Speaker 2 (00:00.578)
This is Dentistry Disrupted with Dr. Craig D. Clayton. I'm a wellness and biomedic dentist, passionate changemaker, social media thought leader, and educator on disrupting the way we approach oral healthcare. Come along with me as we journey towards a healthier and more empowered you.
Speaker 2 (00:30.124)
Welcome back to another episode of Dentistry Disrupted. I'm Dr. Clayton and I have a very special guest today, Dr. Ben Moralia. And he has over 30 years of general practice experience in dentistry and over 20 years of orthodontic experience. He's passionate about early childhood jaw growth and development and lectures nationally on malocclusion, its connection to sleep disorder, breathing and how to treat it early in a patient's life. Outside of his practice in Mount Kisco, New York,
He works with and leads innovative companies that align with his professional interests and is a founding member and the chief clinical officer of the company Toothpillow. Dr. Ben, what else do you like to do outside of your very impressive professional life? What are some of your personal hobbies and interests?
Well, with being married with three children, a lot of it is about the kids. So family time is good, a little bit of travel mixed in there. The interests usually center around what the kids are up to and what they're doing. So we, our hobbies are there.
Okay, I love that. Thank you so much for taking the time to join us today. I'm really excited to learn from you and for our listeners to learn from you about something that is very, very important. So my goal of this podcast is to help our listeners understand the root cause of shrinking jaws. Why are our jaws smaller than they were, you 100 years ago and how that affects our health, why we are seeing such a
prevalence in sleep disorder breathing and narrow airways, which then causes a whole host of problems. So let's dive in as a leading expert in the field of airway medicine, airway health, and someone that's dedicated their professional life to it. Where did you start? Where did this whole journey start?
Speaker 1 (02:14.018)
The starting point was about 20 years ago, roughly. Basically, I just got dissatisfied looking at braces and what they were doing. And so it just felt like braces from 11 to 14 in that age range. They were addressing the teeth only. And as soon as the braces came off, the teeth would kind of shift back if the child didn't wear their retainer. So seeing extractions done and having, you know, just an unsettling feeling about extracted teeth for kids that didn't look that crowded either. The weird thing was
that I was seeing extractions done on kids who didn't have much crowding and it didn't add up. So one thing led to another, I started taking courses and then taking courses in expansive orthodontics and growth and development and then starting to realize, there is a whole side of this that can be done earlier. And instead of waiting until 12, why don't we just treat it earlier? Well, I started to treat the kids and you know, basically it's a puzzle piece at a time. I didn't have all the puzzle pieces 20 years ago, but as I started to do more and more and more and then following the kids over time, you start realizing,
there's more involved than just the teeth and the jaws. So the transition for me was being dissatisfied with braces alone as a treatment, then exploring expansive and early orthodontic techniques and basically a shift from focusing on the teeth to focusing on the foundation. And so having a foundation first approach and then teeth second approach. And when I say foundation, I mean jaws, you know, working on the jaws early. So that
That's been the big shift for me is focusing on the foundation, getting that to grow properly and then worrying about the teeth second. So that that transformation began 20 years ago. And, I like to say, you know, still learning because there are people out there doing beautiful work and everybody can learn from everybody. So I'm still learning. I don't have all the pieces, but I have a lot of them now. And it feels like after two decades, the kids we've treated have done very well. And having some long term success with them kind of shows that, this is a really nice approach, better than the traditional model.
And that's really important for our listeners to understand is that, one, the anecdotal evidence you have, right? You've been doing this for a long time. You have these long-term follow-up cases where you see patients that are no longer kids or young adults or teenagers, but also full-blown adults where they've matured, they've grown. Because that's something that I see at large in my practice every day is that patients, although they've gone through orthodontic treatment,
Speaker 2 (04:38.178)
They may have been okay as a teenager, but now we're seeing them and they have red flags for sleep disorder, breathing, airway related issues, and they're narrow. And I think that's something that's wonderful that you get to see is the difference it can make when the approach is correct and comprehensive because teenagers grow bigger tongues and bigger necks and grow to be bigger humans, which then affects the airway. And then there's relapse. But with your journey, do you have a specific?
patient or a couple of patients that you look back on, know, 20 years ago and think, you know, this patient is the one that you felt like, my gosh, I changed their life. Like this is, this is my calling.
It's hard to put it on one or two because as we were doing this treatment and we started treating kids between 3 and 11 early on and when we started treating those kids their changes happened within weeks to months and So as we started learning more and more about following those kids over time their changes were so profound and early That it's not like one stood out and was like, this is the turning point
We were treating several hundred kids a year. And so with several hundred kids getting started at a time, it was like weekly we were seeing improvements, weekly seeing changes, because in the rotation that they're coming in the office, it was the entire clientele. And so it wasn't just an anecdotal one kid here or one kid there stopped bedwetting or never had another ear infection or didn't have nightmares anymore or slept through the night where they were waking up at night. It wasn't a one-off here and there. It was all of these kids that had lists of symptoms. They were fading away.
And so I would have to say my entire clientele has been eye-opening to see the benefit and the changes in them, their parents, their family, their school, academic careers, like all of the stuff that changes downstream. It's just all of them. We don't have a whole lot of kids that remained unhealthy once we got working towards growing their foundation early. So I wish I could name one child where the light bulb went off, but when we were doing that volume,
Speaker 1 (06:40.544)
It just felt like every kid would come in and we're like, wait, what? They'd stopped this, hear they're doing better at school. We couldn't believe, we didn't know a lot of the things it was gonna do till we started doing this. And then we realized, my God, it's affecting everything.
That's amazing. What did that feel like as a oral healthcare physician when you started to observe those changes? What was that experience for you personally, for your team?
Very rewarding. It's a little mind-blowing at first because you're like wait a second the parents telling us that their child stopped bedwetting At first you do it's like a double-take did I really hear that did it is that really? Happening then you ask again And then you check again in a week or a month and a year later to see like is it was it just one night or or is it all gone and same thing with like ear infections and and headaches and nightmares and you know night sweats the kids who are waking up multiple times a night that would reduce and then go away they'd sleep through the night just
The one after the next where we started getting feedback and then we started asking more questions. Like once we started hearing these things, then we've got even longer forms asking more things. Like let's learn more about the child before we treat them. Then we learned more and then we started asking, you know, follow-ups like one month, two months, three months. Like how is it going? Because we were expecting that. At first we were surprised and very happy that things were changing downstream, but it was news to us because this wasn't a thing 20 years ago where we would expect all of this to happen. Sure enough.
a decade in, now you're asking all of these things upfront. Because now your goal is to not only help treat the jaws enough, but you do expect that list of symptoms downstream to fade away. And we don't promise it. You know, we're not promising to change that list because a lot of that list are medical symptoms. And we don't treat that list. Like, we don't treat behavior, and we don't treat bedwetting, and we don't treat asthma, we don't treat ear infections, and we don't treat nightmares. You know, we don't treat digestive issues.
Speaker 1 (08:34.146)
We don't treat anxiety and depression. But while these are downstream things, we're recognizing that the jaws are too small. The teeth are crowded, the breathing is affected, so the sleeping is affected. Well, let's treat in our lane. Let's treat the malocclusion, the underdeveloped jaws, get some growth, improves the breathing, improves the sleeping, and it gives the child a chance to heal downstream. And so what we recognized was that we're in the end, we're treating in the cause category, because we're helping those jaws grow to get better breathing and sleeping.
every one of those things I was labeling off like symptoms or medical symptoms can be treated in the symptom column, which typically we see today as what are your symptoms? Here's your medicine. But that's treating the symptom and treating the symptom has a different outcome than treating the cause. So yeah, it's been an unbelievable journey.
So you're telling me by changing the size of the jaws and where the teeth are in the mouth that you are seeing a reduction or elimination of bedwetting, improvement in academic scores, improvement in attention behavior, really, just from changing the jaw shape.
Yes, not anecdotally either. All of the things I was calling off as symptoms have relation and connection to poor breathing and sleeping. And poor breathing and sleeping comes from the underdeveloped jaws. So the smaller the jaws are, the more difficult it is to nose breathe. So if you really boil it down, you could talk about how a child with smaller jaws is gonna convert or compensate to mouth breathing instead of nose breathing. And once a child is mouth breathing,
day or night or both, they're bound to end up unhealthy and have a list of symptoms they struggle with. So that transition from nose breathing to mouth breathing is largely due to the smaller jaw size. And as soon as the jaws are smaller, your poor breathing sets in, then your poor breathing gives you your disrupted sleep cycles. And once you've kind of fragmented the sleep cycles or destroyed a quality night's sleep, that child's gonna wake up and have struggles during the day. So mouth breathing day or night is wildly unhealthy for children. And I try to...
Speaker 1 (10:33.346)
give parents like a little analogy the difference between nose breathing and mouth breathing and so I teach them that melt the child let's pretend you have a high-performance race car if you've got a high-performance race car you need to put in an appropriate gasoline in that car it has to have a high octane a specialized fuel and that
You're speaking my language here. Alright, You can even adapt it to high-performance motorcycles.
There we go, high performance motorcycle and it's gonna race. It needs to race, that's what it does. Well, you have to put the right gasoline in that tank for it to have peak performance. now that is nose breathing in a child. Your child is your high performance, you know, we'll call it motorcycle, but you put the right gasoline in, you get your performance. Now let's take that motorcycle that's high performance. put...
Go put the lowest watered down octane you could find that's garbage. And in that motorcycle, it may start up and it may go around the track, but it will not achieve peak performance. It's going to struggle, but it's also going to break down sooner. And then it basically has malfunctioning coming instead of peak performance. Now that child, that's mouth breathing for a child. Mouth breathing is getting the wrong ingredients in. And I say fuel because the number one fuel is going to be oxygen, but it has to come in a certain way. It's got to come through the nose. The nose prepares that fuel so it's right for the lung.
The mouth does not. yeah, breathing through the nose is fueling yourself appropriately and breathing through the mouth is getting the wrong fuel in and then you will malfunction. So parents get that quickly that, my goodness, yeah, of course. You know, that's a pretty good analogy. It starts to highlight the difference between nose and mouth breathing. A lot of people don't even think there's a difference. I can breathe through my nose, I can breathe through my mouth. They're both the same, they get air in. They're opposites, they're opposites. One is healthy and one is a disaster for any child. So really you have to nose breathe full time. It has to be day and night in order to be healthy.
Speaker 1 (12:18.294)
Otherwise, a small amount of mouth breathing day or night will lead to unhealthy. And I like to share with parents that if you recognize there's a little bit of mouth breathing day or night, I'll show you a child with a short list of mild symptoms. But if you have a parent who notices my child mouth breathes all day and all night, I'll show you a child with a lot of symptoms and they're really struggling.
Isn't that amazing? Just just the difference of breathing through the nose or the mouth. Yes. And this is something that you know, our listeners need to understand that is it's well established. Just just this simple transition. Right breathing through the mouth is correlated with increased sympathetic tone, chronically day and night fight or flight system, increased cortisol, decreased growth hormone. I mean, if you're listening to this and you're thinking of those symptoms in your child or in yourself,
That's something you can't ignore. This increase of cortisol at night also decreases growth hormone, another restorative hormone. So are you also seeing increase in growth of these children as they begin to breathe better, function better, have restorative sleep? What have you seen there as well?
Yes. And so, yeah, that's exactly like when you mentioned when you're nose breathing at night and you're in what's called parasympathetic drive, that's your rest and digest functioning. That's where you get your growth hormone. So most children get their growth hormone at night, but it has to come when you're in a proper sleep cycle. But a mouth breather doesn't have the proper sleep cycles, so they don't get the growth hormone. Instead, they get cortisol. So it can affect their growth. And it should be no surprise. A lot of kids struggle with the height and weight charts. And so what we recognize over time is that
When you get involved, the earlier you get involved, the better, but you can catch up. The crazy thing is you can catch up. So even if you catch a five, six, seven, eight year old and you start treatment and you get better breathing, better sleeping, it's amazing how they catch up. And one analogy I like to give is, know, imagine a child is healthy to the age of, let's say six, they're doing great. But let's say a six year old to eight years old for two years, they're malnourished. So let's say a child gets malnourished for two years till eight. Do know if you go back into healthy nutrition at eight and you give them back the proper nutrition, they can recover.
Speaker 1 (14:28.194)
They don't have to maintain the same malnourishment that their physical body is presenting with and the symptoms at that time, they can recover. another analogy would be like a broken bone for a child, a four-year-old who jumps around on a trampoline and breaks their leg and they get a cast. It's amazing how the kids are growing so fast when they're younger, but having a cast for so many weeks on a leg, your leg could be like a quarter inch or a half inch shorter when the cast comes off. And you just let the child run and play and it catches up to the same length as the other one. It doesn't remain shorter for the rest of your life.
So a child can rebound. It's amazing that the young kids can rebound. So they do gain the height and weight as you restore the breathing. Same thing like you mentioned, like we don't treat undersized children. We treat underdeveloped jaws. And so our lane is treating the malocclusion that we can diagnose, treat the underdeveloped jaws, restore the breathing, restore the sleeping, and then your child can heal. And that's the pathway.
I love that. Let's flesh out a little bit more the underdeveloped jaws and what exactly does that mean? So malocclusion, let's start first with malocclusion. And if you'll give a little definition of what malocclusion means and then, and then follow up with when you say underdeveloped jaws, can you paint a visual image of, what that looks like, especially as people are listening to this and wondering, well, does my child, you know, my child's checking these.
She's checking some of these boxes. wanted, I want to know more. What is something, some other, some appearances that are easily observable when you look at the jaw form. So malocclusion.
That's our professional word malocclusion and it just means bad bite and Having a bad bite is is kind of loose terminology But it does stem from having underdeveloped jaws. And so when I say underdeveloped jaws, I mean smaller jaws and usually Well, your teeth were designed to fit together perfectly like a puzzle and so the top and bottom teeth a human being is supposed to have all 32 16 on top 16 on the bottom and they're built to come together and connect appropriately so
Speaker 2 (16:09.486)
What does a bad bite look like?
Speaker 1 (16:23.362)
When you say good bite, we would think about, okay, I've got all of my teeth. I've got them well aligned and they connect perfectly. So I would talk about three boxes. First, I've got them all 32. That's a good box to check. Number two is gonna be they're well aligned or kind of straight, perfect curve around the arch. And then number three is gonna be when I close my mouth, they connect appropriately. So you could almost think of your teeth like Legos. They have points and grooves. The back teeth all have points and grooves and they need to connect just right. When they don't, you have a bad bite.
So teeth that connect poorly have a bad bite. Teeth that are not aligned well are the reason they're not connecting. And sure enough, if you don't have a mole, you don't have a good bite. Just because you have 28 teeth doesn't mean you have a good bite. You don't have four out of those 32 teeth. You're missing a significant percentage. So we do want all the teeth lined up perfectly, but then connecting appropriately. All of that would add up to having a really good healthy bite. But that's about the teeth. The focus on the teeth
is really not the main focus in order for that to happen. 32, well aligned, connecting appropriately. In order to have that, you first need to have the right size garage, we'll say. So, you know, if you look, if you were going to buy 32.
The is like the jaw.
Yeah, the jaw. So the jaws are a certain size. Now look, if you were going to be, yeah, let's say your relative is going to leave you 32 cars in the will. You know, you've been such a wonderful, you know, relative, you're going to get 32 cars from your in-law. Well, the first thing you do is, isn't that nice? That's a nice, I need to be adopted. I need to be adopted by somebody. But if you knew that, if you knew that, and then they said, and also we're going to give you the money to make a garage to put them in.
Speaker 2 (17:48.984)
That would be fun.
really nice.
Speaker 1 (18:01.326)
You would not go build a garage for 28 cars and throw four in the garbage. You would say, well, I know 32 are coming. They left me the money to do it. Let me just go put it. I'm going to build a garage for 32 teeth. So the whole point is having the right size jaws. Now to kind of continue with the question you were asking is what would parents see? Like how does a parent know that jaws are too small? Well, the teeth are the first sign. And so let's talk about the kids who have the baby teeth. So three to five years old, you got your baby teeth in there.
Well, one of the big signs would be there's no space between them. so a lot of kids today, a lot of kids, have these perfect.
they look perfect. Look at they're not gonna need braces all their teeth are yeah
Of course, and their teeth, the baby teeth are just so perfect, right? And the kids got these beautiful cheeks and in the Italian families they would grab them and look at those cheeks. have like those cheeks. This is what would happen. The point is that if a parent sees that their baby teeth are connected or there's no space between them, that's a sign of future crowding. The permanent teeth won't fit. So we already know.
If the baby teeth are connected where there's no space, big troubles. Now, what kind of space would be good? On one level, having them connected in no spaces thing, but there actually was a dentist a long time ago who did some research to measure like what's the space between baby teeth that says or predicts the permanent teeth are gonna come in well. And it turns out, this was like a hundred years ago, they did this research, the width of a nickel. It turns out if the width of a nickel can fit between these teeth, then you have good growth, you have good jaw growth, your permanent teeth will come in well.
Speaker 1 (19:34.872)
So any parent who recognizes, uh-oh, my child does not have a nickel worth of space between all those front teeth, we're gonna have crowded teeth coming. And of course, when the new teeth come in, you would recognize, they're not where they belong. They're crowded, they're shifted, they don't fit. That's very common. So it's much more common to see crowded permanent teeth coming in and or baby teeth with no space. One word of caution, parents, please do not take a nickel and try to fit it between your kids' teeth because...
their mouth will become like a parking meter. That nickel's gonna go right into there and you're gonna lose it. It's bad news. So we don't put a nickel in the mouth. This was 100 years ago when they did things differently. You can look at a nickel, you can see the thickness and say, does my child have that space? Most of the time the answer's gonna be no. That space doesn't exist in the baby teeth today. And sure enough, it's rare to find a child who does have that. It's we call it a unicorn.
All right, parents, so don't use a nickel to measure your kids' teeth, but also get a flashlight out look between those back teeth too, because something I'll see in my patients is they may have some spacing between their front teeth that looks ideal, but then those back teeth are missed and those back molars are touching together.
And most parents are aware, because most parents will have had the braces routine. They'll either have had a history of braces or maybe headgear or extractions or, you know, years in it, rubber bands. And they'll probably recognize most parents are familiar with, I had my braces, my teeth were straight. I didn't wear my retainer. They got crowded again. Then I went and got clear liners or I had braces again.
Yeah, my hand.
Speaker 1 (21:04.854)
Right, same thing here, threw it out in the lunch. was like three weeks later, right in the lunch, threw it out at school. But that's a very common pattern is that most adults have had braces and multiple times or tried clear liners because they know once they stop wearing the retainer, they will shift back. And that's super common. But that whole pathway of braces later when you're 12 years old or so really only offers straight teeth temporarily. So braces offer straight teeth temporarily. They don't have an effect on the foundation.
so they really don't have an effect on your breathing or sleeping. So braces really just address the symptom, which is why we don't want to wait until 12 anymore, because why would you go after the symptom late when you could treat the cause early? So our preference is to get involved early and help those jaws grow better to accommodate the teeth. Now we have all the teeth where they belong and you need little or no braces when you're 12, but the advantage of that is when the jaws are the right size, you breathe better. And when you breathe better, you sleep better. And when you sleep better, you have less symptoms or no symptoms.
Yes. Yes. Exactly. And braces and orthodontic treatment has become so normalized and has because has been normalized for decades as just it's, you know, it's a lot of people write a passage that yeah, they it's a right passage. Exactly. You know, you're lucky if you have, if you have enough room for your teeth so that they come in, not crowded. And I remember going through the whole routine of getting, getting an expander, creating more space and then having braces and getting them off and having braces again.
and then being an adult and having that poor bite and then going through clear liners and still not getting the result that I needed because now I don't even have enough space in the front of my jaws. So the teeth are crowded and they don't have anywhere to go. What are you seeing then based on the literature and some of the evidence we have, what are some of the main causes of these underdeveloped jaws and airway issues? especially now there can be such a negative.
connotation around airway health, especially when it comes to tongue space and tongue ties, where a lot of people are saying it doesn't exist, it's not a problem. And then that can, you know, concern parents of, I'm being told this by my, you know, other healthcare providers, but then I'm hearing this from you or seeing this in other spaces. And it seems when I got into the space, I couldn't believe how many patients, children, especially, have airway issues, but patients at large, I mean,
Speaker 2 (23:29.23)
95 % of my adult patients, I would say are below that lower threshold of what the upper jaw should measure. And then I have patients that have gone through my functional therapy that are in appliances that are now 40, 41 millimeters and they're seven, eight years old. And I've got 5 % of my adult patients that are lucky to be above 37 millimeters. And so it is just, it is frightening how pervasive it is. And what are some of this?
Speaker 1 (24:01.226)
Exactly. So that's like the big question is why are in almost all humans the jaws smaller today? And so when you think about the kids, their parents and grandparents and great-grandparents, this is multiple generations. So it turns out the literature, the research is out there and it's anthropology research. Anthropology research has the answer for why the jaws are smaller today and there is a
And what does anthropology mean?
So it's basically the study of humans, like the study of human existence going back and following all the way through. So what anthropologists do is they study cultures all the way through. you could do it forwards and backwards. Like if you go and you meet a culture, you can study grave sites in previous generations, but then you can also follow them going forward. So you can kind of follow both ways, see what happened when and when did this thing begin? Well, anthropology teaches us that when the pre-industrial, pre-Western lifestyle existed,
And that's where we think about natural living cultures that are not influenced by any Western industrial society. can think about Native American type populations. Well, pre-Western, pre-industrial living, there was an early hard food used. So the breastfeeding transitioned to early hard food. So the six to nine month old, usually it corresponded with being able to hold their head up and being able to grab and pull to the mouth. And those two milestones are about six to nine months old. And in that timeframe,
the infants in the pre-modern, pre-Western, pre-industrial cultures would begin to eat and gnaw on harder things. Well, harder food early from that six to nine month old all the way to two and then continuing, hard food early makes your muscles stronger and your muscles have to work harder. As your muscles are stronger, it promotes the bone growth. So it turns out in a human being, your bone yields to the muscle. So you use your muscles appropriately and your bones grow.
Speaker 1 (25:47.104)
and the jaws, the upper and lower jaws, are primarily growing by the muscle activity. So when we have early hard food, all of a sudden the muscles are stronger, the bones grow bigger, the teeth all fit. So it corresponds to primitive, isolated, natural aboriginal cultures have no malocclusion, little to none to show for it. All the jaws are fully...
examples of those cultures.
Any human population before industrial Western living, all around the world, anywhere, doesn't matter what country, doesn't matter what land, it makes no difference where they come from. All pre-industrial, pre-Western cultures have little to no evidence of malocclusion and it's really anything about 400 years prior. So 400 years ago and back, there's little to no evidence and then it starts to creep in. But going back 400 and forever, the entire human race has fully developed jaws, 32 teeth and beautiful bites that are uniform.
not teeth crowded in all over the place. And then they recognize when they start studying cultures, uh-oh, here's what happens. The Western industrial model begins with food trade. So a culture would start to trade for food. And instead of having early hard food, their natural diet, they would switch to softer foods. And as the foods get softer, the bad bites get worse because the muscles get weaker. And as the muscles get weaker, the jaw growth gets smaller and smaller and smaller and the teeth don't fit.
So if you look at today where we are, our kids are like seventh generation post-industrial post-western living. So we're seven generations into this soft food early, but the soft food early is mush. It's either out of a jar, it's like applesauce, or pureed. Even if we went and got the right stuff and blended it, we're pureeing it. So a child today, and even the parents and grandparents, had softer foods early. And that mush does not help develop the muscles. When the muscles don't develop, the muscle activity will not promote bone growth.
Speaker 1 (27:38.424)
So we lose the growth of our jaws because of the weakened muscles thanks to early soft food. It's the number one trigger for all cultures. So for all cultures around the world, even if they're not connected in any way, shape or form, they have the same pathway of having smaller jaws and crowded teeth once they start using an early soft diet. That's the first trigger is the softer foods early. Basically baby food, what we call today baby food, a liquid diet early, this mushy diet. The second trigger that jumps in is bottles.
and the third is pacifiers. And the reason is the bottle and pacifier get between the tongue and the palate. So the bottle and the pacifier live between the tongue and the palate. They keep the tongue low. But when the tongue is low, we lose our jaw growth. We need the tongue functioning up into the palate to generate pressure and to basically produce a beautiful hard food chewing type swallow. But the more bottles and more pacifiers are used keeping the tongue low, it basically
promotes the jaws to not grow wider forward, but to sink back and narrow and drop longer. So all of a sudden we have a change in the muscle pattern. So bottles and pacifiers, followed by last but not least, you could put fingers in there, like a thumb sucker. Thumb sucking changes how your jaws grow, and that's easy to see. Parents know, my child sucks their thumb. They become narrower, it changes the bite. That's an inhibition of good jaw growth. So...
We're looking at early soft food from anthropology research as the defining kind of change that says, yeah, with an early soft food, we're gonna lose our jaw growth and development. And it turns out most of your jaw growth is zero to two years old. That's where about 54 % of it happens. Then from two to four, you get another roughly 15%. By four years old, you've got a lot of jaw growth accomplished, but we've missed our window because that's when the softer foods are. So any culture that adopts soft food early will have a very high rate of
crowded teeth and bad bites. And if we look at it today, we could say, you know, it's even hard to say one in a hundred children will grow up with perfect teeth without needing orthodontics and get all 32. It's hard to say one in a hundred. It's less than that. So one in a thousand, one in 10,000 kids will grow up and have all 32 teeth on their own. Very rare. But meanwhile, that was the rate. was one, it was one in a hundred or a thousand or 10,000 that actually you could find a malocclusion on way back when. So it was the, it's a complete flip. Early hard diet.
Speaker 1 (29:55.886)
Little to no malocclusion, early soft diet, lots of malocclusion. And it's a 99 % in either direction. It's an unbelievable dynamic that softer foods early change the entirety of how your muscles and bone will grow and form.
And I'm going to ask a question that I'm asked routinely in my office is why didn't I know about this? That's what patients ask. Why didn't I know about this? Why didn't I learn about this? Why am I not told this by, you know, by other care providers? Why was I taught that I should start with baby food and mush and then... Of course. So if you could answer quickly what kind of what your take is on that. I know that's all that could be a hard question to answer, but...
That could also be touchy one because you know, that could be a touchy one. One of the answers might be, well, you have a food industry out there that would love you to keep using that softer foods. But it is and it's really an entire myth that a child or an infant can't have hard food early because of choking, let's say. Because when you go from breastfeeding to hard food, you're already prepared to handle it because you're doing your muscle work appropriately. The breastfeeding trains the tongue and the lips and cheeks to do their jobs correctly. So you have proper function.
So when the child starts to have harder foods, they already have the proper muscle strength and function. But when you go from breastfeeding to softer foods, the softer foods decrease the muscle strength. Now the muscles get weaker, but they also then are malfunctioning because they're going to stay, the tunnels stay low. So that softer food now changes the musculature. Switching back to hard is tough. when anthropology does research on choking incidents, it only picks up after the Western industrial model of softer foods being used.
Then you notice choking picks up because you have a child eating mush, then at some point asking them to chew something harder, but they've trained themselves to drink their food. Having mush or applesauce pureed food is basically a drinking swallow. So when you go ahead and you put something harder in there, and we'll just say a piece of chicken, not even harder, just a solid, put a solid right in, they're already, muscles are looking to swallow it. So they pop it right in. That's the choking hazard. Here's the analogy I give parents. If you haven't been to the gym in a long time,
Speaker 1 (32:03.746)
The last thing you do is go into the gym and pick up the heaviest weights and think you're gonna work out with the heaviest weights. Well, that's a child who has been eating soft food and now you want them to chew hard food. Choking is coming. So you don't take an infant that's had soft food and then give them hard food and expect good things to happen. That's like taking the adult who hasn't been in the gym for years. Go in the gym, here's the heaviest weights, let's get started. No, you gotta work your way up. So you have to work your way from softer to harder food so the muscles can slowly transition.
And there's a pathway to do that. Parents can look into things like baby led weaning and solid starts. Those are two Instagram places where you can learn more. It's almost like instructions on how to transition your child to solid food because going from pureed food to hard food is not something you can do like a light switch.
we'll put all these resources in the show notes and something that I want to mention because we took our kids through the baby lead weaning program and they both did great. But something that can be startling for parents and we've coached a couple friends through this process is that their child's will as they become familiar with that new texture, that new solid swallowing, that's the gagging or the...
you know, is a normal process, body learning how to adapt to that new foods. Don't get spooked by that. That's a normal part of the process. I hope, Dr. Ben, you can verify that for me. That was our experience.
A little bit of gagging is fine. That's the tongue pushing it back out to chew it meal Safety mechanism that should happen. It's okay. It's like a sneeze You know if you breathe in the wrong stuff your body sneezes to get it out So you're not trying to prevent sneezing let it happen You're not trying to prevent gagging and just by giving the child liquid it causes the list of problems for so long downstream forever that yeah societies Basically for the entire existence of the human race. It's been hard food early
Speaker 2 (33:30.913)
This is
Speaker 1 (33:56.97)
up until we have this pre, you know, this Western industrial model of making baby food. And so that's the biggest tragedy in all of it is it's a self-inflicted wound. We did it to ourselves. Crazy.
These are the huge impact, it also, you know, I hope it brings hope to everybody listening is that there is a path forward and there is a way to overcome this. But circling back to thumb sucking pacifiers, those sorts of habits of self soothing for the child and how to eliminate those is that's also a question that, you know, is prevalent of this is a hard habit to help our child break. Do you have some resources that you could share with our listeners of
where they can turn to start to get some help with just starting with those habits.
In the bottle and pacifier category, know, certainly there might be a need for that. So the example I can give is my wife had to go back to work. And so we use those. We use the bottles, we use the pacifiers. And so we did those things, even though they weren't helping with the jaw growth and development out of necessity. So then the idea was to transition away from those as we could. My kids are a little bit older. So when they got to five years old, I could see, yeah, there's no space in the baby teeth. So we got started treating them. But kids who have habits when it comes to like fingers or sleeves or other stuff,
you are trying to substitute something for it. And so, you know, one of the things we'll talk about in a little while is what are the options for parents? But when it comes to treatment and giving them a guidance appliance, that guide can be the soother. And so now they can have something in their mouth that actually redirects their breathing and muscles to do the right thing instead of the wrong thing. And if you can have a guide in your mouth instead of a thumb or a sleeve, you'll be growing the right way as opposed to kind of collapsing the wrong way.
Speaker 2 (35:36.398)
I love that. That's a great explanation. Substituting habits that that is a very important life skill. And that'll be great for the child to learn at a very young age. So wanted to recap a couple things before moving to a couple different topics. But real quick, if you could just lift list off some early signs that a parent should look for in their children or that someone can look for in themselves.
to that that would indicate that there's an airway issue that they're not breathing well, not breathing through their nose that these things are an issue of you. Yeah, what's kind of a rapid fire list of things to look for.
Yeah, baby teeth with no spaces, permanent teeth with crowding. Then of course you could look at and just observe, is there mouth breathing? Do I see mouth breathing during the day or night? Can I hear my child breathing? Because if you can see mouth breathing or you can hear them breathing, that's labored, that's poor breathing. Breathing should be silent and invisible. So if you can see or hear breathing, that's bad, that's a bad sign. Dry lips, dry and cracked lips, that's a telltale sign of, you know, mouth breathing.
Now another big sign of mouth breathing, which a lot of parents are getting to now as we're getting the word out, happens to be cavities. And it turns out cavities, you can get cavities for any number of reasons, but really the primary driver of getting cavities is mouth breathing. And so if your child is getting cavities over and over and over, and I hear this from a lot of parents, we have a very strict diet, there's no sugar. We brush and clean our teeth even with the floss and the picks. I'm in there every day doing this. My kids get eight cavities every time we go to the dentist.
Yeah, it's obvious because it's the mouth breathing. Then you would look at symptoms that are just a little bit disconnected with the jaw growth and development where parents would think about ear infections. Ear infections can come from smaller jaw size and it has more to do with the swallowing pattern from the softer food, the weakness in the tongue. And the weakness in the tongue, that poor swallowing pattern, doesn't help drain the fluid from the eustachian tube. So we get the fluid sitting there longer. So ear infections are a sign of mouth breathing and poor tongue function.
Speaker 1 (37:39.128)
So you could have this kind of pathway to think about ear infections, bedwetting, behavioral issues, nightmares. Yeah, the things downstream that almost any symptom overnight, you could relate to mouth breathing or worse. And then for parents to think about this another way for perspective is a lot of parents do bring their kids and they ask for help and they say, I've got these symptoms. My child is struggling with this. They're struggling with that. A lot of times we hear from parents, I went for a sleep study. They said we don't have apnea. Well, that will be most kids.
Most kids are not gonna have apnea. Only three to 5 % will have apnea. But having obstructive sleep apnea or sleep apnea is the worst you could be. That's the worst breathing you could be. So I like to give parents this perspective on this. So we're gonna call obstructive sleep apnea or sleep apnea a stage four disease. It's the worst part of breathing you could be is having apnea. Well, that makes mouth breathing stage one. So mouth breathing is stage one disease. Apnea is stage four disease.
You don't wait until stage four to treat but when it comes to breathing, your mouth breathing is fine. Mouth breathing is normal. Don't worry about growth
Snoring's cute, take a video of it and post it on the internet with the grandfather, cause your grandfather is snoring and your baby's snoring so it's the same thing, it's funny. No!
Right? It's normal. Like when we play, you know, when we play, I'm going to pretend I'm asleep. I breathe noisily or snore. And then we see that, you know, we see that in movies, television, cartoons. Such a good, such a great explanation and really, really helpful. I hope that you all feel confident that you will be able to evaluate your child over the next 24 hours and look for these red flags. And I want to add as well that mouth breathing doesn't have to be all the time.
Speaker 2 (39:21.548)
Right, you may check on your child at night to see if their mouth breathing, they may have their lips closed. But I thank you for pointing out noisy breathing. Put your ear close to their mouth, to their nose. Is it noisy breathing? Is it not silent? Is it silent? And also check, right, we need to check to see, you know, even if the lips are part just slightly, that still counts, right? It doesn't have to be wide open. Mouth, it can just be just a slight open mouth posture.
Yeah, and it could be day or night. could see a little bit of mouth breathing day or night. You don't need to be full time. It does not have to be full time mouth breathing day and night with the jaw always open wide. In fact, one of the things I forgot to mention was grinding the teeth. Grinding the teeth is a common symptom of breathing. Poor airflow and poor pressure. When you're not breathing well, you grind your teeth to actually improve your breathing. So it's a protected mechanism. But a lot of parents know my kid is grinding your teeth all night while they grind your teeth.
They have periods of grinding the teeth, clenching the teeth, open mouth, like it's a big mix of things happening at night. But grinding the teeth is another one that parents should know, boy, if my child's grinding their teeth, it's because they're not breathing well. And the body is actually trying to fix it by grinding the teeth.
Something that I want to just throw out to parents, the parents of grinding, may say, well, I never hear them grind their teeth. So something you can look at parents is have your child open up and look at those teeth surfaces. Are they angular? Do you see a flat kind of tabletop appearance where those rounded edges of the teeth are gone? And something you could do too easily is either have your child bite down on their front teeth and slide their lower jaw forward and see if all those teeth just...
fit together the whole time on a plane, or you could even take an index card and trim that so it'll fit over their teeth and look at that, do all the teeth touch at the same time on that index card, just like a flat tabletop surface. So yeah, that is a big thing that we're seeing in a little bit of the etiology, right? If they're not breathing well, they're gonna compensate. And that's why that teeth grinding happens because that jaw comes forward to open up the airway, right?
Speaker 2 (41:22.83)
And then those teeth get worn down because they're doing that, you know, every minute all night long over years. And that they just, they wear down those teeth and it's all right. Dr. Ben time for a rapid fire question round here. And then we're going to talk about, about your company tooth pillow and why that is such an innovative treatment option for parents of kids that are experiencing these things. Question number one, what can parents do to help their children develop healthy jaws? What's an action item they can do today?
Well, definitely you can look into things like solid starts and baby-led weaning to learn more about transitioning to solid foods. Another thing you can do is look into locally airway dentists or at least a dental office that has an airway focus where they will pay attention to the foundation size related to sleeping and breathing and this way you have an opportunity to have early treatment.
Number two, is there an ideal age to intervene?
As soon as you recognize there's an issue. So the ideal age is basically when you meet that child because as soon as you see a problem you should be working towards fixing it through the cause.
Okay, what if the ideal age of treatment is passed?
Speaker 1 (42:30.69)
Well, the good news is you can help any age out. And so it doesn't matter what age you are. It is just harder to do the older you get. There are treatments that are available in both the non-surgical and surgical category for teens and adults. And so you can treat it any age, but it is much more rewarding and much better to do it earlier while we're still growing.
And number three, what treatments or therapies are available for kids and adults? Yeah.
Yeah, so for children, we use a lot of guidance appliances. We do use fixed expanders sometimes. We do a lot of myofunctional therapy. I refer to the myofunctional therapy community. That's another good thing parents can do is search in their area. Just Google myofunctional therapy near me. Myofunctional therapy is beneficial at any age, and it's one of the first and early things you can do to help a child because it specifically works on the breathing, the musculature, and the posture to get all of the basically
muscle function back to grow the jaws. So that's a wonderful opportunity.
And why is it so important to take a functional and collaborative approach to airway problems, including various providers?
Speaker 1 (43:33.798)
is a team sport. Growing the jaws is a team sport. It is not a one-person-can-do-it type of job. So you're thinking about, you know, dentist that does growth and development. Then you need a myofunctional therapist. Then you might need to talk to the pediatrician about certain things that are medically related. You might need a surgeon or periodontist to do phonectomies if the general dentist doesn't offer phonectomies. You may need other specialists that, and that can be in the lactation column, that can be in the body worker column, you know, pretty much
Anyone that is in functional, integrative, or holistic medicine can be an aid or benefit to helping that child grow and develop properly.
Excellent. So tell us about the Toothpillow. You started because you saw this demand to respond to or this need of providing access to treatment, collaborative treatment to address the issue. So first, what is the Toothpillow Appliance? You mentioned oral appliances earlier to help with replacing habits. So what is the appliance and tell us about your program and the role of the appliance and treatment and how things work.
Yeah, basically, Toothpillow was founded to solve for access and affordability. I'm one of the co-founders, not the actual owner, just to be...
Thanks for the correction.
Speaker 1 (44:47.308)
Yeah, that's okay, that's okay. know, were a couple of- Chad Rasmussen and Michelle Grasmick really got this ball rolling, invited other people. And the idea was that we're using guides and myofunctional therapy and nasal hygiene in the office to treat children. going very well. Can we do this remotely? And so solving for access meant that there are so few people around the country doing this type of treatment or offering this type of treatment. What if we could build a model that could be done remotely? And so Toothpillow basically combines three things that we do in office.
people
Speaker 1 (45:16.312)
but now we're gonna do it remotely. Number one is gonna be wearing guidance appliances. So it turns out, yes, you can measure with rulers and photographs to get the right size guide to a child. So wearing a guidance appliance will help. And number two, myofunctional therapy can be done remotely. We can do it just like you and I are having this nice conversation. A child and a myofunctional therapist can do custom one-on-one sessions where they mimic and do exercises repeated back so they can get the muscles right. And then the third thing is nasal hygiene, which I even noticed on your shelf up there, you got the clear.
Nasal spray right up on your shelf behind you. Yeah, getting the right products and techniques to parents to do nasal hygiene, getting the guidance appliances to the child to wear for an hour a day plus overnight, and getting myofunctional therapy done via Zoom is a remote model which solves for access. Now, any parent can find Toothpillow.com. The website is built for education. They can learn all about us. But meanwhile, there is a tab there that says, you know, is my child the candidate? And if you click on that tab, you would then submit information.
Good stuff.
Speaker 1 (46:14.316)
We ask all the sleep breathing questions to learn about the symptoms the child might be having. But then we also have a template to upload photographs and it shows the parent like which types of photos we would need to evaluate their child. When the parent uploads that information, I screen most of the kids who come in, I'll screen them. And that when I look them over, I can see, okay, I can treat this child remotely. So they're approved for tooth pillow care or no, I can't do that. This child needs in office attention. Then we try to locate an office for that parent that is
growth and development airway focused. So we're partly a locator, but the good news is most kids do qualify for remote care between the ages of three and 12. So we solve for access with this model for most kids. Second, we solve the affordability, which once we got this rolling and beta tested and kind of put the pieces together, we recognize that this is, costs a fraction of the cost to do this remotely than it would to come in my office and do this. So the fees in the office have to sustain a brick and mortar building and run a profit, but.
When you're doing this remotely, it takes away the building. And all of a sudden, you take away the building and its expenses, we recognize that we can do this for about a quarter to a third of the pricing when we're doing it remotely. So sure enough, Toothpillow solved for access. Any parent anywhere could learn about us and decide it's a good choice for their child and pursue remote treatment. Or affordability is also a wonderful solve there. And Toothpillow exists basically to give kids an opportunity for growth and development early on.
I love it. That is so innovative, so wonderful. We have a lot of people that follow us and reach out with all sorts of different questions. But one of the biggest questions is how can I find providers like you? How can I find provider, a myofunctional therapist? How can I find providers that offer these different, this specialized care? So I'm really grateful that, that Toothpillow exists because it can serve that person no matter where they are, which I think, I think is really
wonderful. Now for our international audience, are there international options? Yeah, for tooth pillows. That's something planned in the future. I know that can be really challenging.
Speaker 1 (48:14.232)
Building the remote model exists in the United States and as well, believe we have opened up Australia as well. so depending upon, you know, all of the things that have to be done to do that, we're just going one place at a time. You know, it's a big airplane to build. I believe we're accessible in Australia right now, but we're working on other countries as well. It's just, those are slow to get together.
Well, I think we've given the listeners a lot of really really valuable information that is going to help people get started and understand I think what's most important understand the broad nature of this topic and the the need for Intercollaborative work among providers to address the issue that is there's no quick fix like just like cavities There's no quick fix to stop getting cavities or stop having any sort of medical issue. It's it's something that has to be
a holistic comprehensive model. So thank you so much for spending your time with me today and for educating all of our listeners. And if you're wondering if Toothpillow is the right option for your child, as Dr. Ben said, there is an online consultation where you can walk through to see if it's the right treatment option for you, or if you'll need to find someone in office. But from what I understand, you're able to see a lot, a lot of cases, a lot of what comes through.
Yes, yeah, we can treat about 80 % of the kids remotely. So it's a 20 % rate where we have to refer them to an office to do it because we can't do it remotely. So most kids can have a remote access availability if a parent chooses that. And remote's not for everybody either, which is fine. But at least coming through TruthPillow, we might be able to guide you in the right office near you. We know a lot of places now where they do this in the office. We'll help you find the right one.
That's wonderful. Well, I have a special offer for my listeners, my community here. You can use the code Clayton to get a free video console by a trained airway dentist with Toothpillow and $200 off the cost of Toothpillow treatment. So just visit Toothpillow.com and use that code when you set up your video consult. And thank you so much, Dr. Ben for generously providing that discount for our listeners.
Speaker 2 (50:30.734)
That is very, very kind and generous to offer that $200 off. And the information about this will be in the show notes. So the website and the code and then more information on the resources that Dr. Ben has talked about today, where you can learn more and you can review about these things. So I am so ecstatic that again, that we got to have you on here and thank you so much for taking the time. I know this is going to change a lot of lives.
Thank you very much, I appreciate it.
Thanks for joining us for another episode of Dentistry Disrupted. Thank you, Dr. N, and I'll talk with you real soon.
