In the first 6 months of our life our weight doubles. In the first 3 years of our life, our height doubles. This proportional growth is not seen in human growth and development again. Obviously, early child development is critical for our wellness. If the young moms reading this are not stressed enough following the gluttony of recommendations for your children's health in our present "information age," may I add another thing to your watch-list, but not your stress-list. Make sure your children can breathe through their noses. If they are not, get them on the right medical track to correct the problem, not the symptoms. It is very important for your children's normal growth and development.
My dental school classmate Adam used to torment his fun-Uncle, with the above expression as a greeting. Napolean's profile and facial expression is an example of a "long face," or sometimes referred to in medical literature as "adenoid face." Lack of chin, open mouth, short upper lip, small underdeveloped nostrils, and gummy smile. This prevalent facial deformation has been linked to a simple but chronic, nose blockage. Proper breathing in early child development is essential for the normal growth of our children, but strong evidence suggests tonsills and adenoids are secondary to the real problem, a chronically stuffed nose. First some background, then our recommendations.
60% of our facial skeleton is formed by the age of 4. By the age of 12, our facial skeleton has typically surpassed 90% of it's growth. In the US, children are typically referred to orthodontists at 11 years of age despite the American Academy of Orthodontists recommendation of 7 years of age. This is significant because we are utilizing orthodontists way too late. Earlier interception could allow the talents of Orthodontia to guide and develop childrens facial skeleton way easier that at age 12 when the skull is 90% of it's overall size. For all parents scratching their heads about the last statement, orthodontics do way more than straighten teeth for growing children. However, this is a topic in itself that I can elaborate on separately if interest is there.
What happens to a child that has a long-term nasal stuffage (months-years) and breathes through his/her mouth? A cascade of muscle events that is unpredictable occurs, but varies in adaption individually. Normal tongue position is on the roof of our mouth when breathing properly. Therefore, proper breathing will actually shape the palate or roof of your mouth (your tongue should fit into the pocket of the roof of your mouth) by pressing the palate while breathing. The muscle, our tongue, shapes the bone over time by proper position, just like glaciers and water cut through rock with time. Time and frequency are direct factors. It has been reported we swallow 2000 times per day and breathe relatively every 3 seconds. The time and frequency our tongue spends on the roof of our mouth shape our development oral-facially.
A mouthbreathers tongue drops to the floor of the mouth. The tongue then protrudes (sticks out) to allow a greater volume of air into the back of the throat. This is probably due to the ineffectiveness of oxygen delivery to the lungs when mouth-breathing. This effects the muscles that swallow and changes our swallowing patterns. The nostrils underdevelop by "disuse atrophy," or don't develop properly due to lack of use. The lip appears short because it is not needed to balance out the tongue when in proper position. As you can see, a cascade of muscle changes occur. Remember, muscle shapes the bone. Also recall that skeletal growth doubles in the first 3 years, then grows another third before the age of 12. These different muscles pulling in an unbalanced fashion, cause alterations from our normal growth.
The changes in our muscle then shape the bone growth by pulling at the bone in an unbalanced fashion. The jaw rotates backward causing a "vacant" expression with an open mouth. The chin rotates downward when the jaw goes backward. Dropped, double chin makes the face appear long. The resultant gummy smile is a common result.
Thus, the long face in some individuals was a result of a chronic nasal obstruction. Typical presentations of an adult patient that dealt with this as a child include TMJ signs and symptoms, a gummy smile, and a history of breathing problems and sinus infections. The facial skeleton is already formed with built-in dysfunctional muscle imbalances. The rest of her young life we will treat her symptoms palliatively because we can't correct the source of the problem, because she is already fully developed. Some doctors recommend surgical correction, breaking jaws called "orthognathic surgery," and repositioning them. However, aside from having your jaws wired shut for 6 months, we see a high relapse rate, meaning the jaws get pulled back to their original position because of the developmentally incorrect pull of muscles.
I assisted over 12 orthognathic surgeries in my residency performed by a team of surgeons. The surgeries would take over 8 hours as we fractured the upper jaw off the skull (called a Lefort fracture), fractured the lower jaw on both sides then pulled the lower jawbone forward and placed titanium plates to hold the new position. We did a chin graft to improve their profile. We performed cheekbone implants and installed them, all to improve the effects of a chronic childhood breathing problem. As I hope you now realize, the key is prevention. A little more info, then the recommendations.
The best analogy in nature I have found is this. Oxygen is to humans as sunlight is to trees in the growth phase of development, not for respiration. Do you see how this tree is deforming trying to reach it's growth source? The body also deforms its growth in the attempt to get more oxygen to our system. This rubber tree sits in a corner between two windows. It deformed by growing sideways to get to the sunlight.
I am an evidence-based restorative and surgical doctor of medical dentistry. The recommendations I will offer are based largely on my experience treating 3 converging fields; sleep apnea, TMJ disorders (TMD), and sinus evaluations using a digital CT scanner in my office primarily used to surgically place dental implants. I cannot say I have concrete evidence that this is a definitive occurence. However, prevention is key and I cannot think of one single reason why improper breathing would be a good thing for our bodies. My qualifications to offer a recommendation:
As stated previously, I was on a team of doctors in my residency that performed over a dozen orthograthic surgeries to correct the chronic childhood breathing problem in adulthood. I have treated sleep apnea with appliance therapy since 2002 when I earned a certificate for Orofacial Pain Management while in residency with the USAF at Keelser AFB in Biloxi, MS. This training helped me recognize airway problems in my patients. I have treated craniofacial problems such as TMJ disorders since 2001 while focusing on proper positioning of the lower jaw into the skull to reduce muscular activity and muscle tension. I receive many referrals from local physical therapists, chiropractors, physicians, and dental specialists for treatment of their patients TMJ/TMD problems. I surgically graft sinuses and take/view hundreds of CT scans in my office to evaluate our patients sinus anatomy evaluating their anatomy and have worked with local ENTs to improve airways for my patients.
Recommendations for the concerned mother:
1. Any chronic nasal obstructions (long-term stuffy noses) should not be taken lightly nor treated with antibiotics as the first line of defense.
2. Ensure your medical team of pediatricians, dentists, ENT, and allergist can recognize the problem first. Your team should have the same philosophy as you regarding the health of your child. Pills for treatment (i.e. antibiotics) are oral bandaids that do nothing for the problem if chronic.
3. Get allergies under control (even if you have to remove a pet) prior to having tonsils and adenoids removed. Sinus allergies precede infections. I have seen many children with their tonsils and adenoids removed yet have an nasal airway obstruction. It is my opinion that tonsil and adenoid removal is routinely secondary to the nasal airway obstruction.
4. Do not be fooled into thinking chronic mouth breathing is normal. It is not. It effects the facial bone development of a growing child in addition to nearly every one of our systems from breathing, to sleep, to chewing, etc.
5. Early interception is better and easier than a mid-course correction. An adult correction can be very aggressive (orthognathic surgery) or only palliative in nature (unable to treat the source or problem; only able to treat it's symptoms.)
6. The biomechanics of our bite, longevity of our teeth, reduction of TMJ-related headaches, improved muscular function, and a toothy smile are some of the benefits of breathing properly your children's dental well-being.
7. Improved concentration and brain development (improved oxygen), improved energy levels in "lazy kids" that may be under-oxygenated, improved athletic performance (more oxygen to muscles is better just ask Lance Armstrong), improved facial profile, better sleep, reduced cardiac problems linked to sleep apnea, are some of the reported advantages by improving nasal breathing in growing children. If you want to feel the difference, do one of your normal workouts with a motorcycle helmet on. Wait until you see the difference in your performance from balance to strength and endurance.
Recommendations for the overly-concerned mothers (you know who you are);
1. Don't panic, your child will be alright. Knowledge leads to recognition. Recognition leads to diagnosis. Diagnosis leads to successful treatment. Successful treatment early will improve your childs development. There are plenty of individuals I am sure, that defied the odds and still matured in a normal fashion with unnoticeable changes.
2. Do not start asking doctors to radiate your child with a medical CT scan to determine if your child's breathing complex is healthy. Go by the signs and symptoms. Medical CTs (MSCT) have much more radiation than the digital CBCT (cone beam CT scan) found in dental offices. For comparison, MSCT of the upper jaw only is roughly 1400 (units of radiation). My digital scan for both jaws is 130 (units of radiation). Less than ten times the radiation of a medical multi-slice CT scan, with more information. A plane flight from Paris to Tokyo is roughly 139 (units of radiation) for comparison.
Recommendations for mothers with "internet based medical knowledge" rather than a medical degree;
1. There are many doctors out there with a deeply caring disposition. Find them and do not determine your children's future health because of poor experiences or misdiagnosis of previous ailments in your life. In some instances, medicine can be trial and error due to lack of ability to objectively determine.
2. The internet is an excellent tool to find information. The problem can be if your sources are not evidence-based. In our information age, anything can be stated. Look at politics. Just because things "make sense," does not make them true. Be critical of your sources of information and learn how to critically evaluate a study.
3. Alternative medicine is a great blend for "western medicine." Alternative medicine involving prevention. There is an emerging form of alternative medicine appearing mostly on the internet, that is business based and not evidence based. Be critical. A broken clock is correct, twice a day!