ways that are above expectations for a dentist.  Being a dentist is not about being a "tooth doctor" for me, but a doctor who really wants to improve your health.