By Shirley Gutkowski, RDH, BSDH, with Timbrey Lind, RDH
Recently, Timbrey and her baby son visited with another young mother and her baby. The other mother looked at her sleeping little baby and commented on how cute his snoring was. Timbrey was rightfully frightened. This baby, mouth gaping, breathed noisily. Although people have become accustomed to this open mouth posture in infants, it's not normal. By breathing through his mouth, he was missing out on a laundry list of healthy hormones and may be contributing to a host of negative outcomes, ranging from failure to thrive to attention-deficit/hyperactivity disorder or obesity.
Natural breathing isn't so natural any longer. Epigenic changes have caused the maxilla and mandible to become smaller. This change was slow and gradual, so slow and so gradual that a retrognathic chin is now considered a normal development to facilitate birthing. Dr. Kevin Boyd, a pediatric dentist in Chicago, not only disagrees, he is on a mission to make sure he proves it. Studying fetal skulls he cannot find any evidence of retrognathia until industrial times. Although it may have seem a slow change, it's evolutionarily impossibly fast. Normal evolution would take 10,000 years or more to accomplish the change that has occurred in fewer than 200 years.
These epigenetic changes have removed space for the tongue and remodeled the nasal airway to make it nearly impossible to breathe through it. Just the airway issue alone makes this problem urgent to address. Mouth breathing affects brain development.
Dr. Karen Bonuck, a pediatric sleep researcher at Albert Einstein College of Medicine, has studied over 11,000 children for six years and finds that those children with sleep disordered breathing are prone to "developing behavioral difficulties such as hyperactivity and aggressiveness, as well as emotional symptoms and difficulty with peer relationships." Dr. Bonuck suggests strongly that we need to notice these sleep problems before the first birthday.
Dr. Bonuck's paper, "Pediatric Sleep Disorders and Special Educational Need at 8 Years," can be viewed online.
In dentistry, we know that structural issues contribute to sleep issues in the growing newborn. The first sign is the newborn's inability to nurse. Without nursing, the palate often never achieves its genetic potential, often becoming high and narrow. If the tongue is tethered to the floor of the mouth the tongue cannot do its job between nursings. When the infant is sleeping, the tongue should be on the palate, which is difficult if the baby is using the secondary airway to stay alive.
The alarm bell that Dr. Bonuck rings continues to peal: A history of sleep-disordered breathing through five years of age was associated with approximately 40% increased odds of special education needs. Behavioral sleep problems were associated with a 7% increased odds of needing special education with each additional 12 months of reported sleep breathing.
These findings are very expensive too. Education costs show that for every dollar spent on educating a child without a learning disability, it costs $1.90 to educate a child with a learning disability. Nearly double. Of course, dollar signs don't measure the pain and suffering of the child or the family, nor the costs of living for a person who cannot perform. This is especially problematic knowing that if airway problems are addressed earlier, piles of money could be redirected.
Leaders in dentistry are shying away from using breathing and airway terms associated with sleeping. Sleep dentists are converting to the term "airway dentists" and wondering if they should do more with anticipatory guidance for their young women patients.
We can all help by starting new conversations with new mothers or pregnant women. Not just about periodontal disease, but about how they plan on feeding their babies (and that snoring is not cute). Infant symptoms for disordered breathing are:
- Difficulty nursing
- Open mouth posture
- Frequent feeding
Symptoms in toddlers and small children are:
- Open mouth posture
- Finicky eater
- Dry lips, licking lips
- Naughtiness, crankiness
- Resistance to sleep
- Failure to thrive
- Dark circles under the eyes
Dental hygienists can network with doulas, nurse midwives, and lactation consultants to find out how they work with infants and exchange an understanding of mouth breathing.
Secondly, dental hygienists can network with myofunctional therapists to learn how to refer small and medium children for guidance to keep their mouths closed and breathe primarily with their nose.
Thirdly, remember that the palate is the floor of the sinus, and a tied tongue and bottle feeding interfere with the natural palatal expansion. Dentists are developing a new income stream releasing tongue ties in people of any age. No longer are they satisfied with an attached tongue in a patient who can talk and eat.
Prevention is the name of the game in everything dental hygiene. We've gotten our perio protocols under control. More offices are practicing under the CAMBRA mindset, and oral cancer walks are cropping up all over the country; the airway is the next frontier. A snoring baby is not cute.
To learn more about myofunctional therapy, "like" the Academy of Applied Myofunctional Sciences on Facebook for updates, or visit aamsinfo.org for information about these issues. The AAMS meeting in Chicago during March 2017 is for all types of practitioners. RDH
Shirley Gutkowski, RDH, BSDH, is a practicing dental hygienist specializing in orofacial myofunctional therapy. Her practice, Primal Air, LLC, is in Sun Prairie, Wisconsin. Ms. Gutkowski is also the host of Cross Link Radio, a podcast with timely information integrating oral and systemic health.