I was excited to order Jaws: The Story of a Hidden Epidemic a few months ago when it first came out, but didn’t get a chance to read it until recently. The two authors complement each other with their very different backgrounds. Dr. Sandra Kahn is a pioneering orthodontist with 22 years of practice, and Dr. Paul Ehrlich is a world-renowned evolutionary biologist. Their basic premise is that that modern humans’ jaws are shrinking, and as a result, our teeth are coming in more crooked and our airways are more crowded than ever. Inspired by the work of Dr. John Mew, they present a convincing argument that there truly is an epidemic that’s not being addressed by the orthodontic, let alone the medical community.
This book is a much more in-depth, and up-to-date description of what I described in my book, Sleep Interrupted: A physician reveals the #1 reason why so many of us are sick and tired, which was published in 2008. Coming from an orthodontic and evolutionary biology perspective, the authors add enormous value to enlightening our dental and medical colleagues (and the general public) about the enormity of this problem. One recent and welcoming trend that’s common with the age of the internet is that increased awareness by the general public can oftentimes change the way doctors and dentists practice. It can also drive more interest in research topics and funding for such projects.
The first 3 chapters cover the origins of malocclusion (crooked teeth) from a evolutionary perspective. In particular, they go into great detail about George Catlin’s book, Shut Your Mouth and Save Your Life. Catlin was a civil war era naturalist and painter, who had an interest in painting native Americans in their natural habitats. He noticed that those who kept their mouths closed had broader faces and were much healthier, whereas these who kept their mouths open hand more narrow and long faces, and were much more prone to illnesses. You can see many of his paintings at the Smithsonian museum. They also note that many paleontologists have demonstrated that ancient skulls usually have very good teeth and essentially no dental crowding. No book talking about shrinking faces and smaller airways is complete without mentioning Dr. Weston Price’s classic book, Nutrition and Physical Degeneration. Price was a dentist who traveled the world in the early 1900s, showing that across the board, cultures that ate naturally without modern Western influences had broad dental arches with a full set of teeth, beautiful smiles, and essentially no cavities.
Dr. Brian Palmer, who was my original inspiration and mentor in this areas, documented this finding as well. Kahn and Erlich also liberally cite Dr. Robert Corrucinni, an anthropologist who found that communities with soft diets had higher rates of malocclusion (see podcast interview with Dr. Corruccini). This highlights the importance of how and what we chew determines how our faces grow. These concepts also build on one of the basic tenants of modern dentistry proposed by my medical school anatomy professor, Dr. Melvin Moss, DDS, who proposed the functional matrix hypothesis, which states that facial bone growth is not only influenced by your genes, but also the forces around your jaws, including direction and intensity of muscle forces, as well air pockets surrounding the bones. They finish the introductory chapters with many convincing arguments that there is an epidemic of shrinking faces (and airways) in modern humans, and that there are strong associations with numerous chronic health conditions in the United States.
Chapter 4 delves into how the perception of facial beauty is directly influenced by how well your facial bones develop. It’s no wonder that for the most part, elite athletes have relatively “attractive” faces which stem from more fully developed facial structures and dental development. This leads to more optimal breathing during the day as well as at night, potentially leading to higher levels of endurance or physical abilities. Jaws makes it clear that crooked teeth are only the tip of the iceberg, and not just a cosmetic problem. With an estimated 50 to 70% of children in the US needing braces, this truly is an epidemic that’s hidden under the surface of our medical and dental system’s level of awareness.
Chapter 5 covers early development and oral posture, and how poor development can lead to facial and airway underdevelopment. Bottle-feeding, thumb-sucking, pacifier use, eating soft diets and poor tongue-lip and mouth postures are all potential sources of contribution to our facial shrinking epidemic.
The next chapter brings everything together to culminate in the end result, or the tip of the iceberg called obstructive sleep apnea. Here the authors bring up Dr. Robert Sapolsky’s analogy of the stress response that’s created when a zebra is being chased by a tiger. People with obstructive sleep apnea react physiologically like they are being chased by a tiger all the time, especially when they have breathing obstructions during sleep. Over time, chronic obstructive sleep apnea has been strongly linked to a myriad of health conditions including ADHD, memory problems, heart disease, heart attack, stroke, cancer, sexual dysfunction, and car accidents. The chapter ends with a cursory discussion about jaw surgery (maxillomandibular advancement), uvulopalatopharyngoplasty, tonsillectomy, and CPAP. Disappointingly, there’s no mention of mandibular advancement devices, which are a mainstream alternative to CPAP for mild to moderate sleep apnea, and recommended by the American Academy of Sleep Medicine.
The following chapter (What Can You Do?) describes the fundamental of proper nasal breathing, optimal chewing, and good body posture. In particular, Buteyko Breathing and Good Oral Posture Exercises (GOPex) are described in detail.
The penultimate chapter describes Dr. Kuhn’s philosophy in treating airway disorders with orthotropics (developed by Dr. John Mew in the UK and promoted in the US by Dr. Bill Hang. Listen to interviews with Dr. Michael Mew and Dr. Bill Hang). Orthotorpics (also called forwardontics) is compared to other fields such as orthodontics and dental orthopedists. It’s not surprising that mandibular advancement devices are not mentioned, since orthotropics is fundamentally different from mandibular advancement devices in the way they work. Additionally, orthotropics is available only for children, whereas mandibular advancement devices are indicated for adults only.
The final chapter concludes with a passionate plea for the general dental community to open their eyes to the importance of the airway as they treat patients for routine dental problems. They also advocate for more cross-collaboration between dental, medical and allied health fields, such as myofunctional therapists. Finally, they also are calling on all medical professionals and legislators to place higher value on oral health and screening for breathing-related sleep disorders.
This book is a valuable addition to a recent surge in books with similar messages, such as Your Jaws – Your Life, Gasp!, Six-Foot Tiger, Three Foot Cage, and the Dental Diet. It’s an excellent review of what causes crooked teeth and narrowed upper airways, leading to a range of chronic conditions, such as headaches, fatigue, weight gain, anxiety, TMJ, as well as complications of untreated obstructive sleep apnea. I highly recommend this book.