SHRINKING AIRWAYS: ORIGIN STORY AND TREATMENT OPTIONS FOR KIDS

Nov 29

7 min read

Growing evidence suggests that modern humans' jaws and airways are shrinking. These changes are believed to be influenced by a combination of evolutionary, lifestyle, nutrition, and environmental factors.

Over the past few thousand years, human jaws have become smaller. This is partly due to changes in diet starting around the Industrial Revolution. Early humans had to chew tougher, raw foods, which helped develop larger jaws and teeth. However, the need for powerful jaw muscles and larger teeth decreased as humans transitioned to cooking and processing food. As a result, over generations, human jaws have become smaller.

"Crooked teeth and poor jaw alignment were unknown to our distant ancestors. When humans were hunter/gatherers, people would not have survived without the ability to procure and eat their food. Anthropologists tell us that these problems didn’t exist until probably 10,000 years ago when agriculture was developed and cooking food to make it easier to eat became commonplace. They tell us this process of shrinking jaws was slow at first but the pace accelerated dramatically with the Industrial Revolution. That change accelerated to warp speed with the adoption of the Standard American Diet (S.A.D.) that most people consume. Pitifully few people today have well-developed faces." ~ Dr. Bill Hang, Ortho2Health

Smaller jaws can lead to narrower dental arches, which, in turn, affect the airway. A smaller jaw may reduce the space available for the tongue, leading to crowding of teeth and potentially obstructing the airway. This can cause issues such as:

Open mouth posture
Chronic mouth breathing
Chronic snoring
Upper airway resistance
Sleep apnea
Other breathing problems

SHRINKING AIRWAYS: BRACES - A RIGHT OF PASSAGE?

The rise in orthodontic treatments, such as braces, is partly due to the narrowing of jaws, which has led to misaligned teeth and bite issues. As jaws have become smaller, the teeth often lack sufficient space, leading to crowding and misalignment. These problems may not have been as common in early human populations, where people had larger jaws and wider dental arches.

The retractive nature of typical orthodontic treatment plans further exacerbates the problem. Extracting teeth, including wisdom teeth, or moving the teeth or jaws back have significant implications for airway space.

SHRINKING AIRWAYS: EARLY INTERVENTION

As with most problems, the earlier you intervene, the easier it will be! This blog will focus on expansion methods, which can be an excellent early intervention method for kids!

Our mission is to ensure every child has access to screening, evaluation, and treatment of all children's airway disorders before six years of age. If you are starting after your child is six years old, airway-focused expansion can still be of benefit!

Expansion methods help to grow the jaws, which creates more room for the teeth. If there is insufficient spacing or malocclusion in the baby teeth (primary dentition), there is no need to wait until all the adult teeth (permanent dentition) come in.

The palate is separated into two by a midline suture. The expander applies a gentle force to push the two halves away from each other to stimulate bony expansion in the midline of the palate. This type of palate expansion has been well studied and has been proven to improve nasal airway and nasal airflow. (Listen to the Airway First episode with Dr Lim to learn more!)

Working with a practitioner who utilizes various appliances can be helpful as what is best for each family and child will differ, or seeking a provider who offers the appliance that works best for your family and child. There are both fixed and removable types of appliances available on the market.

One category of expanders includes those with a screw mechanism in the middle that applies gentle pressure to the palate to stimulate bone growth at the midline suture. Some of these options include:

The rapid palate expander which consists of a central screw and two parts that attach to the back molars. Turning the screw gradually applies pressure to the two halves of the palate, which then slowly separate over time. This process encourages the bone to grow, increasing the upper jaw's width.

Dr. John Mew created the Biobloc system. The Biobloc treatment philosophy is centered around “orthotropic treatment,” which looks at the functional jaw and airway development. It's based on the idea that improving the function of the muscles around the face (like the tongue and the jaw) can guide more optimal skeletal growth to support a healthy airway. The Biobloc expander also focuses on encouraging forward development of the maxilla, as opposed to simply widening the palate.

Dr. Bill Hang designed the Hang Expander System. This system is similar to the Biobloc in that improving function supports bone development and has both a lateral and forward growth component.

The Three-way Schwartz Appliance is also similar to the Biobloc and Hang expanders. It is the most frequently used removable appliance to develop a lower arch. A slow expansion occurs by turning a small screw in the center of the appliance at home weekly. Over time, the arch will develop and grow, expanding due to the pressure provided by the Schwarz. It is typically worn for about six months and in conjunction with braces to move teeth into their final position.

Your provider may offer additional options! Be sure to discuss with your airway-focused dentist to determine what type of appliance is best for your child's case. And as always, follow your parental intuition!

Additionally, some types of appliances do not utilize a key mechanism. Some of these options include:

Advanced Lightwire Functional (ALF) is a light and flexible wire appliance that runs along the inside of the teeth. ALF treatment integrates cranial osteopathy and oro-facial myology.
The Invisalign Palate Expander uses a series of 3D-printed expanders that gradually widen to create space for adult teeth.

Imaging plays a crucial role in any treatment plan focused on the airway. Cone-beam Computed Tomography (CBCT) is a medical imaging method that employs X-rays to produce 3D images. This technique enables providers to obtain a more comprehensive view of the mouth, airway, and nasal cavity. Discover more in our CBCT blog post.

Beyond expanding the palate, having an appliance on the lower arch is also an important consideration.

“Developing both arches (even though there is no suture in the mandible) dramatically increases the amount of expansion possible and thereby maximizes tongue space/airway improvement.” ~ Dr. Bill Hang, Ortho2Health

SHRINKING AIRWAYS: PREVENTATIVE & MYOFUNCTIONAL THERAPY ADJUST RESOURCES

Myofunctional therapy serves as an excellent resource for early intervention. The principle that form follows function implies that proper movements of the tongue and facial muscles will contribute to the ideal shaping of the jaws. Engaging with a myofunctional therapist is a crucial initial step in the process of airway development.

Your myofunctional therapist may recommend additional tools to boost therapy success, or you can always ask your myofunctional therapist if you feel called to use any of these tools:

Myobrace, Vivos Guides, and Healthy Start are a series of removable intraoral appliances that are worn for one to two hours each day plus overnight while sleeping. They are myofunctional growth guidance appliances, so they encourage the muscles of the face and the tongue to function optimally, therefore supporting jaw and airway development.
Toothpillow is a platform that brings myofunctional guidance appliances like the Vivos guide or Myobrace to families that may not have access to an airway-focused dentist.
Myo Munchee is a great myofunctional therapy adjunct tool to get your child chewing more! It is shaped similarly to a mouth guard with an attached handle and is made of medical-grade silicone. (Listen to the Airway First episode on the Myo Munchee.)
The Froggy Mouth device is a passive myofunctional therapy tool that re-educates the tongue. This device will improve swallow function, oral rest posture, and orthodontic stability.
Oral motor tools like Fluxy, Talk Tools, Ark Therapeutics, and more can be great ways to integrate myofunctional therapy at home! Teether-type toys are not just for babies.
Mouth taping can be another tremendous at-home tool to promote nasal breathing when cleared by your myofunctional therapist and/or airway dentist! Myotape is a special size for kids, teens, and adults. This tape lines around the lips to support a lip seal while allowing the mouth to open if needed.

SHRINKING AIRWAYS: ADDITIONAL CONSIDERATIONS FOR OPTIMAL OUTCOMES FOR YOUR CHILD

One thing that often pops up on our Airway First podcast is that “It’s all connected!” Nothing in the body works in isolation. When utilizing a modality like airway-focused expansion, it is more important to look at it through this lens.

When encouraging the body to grow more bone through expansion. It is vital to meet the nutritional needs this may require. A diet robust in protein and fat-soluble vitamins, like A, D, E, and K, is essential to support new bone development.

Supporting the process through minerals like calcium and magnesium is crucial as well. Using nutrition to support gum health through this process can also be helpful.

Returning to the phrase “It’s all connected!” other things to consider that can be impacted by expansion (or any orthodontic treatment) are the nervous system, cranial nerves, fascia, and postural support. Bodywork can be a fantastic way to support the body through the expansion process.

Directories to find a bodywork practitioner near you:

SUPPORT IS BEST!

All of this information can certainly be overwhelming! Don’t go on the journey alone. A myofunctional therapist can be a great resource hub for you – the quarterback of the treatment team, if you will.

You can always reach out to our parent liaison, Christi, for help finding a provider and other resources for your child. You can reach Christi at christi@childrensairwayfirst.org. Sometimes, it is nice to consult with a professional as well to seek more guidance for your child's specific circumstances!