1 00:00:00,000 --> 00:00:23,160 Hi everybody and welcome to another episode of Airway First, the podcast from the Children's 2 00:00:23,160 --> 00:00:24,960 Airway First Foundation. 3 00:00:24,960 --> 00:00:28,240 I'm your host, Rebecca Downing. 4 00:00:28,240 --> 00:00:35,320 My guest today is Dr. Kevin Boyd, a board-certified pediatric dentist practicing in Chicago. 5 00:00:35,320 --> 00:00:40,280 He is also an attending instructor in the Pediatric Dentistry Residency Training Program 6 00:00:40,280 --> 00:00:45,380 at Lurie Children's Hospital, where he also serves as a dental consultant to the Sleep 7 00:00:45,380 --> 00:00:47,000 Medicine Service. 8 00:00:47,000 --> 00:00:53,600 Additionally, he serves as a dental consultant to Lutheran General Hospital. 9 00:00:53,600 --> 00:00:58,480 He is a visiting scholar at the University of Pennsylvania's Museum of Anthropology, 10 00:00:58,480 --> 00:01:02,120 conducting research in anthropology and orthodontics. 11 00:01:02,120 --> 00:01:07,840 Prior to completing his DDS degree from Loyola University's Chicago College of Dental Surgery 12 00:01:07,840 --> 00:01:14,200 in 1986, he obtained an advanced degree in Human Nutrition and Dietetics from Michigan 13 00:01:14,200 --> 00:01:15,680 State University. 14 00:01:15,680 --> 00:01:20,720 He completed his postgraduate residency training in Pediatric Dentistry at the University of 15 00:01:20,720 --> 00:01:21,960 Iowa. 16 00:01:21,960 --> 00:01:26,720 We are also proud and honored to have Dr. Boyd as a member of the Children's Airway First 17 00:01:26,720 --> 00:01:28,400 Advisory Board. 18 00:01:28,400 --> 00:01:34,040 You can find out more about Dr. Boyd at dentistryforchildren.net. 19 00:01:34,040 --> 00:01:37,760 And now, here's my interview with Dr. Kevin Boyd. 20 00:01:37,760 --> 00:01:39,560 All right. 21 00:01:39,560 --> 00:01:40,640 Good morning, Dr. Boyd. 22 00:01:40,640 --> 00:01:42,640 Thanks so much for joining us on our podcast. 23 00:01:42,640 --> 00:01:44,600 Can you just call me Kevin? 24 00:01:44,600 --> 00:01:49,880 Yeah, I have a doctor of dental surgery, but I'm Kev. 25 00:01:49,880 --> 00:01:53,240 I'm a kid's dentist. 26 00:01:53,240 --> 00:01:54,760 Then Kev it is. 27 00:01:54,760 --> 00:01:55,760 All right. 28 00:01:55,760 --> 00:02:03,000 So I want to start our conversation by just jumping into, you've done a lot of research 29 00:02:03,000 --> 00:02:08,840 on the modern jaw, and I've heard you speak about Darwinian dentistry. 30 00:02:08,840 --> 00:02:17,520 So I want to talk a little bit about the differences in our jaws, our jaws versus our ancestors, 31 00:02:17,520 --> 00:02:21,360 what caused it, and why this is important to our health. 32 00:02:21,360 --> 00:02:22,640 You know, it's interesting. 33 00:02:22,640 --> 00:02:30,360 I borrowed that term, Darwinian dentistry, from Randy Nessie, who's a psychiatrist from 34 00:02:30,360 --> 00:02:32,160 the University of Michigan, now at Arizona. 35 00:02:32,160 --> 00:02:40,200 And he has had, he created George C. Williams, an evolutionary biologist in the 90s, this 36 00:02:40,200 --> 00:02:46,120 whole area of evolutionary medicine. 37 00:02:46,120 --> 00:02:54,000 So he calls Darwinian medicine, and he wrote a book called Why We Get Sick. 38 00:02:54,000 --> 00:03:01,960 And I just was inspired by him, and actually talked to him about creating a branch, if 39 00:03:01,960 --> 00:03:09,120 you will, or an offshoot, and just call it evolutionary oral medicine that specifically 40 00:03:09,120 --> 00:03:18,320 does the same thing in terms of teaching students, pre-med and medical students, and post-doc 41 00:03:18,320 --> 00:03:25,920 training residencies in all branches of medicine about evolutionary explanations for why we 42 00:03:25,920 --> 00:03:32,560 get sick, the title of Nessie's book, and why do mouths get sick? 43 00:03:32,560 --> 00:03:33,840 Why do we get cavities? 44 00:03:33,840 --> 00:03:35,280 Why do we get gum disease? 45 00:03:35,280 --> 00:03:40,560 Why do we have crooked teeth and poorly formed jaws? 46 00:03:40,560 --> 00:03:44,720 So that's kind of where that came from. 47 00:03:44,720 --> 00:03:54,520 And I've since learned things by looking at skulls, mainly from the University of Pennsylvania's 48 00:03:54,520 --> 00:04:03,240 Museum of Anthropology and Archaeology, studying with Mariana Evans, who is, she was in the 49 00:04:03,240 --> 00:04:10,360 orthodontic department with her, joined as a visiting scholar at Penn. 50 00:04:10,360 --> 00:04:17,760 And we x-rayed with cone beam, three-dimensional scans in her private practice. 51 00:04:17,760 --> 00:04:23,200 We would take skulls out of the museum very carefully with permission and x-ray them and 52 00:04:23,200 --> 00:04:32,320 then compare them, the numbers that we use, it's called cephalometrics, of how orthodontists 53 00:04:32,320 --> 00:04:40,160 and other dental practitioners who provide orthodontic services to patients, they use 54 00:04:40,160 --> 00:04:41,160 those as norms. 55 00:04:41,160 --> 00:04:47,760 Well, the norms, normative values for the lines and angles and how the face should be 56 00:04:47,760 --> 00:04:58,320 shaped and the jaw should grow are based upon a bunch of Caucasians from Cleveland area 57 00:04:58,320 --> 00:05:10,440 and in other places by a couple of guys, Steiner and Downs and later a guy named the Bolton 58 00:05:10,440 --> 00:05:14,360 Brush norms, it's called from Case Western. 59 00:05:14,360 --> 00:05:21,200 So we wanted to compare what we were getting on all of these people who died before the 60 00:05:21,200 --> 00:05:29,360 Industrial Revolution in the 18th and 19th century and to come up with an anthropologically 61 00:05:29,360 --> 00:05:33,200 correct base for looking at skulls. 62 00:05:33,200 --> 00:05:36,560 So that's how it all started for me. 63 00:05:36,560 --> 00:05:37,560 Okay. 64 00:05:37,560 --> 00:05:38,560 Okay. 65 00:05:38,560 --> 00:05:41,200 And what did you end up finding? 66 00:05:41,200 --> 00:05:44,480 I mean, there's obviously a vast difference, correct? 67 00:05:44,480 --> 00:05:45,480 Yeah. 68 00:05:45,480 --> 00:05:51,160 And it's not, Mariana Evans and I, you know, we've worked really hard and long. 69 00:05:51,160 --> 00:05:57,480 In eight or nine years now, we've been doing this and it's really informed the way we practice, 70 00:05:57,480 --> 00:06:01,640 but there's other people who've done this. 71 00:06:01,640 --> 00:06:08,480 Jerry Rose is a dental anthropologist at the University of Arkansas where I am an adjunct 72 00:06:08,480 --> 00:06:16,240 assistant professor there working in dental anthropology with some of the graduate students. 73 00:06:16,240 --> 00:06:21,640 And he's the one with Rick Robly who's North of Doniston, Arkansas, they worked together 74 00:06:21,640 --> 00:06:24,040 and wrote a paper. 75 00:06:24,040 --> 00:06:30,200 And what they discovered is that our jaws in the last, you know, maybe a couple hundred 76 00:06:30,200 --> 00:06:34,360 years, that sounds like a long time, doesn't it? 77 00:06:34,360 --> 00:06:37,320 But considering it, but it's really not, well, it's really not. 78 00:06:37,320 --> 00:06:42,920 And what we call modern humans or anatomically modern humans have been around for at least 79 00:06:42,920 --> 00:06:51,000 250,000 years and, you know, in order to survive childhood, you had to have perfect jaws. 80 00:06:51,000 --> 00:06:58,240 The foundation for, you know, getting out of childhood was, you had to have that. 81 00:06:58,240 --> 00:07:00,800 So it's in our genome. 82 00:07:00,800 --> 00:07:06,000 But in the last couple hundred years, since the Industrial Revolution, jaws have gotten 83 00:07:06,000 --> 00:07:07,000 narrower. 84 00:07:07,000 --> 00:07:13,560 They've gotten further back, retrusive, and they've gotten longer. 85 00:07:13,560 --> 00:07:14,560 Okay. 86 00:07:14,560 --> 00:07:16,440 So our faces have gotten longer. 87 00:07:16,440 --> 00:07:18,840 Our jaws have gotten narrower. 88 00:07:18,840 --> 00:07:21,720 And our faces have gone backwards. 89 00:07:21,720 --> 00:07:24,920 So we call that, you know, retronathia. 90 00:07:24,920 --> 00:07:27,920 There's three dimensions on how you look at a face. 91 00:07:27,920 --> 00:07:30,080 And one is that they're transverse. 92 00:07:30,080 --> 00:07:31,680 The other one is length. 93 00:07:31,680 --> 00:07:33,920 That's sagittal, front to back. 94 00:07:33,920 --> 00:07:36,280 And then the other is height or vertical. 95 00:07:36,280 --> 00:07:37,280 Okay. 96 00:07:37,280 --> 00:07:40,960 So that's kind of, we've confirmed that. 97 00:07:40,960 --> 00:07:47,720 That was a hypothesis that had been laid down really in the 50s and 60s. 98 00:07:47,720 --> 00:07:56,000 First that I know of by Dr. John Mu, who was North of Doniston, England, who went into 99 00:07:56,000 --> 00:08:00,960 the British Museum and looked at old Roman skulls and came up with what he called the 100 00:08:00,960 --> 00:08:08,240 orthotropic, which just means correct growth or optimal for health growth and optimal for 101 00:08:08,240 --> 00:08:09,240 aesthetics. 102 00:08:09,240 --> 00:08:13,920 And he developed the first hypothesis and published on it. 103 00:08:13,920 --> 00:08:15,320 I learned from him. 104 00:08:15,320 --> 00:08:20,680 I went to England a couple of times and stayed with him and went to his clinic. 105 00:08:20,680 --> 00:08:29,600 And Bill Hang is another sort of apprentice, if you will, of John Mu, who's taken it in 106 00:08:29,600 --> 00:08:39,400 really provided lots of support for Mu's orthotropic hypothesis and also trained many, I'm a pediatric 107 00:08:39,400 --> 00:08:47,480 dentist, but many orthodontists in general dentists are educated by Mu and Hang. 108 00:08:47,480 --> 00:08:51,480 That's the broadest space of people who are doing this. 109 00:08:51,480 --> 00:08:52,880 We're doing this. 110 00:08:52,880 --> 00:08:59,040 And then so the Industrial Revolution, how specifically did that impact our jaws? 111 00:08:59,040 --> 00:09:03,000 What happened there that's causing everything to get smaller? 112 00:09:03,000 --> 00:09:11,160 Well, we think, and the hypothesis that we've laid out, speculation, if you will, is that 113 00:09:11,160 --> 00:09:20,640 it seems to coincide with women entering into the workforce, the textile mills and coal 114 00:09:20,640 --> 00:09:21,640 mines. 115 00:09:21,640 --> 00:09:25,280 And what did that mean? 116 00:09:25,280 --> 00:09:33,800 Well, an ancestral pattern of nursing and weaning that went on pretty much for our entire 117 00:09:33,800 --> 00:09:42,000 existence as anatomically modern humans over 250,000 years was that a baby newborn was 118 00:09:42,000 --> 00:09:48,480 immediately breastfed on demand for up to 10 to 12 months of age, maybe exclusively, 119 00:09:48,480 --> 00:09:52,960 but certainly the first six, eight months, all they had was breast milk or they died. 120 00:09:52,960 --> 00:10:02,160 Well that helped build, what I say is, a baby's tongue starting in utero really about 20 121 00:10:02,160 --> 00:10:07,080 weeks is responsible for building itself a home to live in for the rest of its life. 122 00:10:07,080 --> 00:10:11,120 And that's called the hard palate, the roof of the mouth. 123 00:10:11,120 --> 00:10:19,760 So in about 16 to 20 weeks of age, a baby will start chewing amniotic fluid with their 124 00:10:19,760 --> 00:10:23,720 gums and their tongue will be pressing up on the roof of their mouth and pushing their 125 00:10:23,720 --> 00:10:25,240 faces out. 126 00:10:25,240 --> 00:10:32,800 We've got, you know, pre-industrial specimens of fetuses that were still born and their 127 00:10:32,800 --> 00:10:36,400 jaws, mandibles, everything is forward. 128 00:10:36,400 --> 00:10:39,000 So this probably starts in the womb. 129 00:10:39,000 --> 00:10:44,560 You know, there's no way you can go back in time and prove that, but as a proxy, we look 130 00:10:44,560 --> 00:10:52,440 at these four or 500,000 year old fetuses that their jaws are both forward, the lower 131 00:10:52,440 --> 00:10:57,280 jaw, and if you look at, if you have kids and you look at an ultrasound of your own 132 00:10:57,280 --> 00:11:04,920 child when 18 to 22 weeks old, many children have chins that are way recessed. 133 00:11:04,920 --> 00:11:10,640 And that's something we're really interested that this problem could start in the womb. 134 00:11:10,640 --> 00:11:16,760 When we think of an ancestral mother carrying a child, well, you know, she was hunting, she 135 00:11:16,760 --> 00:11:21,440 was gathering and she was walking around, she was breathing through her nose or she 136 00:11:21,440 --> 00:11:22,960 wouldn't be alive. 137 00:11:22,960 --> 00:11:28,760 And some of those, you know, we talk about nutrients, vitamins and minerals, and, you 138 00:11:28,760 --> 00:11:31,640 know, they were eating natural unprocessed food. 139 00:11:31,640 --> 00:11:33,280 That's all there was. 140 00:11:33,280 --> 00:11:38,080 And the placenta was delivering that to the baby, but the placenta was also delivering 141 00:11:38,080 --> 00:11:45,040 nasally inspired oxygen from the mother, which probably helped not just the long bones grow. 142 00:11:45,040 --> 00:11:51,160 I mean, you hear of premature babies that they're short for their gestational age, 143 00:11:51,160 --> 00:11:56,880 their low birth weight, some of the term, none of that, a baby just wouldn't survive 144 00:11:56,880 --> 00:12:03,200 if they weren't really well developed as a, you know, during their gestation fetal life. 145 00:12:03,200 --> 00:12:07,960 So oxygen is a nutrient. 146 00:12:07,960 --> 00:12:11,880 And that's the one that, that's the really the only one that the mother has priority 147 00:12:11,880 --> 00:12:18,440 for the growing fetus gets all the vitamins and what's left over the mom gets, but not 148 00:12:18,440 --> 00:12:19,440 oxygen. 149 00:12:19,440 --> 00:12:25,360 And it's just the analogy I think is on an airplane when the flight attendant says, you 150 00:12:25,360 --> 00:12:29,640 know, if you're traveling with a child in the event of loss of cabin pressure, put the 151 00:12:29,640 --> 00:12:33,360 mask on yourself first and then help your child. 152 00:12:33,360 --> 00:12:37,840 Because you pass out, you can't help your kid, you're both going to die. 153 00:12:37,840 --> 00:12:45,200 And it's the same sort of thing that, and that's a speculation that Mariana and I have 154 00:12:45,200 --> 00:12:48,680 developed that we really think. 155 00:12:48,680 --> 00:12:53,960 And there's a, there's a entity that you see in some of the obstetric gynecology journals 156 00:12:53,960 --> 00:12:57,040 called gestational apnea. 157 00:12:57,040 --> 00:13:02,840 It's like gestational diabetes or hypertension that a woman who's not sleeping and breathing 158 00:13:02,840 --> 00:13:12,000 well during pregnancy can really rob her baby of that vital nutrient oxygen that is required 159 00:13:12,000 --> 00:13:15,800 for them, you know, to grow right in the womb. 160 00:13:15,800 --> 00:13:19,360 And then it continues once they're born. 161 00:13:19,360 --> 00:13:24,920 So then if I'm understanding this, the industrial revolution, there's kind of this perfect storm 162 00:13:24,920 --> 00:13:25,920 happening. 163 00:13:25,920 --> 00:13:33,600 So women going into the workforce means we're not breastfeeding like we were. 164 00:13:33,600 --> 00:13:39,040 So that jaw development exercise isn't happening in newborns. 165 00:13:39,040 --> 00:13:45,240 We're eating processed foods or our nutrients are changing as well as everything is softer. 166 00:13:45,240 --> 00:13:51,120 And is that somehow also leading to that third trifecta of suddenly we're becoming mouth 167 00:13:51,120 --> 00:13:53,520 breathers instead of nasal breathers? 168 00:13:53,520 --> 00:13:59,160 Yeah, there's a, there's a, there's a lot to unpack there, but you've made, yeah, we've 169 00:13:59,160 --> 00:14:02,640 connected the dots and I'm impressed. 170 00:14:02,640 --> 00:14:08,280 Because it is that, you know, women, I mean, if they weren't too exhausted when they got 171 00:14:08,280 --> 00:14:13,920 home from a 14 hour day in the textile mill, maybe they could, you know, do some breastfeeding. 172 00:14:13,920 --> 00:14:19,880 But in that created the necessity of infant formulas and giving cows milk. 173 00:14:19,880 --> 00:14:28,400 And now we know that cows milk has maybe four vital oligosaccharides, they're sugars that 174 00:14:28,400 --> 00:14:30,320 stimulate the immune system. 175 00:14:30,320 --> 00:14:33,720 Human milk has maybe 200. 176 00:14:33,720 --> 00:14:40,600 So but they, we had the substance and that's, you know, the baby formulas, the purees, the 177 00:14:40,600 --> 00:14:45,640 slop, and, you know, a mom, if she, if the formula hadn't been advantage yet and the 178 00:14:45,640 --> 00:14:50,440 mom wasn't there to breastfeed, they could hire a lactating woman from the village called 179 00:14:50,440 --> 00:14:56,080 a wet nurse that doesn't have any commitment, you know, biologically to, you know, to a 180 00:14:56,080 --> 00:14:59,760 baby that they're hired, you know, to, to nurse. 181 00:14:59,760 --> 00:15:08,840 So it's a combination of, you know, abandoning 250,000 years of what ancestral patterns of 182 00:15:08,840 --> 00:15:14,960 nursing and weaning nursing on demand for about three years or four years into, into 183 00:15:14,960 --> 00:15:21,240 the third or fourth year of life on demand continued, but exclusive breastfeeding usually 184 00:15:21,240 --> 00:15:24,240 was done by 10, 12 months. 185 00:15:24,240 --> 00:15:30,800 And then the kid was eating every solid that every adult was eating, or they didn't survive. 186 00:15:30,800 --> 00:15:35,080 When we were hunter-gatherers, we had to move around, you know, maybe every two to three 187 00:15:35,080 --> 00:15:36,080 months. 188 00:15:36,080 --> 00:15:42,280 And if a baby needed to have their food finally chopped up in pure aid, sorry, you know, we 189 00:15:42,280 --> 00:15:43,280 can't do that. 190 00:15:43,280 --> 00:15:44,280 Right. 191 00:15:44,280 --> 00:15:49,880 There's, they're, they're all hypotheses there, but there's lots of support for them 192 00:15:49,880 --> 00:15:54,760 in the anthropological literature on, you know, unfortunately, this isn't really in 193 00:15:54,760 --> 00:16:01,080 medical textbooks yet and dental textbooks, but it will be, it absolutely will be. 194 00:16:01,080 --> 00:16:02,080 It's time has come. 195 00:16:02,080 --> 00:16:03,080 Got it. 196 00:16:03,080 --> 00:16:04,080 Got it. 197 00:16:04,080 --> 00:16:09,480 So there's, there's really two follow-up questions I want to make sure we cover. 198 00:16:09,480 --> 00:16:16,160 The first of which is, okay, so now we know we can prove we're not necessarily 100% sure 199 00:16:16,160 --> 00:16:21,560 why we have hypothesis, but we know the jaws are getting smaller and smaller and smaller. 200 00:16:21,560 --> 00:16:24,640 So how is this impacting children? 201 00:16:24,640 --> 00:16:27,680 Where are you seeing this in the world of dentistry? 202 00:16:27,680 --> 00:16:34,040 Well, again, it's, you know, you just grow up and the food is processed and, you know, 203 00:16:34,040 --> 00:16:40,280 it doesn't require a lot of effort of chewing and, you know, like it starts in early childhood. 204 00:16:40,280 --> 00:16:47,440 Well, it also, that means that the jaws, the upper jaw, when connected to the back of the 205 00:16:47,440 --> 00:16:52,040 upper jaw, to the heart palate is the soft palate. 206 00:16:52,040 --> 00:17:00,160 And if the upper jaw is too far back, that soft palate can be closer to the back of the 207 00:17:00,160 --> 00:17:01,600 airway where the adenoids are. 208 00:17:01,600 --> 00:17:03,960 It's a throat tonsil, right? 209 00:17:03,960 --> 00:17:07,560 And that can make it difficult to breathe. 210 00:17:07,560 --> 00:17:12,000 If the lower jaw is back, and if they're both back, well, that means the base of the tongue 211 00:17:12,000 --> 00:17:16,760 which lives in the floor of the lower jaw, the mandible, that's close to the back of 212 00:17:16,760 --> 00:17:19,920 the throat, what we call the hypo or laryngeal pharynx. 213 00:17:19,920 --> 00:17:22,760 Pharynx just means throat. 214 00:17:22,760 --> 00:17:31,120 And what will happen is the child will switch the natural mode of respiration, which is through 215 00:17:31,120 --> 00:17:32,120 the nose. 216 00:17:32,120 --> 00:17:37,480 I mean, that's really how we're designed, how mammals are designed to breathe. 217 00:17:37,480 --> 00:17:39,800 And they'll gradually go to mouth breathing. 218 00:17:39,800 --> 00:17:46,440 Well, there's a guy named Christian Guimineau from Stanford who really identified that children 219 00:17:46,440 --> 00:17:53,600 can get obstructive sleep apnea, not just adults in 1976, I believe it was. 220 00:17:53,600 --> 00:17:59,720 But his hypothesis was that the adenoid, that throat tonsil, it's a big bump right 221 00:17:59,720 --> 00:18:08,920 here, soft, hard palate, is that what happens is kids gradually start mouth breathing for 222 00:18:08,920 --> 00:18:10,480 a number of reasons. 223 00:18:10,480 --> 00:18:18,240 Well, when that happens, you get pathogens from the air coming in, and the nasal sinuses 224 00:18:18,240 --> 00:18:23,360 which when you breathe through your nose, you kill all that stuff, and you warm and 225 00:18:23,360 --> 00:18:29,680 humidify the air, and you also release something called nitrogen oxide, which opens up a lot 226 00:18:29,680 --> 00:18:34,480 of blood vessels and facilitates oxygen getting into the bloodstream and to the heart of the 227 00:18:34,480 --> 00:18:35,480 brain. 228 00:18:35,480 --> 00:18:41,840 Well, that gradually, as kids start to mouth breathe more, and their jaws get further back, 229 00:18:41,840 --> 00:18:48,120 then the adenoids start to grow, and that just exacerbates, makes it worse. 230 00:18:48,120 --> 00:18:57,560 And the general theory that's accepted in most medical textbooks is that the enlarged 231 00:18:57,560 --> 00:19:02,200 throat tonsil, adenoid, is what causes the mouth breathing. 232 00:19:02,200 --> 00:19:08,840 And it's sort of like, you know, maybe not, and this is my hypothesis. 233 00:19:08,840 --> 00:19:13,480 So gradual nasal disuse is what he called it. 234 00:19:13,480 --> 00:19:15,680 And then, you know, the face will get long. 235 00:19:15,680 --> 00:19:21,520 In fact, that medical profession calls a kid with a long face, you know, and dark bags 236 00:19:21,520 --> 00:19:24,560 on the eyes, they call it an adenoid face. 237 00:19:24,560 --> 00:19:25,560 Adenoid face. 238 00:19:25,560 --> 00:19:29,800 Long face syndrome. 239 00:19:29,800 --> 00:19:36,720 And that's all from mouth breathing, because as you breathe, it impacts your face. 240 00:19:36,720 --> 00:19:39,800 It influences the way your face will develop. 241 00:19:39,800 --> 00:19:42,040 And your face is connected to what? 242 00:19:42,040 --> 00:19:43,040 Your airway. 243 00:19:43,040 --> 00:19:47,880 Now, we say the back of the face is the airway, or the front of the airway is the face. 244 00:19:47,880 --> 00:19:54,800 So, you know, the position and shape of your face is sort of a proxy for what your primary 245 00:19:54,800 --> 00:19:56,960 mode of respiration is. 246 00:19:56,960 --> 00:19:59,880 It's not 100%, but it gives you an indication. 247 00:19:59,880 --> 00:20:01,880 There's things we can look at. 248 00:20:01,880 --> 00:20:04,600 So, okay. 249 00:20:04,600 --> 00:20:10,160 So then it's impacting the way that children are breathing. 250 00:20:10,160 --> 00:20:14,880 And is it this new pattern of breathing, the mouth breathing? 251 00:20:14,880 --> 00:20:19,240 Is that what's impacting their development physically and mentally? 252 00:20:19,240 --> 00:20:21,000 Yeah, absolutely. 253 00:20:21,000 --> 00:20:26,080 You know, like I said, how often should you breathe through your mouth? 254 00:20:26,080 --> 00:20:34,680 And you know, my colleague, Karen, in Grand Rapids says as often as you eat with your 255 00:20:34,680 --> 00:20:36,280 nose, okay? 256 00:20:36,280 --> 00:20:45,080 So you don't eat with your nose unless you're tube fed in a hospital or, but no, you know, 257 00:20:45,080 --> 00:20:46,080 nose breathing. 258 00:20:46,080 --> 00:20:51,680 Your tongue should always be in the roof of your mouth, except when you're eating. 259 00:20:51,680 --> 00:20:55,040 You know, and our ancestors used to eat and chew all day long. 260 00:20:55,040 --> 00:20:59,560 So the tongue spent a lot of time on the lower jaw developing it along when they weren't 261 00:20:59,560 --> 00:21:05,120 eating, that, you know, talking and forming consonants and click sounds. 262 00:21:05,120 --> 00:21:08,040 Our ancestors in Africa talked with flicks. 263 00:21:08,040 --> 00:21:10,920 And if they couldn't do that, you know, they died. 264 00:21:10,920 --> 00:21:12,760 It's a survival mechanism. 265 00:21:12,760 --> 00:21:13,760 Right. 266 00:21:13,760 --> 00:21:22,160 So chewing and breathing through the nose, they develop both jaws and, but the tongue 267 00:21:22,160 --> 00:21:26,600 at rest should never be anywhere but in the roof of the mouth. 268 00:21:26,600 --> 00:21:32,480 So how does breathing through your mouth though impact just so people understand? 269 00:21:32,480 --> 00:21:36,880 How does that impact your brain and a child's brain development? 270 00:21:36,880 --> 00:21:42,880 Well, the same thing is that you have to breathe in a lot more air when you're doing it through 271 00:21:42,880 --> 00:21:49,560 your mouth to get it, you know, sufficient quantity, 100 milligrams percent to your brain. 272 00:21:49,560 --> 00:21:53,640 You know, you have to, you have to breathe over breathe or breathe faster, take in more 273 00:21:53,640 --> 00:22:00,320 volume of it, which coincides with systemic inflammation, nose breathing. 274 00:22:00,320 --> 00:22:06,000 Again, the most powerful antioxidant on the planet is nitrogen oxide. 275 00:22:06,000 --> 00:22:09,280 And you know, that's in the lining of your sinuses. 276 00:22:09,280 --> 00:22:13,040 So when you breathe through your nose, you've heard of something called turbinates. 277 00:22:13,040 --> 00:22:17,160 Turbine is the root word like, like in a jet engine. 278 00:22:17,160 --> 00:22:21,840 It causes turbulent of the air, which is a catalyst. 279 00:22:21,840 --> 00:22:28,240 It sparks the release and formation of nitrogen oxide in the sinus lining. 280 00:22:28,240 --> 00:22:36,240 It's L-Arginine is amino acid that is released and turned into pre-nitric oxide synthase, 281 00:22:36,240 --> 00:22:37,240 which makes us. 282 00:22:37,240 --> 00:22:41,960 And it kills, it's an antioxidant, it's an antimicrobial. 283 00:22:41,960 --> 00:22:47,680 And then plus from nasally inspired air, it warms it to your body temperature. 284 00:22:47,680 --> 00:22:54,600 The ambient air is maybe 70 degrees, unless you're in a rainforest and it's not humidified. 285 00:22:54,600 --> 00:22:57,280 I mean, our bodies are like three quarters of water. 286 00:22:57,280 --> 00:23:06,000 Well, the dry, cold, dirty air gets warmed, humidified, chemically filtered and mechanically 287 00:23:06,000 --> 00:23:07,000 filtered. 288 00:23:07,000 --> 00:23:15,400 So that delivers much more efficiently oxygen first to the heart in the hepatic portal system 289 00:23:15,400 --> 00:23:16,400 we call it. 290 00:23:16,400 --> 00:23:19,960 You know, it's cleaned by the liver and then it goes to the heart and it goes to the brain 291 00:23:19,960 --> 00:23:26,960 and you're getting, you know, this beautiful, efficient delivery of oxygen that, you know, 292 00:23:26,960 --> 00:23:29,560 and it can impact the way a brain grows. 293 00:23:29,560 --> 00:23:38,360 And, you know, gray matter, Dr. Gosal and his wife have published on this and said, you 294 00:23:38,360 --> 00:23:45,720 know, the cortex of the brain is affected by mouth breathing versus nose breathing. 295 00:23:45,720 --> 00:23:53,760 And behavior, attention, intelligence can knock points of IQ off some kids if they're, you 296 00:23:53,760 --> 00:23:59,440 know, mouth breathers, habitual mouth breathers and, you know, have don't cycle normally through 297 00:23:59,440 --> 00:24:01,640 the stages of sleep. 298 00:24:01,640 --> 00:24:13,160 So that that's the whole neurological connection there to breathing. 299 00:24:13,160 --> 00:24:18,160 You were listening to Airway First with today's guest, Dr. Kevin Boyd. 300 00:24:18,160 --> 00:24:21,720 You can find out more about the Children's Airway First Foundation and our mission to 301 00:24:21,720 --> 00:24:26,920 ensure that every child has access to screening, evaluation, and treatment of all Children's 302 00:24:26,920 --> 00:24:33,760 Airway and sleep disorders before the age of six on our website at childrensairwayfirst.org. 303 00:24:33,760 --> 00:24:38,480 You can also find a ton of great resources for parents on our website, including videos, 304 00:24:38,480 --> 00:24:44,640 blogs, recommended books, comprehensive medical research, and more. 305 00:24:44,640 --> 00:24:50,360 As a reminder, this podcast and the opinions expressed here are not a medical diagnosis. 306 00:24:50,360 --> 00:24:55,120 If you suspect your child might have an airway issue, contact your pediatric airway dentist 307 00:24:55,120 --> 00:24:57,320 or pediatrician. 308 00:24:57,320 --> 00:25:02,120 And now back to my interview with Dr. Kevin Boyd. 309 00:25:02,120 --> 00:25:05,440 Got it. 310 00:25:05,440 --> 00:25:07,440 Yeah. 311 00:25:07,440 --> 00:25:16,280 And you touched on behavioral impact. 312 00:25:16,280 --> 00:25:19,000 And I like to talk about that a little bit. 313 00:25:19,000 --> 00:25:28,080 You introduced us at CAF to the Dunedin study, which I thought was incredibly fascinating. 314 00:25:28,080 --> 00:25:32,560 So would you mind explaining a little bit of that to our listeners? 315 00:25:32,560 --> 00:25:42,240 The 1970, toward the end of 1973 and early 1974, every baby that was born at the Central 316 00:25:42,240 --> 00:25:49,960 Hospital in Dunedin, New Zealand, 1037 of them, they had funding for like a four or five-year 317 00:25:49,960 --> 00:25:57,960 study where they would follow them and do metrics on them and measure their weight and 318 00:25:57,960 --> 00:26:06,960 their, believe it or not, their dental health, their sleep, and the agility, apcar scores 319 00:26:06,960 --> 00:26:10,400 you may have heard of, but that's neurologic when a kid's born. 320 00:26:10,400 --> 00:26:12,400 But it's kind of like that. 321 00:26:12,400 --> 00:26:17,560 And they would do this periodically over two or four years. 322 00:26:17,560 --> 00:26:24,040 Well, it was going so well that they got more funding to continue it. 323 00:26:24,040 --> 00:26:28,120 Even our National Institute of Health in America invested in this. 324 00:26:28,120 --> 00:26:34,560 And now over a thousand of these babies are still participating. 325 00:26:34,560 --> 00:26:38,080 They're in their 50s, 60s, if you will. 326 00:26:38,080 --> 00:26:42,200 I don't know, do it from 73 to 50, they're in their 50s. 327 00:26:42,200 --> 00:26:46,320 But what they found is just incredible. 328 00:26:46,320 --> 00:26:50,880 I told you they took dental data while they were looking for cavities and gum disease. 329 00:26:50,880 --> 00:26:53,520 And then all the doctors looked at them at 12. 330 00:26:53,520 --> 00:26:57,880 So there wasn't really anything about the dental facial development that goes in here, 331 00:26:57,880 --> 00:27:00,120 but there was sleep. 332 00:27:00,120 --> 00:27:08,040 And one of the things that they found is that children, before the age of 11, if they demonstrated 333 00:27:08,040 --> 00:27:17,000 self-control, impulse control, and they had metrics, validated metrics to gauge this, 334 00:27:17,000 --> 00:27:22,760 they, in their 30s and 40s, looked 10 years younger. 335 00:27:22,760 --> 00:27:30,160 And I'm going to show maybe just one slide, not to you today, but of where they'd done 336 00:27:30,160 --> 00:27:36,000 composites of these babies that demonstrate the marshmallow tests. 337 00:27:36,000 --> 00:27:39,920 You've heard of that, or they'd done it like that. 338 00:27:39,920 --> 00:27:45,560 Kids who really could do that, and they didn't do the marshmallow tests, they had ways of 339 00:27:45,560 --> 00:27:50,440 estimating a child's self-control in the 70s and 80s. 340 00:27:50,440 --> 00:27:57,480 But these people, they found in this, if you just Google Dunedin study and self-control, 341 00:27:57,480 --> 00:28:03,960 what you will find is amazing, is they not only looked younger, but they were resistant 342 00:28:03,960 --> 00:28:13,960 to systemic illnesses like cardiovascular disease and type 2 diabetes and obesity, wealth management, 343 00:28:13,960 --> 00:28:20,560 attaining educational level, criminal and addictive behavior, almost non-existent in 344 00:28:20,560 --> 00:28:25,800 these kids who exhibited self-control before the age of 11, and sleep was one of the things 345 00:28:25,800 --> 00:28:27,280 that they measured. 346 00:28:27,280 --> 00:28:37,360 So I am so excited about this, and to be able to talk to parents and introduce something 347 00:28:37,360 --> 00:28:38,840 called health span. 348 00:28:38,840 --> 00:28:42,440 Everyone knows life span or life expectancy from birth. 349 00:28:42,440 --> 00:28:50,600 Well, now it's, I don't know, 78, 79, it's gone down a few because of the pandemic, but 350 00:28:50,600 --> 00:28:55,640 how long do you stay healthy into your extended lifespan? 351 00:28:55,640 --> 00:29:04,240 And the conjecture in what we're projecting from the data from the Dunedin study is that 352 00:29:04,240 --> 00:29:11,160 having this ability of self-control before the age of 11, not only projects optimistically 353 00:29:11,160 --> 00:29:16,840 for an increased life expectancy, many of these kids will probably, according to some 354 00:29:16,840 --> 00:29:23,880 of the investigators on this trial, will live to be 100 years old, and they will stay healthy 355 00:29:23,880 --> 00:29:25,400 into their extended lifespan. 356 00:29:25,400 --> 00:29:27,160 I mean, wouldn't that be the greatest? 357 00:29:27,160 --> 00:29:28,160 Wild. 358 00:29:28,160 --> 00:29:34,520 95, get sick one day and drop dead, you know, and be able to be healthy in your old age. 359 00:29:34,520 --> 00:29:35,680 That's health span. 360 00:29:35,680 --> 00:29:38,280 We've got to get that point across. 361 00:29:38,280 --> 00:29:45,440 And I think that's really what CAF, my contribution is going to be, to really try to raise awareness 362 00:29:45,440 --> 00:29:53,160 about the possibilities of not just building beautiful faces, but the whole thing, if a 363 00:29:53,160 --> 00:29:59,080 child can nose breathe as early in life as possible, habitually, I think it's reasonable 364 00:29:59,080 --> 00:30:05,400 to be optimistic that they're going to have a better quality of life immediately and an 365 00:30:05,400 --> 00:30:11,440 extended lifespan and health span, quality of life all the way through. 366 00:30:11,440 --> 00:30:14,400 Anyway, that's the goal. 367 00:30:14,400 --> 00:30:15,400 That's wild. 368 00:30:15,400 --> 00:30:16,400 I love this study. 369 00:30:16,400 --> 00:30:21,200 Yeah, and I'll make sure to include a link in our show notes as well so people can check 370 00:30:21,200 --> 00:30:25,640 it out because it really is, it's fascinating, absolutely fascinating. 371 00:30:25,640 --> 00:30:33,040 So when we're talking about smaller jaws and children, at least in my conversations at 372 00:30:33,040 --> 00:30:39,000 some point, retractive braces pop up because now, you know, over the last year, we've heard 373 00:30:39,000 --> 00:30:46,960 a lot about retractive braces and why that can be dangerous for children with undiagnosed 374 00:30:46,960 --> 00:30:47,960 airway disorders. 375 00:30:47,960 --> 00:30:52,400 So I'd like to chat a little bit about that and get your insight on that. 376 00:30:52,400 --> 00:30:57,560 You know, really, first of all, just to explain to parents what that is and why that's dangerous, 377 00:30:57,560 --> 00:30:58,800 what they should be looking for. 378 00:30:58,800 --> 00:31:11,160 Well, right away, people use interchangeably braces and orthodontia, orthodontic treatment. 379 00:31:11,160 --> 00:31:18,520 And it's really the American Association of Orthodontics changed the name of their journal 380 00:31:18,520 --> 00:31:24,360 from the American Journal of Orthodontics to the American Journal of Orthodontics and 381 00:31:24,360 --> 00:31:27,040 Dental Facial Orthopedics. 382 00:31:27,040 --> 00:31:33,840 Now dental facial orthopedics, that implies that the airway is going to be involved because 383 00:31:33,840 --> 00:31:36,280 what's the face connected to in the jaws? 384 00:31:36,280 --> 00:31:37,440 The respiratory system. 385 00:31:37,440 --> 00:31:43,960 I mean, also the auditory visual olfactory system, there's all these survival mechanisms. 386 00:31:43,960 --> 00:31:51,320 But you know, if you change in, you know, straighten teeth, well, braces implies permanent 387 00:31:51,320 --> 00:31:52,320 teeth. 388 00:31:52,320 --> 00:31:54,720 You don't put braces on baby teeth, right? 389 00:31:54,720 --> 00:31:58,720 So orthodontics doesn't start till there's permanent teeth. 390 00:31:58,720 --> 00:32:04,720 Well, usually by eight years old, a kid will have 12 permanent teeth. 391 00:32:04,720 --> 00:32:09,880 And then, oh, an orthodontist can be really aggressive and, oh, really proactive and start 392 00:32:09,880 --> 00:32:10,880 treating at eight. 393 00:32:10,880 --> 00:32:14,960 Well, I call eight years old a geriatric patient in my practice. 394 00:32:14,960 --> 00:32:22,960 You can begin optimizing the craniofacial connected to the respiratory complex. 395 00:32:22,960 --> 00:32:26,280 Mike Mu calls that craniofacial dystrophy. 396 00:32:26,280 --> 00:32:29,200 But I like to get the respiratory aspect into that. 397 00:32:29,200 --> 00:32:33,040 So I call it the craniofacial respiratory complex. 398 00:32:33,040 --> 00:32:40,720 You can start optimizing not only the form, but the function of those interconnected survival 399 00:32:40,720 --> 00:32:45,920 mechanisms, the craniofacial complex and the respiratory complex. 400 00:32:45,920 --> 00:32:52,160 You can start optimizing the hard and soft tissues, hard being bone, soft being muscles 401 00:32:52,160 --> 00:32:57,240 and vasculature and bascia, all these other tissues. 402 00:32:57,240 --> 00:32:59,200 You can start optimizing them. 403 00:32:59,200 --> 00:33:01,360 Are you ready for this? 404 00:33:01,360 --> 00:33:02,360 Yes. 405 00:33:02,360 --> 00:33:03,360 And birth. 406 00:33:03,360 --> 00:33:04,440 I mean, nursing. 407 00:33:04,440 --> 00:33:05,440 What? 408 00:33:05,440 --> 00:33:09,680 Breastfeeding is a dentifacial orthopedic appliance. 409 00:33:09,680 --> 00:33:12,440 It starts helping the tongue. 410 00:33:12,440 --> 00:33:20,520 If you watch a video that by Donna Gettys, who GEDDES in Australia at birth, she did 411 00:33:20,520 --> 00:33:27,760 ultrasounds of baby's breastfeeding and showed how the tongue, the baby's tongue will push 412 00:33:27,760 --> 00:33:33,680 against the mother's nipple up into the sutures, the fontanelles on the baby's head, the soft 413 00:33:33,680 --> 00:33:37,800 spots, those are all over your face and all over your jaws. 414 00:33:37,800 --> 00:33:43,600 And the baby's tongue will push the nipple and create a vacuum and push forward and all 415 00:33:43,600 --> 00:33:48,120 these palatal facial sutural complex, I call it, or fontanelle complex. 416 00:33:48,120 --> 00:33:56,240 They all start developing first in utero, like I said, with the action of chewing amniotic 417 00:33:56,240 --> 00:34:04,640 fluid, but then when they're born and they start nursing, and if a mom can't nurse, cupfeeding 418 00:34:04,640 --> 00:34:08,840 is better than giving an artificial nipple unless it's to save the kid's life. 419 00:34:08,840 --> 00:34:10,720 But premies can even cupfeed. 420 00:34:10,720 --> 00:34:12,680 They do that in some nurseries. 421 00:34:12,680 --> 00:34:14,240 There's studies on that. 422 00:34:14,240 --> 00:34:21,840 But introducing something called baby-led weaning, but not overly commercially processed 423 00:34:21,840 --> 00:34:25,000 foods, but stuff that kids can chew on. 424 00:34:25,000 --> 00:34:28,280 They can chew a pork chop at six, eight months of age. 425 00:34:28,280 --> 00:34:31,160 If they can sit up, they can baby-led wean. 426 00:34:31,160 --> 00:34:36,320 Well, all those things start dental facial orthopedic development. 427 00:34:36,320 --> 00:34:37,320 Okay? 428 00:34:37,320 --> 00:34:45,120 Well, then when the child has 20 teeth, and even before that, but usually by 2 1⁄2, 429 00:34:45,120 --> 00:34:49,600 24, 28 months of age, a child will have 20 teeth. 430 00:34:49,600 --> 00:34:57,840 Well, Journal of the American Medical Association, December 1922, an article by Cohen talks about 431 00:34:57,840 --> 00:35:07,800 how 30 to 32 months of age is the ideal time to start palatal expansion in a child for respiratory 432 00:35:07,800 --> 00:35:12,600 advantage, not for straightening teeth, for respiratory advantage. 433 00:35:12,600 --> 00:35:13,600 Wow. 434 00:35:13,600 --> 00:35:14,600 1922. 435 00:35:14,600 --> 00:35:15,600 1922. 436 00:35:15,600 --> 00:35:21,600 And I'll send a link to that article, or you can download it and anybody can read it. 437 00:35:21,600 --> 00:35:23,440 Well, David put it in the show notes. 438 00:35:23,440 --> 00:35:26,680 It's not random controlled trials. 439 00:35:26,680 --> 00:35:30,400 You didn't have evidence-based medicine until after World War II. 440 00:35:30,400 --> 00:35:33,520 They were observational trials, like Einstein. 441 00:35:33,520 --> 00:35:37,920 He didn't discover relativity not by doing a random controlled trial. 442 00:35:37,920 --> 00:35:38,920 It was a thought experiment. 443 00:35:38,920 --> 00:35:45,560 He was riding his bike and the turn into the last century, and imagined himself overcoming 444 00:35:45,560 --> 00:35:49,000 the headlight beam on his bicycle. 445 00:35:49,000 --> 00:35:50,560 And he would turn into energy. 446 00:35:50,560 --> 00:35:52,800 That's how he came up with E equals MC squared. 447 00:35:52,800 --> 00:35:55,560 It's an observational study. 448 00:35:55,560 --> 00:36:02,880 You know, scurvy, vitamin C, all those things were cholera as being a waterborne rather than 449 00:36:02,880 --> 00:36:05,000 an airborne disease. 450 00:36:05,000 --> 00:36:07,320 A book called The Ghost Map. 451 00:36:07,320 --> 00:36:08,320 Excellent. 452 00:36:08,320 --> 00:36:10,040 By Stephen Johnson, talks about all that. 453 00:36:10,040 --> 00:36:19,960 But these are observation and the 1922 JAMA article talks, it's based on controlled observational 454 00:36:19,960 --> 00:36:20,960 studies. 455 00:36:20,960 --> 00:36:25,360 I came up with that. 456 00:36:25,360 --> 00:36:27,640 Okay. 457 00:36:27,640 --> 00:36:37,360 So then with regard to braces, I mean, obviously they have their place, right? 458 00:36:37,360 --> 00:36:41,960 Their, our benefits for straighter teeth. 459 00:36:41,960 --> 00:36:50,960 You know, as a parent, I go in with my 11 year old, the geriatric child, which I love 460 00:36:50,960 --> 00:36:51,960 that. 461 00:36:51,960 --> 00:36:58,200 So I go in and I'm told that there's not enough room in my child's mouth. 462 00:36:58,200 --> 00:37:02,120 And we have to remove all these teeth and we're going to do braces. 463 00:37:02,120 --> 00:37:07,840 Because you know, as a parent, is there something I should ask? 464 00:37:07,840 --> 00:37:13,600 Do I, how, how, how do I know that that's going to be okay for my child not to do more 465 00:37:13,600 --> 00:37:16,720 damage if they have an undiagnosed airway issue? 466 00:37:16,720 --> 00:37:24,360 Well, most, most orthodontists don't really consider the airway complex as being all that 467 00:37:24,360 --> 00:37:28,080 intimately related, you know, to the craniofacial complex. 468 00:37:28,080 --> 00:37:31,760 So that, that's something, and it's not their fault. 469 00:37:31,760 --> 00:37:33,160 It's the curriculum. 470 00:37:33,160 --> 00:37:37,640 The curriculum does not teach anything really about it. 471 00:37:37,640 --> 00:37:41,320 Now it's starting to maybe. 472 00:37:41,320 --> 00:37:46,360 Orthodontists are also not taught anything about child development, behavior, guidance, 473 00:37:46,360 --> 00:37:47,360 anxiety, control. 474 00:37:47,360 --> 00:37:49,280 I'm a pediatric dentist. 475 00:37:49,280 --> 00:37:50,800 Are you kidding? 476 00:37:50,800 --> 00:37:58,960 That's, that's how I make my, my existence worthwhile, how I stay pertinent to the profession 477 00:37:58,960 --> 00:38:05,280 is I know how to understand a child's fears, anxieties, curiosities. 478 00:38:05,280 --> 00:38:09,760 Most of them are just curious and they're, they're maybe threatened by a novel clinical 479 00:38:09,760 --> 00:38:10,760 setting. 480 00:38:10,760 --> 00:38:16,000 Well, I had to demonstrate extreme competence in that before I could get board certified 481 00:38:16,000 --> 00:38:18,320 in pediatric dentistry. 482 00:38:18,320 --> 00:38:21,960 And at the University of Iowa, you don't get a certificate unless you're competent in 483 00:38:21,960 --> 00:38:25,040 managing anxiety of children and their parents. 484 00:38:25,040 --> 00:38:28,240 They don't learn that in orthodontic school because it's implied you're not going to need 485 00:38:28,240 --> 00:38:32,800 those skills because you're not going to see them mostly till they're about nine, 10 or 486 00:38:32,800 --> 00:38:34,920 11 at the soonest. 487 00:38:34,920 --> 00:38:38,720 They say, you know, do the first visit by age seven. 488 00:38:38,720 --> 00:38:42,720 But that doesn't mean start treating by age seven. 489 00:38:42,720 --> 00:38:48,320 More on that later, but I just, orthodontics visit by age seven is what you're saying. 490 00:38:48,320 --> 00:38:54,000 They're, they're, yeah, the AAL American Association worth of Donis has a pamphlet that they renew 491 00:38:54,000 --> 00:38:59,640 every couple of years and it just says first orthodontic visit evaluation should be no later 492 00:38:59,640 --> 00:39:06,920 than age seven, but it says in the same brochure, but most treatment won't begin, you know, 493 00:39:06,920 --> 00:39:09,640 till they're somewhere between nine and 11. 494 00:39:09,640 --> 00:39:14,760 And, you know, to me, so, so I, an answer to your question, like, well, you know, if 495 00:39:14,760 --> 00:39:19,120 they say that teeth don't fit and, you know, we, how do I make them fit? 496 00:39:19,120 --> 00:39:23,760 Well, you know, what, what if you go to a shoe store and you were a size. 497 00:39:23,760 --> 00:39:30,080 I wear a size eight and they bring out a size six and it's like, well, um, you really like 498 00:39:30,080 --> 00:39:35,200 these shoes, Dr. Kev, um, we're going to have to cut off some of your toes, but they'll 499 00:39:35,200 --> 00:39:36,840 fit and you'll have them. 500 00:39:36,840 --> 00:39:39,560 And it's like, that's, that's ridiculous, right? 501 00:39:39,560 --> 00:39:45,040 Or even, even for a third year dental student, depending on where they train, they can look 502 00:39:45,040 --> 00:39:48,200 at a kid with no space, you know, a three year old, four year old with no space between 503 00:39:48,200 --> 00:39:53,560 their teeth and they'll say, you know, save up your money for braces. 504 00:39:53,560 --> 00:39:58,080 And that's like an endocrinologist or a pediatrician telling the parents of a kid with high blood 505 00:39:58,080 --> 00:40:02,480 sugar, save up your money for an insulin pump because guess what? 506 00:40:02,480 --> 00:40:07,320 Your kid is going to be a brittle diabetic and maybe, or, or an ophthalmologist telling 507 00:40:07,320 --> 00:40:11,720 the parents of a near-sighted four year old, save up your money for glasses. 508 00:40:11,720 --> 00:40:13,760 You know, you don't, you don't want to do it now. 509 00:40:13,760 --> 00:40:15,280 It's too early. 510 00:40:15,280 --> 00:40:18,200 Wait till they're driving a car, then you'll save a lot of money and you only have one 511 00:40:18,200 --> 00:40:19,200 prescription, right? 512 00:40:19,200 --> 00:40:24,040 That is sound analogy, that's medically defensible. 513 00:40:24,040 --> 00:40:30,280 What I just told you about myopia anyway, you know, the diabetes thing is a little extreme, 514 00:40:30,280 --> 00:40:37,120 but myopia, near-sightedness, that can cause the same neurological issues as mouth breathing. 515 00:40:37,120 --> 00:40:43,680 You know, a kid can be psychologically damaged because they can't see and, you know, the 516 00:40:43,680 --> 00:40:46,640 behavioral issues, even cognitive issues. 517 00:40:46,640 --> 00:40:52,000 Are you kidding, they can't learn if they're not seeing, it used to be the chalkboard or 518 00:40:52,000 --> 00:40:54,520 they, you know, right? 519 00:40:54,520 --> 00:41:02,320 So anyway, I digress, but that's kind of the 11 year old, you know, you can't go back 520 00:41:02,320 --> 00:41:08,960 in time, but no, don't, you want your kid to have in three dimensions, you want them 521 00:41:08,960 --> 00:41:13,360 to be wide enough so their tongue will fit, you want them to be forward enough so their 522 00:41:13,360 --> 00:41:20,520 tongue will fit and you don't want them to be deficient and vertical like deep overbite 523 00:41:20,520 --> 00:41:24,160 or excessive like long face, all right? 524 00:41:24,160 --> 00:41:27,160 You want all three dimensions to be optimized. 525 00:41:27,160 --> 00:41:30,900 It's harder to do in an 11 year old, but you can, you know, you can prevent things from 526 00:41:30,900 --> 00:41:36,720 getting worse, but if you take out teeth and then you put them in headgear that pulls things 527 00:41:36,720 --> 00:41:42,480 back and everything, you're going to take a suboptimal situation and you're going to 528 00:41:42,480 --> 00:41:50,000 make it worse by doing retractive orthodontic procedures, dental facial orthopedic procedure 529 00:41:50,000 --> 00:41:53,160 procedures. 530 00:41:53,160 --> 00:41:58,320 So would this be a good opportunity then as a parent if, you know, this is what you're 531 00:41:58,320 --> 00:42:03,560 presented with and you suspect, you know, you've done some of the things we've talked 532 00:42:03,560 --> 00:42:09,280 about in previous podcasts, watch your child sleep so you know their mouth breather, you 533 00:42:09,280 --> 00:42:12,960 know, I figured out they have sleep apnea because they're snoring. 534 00:42:12,960 --> 00:42:17,640 Would this be the right time then to say, you know what, before we go down this path, 535 00:42:17,640 --> 00:42:22,160 I'm going to take my child to an ENT or an airway centric dentist. 536 00:42:22,160 --> 00:42:24,360 Yeah, I would do anything. 537 00:42:24,360 --> 00:42:25,360 Yeah. 538 00:42:25,360 --> 00:42:30,520 First of all, snoring doesn't mean a diagnosis of apnea. 539 00:42:30,520 --> 00:42:35,640 It's sleep disorder, breathing, we call that apnea snoring is, you know, sort of on one 540 00:42:35,640 --> 00:42:41,000 end of the spectrum and in stage is apnea and that has to be diagnosed with an overnight 541 00:42:41,000 --> 00:42:44,840 polysomnograph or a sleep study. 542 00:42:44,840 --> 00:42:52,600 And I don't, even I don't make direct referrals, even though I can, I'm on staff at Tertiary 543 00:42:52,600 --> 00:42:58,240 Care Children's Hospital, but I always go through the primary care physician, which 544 00:42:58,240 --> 00:43:04,520 is the pediatrician, is, you know, I do work with the sleep medicine service at Lurie and 545 00:43:04,520 --> 00:43:09,720 I know that a lot of the ENTs, but who would you, is there anybody you like referring to 546 00:43:09,720 --> 00:43:14,920 because our mutual patient and you're the primary care physician, I'm the primary care 547 00:43:14,920 --> 00:43:19,400 dentist or, you know, somebody else's and they referred to me. 548 00:43:19,400 --> 00:43:22,320 I want to introduce that into the lexicon too. 549 00:43:22,320 --> 00:43:24,480 PCP is primary care physician. 550 00:43:24,480 --> 00:43:25,480 Everybody knows that. 551 00:43:25,480 --> 00:43:26,480 But, right. 552 00:43:26,480 --> 00:43:31,760 How about PCD, primary care dentist, because many of us, I'm a pediatric dentist and I 553 00:43:31,760 --> 00:43:38,320 can do all phases of dentistry for kids, but I've really just narrowed my focus to dental 554 00:43:38,320 --> 00:43:41,440 facial orthopedics on kids and the primary dentition. 555 00:43:41,440 --> 00:43:47,120 That's just because nobody else really wants to do it or isn't yet doing it as much. 556 00:43:47,120 --> 00:43:54,120 So I call the referring pediatric dentist or the family dentist, general dentist, I call 557 00:43:54,120 --> 00:43:57,280 them PCDs, primary care dentists. 558 00:43:57,280 --> 00:44:00,760 And just so, you know, you as a mom. 559 00:44:00,760 --> 00:44:07,000 Yes, you want to talk to your pediatrician, but you might be the one that's going to, 560 00:44:07,000 --> 00:44:09,080 you know, say, look, would you please look at this? 561 00:44:09,080 --> 00:44:16,120 There's a flyer from American Dental Association and all of a sudden we hang up, but everybody, 562 00:44:16,120 --> 00:44:19,800 you can just, I give it to parents and you can give it to your pediatrician, give it 563 00:44:19,800 --> 00:44:21,680 to your primary care dentist. 564 00:44:21,680 --> 00:44:26,800 I'm on a task force at the American Dental Association, the pediatric airway task force, 565 00:44:26,800 --> 00:44:35,200 started by Stephen Carsonson and we're coming up with our own screening, you know, tools 566 00:44:35,200 --> 00:44:43,600 for dentists and physicians to use in addition to the pediatric sleep questionnaire. 567 00:44:43,600 --> 00:44:50,160 But it's written in very plain English and you could be the one that could change the 568 00:44:50,160 --> 00:44:51,880 course of that dentist career. 569 00:44:51,880 --> 00:44:54,440 Oh my gosh, I had no idea. 570 00:44:54,440 --> 00:44:58,440 You know, I didn't learn any of this stuff in dental school. 571 00:44:58,440 --> 00:45:03,520 I didn't learn it even in my pediatric dentistry training and I went to one of the best programs 572 00:45:03,520 --> 00:45:07,200 in the world at the time, University of Iowa in the late 80s. 573 00:45:07,200 --> 00:45:14,080 And I learned that retranathic chins at four years old are always going to be retranathic. 574 00:45:14,080 --> 00:45:18,200 Sam Bishara, famous orthodontist, taught us that, but he didn't really say anything about 575 00:45:18,200 --> 00:45:19,200 breathing. 576 00:45:19,200 --> 00:45:23,960 He just said, look, once a class two, always a class two. 577 00:45:23,960 --> 00:45:25,840 You know, he's the one who talked about that. 578 00:45:25,840 --> 00:45:26,840 And it's true. 579 00:45:26,840 --> 00:45:27,840 It's defensible. 580 00:45:27,840 --> 00:45:33,720 It's that, you know, jaws are too narrow, maxillary transfer sufficiency, with or without 581 00:45:33,720 --> 00:45:36,840 a cross bite, cannot self-correct. 582 00:45:36,840 --> 00:45:38,960 It cannot self-correct. 583 00:45:38,960 --> 00:45:40,640 It will persist. 584 00:45:40,640 --> 00:45:46,120 It will usually worsen and either is or will become a comorbidity, we say, with sleep and 585 00:45:46,120 --> 00:45:47,560 breathing disorders. 586 00:45:47,560 --> 00:45:57,120 So width, height and length all need to be optimized as early in life as possible to assure 587 00:45:57,120 --> 00:46:02,760 a child has the best chance to be a habitual nose breather as soon in their life as is 588 00:46:02,760 --> 00:46:04,760 feasible to do so. 589 00:46:04,760 --> 00:46:09,960 I mean, you know, if I meet a kid at 12, that's the earliest feasible time I can try to optimize 590 00:46:09,960 --> 00:46:10,960 it. 591 00:46:10,960 --> 00:46:14,200 But as a pediatric dentist, I'm seeing them before their age one. 592 00:46:14,200 --> 00:46:15,200 I'm even looking at it. 593 00:46:15,200 --> 00:46:16,200 Really? 594 00:46:16,200 --> 00:46:17,200 Yeah. 595 00:46:17,200 --> 00:46:20,360 So in the Academy of Pediatric Dentistry, all children should have their first dental 596 00:46:20,360 --> 00:46:23,120 visit by age one. 597 00:46:23,120 --> 00:46:27,840 The American Association of Orthodontists, they should have their first orthodontic evaluation 598 00:46:27,840 --> 00:46:29,720 by age seven. 599 00:46:29,720 --> 00:46:36,640 You know, so no, this is something that needs to be understood by everybody in healthcare. 600 00:46:36,640 --> 00:46:40,120 And you don't have to be someone who even sees kids. 601 00:46:40,120 --> 00:46:44,960 You know, if you're somebody like a prosthodontist who makes dentures and does implants, well, 602 00:46:44,960 --> 00:46:46,060 guess what? 603 00:46:46,060 --> 00:46:51,120 You're treating the grandparents and great grandparents of little kids who may have sleep 604 00:46:51,120 --> 00:46:56,440 and breathing disorders and the information may come from you. 605 00:46:56,440 --> 00:47:03,360 Grandpa, I hear, you know, your daughter just had or your daughter has a two year old. 606 00:47:03,360 --> 00:47:05,720 Why don't you ask her if he snores? 607 00:47:05,720 --> 00:47:10,720 I mean, there's so many ways we can all share knowledge and information. 608 00:47:10,720 --> 00:47:15,320 And really, it's the general public that's going to cause policy change. 609 00:47:15,320 --> 00:47:22,000 And what I say is angry moms, boy, you get so many moms when I'm consulting. 610 00:47:22,000 --> 00:47:25,400 And when I tell them, you know, they've already had an orthodontic console. 611 00:47:25,400 --> 00:47:28,560 Oh, they said, wait for the adnoits to shrink and all this. 612 00:47:28,560 --> 00:47:35,080 And then I tell them what I think after I show them, you know, the cone beam x-ray and they 613 00:47:35,080 --> 00:47:36,760 all go, I thought so. 614 00:47:36,760 --> 00:47:38,920 I thought there was something wrong here. 615 00:47:38,920 --> 00:47:42,040 I thought there's something that could be done. 616 00:47:42,040 --> 00:47:47,200 Real instinct is the most powerful force on planet Earth, I think. 617 00:47:47,200 --> 00:47:50,920 And you know, I don't have many people disagree with me, especially husbands. 618 00:47:50,920 --> 00:47:59,160 And they'll stand back and say, as a mom, I'm obviously going to agree with that. 619 00:47:59,160 --> 00:48:02,800 So and it's funny because one of the things I was going to ask you is, you know, how do 620 00:48:02,800 --> 00:48:10,800 we, how do we turn the ship and change the course of really medicine? 621 00:48:10,800 --> 00:48:12,360 How it's working? 622 00:48:12,360 --> 00:48:19,680 How dentist and pediatricians are being taught or in most cases not taught this information? 623 00:48:19,680 --> 00:48:20,840 And how do we get it to parents? 624 00:48:20,840 --> 00:48:23,160 And you already touched on part of it is advocates. 625 00:48:23,160 --> 00:48:25,920 I mean, we have to be our kids advocates. 626 00:48:25,920 --> 00:48:29,560 We have to trust our guts. 627 00:48:29,560 --> 00:48:30,920 We have to ask the questions. 628 00:48:30,920 --> 00:48:31,920 We have to do the research. 629 00:48:31,920 --> 00:48:33,720 We have to fight for our kids. 630 00:48:33,720 --> 00:48:40,920 So how do we handle the other part of that equation as far as just medical practice? 631 00:48:40,920 --> 00:48:44,080 We have the up and coming pediatricians and dentists. 632 00:48:44,080 --> 00:48:50,400 How do we get them this information and just change the course we're on? 633 00:48:50,400 --> 00:48:55,640 Well, it's, I mean, I just feel it's the curriculum. 634 00:48:55,640 --> 00:49:01,000 It's the healthcare professional curriculum, the medical school curriculum, the dental 635 00:49:01,000 --> 00:49:07,720 school curriculum, the dietetics curriculum, the speech and language pathology curriculum. 636 00:49:07,720 --> 00:49:09,960 All these, they all need to change. 637 00:49:09,960 --> 00:49:12,320 They all need to be influenced by this. 638 00:49:12,320 --> 00:49:15,280 And we can't work alone. 639 00:49:15,280 --> 00:49:19,400 I mean, everybody needs to be talking to each other. 640 00:49:19,400 --> 00:49:25,000 The OB-Gynes, they need to understand of the gestational apnea. 641 00:49:25,000 --> 00:49:30,640 I know more about gestational apnea than a lot of obstetric gynecologists. 642 00:49:30,640 --> 00:49:31,640 Why? 643 00:49:31,640 --> 00:49:34,440 I mean, it's all over their literature, but they don't, you know, you don't read. 644 00:49:34,440 --> 00:49:36,960 I don't read everything in the dental literature. 645 00:49:36,960 --> 00:49:41,960 There's things there that I'm, you know, I discover every day, but I, it just, it really 646 00:49:41,960 --> 00:49:44,320 is and not being judgmental. 647 00:49:44,320 --> 00:49:48,640 Like it's like, oh, the orthodontist, he told me they want to pull teeth and all this. 648 00:49:48,640 --> 00:49:51,640 And I used to like be judgmental. 649 00:49:51,640 --> 00:49:55,680 And it's like, wait a minute, I just learned this a minute ago. 650 00:49:55,680 --> 00:49:57,680 This has been a career. 651 00:49:57,680 --> 00:50:04,640 It's, you know, it's been 12 years now, but I spent a long time not knowing anything about 652 00:50:04,640 --> 00:50:05,640 this. 653 00:50:05,640 --> 00:50:09,600 And now all of a sudden I'm going to judge other people who haven't been exposed. 654 00:50:09,600 --> 00:50:15,480 So that's part of it is that we have to be understanding and raise public awareness. 655 00:50:15,480 --> 00:50:22,280 And that's again, policy change and really the curriculum, the educational curriculum, 656 00:50:22,280 --> 00:50:30,080 the training modules in integrating it into an existing base curriculum slowly, gradually. 657 00:50:30,080 --> 00:50:34,840 There's a couple of, I mean, this is, you know, the partnership that CAF has, you know, 658 00:50:34,840 --> 00:50:39,480 with Dell and in Austin at the University of Texas and the medical school and the dental 659 00:50:39,480 --> 00:50:41,720 school and Leah here. 660 00:50:41,720 --> 00:50:47,520 I mean, there's just so many good things, connections that can happen here. 661 00:50:47,520 --> 00:50:53,520 I'd love to be invited to, to lecture the ENTs and I have been at, you know, Loyola University 662 00:50:53,520 --> 00:50:58,560 Medical Center here where I went to dental school, but I got invited to do a grand rounds 663 00:50:58,560 --> 00:51:00,400 in the ENT department. 664 00:51:00,400 --> 00:51:02,960 It was invited by the head of ENT. 665 00:51:02,960 --> 00:51:04,240 It was great. 666 00:51:04,240 --> 00:51:10,120 So that's the sort of thing that we have to cross disciplinary, you know, cross curriculum 667 00:51:10,120 --> 00:51:11,120 activities. 668 00:51:11,120 --> 00:51:15,080 And, you know, UT Austin is going to be a leader in this. 669 00:51:15,080 --> 00:51:16,080 There's another institution that's. 670 00:51:16,080 --> 00:51:17,080 I think so. 671 00:51:17,080 --> 00:51:18,080 I think similar. 672 00:51:18,080 --> 00:51:21,520 Yeah, I agree. 673 00:51:21,520 --> 00:51:26,200 So as, as we wrap things up, I always like to give our guests the opportunity to speak 674 00:51:26,200 --> 00:51:32,920 directly to parents and just, you know, leave them with something. 675 00:51:32,920 --> 00:51:39,360 What is it that you would tell parents specifically around. 676 00:51:39,360 --> 00:51:44,840 Airway health and, you know, how to do the best for your child in this, you know, the 677 00:51:44,840 --> 00:51:47,880 environment that is life today. 678 00:51:47,880 --> 00:51:56,040 There's many things you can do to raise your child's optimize your child's quality of life. 679 00:51:56,040 --> 00:52:00,160 Which it also enhances family quality of life. 680 00:52:00,160 --> 00:52:04,480 I mean, what, what parent has a quality of life if their child doesn't. 681 00:52:04,480 --> 00:52:12,280 And one in addition, you know, to getting them, you know, square meals and shelter and 682 00:52:12,280 --> 00:52:19,040 education and physical activity, you know, all those wonderful things that parents can 683 00:52:19,040 --> 00:52:26,760 assure that their child get is the ability to breathe through their nose habitually while 684 00:52:26,760 --> 00:52:30,160 they're awake and especially while they're asleep. 685 00:52:30,160 --> 00:52:31,160 How you do that? 686 00:52:31,160 --> 00:52:32,400 Well, you know what? 687 00:52:32,400 --> 00:52:36,240 You need to know that that should be done. 688 00:52:36,240 --> 00:52:43,720 How it's done and the nuances pretty soon will be as public knowledge as is eating fresh, 689 00:52:43,720 --> 00:52:50,640 minimally processed food and not, you know, living in front of a computer screen and video 690 00:52:50,640 --> 00:52:52,880 games but being outdoors and playing. 691 00:52:52,880 --> 00:52:56,320 That's sort of, you know, in the public domain now. 692 00:52:56,320 --> 00:53:00,280 But this sleep and breathing thing is early in life as possible. 693 00:53:00,280 --> 00:53:01,680 This is just not out there. 694 00:53:01,680 --> 00:53:02,680 Air is there. 695 00:53:02,680 --> 00:53:04,600 I still have some healthcare professionals. 696 00:53:04,600 --> 00:53:05,920 Well, you know, it's oxygen. 697 00:53:05,920 --> 00:53:08,960 I mean, what difference does it make if you get it through your mouth and your nose? 698 00:53:08,960 --> 00:53:13,920 Most it's getting less and less, but most people, they'll say, Oh yeah, yeah, you should 699 00:53:13,920 --> 00:53:14,920 breathe through your nose. 700 00:53:14,920 --> 00:53:19,320 But I, you know, I just don't think they don't really understand what is in healthcare and 701 00:53:19,320 --> 00:53:20,760 the public domain as well. 702 00:53:20,760 --> 00:53:21,760 Yeah. 703 00:53:21,760 --> 00:53:23,360 And that's, that's really what we need. 704 00:53:23,360 --> 00:53:25,320 That's what we tell parents. 705 00:53:25,320 --> 00:53:28,360 Your child needs to be a nose breather immediately. 706 00:53:28,360 --> 00:53:31,360 It's quickly as possible. 707 00:53:31,360 --> 00:53:34,920 And we have to find out why they're not if they're not first find out if they're not. 708 00:53:34,920 --> 00:53:41,280 Maybe they already are, you know, but that's another thing you can feel good about. 709 00:53:41,280 --> 00:53:42,360 I love it. 710 00:53:42,360 --> 00:53:44,000 Thank you so much for being with us today. 711 00:53:44,000 --> 00:53:45,000 Dr. Kev. 712 00:53:45,000 --> 00:53:46,000 I really appreciate it. 713 00:53:46,000 --> 00:53:50,800 Oh, and thank you very skillful in your questioning and interviewing. 714 00:53:50,800 --> 00:53:53,720 I enjoyed it very much. 715 00:53:53,720 --> 00:53:56,080 Thank you. 716 00:53:56,080 --> 00:54:00,680 Thanks again to today's guests, Dr. Kevin Boyd for sharing his medical insight and to 717 00:54:00,680 --> 00:54:03,560 each of you for listening to today's episode. 718 00:54:03,560 --> 00:54:06,800 If you're new to our podcast, please don't forget to subscribe. 719 00:54:06,800 --> 00:54:11,240 And if you enjoyed today's episode, please remember to leave us a review or comment about 720 00:54:11,240 --> 00:54:13,360 what you enjoyed most. 721 00:54:13,360 --> 00:54:17,400 You can stay connected with the Children's Airway First Foundation by following us on 722 00:54:17,400 --> 00:54:21,760 Instagram, Facebook, Twitter and LinkedIn. 723 00:54:21,760 --> 00:54:25,840 If you'd like to be a guest on an upcoming episode, shoot us a note via the contacts 724 00:54:25,840 --> 00:54:34,440 page on our website or send us an email directly at info at childrensairwayfirst.org. 725 00:54:34,440 --> 00:54:38,200 And finally, thanks to all the parents and medical professionals out there that are 726 00:54:38,200 --> 00:54:43,040 wanting to help make the lives of kids around the globe just a little bit better. 727 00:54:43,040 --> 00:55:10,600 Take care, stay safe and happy breathing, everyone.