March 28, 2013
Dr. Weston Price showed that cultures that change from native to modern, Western diets produce jaws with more dental crowding, crooked teeth and more cavities. Others have shown that softer foods and even bottle-feeding can also promote dental crowding. Smaller jaws can lead to smaller airways, leading to a number of health problems due to poor sleep. Here’s an interesting perspective on how modern man’s bites have changed simply by eating in a more civilized manner: using table knives and forks.
Staff writer for the New Yorker magazine Jane Kramer reviews a book by Bee Wilson, “Consider the Fork: A History of How We Cook And Eat.” On the third page of the online version, there a section where the author describes the work of American anthropologist Charles Loring Brace, who specialized in the evolution of hominid teeth. He dates the onset of the modern Western overbite at around 250 years. Prior to this human incisors lined up edge to edge, like a guillotine. Then all of a sudden, human jaws, especially in the more civilized areas (who used forks and knives to cut meat into bite-sized pieces), started to develop an overbite. This change happened too quickly to be as a result of evolution. Here’s an excerpt from Kramer’s article:
By the late eighteenth century in Europe, people were slicing their food into bite-size morsels and carrying them to their mouths with forks—those formerly weird things, Wilson calls them. And they hardly needed to chew such tiny pieces, which in most cases were already softened by pounding, overcooking, or long, gentle braisings. At the same time, the modern overbite began to appear prominently in upper-class Western European jaws. Do not confuse this with the seriously inconvenient condition known to the world as buck teeth (without which we would have no orthodontists, and no mortified adolescents with mouthfuls of rubber bands and wire braces). Wilson’s modern overbite refers to “the way our top layer of incisors hangs over the bottom layer, like a lid on a box,” as she nicely puts it, and is “the ideal human occlusion” for the way we now eat. Why this happened and how long it took to happen is open to some debate, but it’s clear that until it happened most humans had the bite of other primates—“where the top incisors clash against the bottom ones, like a guillotine blade.”
Wilson’s favorite theory comes from the American physical anthropologist Charles Loring Brace, a specialist in the evolution of hominid teeth. In 1977, Brace published an article that put the age of the Western overbite at no more than two hundred and fifty years—which is to say that flatware and, with it, a significant change in how we chewed were all it took for the edge-to-edge occlusion that we inherited from the Neanderthals to be replaced by the bite we now call normal. Brace was haunted by overbites. He had long assumed them to be an incremental and selective evolutionary change that began with agriculture and the consumption of grains. But the jaws he studied, on his way to building a database on the evolution of hominid teeth—apparently the biggest in the world—changed his mind. The transformation he’d seen in those eighteenth-century-gentlemen jaws was too abrupt, and too radical, to qualify as evolution, especially given the rapidity with which it then followed the spread of flatware into the middle classes, in the nineteenth century. In 1914, in the run-up to war with Germany, a stainless-steel alloy—developed to prevent corrosion in gun barrels—went on sale in Sheffield, England. Once stainless appeared on the country’s dinner tables, the guillotine bite all but disappeared.
There have been further significant milestones in how to eat our food, what foods we eat, as well as how we feed our children. If you think about the implications of how quickly modern humans’ jaws have changed just in the past few hundred years, it’s a frightening thought. As our faces get smaller and our brains get bigger, what will we look like in 2000 years? Here’s a thought.
What do you think about Kramer’s article?
January 23, 2013
How do two different cultures view facial features when it comes to beauty? Here’s an interesting blog by a Canadian husband and wife team (living in Korea) who make some insightful observations on how Koreans view facial beauty. In particular, they comment on the fact that native Koreans prefer a V-Line face, with narrow jaws and smaller cheekbones. They even sell facial rollers to narrow your face.
While reading this post and watching this video, I couldn’t help but to think about the airway implications with narrow jaws—the more narrow your face, the less room there is for your tongue, and the more likely you’ll have breathing problems when sleeping. There are reports of plastic surgeons performing jaw-line narrowing procedures, such as masseter muscle or jaw reduction, and even using botox to shrink the masseter muscles. There’s also a recent trend to perform maxillo-mandibular advancement procedures purely for cosmetic reasons. This procedure will actually enlarge your airways, if done properly.
Even in the United States, people’s preferences for facial beauty may be changing, with more popular celebrities having narrower faces and jawlines.
It’s surprising how far some people will go to improve their facial appearance, at the cost (unknowingly) of diminished sleep quality and accelerated aging.
What’s your perception of facial beauty? Do you prefer a round face with wide jaws, or a narrow, triangular face?
September 16, 2012
In this Expert Interview, Dr. Michael Mew gives us a talk on “Breathing and the Modern Melting Face.” Dr. Mew and his father, Dr. John Mew, are pioneers in functional orthodontics. I’m confident you’ll find it a fascinating discussion.
Download mp3 file
March 19, 2012
I was shocked and saddened to find out that my friend and colleague, Dr. Brian Palmer, recently passed away. Dr. Palmer was responsible for opening my eyes to the importance of breastfeeding and good dental hygiene when it comes to your risk of developing obstructive sleep apnea. His decades of research and teaching has educated thousands of health care professionals. I had him as a guest on my Expert Interview program twice, the last time being December, 2011. Prophetically, I do remember him telling me that his 2 hour presentation was his gift to society. You can listen to his talk on the Evolution of Malocclusion and Sleep Apnea here. His website is a valuable resource for the lay public and professionals alike.
Rest in peace, Brian.
March 7, 2012
The American Academy of Pediatrics just published a policy statement reiterating their recommendation that infants should be breastfed exclusively for 6 months. They also made this recommendation in their 2005 paper, but this time they actually quantify the health benefits.
The authors wrote that others have suggested that more than 900 infant deaths per year in the United States could be prevented if 90% of mothers breastfeed exclusively for six months. They also cited evidence that breastfeeding improves neurodevelopmental outcomes and enhances development of host defenses in infants born preterm. Other benefits include the following:
- 72% reduction in hospitalization for respiratory infections
- 64% reduction in the incidence of gastrointestinal infections
- 58% to 77% reduction in the incidence of necrotizing enterocolitis
- 36% to 45% reduction in the risk of sudden infant death syndrome
- 27% to 42% reduction in the incidence of asthma, atopic dermatitis, and eczema
- 52% reduction in the risk of celiac disease
- 31% reduction in the risk of inflammatory bowel disease
- 15% to 30% reduction in the incidence of obesity in adolescences and adulthood
- 15% to 20% reduction in the risk of childhood leukemia and lymphoma.
I’ve also proposed arguments made by dentists that bottle-feeding increases your risk of dental crowding and malocclusion. The smaller your jaws, the less airway you’ll have to breathe through properly during the day and especially at night. Notice that sleep-related breathing problems can directly or indirectly influence most, if not all the bullets listed above.
It’s also important to note that the physical act of breastfeeding itself is what protects against dental crowding and an increased risk of developing obstructive sleep apnea later in life. Obviously, exclusive breastfeeding without pumping is not practical or realistic in our society. However, you have to think about these implications.
Do you think Pediatricians are going a good job promoting breastfeeding?
December 10, 2011
Dr. Brian Palmer is an internationally recognized expert on dental malocclusion, infant feeding habits, and its’ relation to obstructive sleep apnea.
Topic: The Evolution of Malocclusion & Sleep Apnea
Guest: Dr. Brian Palmer
Length: 2 hours
Please enter your information below to register and to receive your download links for the MP3 recordings and slides:
August 5, 2011
There’s no definitive study showing that being born prematurely increases your chances of developing obstructive sleep apnea, but there are a number of papers and studies that suggest that it is possible. A recent Time Magazine article highlighted a 32% increased rate of asthma, vision problems, and hand-eye coordination in babies born between 24 to 34 weeks. They concluded that by age 17, these children had poorer health, growth and neurological issues, as compared to those born full-term.
One concept that the article mentions is the “fetal origins hypothesis,” which suggest that the stress of being born prematurely (with increased levels of cortisol) can affect various aspects of development. Interestingly, there are also numerous papers describing significantly increased rate of dental crowding, malocclusion, and craniofacial changes in pre-term infants.
What all this means is that the facial skeleton, and especially the jaws, don’t develop fully, leading to crowding of the nasal and oral cavities. Add to this the good possibility that most preemies are more likely to be bottle-fed (which can promote malocclusion). Since soft tissues like the tongue and nasal septum will grow to their normal size, the airway gets crowded, leading to an inability to breathe properly during the day and especially at night. Not sleeping well at night has been shown to significantly increase your stress hormone levels.
Knowing that these kids will be more susceptible to sleep-breathing problems, it’s important to address these issues early on to prevent the various medical complications that can occur later in life.
If you have a child that delivered prematurely, what kind of medical issues did your child have, if any?
Expert Interview: Anthropologist Dr. Robert Corruccini on Why We Have Crooked Teeth (And How This Relates To Sleep Apnea)
June 14, 2011
In this program, I interview Dr. Robert Corruccini, anthroplologist and author of How Anthropology Informs the Orthodontic Diagnosis of Malocclusion’s Causes (Edwin Mellen Press). We’re going to talk about why modern humans have crooked teeth, and how this relates to smaller jaw sizes and smaller upper airways. In particular, you’ll learn:
– When did humans begin to experience a lot of occlusal problems?
– What kind of genetic and environmental factors can cause malocclusion?
– How does Dr. Corruccini’s work compare and contrast to Dr. Weston Price’s work?
– Is it true that even a few hundred years ago, humans didn’t have as many impacted wisdom teeth?
– What are some of the health consequences of crooked teeth?
– Has modern dentistry helped or hurt our teeth and our health?
– For those of use with dental crowding already, what can we do? What can we do for our children?
Please enter your information below to receive your free MP3 link:
February 10, 2011
As a resident during otolaryngology training, I rotated in the medical center’s craniofacial clinic, seeing various disorders that lead to underdeveloped or malformed facial or skull structures. These syndromic children clearly had severely asymmetric faces or underformed jaws. In many cases they had breathing problems requiring surgery.
One of the more common conditions you’ll see in such a clinic is Pierre Robin sequence, where due to improper maturation of the lower jaw, the lower chin is recessed severely. You’ll see milder variations of this all the time, but if severe enough, these people can’t breathe, especially at night.
Treating Only The Extremes
One of the problems with modern medicine is that we name and treat only the extreme end of a continuum, or only when significant problems result. Having a slightly recessed chin may be thought of a the person’s normal facial feature, and his or her ability to breathe is never even considered.
The entire basis for my sleep-breathing paradigm is that all modern humans have constricted facial structures, not due to a congenital or genetic problem, but due to our eating and lifestyle habits. Genetically, we’re all programmed to have relatively wide jaws, with room for all your wisdom teeth. Now, that rarely ever happens. This is why obstructive sleep apnea can be described as a mild craniofacial condition that can significantly affect your upper breathing passageways.
Small Jaws, Small Airway
It seems that almost everyone these days will need braces to fix crooked teeth or narrow dental arches. Dental crowding by definition means that your upper and lower jaws are underdeveloped. This creates less total volume inside your mouth, leading to overcrowding of your tongue. Your tongue can then fall back easier when on your back, and when in deep sleep, due to muscle relaxation, you’ll stop breathing more often at night.
Even your nose can be affected by this problem. Since your nasal sidewalls follow your upper molars, the side to side distance in your nose will be more narrow, and as the roof of your mouth (nasal floor) gets pushed up, it’ll also cause your septum to buckle.
If you add additional inflammation and swelling in your nose (due to colds, allergies or nonallergic rhinitis), your nose will become stuffier faster, and even worse, your nostrils will cave in easier.
Having underdeveloped upper jaws prevents proper cheekbone fullness, giving your mid-face a sinked-in look. This type of facial appearance is so common these days that it’s almost accepted as normal. I remember reading in the New York Times a few years back where they reported that women’s preferences for male actors has changed from the classic square-faced, angular facial features, to softer, more feminine, rounded faces.
Despite having some good first line options such as CPAP or oral appliances, these approaches don’t really address the root cause. If your child’s jaw was severely underdeveloped and your choice was either lifetime CPAP or jaw enlargement, which would you choose? What if, rather than cutting the jaws and pulling it forward, you can apply distraction plates that can be pulled slowly, little by little, to normalize the jaws and improve the airway significantly? What about advanced dental appliances that can expand your upper and lower jaws in three dimensions, making more room for your tongue? With current technology, we can modify your jaws significantly. But for adults with obstructive sleep apnea, any kind of surgical or dental modification of the jaws is only considered as a last resort.
I describe obstructive sleep apnea as the end extreme of a continuum of sleep-breathing disorders. Similarly, if you look at obstructive sleep apnea as being a craniofacial problem, everyone will have various degrees of jaw underdevelopment. If you have impacted molars, or had to have your wisdom teeth taken out, then your breathing passageways are compromised.
Not only are your jaws more narrow, but the soft tissues that line your breathing passageways will be much more likely to become inflamed and cause even further obstruction. Frequent obstructions can cause a vacuum effect in your throat which literally suctions up your normal stomach juices into your throat, promoting more inflammation and swelling. These juices (which include acid, bile, digestive enzymes and bacteria) can then also reach your nose, sinuses, ears and even your lungs, causing additional inflammation and swelling. If your nose is stuffy, then a vacuum effect is created downstream in your throat and the tongue can fall back much easier, whenever you’re in deep sleep (due to muscle relaxation).
Our Airways Are Like Plumbing
In the medical community, craniofacial problems are generally treated surgically. Even with plumbing, if you only open up one area of multiple clogged areas, the pipes will still be clogged (like doing a UPPP). Sometimes you can put in drano to soften the clogging and open up the passageways (like allergy medications), but after years of buildup and accumulation, you have to physically open up all the blocked areas. You can also use a plunger to force the water down the drain (like CPAP), but you know that sooner or later, it’ll get clogged again. The older the pipes, the worse it becomes (old age).
CPAP and oral appliances are both important and necessary tools to treat the vast majority of people with sleep apnea, but we also need to open our minds to the idea that we shouldn’t have to sleep with gadgets or devices for the rest of our lives.
A Modern, Western Dilemma
It’s commonly known that our brains are getting bigger over time. As modern human’s mid and lower faces get smaller and smaller, I predict that in a few hundred to a few thousand years, everyone will be tethered to a hose while sleeping, like in the science fiction movies. Maybe vocal speech and communication will not be needed anymore, and we’ll be able to communicate with mental telepathy. We’ll all begin to look like that alien in the old Star Trek episode with the huge brain and a tiny face.
Sadly, it’s already started. If you look at the younger generations, you’ll see how narrow their dental arches are, along with flat cheekbones and narrow nasal widths. Recently, I happened to see an Amish chorus singing songs in the Grand Central subway station. I was amazed how most had very prominent cheekbones, well-formed jaws, and good looking smiles. It’s not surprising that cultures that eat organically and off the land will have more fully developed jaws.
So the next time you’re sitting in an auditorium and a public place with lots of people, think about that classic first day of college speech by the dean or president:
“Look to your left…and look to your right. At the end of this year, one of the two that you see will not be here with you.”
Similarly, every other person sitting next to you will most likely have smallish jaws, and have an undiagnosed sleep-breathing problem. From a craniofacial standpoint, they won’t be able to sleep well due to narrowed breathing passageways. If you end up befriending or marrying one of these people, now you’ll understand what makes them tick, or sick.
November 10, 2010
Here’s some good news for new moms: That women who breast-feed sleep the same amount as those who bottle-feed. This is an important issue since bottle-feeding has been shown to cause or aggravate dental crowding and malocclusions. Having smaller jaws (think smaller mouth) crowds the tongue and other soft tissues of the mouth and throat, aggravating or promoting obstructive sleep apnea.
This brings up a very sensitive issue, which implies that infants should be breast fed by using the natural breast, rather than pumping and using a bottle. Most modern women don’t have the luxury, time, or the resources to breast feed exclusively for 6 months or longer. Work schedules, caring for other children, and other demands of modern society makes breast-feeding difficult.
My feeling is that women (with spousal support) should do everything possible to breast feed, but shouldn’t feel guilty for not being able to do so. Everyone has unique circumstances, and ultimately, not everything we want to do is under our control.
What are your thoughts on this issue?