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.