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A Final Farewell to Dr. Brian Palmer

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.

The Benefits of Breastfeeding on Breathing

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?

 

Expert Interview: Dr. Brian Palmer on “The Evolution of Malocclusion & Sleep Apnea”

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

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Is Sleep Apnea Higher in Pre-Term Babies?

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)

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?

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Sleep Apnea Is A Craniofacial Problem

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.

Good News For Breast-Feeding Moms

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?

Can Bottle Feeding Increase the Risk of Sleep Apnea?

Startling News For Parents of Bottle Fed Children…

 In this hour long interview, Dr. Park talks to Dr. Brian Palmer, a former dentist who has done extensive research in the field of infant oral cavity and airway development.  In this discussion, Dr. Palmer shares shocking information as to why parents who bottle feed their children are putting them at higher risk for ADHD, obesity, not to mention sleep breathing disorders and what parents can do NOW to prevent these problems from developing later on.

Learn:

• Why bottle feeding can make your child more prone to sleep problems as adults
• How bottle fed children are more likely to perform poorly in school
• Why bottle fed children are more at risk for sleep apnea,obesity, ADHD, bed wetting and more
• What you can do NOW to prevent health problems for your bottle fed child

Register below to download and listen to this FREE recording.

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Nutritional Lessons From Africa

 

Traditional cultures in certain parts of the world practice contraception by breast-feeding. Most doctors will tell you that breast-feeding is not a reliable form of birth control. However, the way a woman breast-feeds is vastly different in the developed areas versus underdeveloped parts of Africa. 

 

In the US, most women who breast-feed on demand begin to taper off to intermittent feedings after a few months or at most 1-2 years, either supplementing with solid foods, or pumping and giving the milk through a bottle. I’ve written about how bottle-feeding is thought to aggravate dental crowding and malocclusion. 

 

In certain parts of Africa (such as in Batswana), women breast-feed on demand, with the child strapped in slings to the mother’s chest, feeding on demand until he or she becomes too heavy or becomes more independent. Typically, this lasts about 2-3 years. My patient confirmed that women would typically have 3-4 children evenly spaced over a span of 10-12 years. Repeated, short bursts of breast-feeding promotes prolactin release, which is an effective form of contraception. In developed countries, the interval between feedings lengthen over the first year, increasing the odds that pregnancy may occur.

 

He also noted that for the most part, the natives are very healthy, with few stresses, and they generally eat off the land, without too much processed foods or refined sugars. He even feels stronger and healthier when he lives and eats there. The main health problems that he sees are mainly infectious: malaria and HIV. 

 

Dr. Brian Palmer, a dentist that has spent his entire career researching the link between bottle-feeding and obstructive sleep apnea, has stated that in some areas of the world, people can’t afford infant formula, let alone regular food. The only source of nutrition for infants and toddlers is breast milk. Notice that despite the fact that the children are stick thin, they all have nice smiles and bright teeth.

 

Compare this with pictures of young children (in Dr. Weston Price’s book) who eat lots of sweets and processed foods—you’ll see crooked, stained teeth with lots of cavities, along with narrowed jaws and faces.

 

Take note of a native rural African’s jaw structure, and compare the facial width and jaw structures against multiple generation African-American faces. It’s a pretty stark difference.

Straighten Your Smile, Straighten Your Sleep: Pediatric Orthodontics to Prevent Obstructive Sleep Apnea

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