We are designed to breathe through our nose. When we nasal breathe, the air is filtered, humidified, warmed and sterilized. We use our diaphragm properly and it maximizes our lungs full capacity. The lungs receive a full amount of clean air. We receive nitric oxide through our nasal breathing which dilates the blood vessels and helps get the clean oxygen to our brain. Nasal breathing is difficult when we are sick for the short term but it can be chronically compromised for several reasons. Chronic allergies (or sensitivities) cause turbinate inflammation. There could be a deviated septum or spurs or infections. These all lead to mouth breathing. Mouth breathing brings toxins straight into our system with no filter system and none of the benefits mentioned above.

So if we can't or won't nasal breathe then we are forced to mouth breathe. Mouth breathing causes our jaws to grow differently. We don’t get full growth and development, so our genetic potential is unrealized. Chronic mouth breathing can cause improper tongue function but also improper tongue function can cause mouth breathing. Let me explain. Chronic mouth breathing doesn't force the tongue to the roof of the mouth. Our tongue is our natural palatal expander. Without proper expansion, we see a host of issues develop. Mouth breathing isn't the only factor here. Tongue tie or improper tongue position and function are also contributing factors. We often see tongue thrusts that have an impact on teeth alignment as well. One of our tongue's main role is to form the maxilla to full genetic potential so all the teeth have room to align properly. This then frees the mandible to grow and develop to it's full potential. The tongue's role in dentistry is often over looked and underappreciated. There are many reasons that cause tongue dysfunctions, some of which go back to when we were born. Lack of nursing and use of bottle feeding just to mention a few. The other muscles of the mouth play vital roles as well. Our lips and cheeks act as retention. If they don't have proper tone or don't function well, then we see poor development as well.

Once proper nasal breathing and tongue function are established, we see better sleep. Our bodies need rest. We are designed to rest, and rest PROPERLY. Our body and mind need to “shut down" for several hours if we are to maintain good health. We often see bedwetting resolved and the child wakes up refreshed and attentive for school. In our deep sleep our bodies heal it’s self and our cells regenerate. We DREAM!!!! We rid the toxins in our brain. Sleep recharges us for the next day and can now become our best version of ourselves. So this is my goal for my patients now.

When I exam a child patient, I look at teeth and gums after my sleep exam. This is the opposite of what I have done for years and what I was taught in school. I realized that I am treating a person, not just a mouth. I start from outside in. I look to see what is "off", starting with their posture and shoulders. I look at asymmetries in the head and face. I want to know if there are any craniofacial abnormalities. Do they have dark circles under their eyes? Are there lips chapped? I look for irritation in their eyes and look to see if the lower sclera of their eyes are showing. I look at the size and shape of their nose and look to determine if there is nasal blockage. I look at their jaw line. I look for a chin that is pushed back and deficient maxilla. I look at their mouth posture and look to see if they are mouth breathers. I listen to their nasal breathing. I look to see if they have hypotonic or hypertonic facial muscles. I watch their swallow and listen to their speech. I go over an at home assessment that I have the parents bring in that they have observed for the past 2 weeks because I won’t see everything that child does during my hour exam. I ask the parents or the child’s siblings if the patient snores or grinds their teeth. NO CHILD SHOULD SNORE OR GRIND THEIR TEETH!!!

Then I start my intra-oral exam. I look at their smile. Is there a gummy smile, overbite, underbite, crossbite, vaulted palate, tongue tie(anterior or posterior),check malampati and tonsils, uvala, crowding, missing teeth....then cavities and gums.....

When any of these things are not normal, I know there is an airway issue and/or a tongue function problem usually. Although our bodies are a genetic representation of our parents, most malocclusion is epi-genetic. Epi-genetics is defined as changes in gene expression that do not involve changes to the underlying DNA. So it is things that our environment can change. Bad habits or improper breathing or improper tongue and lip function can change the genetic expression by creating crowding teeth, and craniofacial abnormalities. For example, these IDENTICAL twins seen here:

Both Nicolas and Matthew have dramatic differences in their face. Can you guess which one has sleep disordered breathing issues? Let’s take a closer look at their teeth.

Nicholas’ teeth are crowded and gums are inflamed. However, when I look at this from a dental sleep physician I see a patient that does not sleep, or breathe well. His parents brought him in to us due to, crowded teeth, but what we found was chronic allergies, dark circles under his eyes, snoring, frequent throat infections, sleepiness/irritability during the day and hard time listening and often interrupts people when they are talking. So as a dentist how can I help? As a dental sleep physician how can I help? I can see that the root cause of this problem can all be linked to lack of airway development and lack of that deep sleep I talked about earlier. Both Nicholas and his brother Matthew have been in treatment with us with our natural removable appliance therapy. They have seen GREAT success in their growth and development in their upper and lower jaws. This has helped on many levels including fewer throat infections, less irritability upon waking, because they are now getting the proper oxygen while they are sleeping. The dark circles under their eyes have significantly diminished and have seen their allergies lessen since they have gone from mouth breathing to nasal breathers through our system. The patient’s straight teeth are now the side effect of our treatment. He now is able to enjoy a beautiful smile from us treating the symptoms and it showing in his teeth. With our help he has now reached his full potential and realized his true genetic expression like an identical twin.

We are dental sleep physicians. We are now the first to recognize the signs that will hinder our patients sleep now and in the future. This is vital that we start very early in life. As seen in these before and after pics of a 2 year old that we started treating last year. We are helping our patients reach their full growth and developmental potential. If this 2 year old was to go untreated he would be looking at extensive orthodontic treatment and struggles in life like the above twin.Even with the current tools to correct this problem and the knowledge to coach them we are still needing other professional’s collaborative help. The dream team should consist of a Dentist, ENT, Orofacial Myologist, Craniosacral Therapist, Chiropractor, Nutritionist, Medical Doctor, Orthodontist and many more. My personal goal is to create more awareness of this growing epidemic and teach other professionals about early prevention. We have the power to help children have a better future.