By Amely Greeven
As a parent, catching cues that children are struggling with the basic breathing functions that James Nestor describes on the previous pages can be life-changing, literally. Though still unrecognized by most well-meaning doctors and dentists, the early indicators of poor orofacial habits or development can be detected very early and corrected with appliances from as early as 3 years old, says Hilary Fritsch, DMD, a biological dentist who is specially trained to evaluate and treat airway health. (Loosely put, she zeroes in on how a person’s facial structure supports or impedes optimal breathing.) Fritsch, who treats adults and kids alike, advises parents to watch for things like mouth breathing by day or night, thumb or finger sucking—which pushes the palate into an inverted “v,” reducing the available space for the tongue to seal against it—snoring or very restless sleep, and baby teeth that lack spaces between them, an indicator that the mouth isn’t growing large enough for the adult teeth (including wisdom teeth) to come.
Sounds a bit neurotic? Think again. Fritsch concurs with Nestor that less breastfeeding, blitzed-soft baby foods and industrial diets replacing ancestral ones have been epigenetic pressures changing the shape of our faces. (She almost never sees a child in her practice with an optimally sized palate or jaw.) Meanwhile, restriction in a child’s tongue mobility (aka tongue tie) is very often not diagnosed, even if a mom has had breastfeeding struggles. This convergence of undersized jaws and weak tongues mean our children can be dealing with consequences that are never ascribed to airway health—things like poor and disordered sleep, which affects every cell in the body, night terrors, and even sleep apnea. Chronic sleep disruption doesn’t only cause fatigue and irritability; it can cause behaviors that look like hyperactivity, attention disorders, or mood disorders—and get diagnosed as such. Bed-wetting, chronic earaches or tonsil infections, cavities, headaches, allergies, asthma, malocclusions and crowded teeth are the “heavy hitter” indicators that a child needs airway evaluation, Fritsch says. So are things like lisps, which typically send a kid to speech therapy without addressing the structural root cause. More subtly, nasal congestion, bad temper or heightened reactivity can also suggest airway issues, because the calming vagus nerve and the roof of the mouth are intimately connected.
Unfortunately, most kids who struggle only get flagged for the obvious dental issues, like crooked teeth. Parents are typically told to “wait for the adult teeth to come in” and get to an orthodontist for braces. Fritsch finds this approach—like waiting until after heart disease has taken hold to diagnose chronic sleep apnea at play—outdated, and maddening. “It starts kids’ treatment way too late. We can intervene early with simple things like myofunctional therapy and fixed expanders to create the space for straight, beautiful teeth at a young age—often avoiding the need for traditional orthodontics at all.” It’s infinitely easier to improve a child’s growing oral structure than an adult’s developed one (though correctional procedures to improve airway health, resolve disease-causing sleep apnea and dramatically improve sleep are available at any age.) Not only will getting a jump on it save children from years of health- and cognition-damaging bad sleep—the effect of this neurocognitive deficit is lasting, according to research—it will help them to develop the nice cheekbones, good facial proportions and jawline, and big, broad smile they deserve. Notes Fritsch, “Almost every kid I see who has finished orthodontics still doesn’t have an adequate airway because the current medical system doesn’t fully understand how to develop the jaw, and they don’t believe it’s possible. This leaves kids with a problem that likely will only get worse as they get older.”
Airway-trained dentists are still a rare breed, though this subspecialty is growing. Myofunctional therapists, meanwhile, can teach facial and tongue strengthening exercises, and introduce simple corrective appliances like Myo Munchee and Myobrace. Toothpillow, a new platform streamlining airway assessment, treatment and coaching, aims to make this path easy for families. Fritsch advises parents to take keen interest in their child’s oral habits; the thumb sucking deterrent TGuard AeroThumb is handy, and the nifty REMplenish Myo-Nozzle helps kids (and adults) strengthen airway muscles with every sip of water. Once your child’s permanent molars are in, ask your dentist to measure the distance between them; if needed, fixed expanders can help to naturally achieve optimal growth. (Fritsch likes to see at least 40mm distance for children of European ancestry and 45mm for children of other ancestries.) And never be fobbed off by “they’ll grow out of it”—proactive steps, taken early, pay off a thousandfold as your child grows. saddlepeakdental.com