By Kristine A. Garland
Cavemen, unlike modern humans, did not need braces.
“Our jaws are shrinking,” says Paul R. Ehrlich, Ph.D., world-renowned evolutionist, best known for his 1968 bestseller, The Population Bomb.
Therein lies a silent epidemic that poses a major health challenge.
Along with Sandra Kahn, D.D.S. M.S.D., Dr. Ehrlich is an author of JAWS: The Story of a Hidden Epidemic. In their book, Drs. Ehrlich and Kahn trace how biological, dietary, and cultural changes have resulted in the rapid shift in oral evolution, resulting in smaller jaws, crowded and crooked teeth, and dangerously obstructed airways.
Anthropologists confirm that the jaws of modern humans are smaller, with more malocclusions, and more tooth impaction, compared with the jaws of early humans.
“Richard Klein, the top human paleontologist in the world, told me personally that in all the time he has been working with hunter-gatherer skulls, he had never seen one with serious malocclusion,” Dr. Ehrlich told Incisor.
It’s not just that you don’t find crooked teeth in early human jaws, Dr. Ehrlich explains, you also find jaws with more teeth. The hunter-gatherers have their last molars where the last molars should be.
Drs. Ehrlich and Kahn explain that crooked teeth are a signal of a more basic problem—poor development of the jaw—and that poor development influences other health issues, including obstructive sleep apnea (OSA).
OSA is caused by the physical blockage of the airways, and has become a significant factor in public health. According to the National Sleep Foundation, more than 18 million adults in the U.S. have sleep apnea. It is harder to estimate the number of childhood cases, but the foundation estimates a minimum of 2-3%, with the possibility of as many as 10-20%. The foundation also notes that the factors increasing the risk of sleep apnea are small airways, large tonsils, obesity, small jaws, and recessed chins.
Dr. Ehrlich tells Incisor that although the explanation for the shrinkage of modern human jaws is not certain, a number of environmental/cultural changes are thought to contribute. They include eating soft foods, moving indoors where allergens are more concentrated, mouth-breathing, and poor posture.
To encourage proper jaw development, Dr. Ehrlich recommends reducing exposure to allergens, breathing exercises to improve breathing through the nose, and good oral posture exercises. (Good oral posture is, at rest, mouth and lips closed, teeth lightly touching, and the tongue pressed up into the roof of the mouth.) He recommends that parents encourage their children to keep their mouths closed when not eating or talking, and have children eat chewier foods like those consumed by the hunter-gatherers.
Dr. Ehrlich explains that parents can observe their children to watch for proper jaw development. He notes that key signs to watch for in children include: mouth breathing, gummy smiles, sleepiness, very rumpled bedsheets, daytime sleepiness, disrupted sleep, and snoring.
“If your child snores, there’s a real problem there. The snoring is the start toward obstructive sleep apnea,” Dr. Ehrlich told Incisor.
Melody Barron, DDS, owner and director of the TMJ and Sleep Therapy Center in Memphis, TN, sees patients who are suffering from temporomandibular joint (TMJ) disorder and OSA. A general orthodontist since 1994, Dr. Barron became interested in TMJ disorder and sleep apnea because she suffered from TMJ disorder with debilitating headaches, neck and back pain, and seizures. Within her training to treat the disorder, she was diagnosed and treated successfully.
Dr. Barron’s primary focus is on facial development and more specifically, airway development. When describing the issues in face and jaw development she sees in patients with TMJ or breathing issues, she notes that the face appears to be growing downward, not forward, with receding chin and mouth open.
Dr. Barron explains that treating the problem as early as possible in a child’s development will allow for proper growth and development of the jaw. Her focus is on getting to the source of the problem, not just treating the symptoms.
Teaching patients how to have proper resting oral posture and to breathe correctly, Dr. Barron uses the Myobrace® system: stages of appliances that have graduated types and levels, depending on the age and needs of the patient.
She uses the Myobrace® to treat the causes of crooked teeth, develop the jaws by addressing muscle function, and improve breathing through the nose.
For example, Myochew® would replace a traditional pacifier for infants. It is made to encourage proper breathing through the nose and support jaw development. It doesn’t push the tongue down like a pacifier.
The Myobrace® system includes four stages: 1) habit correction 2) arch development 3) dental alignment, and 4) retention. The system helps address issues related to airway dysfunction and can be used in patients as young as three years old. The daytime appliance is only worn for an hour, during which the patient follows exercises (via a smartphone app or website games) to encourage correct tongue placement, oral posture, swallowing, and breathing. The night appliance puts the tongue in the correct spot to keep the airway open. A Myobrace® is also available for those already wearing braces, and there is a Myobrace® for adults, including a version for adults with TMJ.
Like Dr. Ehrlich, Dr. Barron is also concerned with the issue of sleep apnea. “Mouth-breathing kids should be a red flag. That’s the beginning of apnea. Parents don’t think of a child having apnea. They think of an overweight male adult,” she says.
Dr. Barron explains that practitioners and parents should be aware of signs children may be at risk of, or already suffering, breathing issues including mouth-breathing, dry mouth, significant decay, narrowness of the face and jaw, snoring, odd sleep positions, and hyperactivity.
But children are not her sole focus. Dr. Barron describes one of her patients as a man in his early 40s who was about to quit his job and go on disability, but now says he has hope.
“It goes to quality of life,” she says. “I can take anyone at any age. I can’t regrow you, but I can change your function to be a little better. This is rehabilitation. It’s the thought process of teaching them and changing their habits,” she explains.
Author: Contributing writer Kristine A. Garland received her MA in Journalism from New York University’s Science, Health and Environmental Program. She serves in the U.S. Navy as a public affairs officer.