Hi everybody and welcome to another episode of Airway First, the podcast from the Children's
Airway First Foundation.
I'm your host, Rebecca Downing.
My guest today is Dr. Kevin Boyd, a board-certified pediatric dentist practicing in Chicago.
He is also an attending instructor in the Pediatric Dentistry Residency Training Program
at Lurie Children's Hospital, where he also serves as a dental consultant to the Sleep
Medicine Service.
Additionally, he serves as a dental consultant to Lutheran General Hospital.
He is a visiting scholar at the University of Pennsylvania's Museum of Anthropology,
conducting research in anthropology and orthodontics.
Prior to completing his DDS degree from Loyola University's Chicago College of Dental Surgery
in 1986, he obtained an advanced degree in Human Nutrition and Dietetics from Michigan
State University.
He completed his postgraduate residency training in Pediatric Dentistry at the University of
Iowa.
We are also proud and honored to have Dr. Boyd as a member of the Children's Airway First
Advisory Board.
You can find out more about Dr. Boyd at dentistryforchildren.net.
And now, here's my interview with Dr. Kevin Boyd.
All right.
Good morning, Dr. Boyd.
Thanks so much for joining us on our podcast.
Can you just call me Kevin?
Yeah, I have a doctor of dental surgery, but I'm Kev.
I'm a kid's dentist.
Then Kev it is.
All right.
So I want to start our conversation by just jumping into, you've done a lot of research
on the modern jaw, and I've heard you speak about Darwinian dentistry.
So I want to talk a little bit about the differences in our jaws, our jaws versus our ancestors,
what caused it, and why this is important to our health.
You know, it's interesting.
I borrowed that term, Darwinian dentistry, from Randy Nessie, who's a psychiatrist from
the University of Michigan, now at Arizona.
And he has had, he created George C. Williams, an evolutionary biologist in the 90s, this
whole area of evolutionary medicine.
So he calls Darwinian medicine, and he wrote a book called Why We Get Sick.
And I just was inspired by him, and actually talked to him about creating a branch, if
you will, or an offshoot, and just call it evolutionary oral medicine that specifically
does the same thing in terms of teaching students, pre-med and medical students, and post-doc
training residencies in all branches of medicine about evolutionary explanations for why we
get sick, the title of Nessie's book, and why do mouths get sick?
Why do we get cavities?
Why do we get gum disease?
Why do we have crooked teeth and poorly formed jaws?
So that's kind of where that came from.
And I've since learned things by looking at skulls, mainly from the University of Pennsylvania's
Museum of Anthropology and Archaeology, studying with Mariana Evans, who is, she was in the
orthodontic department with her, joined as a visiting scholar at Penn.
And we x-rayed with cone beam, three-dimensional scans in her private practice.
We would take skulls out of the museum very carefully with permission and x-ray them and
then compare them, the numbers that we use, it's called cephalometrics, of how orthodontists
and other dental practitioners who provide orthodontic services to patients, they use
those as norms.
Well, the norms, normative values for the lines and angles and how the face should be
shaped and the jaw should grow are based upon a bunch of Caucasians from Cleveland area
and in other places by a couple of guys, Steiner and Downs and later a guy named the Bolton
Brush norms, it's called from Case Western.
So we wanted to compare what we were getting on all of these people who died before the
Industrial Revolution in the 18th and 19th century and to come up with an anthropologically
correct base for looking at skulls.
So that's how it all started for me.
Okay.
And what did you end up finding?
I mean, there's obviously a vast difference, correct?
Yeah.
And it's not, Mariana Evans and I, you know, we've worked really hard and long.
In eight or nine years now, we've been doing this and it's really informed the way we practice,
but there's other people who've done this.
Jerry Rose is a dental anthropologist at the University of Arkansas where I am an adjunct
assistant professor there working in dental anthropology with some of the graduate students.
And he's the one with Rick Robly who's North of Doniston, Arkansas, they worked together
and wrote a paper.
And what they discovered is that our jaws in the last, you know, maybe a couple hundred
years, that sounds like a long time, doesn't it?
But considering it, but it's really not, well, it's really not.
And what we call modern humans or anatomically modern humans have been around for at least
250,000 years and, you know, in order to survive childhood, you had to have perfect jaws.
The foundation for, you know, getting out of childhood was, you had to have that.
So it's in our genome.
But in the last couple hundred years, since the Industrial Revolution, jaws have gotten
narrower.
They've gotten further back, retrusive, and they've gotten longer.
Okay.
So our faces have gotten longer.
Our jaws have gotten narrower.
And our faces have gone backwards.
So we call that, you know, retronathia.
There's three dimensions on how you look at a face.
And one is that they're transverse.
The other one is length.
That's sagittal, front to back.
And then the other is height or vertical.
Okay.
So that's kind of, we've confirmed that.
That was a hypothesis that had been laid down really in the 50s and 60s.
First that I know of by Dr. John Mu, who was North of Doniston, England, who went into
the British Museum and looked at old Roman skulls and came up with what he called the
orthotropic, which just means correct growth or optimal for health growth and optimal for
aesthetics.
And he developed the first hypothesis and published on it.
I learned from him.
I went to England a couple of times and stayed with him and went to his clinic.
And Bill Hang is another sort of apprentice, if you will, of John Mu, who's taken it in
really provided lots of support for Mu's orthotropic hypothesis and also trained many, I'm a pediatric
dentist, but many orthodontists in general dentists are educated by Mu and Hang.
That's the broadest space of people who are doing this.
We're doing this.
And then so the Industrial Revolution, how specifically did that impact our jaws?
What happened there that's causing everything to get smaller?
Well, we think, and the hypothesis that we've laid out, speculation, if you will, is that
it seems to coincide with women entering into the workforce, the textile mills and coal
mines.
And what did that mean?
Well, an ancestral pattern of nursing and weaning that went on pretty much for our entire
existence as anatomically modern humans over 250,000 years was that a baby newborn was
immediately breastfed on demand for up to 10 to 12 months of age, maybe exclusively,
but certainly the first six, eight months, all they had was breast milk or they died.
Well that helped build, what I say is, a baby's tongue starting in utero really about 20
weeks is responsible for building itself a home to live in for the rest of its life.
And that's called the hard palate, the roof of the mouth.
So in about 16 to 20 weeks of age, a baby will start chewing amniotic fluid with their
gums and their tongue will be pressing up on the roof of their mouth and pushing their
faces out.
We've got, you know, pre-industrial specimens of fetuses that were still born and their
jaws, mandibles, everything is forward.
So this probably starts in the womb.
You know, there's no way you can go back in time and prove that, but as a proxy, we look
at these four or 500,000 year old fetuses that their jaws are both forward, the lower
jaw, and if you look at, if you have kids and you look at an ultrasound of your own
child when 18 to 22 weeks old, many children have chins that are way recessed.
And that's something we're really interested that this problem could start in the womb.
When we think of an ancestral mother carrying a child, well, you know, she was hunting, she
was gathering and she was walking around, she was breathing through her nose or she
wouldn't be alive.
And some of those, you know, we talk about nutrients, vitamins and minerals, and, you
know, they were eating natural unprocessed food.
That's all there was.
And the placenta was delivering that to the baby, but the placenta was also delivering
nasally inspired oxygen from the mother, which probably helped not just the long bones grow.
I mean, you hear of premature babies that they're short for their gestational age,
their low birth weight, some of the term, none of that, a baby just wouldn't survive
if they weren't really well developed as a, you know, during their gestation fetal life.
So oxygen is a nutrient.
And that's the one that, that's the really the only one that the mother has priority
for the growing fetus gets all the vitamins and what's left over the mom gets, but not
oxygen.
And it's just the analogy I think is on an airplane when the flight attendant says, you
know, if you're traveling with a child in the event of loss of cabin pressure, put the
mask on yourself first and then help your child.
Because you pass out, you can't help your kid, you're both going to die.
And it's the same sort of thing that, and that's a speculation that Mariana and I have
developed that we really think.
And there's a, there's a entity that you see in some of the obstetric gynecology journals
called gestational apnea.
It's like gestational diabetes or hypertension that a woman who's not sleeping and breathing
well during pregnancy can really rob her baby of that vital nutrient oxygen that is required
for them, you know, to grow right in the womb.
And then it continues once they're born.
So then if I'm understanding this, the industrial revolution, there's kind of this perfect storm
happening.
So women going into the workforce means we're not breastfeeding like we were.
So that jaw development exercise isn't happening in newborns.
We're eating processed foods or our nutrients are changing as well as everything is softer.
And is that somehow also leading to that third trifecta of suddenly we're becoming mouth
breathers instead of nasal breathers?
Yeah, there's a, there's a, there's a lot to unpack there, but you've made, yeah, we've
connected the dots and I'm impressed.
Because it is that, you know, women, I mean, if they weren't too exhausted when they got
home from a 14 hour day in the textile mill, maybe they could, you know, do some breastfeeding.
But in that created the necessity of infant formulas and giving cows milk.
And now we know that cows milk has maybe four vital oligosaccharides, they're sugars that
stimulate the immune system.
Human milk has maybe 200.
So but they, we had the substance and that's, you know, the baby formulas, the purees, the
slop, and, you know, a mom, if she, if the formula hadn't been advantage yet and the
mom wasn't there to breastfeed, they could hire a lactating woman from the village called
a wet nurse that doesn't have any commitment, you know, biologically to, you know, to a
baby that they're hired, you know, to, to nurse.
So it's a combination of, you know, abandoning 250,000 years of what ancestral patterns of
nursing and weaning nursing on demand for about three years or four years into, into
the third or fourth year of life on demand continued, but exclusive breastfeeding usually
was done by 10, 12 months.
And then the kid was eating every solid that every adult was eating, or they didn't survive.
When we were hunter-gatherers, we had to move around, you know, maybe every two to three
months.
And if a baby needed to have their food finally chopped up in pure aid, sorry, you know, we
can't do that.
Right.
There's, they're, they're all hypotheses there, but there's lots of support for them
in the anthropological literature on, you know, unfortunately, this isn't really in
medical textbooks yet and dental textbooks, but it will be, it absolutely will be.
It's time has come.
Got it.
So there's, there's really two follow-up questions I want to make sure we cover.
The first of which is, okay, so now we know we can prove we're not necessarily 100% sure
why we have hypothesis, but we know the jaws are getting smaller and smaller and smaller.
So how is this impacting children?
Where are you seeing this in the world of dentistry?
Well, again, it's, you know, you just grow up and the food is processed and, you know,
it doesn't require a lot of effort of chewing and, you know, like it starts in early childhood.
Well, it also, that means that the jaws, the upper jaw, when connected to the back of the
upper jaw, to the heart palate is the soft palate.
And if the upper jaw is too far back, that soft palate can be closer to the back of the
airway where the adenoids are.
It's a throat tonsil, right?
And that can make it difficult to breathe.
If the lower jaw is back, and if they're both back, well, that means the base of the tongue
which lives in the floor of the lower jaw, the mandible, that's close to the back of
the throat, what we call the hypo or laryngeal pharynx.
Pharynx just means throat.
And what will happen is the child will switch the natural mode of respiration, which is through
the nose.
I mean, that's really how we're designed, how mammals are designed to breathe.
And they'll gradually go to mouth breathing.
Well, there's a guy named Christian Guimineau from Stanford who really identified that children
can get obstructive sleep apnea, not just adults in 1976, I believe it was.
But his hypothesis was that the adenoid, that throat tonsil, it's a big bump right
here, soft, hard palate, is that what happens is kids gradually start mouth breathing for
a number of reasons.
Well, when that happens, you get pathogens from the air coming in, and the nasal sinuses
which when you breathe through your nose, you kill all that stuff, and you warm and
humidify the air, and you also release something called nitrogen oxide, which opens up a lot
of blood vessels and facilitates oxygen getting into the bloodstream and to the heart of the
brain.
Well, that gradually, as kids start to mouth breathe more, and their jaws get further back,
then the adenoids start to grow, and that just exacerbates, makes it worse.
And the general theory that's accepted in most medical textbooks is that the enlarged
throat tonsil, adenoid, is what causes the mouth breathing.
And it's sort of like, you know, maybe not, and this is my hypothesis.
So gradual nasal disuse is what he called it.
And then, you know, the face will get long.
In fact, that medical profession calls a kid with a long face, you know, and dark bags
on the eyes, they call it an adenoid face.
Adenoid face.
Long face syndrome.
And that's all from mouth breathing, because as you breathe, it impacts your face.
It influences the way your face will develop.
And your face is connected to what?
Your airway.
Now, we say the back of the face is the airway, or the front of the airway is the face.
So, you know, the position and shape of your face is sort of a proxy for what your primary
mode of respiration is.
It's not 100%, but it gives you an indication.
There's things we can look at.
So, okay.
So then it's impacting the way that children are breathing.
And is it this new pattern of breathing, the mouth breathing?
Is that what's impacting their development physically and mentally?
Yeah, absolutely.
You know, like I said, how often should you breathe through your mouth?
And you know, my colleague, Karen, in Grand Rapids says as often as you eat with your
nose, okay?
So you don't eat with your nose unless you're tube fed in a hospital or, but no, you know,
nose breathing.
Your tongue should always be in the roof of your mouth, except when you're eating.
You know, and our ancestors used to eat and chew all day long.
So the tongue spent a lot of time on the lower jaw developing it along when they weren't
eating, that, you know, talking and forming consonants and click sounds.
Our ancestors in Africa talked with flicks.
And if they couldn't do that, you know, they died.
It's a survival mechanism.
Right.
So chewing and breathing through the nose, they develop both jaws and, but the tongue
at rest should never be anywhere but in the roof of the mouth.
So how does breathing through your mouth though impact just so people understand?
How does that impact your brain and a child's brain development?
Well, the same thing is that you have to breathe in a lot more air when you're doing it through
your mouth to get it, you know, sufficient quantity, 100 milligrams percent to your brain.
You know, you have to, you have to breathe over breathe or breathe faster, take in more
volume of it, which coincides with systemic inflammation, nose breathing.
Again, the most powerful antioxidant on the planet is nitrogen oxide.
And you know, that's in the lining of your sinuses.
So when you breathe through your nose, you've heard of something called turbinates.
Turbine is the root word like, like in a jet engine.
It causes turbulent of the air, which is a catalyst.
It sparks the release and formation of nitrogen oxide in the sinus lining.
It's L-Arginine is amino acid that is released and turned into pre-nitric oxide synthase,
which makes us.
And it kills, it's an antioxidant, it's an antimicrobial.
And then plus from nasally inspired air, it warms it to your body temperature.
The ambient air is maybe 70 degrees, unless you're in a rainforest and it's not humidified.
I mean, our bodies are like three quarters of water.
Well, the dry, cold, dirty air gets warmed, humidified, chemically filtered and mechanically
filtered.
So that delivers much more efficiently oxygen first to the heart in the hepatic portal system
we call it.
You know, it's cleaned by the liver and then it goes to the heart and it goes to the brain
and you're getting, you know, this beautiful, efficient delivery of oxygen that, you know,
and it can impact the way a brain grows.
And, you know, gray matter, Dr. Gosal and his wife have published on this and said, you
know, the cortex of the brain is affected by mouth breathing versus nose breathing.
And behavior, attention, intelligence can knock points of IQ off some kids if they're, you
know, mouth breathers, habitual mouth breathers and, you know, have don't cycle normally through
the stages of sleep.
So that that's the whole neurological connection there to breathing.
You were listening to Airway First with today's guest, Dr. Kevin Boyd.
You can find out more about the Children's Airway First Foundation and our mission to
ensure that every child has access to screening, evaluation, and treatment of all Children's
Airway and sleep disorders before the age of six on our website at childrensairwayfirst.org.
You can also find a ton of great resources for parents on our website, including videos,
blogs, recommended books, comprehensive medical research, and more.
As a reminder, this podcast and the opinions expressed here are not a medical diagnosis.
If you suspect your child might have an airway issue, contact your pediatric airway dentist
or pediatrician.
And now back to my interview with Dr. Kevin Boyd.
Got it.
Yeah.
And you touched on behavioral impact.
And I like to talk about that a little bit.
You introduced us at CAF to the Dunedin study, which I thought was incredibly fascinating.
So would you mind explaining a little bit of that to our listeners?
The 1970, toward the end of 1973 and early 1974, every baby that was born at the Central
Hospital in Dunedin, New Zealand, 1037 of them, they had funding for like a four or five-year
study where they would follow them and do metrics on them and measure their weight and
their, believe it or not, their dental health, their sleep, and the agility, apcar scores
you may have heard of, but that's neurologic when a kid's born.
But it's kind of like that.
And they would do this periodically over two or four years.
Well, it was going so well that they got more funding to continue it.
Even our National Institute of Health in America invested in this.
And now over a thousand of these babies are still participating.
They're in their 50s, 60s, if you will.
I don't know, do it from 73 to 50, they're in their 50s.
But what they found is just incredible.
I told you they took dental data while they were looking for cavities and gum disease.
And then all the doctors looked at them at 12.
So there wasn't really anything about the dental facial development that goes in here,
but there was sleep.
And one of the things that they found is that children, before the age of 11, if they demonstrated
self-control, impulse control, and they had metrics, validated metrics to gauge this,
they, in their 30s and 40s, looked 10 years younger.
And I'm going to show maybe just one slide, not to you today, but of where they'd done
composites of these babies that demonstrate the marshmallow tests.
You've heard of that, or they'd done it like that.
Kids who really could do that, and they didn't do the marshmallow tests, they had ways of
estimating a child's self-control in the 70s and 80s.
But these people, they found in this, if you just Google Dunedin study and self-control,
what you will find is amazing, is they not only looked younger, but they were resistant
to systemic illnesses like cardiovascular disease and type 2 diabetes and obesity, wealth management,
attaining educational level, criminal and addictive behavior, almost non-existent in
these kids who exhibited self-control before the age of 11, and sleep was one of the things
that they measured.
So I am so excited about this, and to be able to talk to parents and introduce something
called health span.
Everyone knows life span or life expectancy from birth.
Well, now it's, I don't know, 78, 79, it's gone down a few because of the pandemic, but
how long do you stay healthy into your extended lifespan?
And the conjecture in what we're projecting from the data from the Dunedin study is that
having this ability of self-control before the age of 11, not only projects optimistically
for an increased life expectancy, many of these kids will probably, according to some
of the investigators on this trial, will live to be 100 years old, and they will stay healthy
into their extended lifespan.
I mean, wouldn't that be the greatest?
Wild.
95, get sick one day and drop dead, you know, and be able to be healthy in your old age.
That's health span.
We've got to get that point across.
And I think that's really what CAF, my contribution is going to be, to really try to raise awareness
about the possibilities of not just building beautiful faces, but the whole thing, if a
child can nose breathe as early in life as possible, habitually, I think it's reasonable
to be optimistic that they're going to have a better quality of life immediately and an
extended lifespan and health span, quality of life all the way through.
Anyway, that's the goal.
That's wild.
I love this study.
Yeah, and I'll make sure to include a link in our show notes as well so people can check
it out because it really is, it's fascinating, absolutely fascinating.
So when we're talking about smaller jaws and children, at least in my conversations at
some point, retractive braces pop up because now, you know, over the last year, we've heard
a lot about retractive braces and why that can be dangerous for children with undiagnosed
airway disorders.
So I'd like to chat a little bit about that and get your insight on that.
You know, really, first of all, just to explain to parents what that is and why that's dangerous,
what they should be looking for.
Well, right away, people use interchangeably braces and orthodontia, orthodontic treatment.
And it's really the American Association of Orthodontics changed the name of their journal
from the American Journal of Orthodontics to the American Journal of Orthodontics and
Dental Facial Orthopedics.
Now dental facial orthopedics, that implies that the airway is going to be involved because
what's the face connected to in the jaws?
The respiratory system.
I mean, also the auditory visual olfactory system, there's all these survival mechanisms.
But you know, if you change in, you know, straighten teeth, well, braces implies permanent
teeth.
You don't put braces on baby teeth, right?
So orthodontics doesn't start till there's permanent teeth.
Well, usually by eight years old, a kid will have 12 permanent teeth.
And then, oh, an orthodontist can be really aggressive and, oh, really proactive and start
treating at eight.
Well, I call eight years old a geriatric patient in my practice.
You can begin optimizing the craniofacial connected to the respiratory complex.
Mike Mu calls that craniofacial dystrophy.
But I like to get the respiratory aspect into that.
So I call it the craniofacial respiratory complex.
You can start optimizing not only the form, but the function of those interconnected survival
mechanisms, the craniofacial complex and the respiratory complex.
You can start optimizing the hard and soft tissues, hard being bone, soft being muscles
and vasculature and bascia, all these other tissues.
You can start optimizing them.
Are you ready for this?
Yes.
And birth.
I mean, nursing.
What?
Breastfeeding is a dentifacial orthopedic appliance.
It starts helping the tongue.
If you watch a video that by Donna Gettys, who GEDDES in Australia at birth, she did
ultrasounds of baby's breastfeeding and showed how the tongue, the baby's tongue will push
against the mother's nipple up into the sutures, the fontanelles on the baby's head, the soft
spots, those are all over your face and all over your jaws.
And the baby's tongue will push the nipple and create a vacuum and push forward and all
these palatal facial sutural complex, I call it, or fontanelle complex.
They all start developing first in utero, like I said, with the action of chewing amniotic
fluid, but then when they're born and they start nursing, and if a mom can't nurse, cupfeeding
is better than giving an artificial nipple unless it's to save the kid's life.
But premies can even cupfeed.
They do that in some nurseries.
There's studies on that.
But introducing something called baby-led weaning, but not overly commercially processed
foods, but stuff that kids can chew on.
They can chew a pork chop at six, eight months of age.
If they can sit up, they can baby-led wean.
Well, all those things start dental facial orthopedic development.
Okay?
Well, then when the child has 20 teeth, and even before that, but usually by 2 1⁄2,
24, 28 months of age, a child will have 20 teeth.
Well, Journal of the American Medical Association, December 1922, an article by Cohen talks about
how 30 to 32 months of age is the ideal time to start palatal expansion in a child for respiratory
advantage, not for straightening teeth, for respiratory advantage.
Wow.
1922.
And I'll send a link to that article, or you can download it and anybody can read it.
Well, David put it in the show notes.
It's not random controlled trials.
You didn't have evidence-based medicine until after World War II.
They were observational trials, like Einstein.
He didn't discover relativity not by doing a random controlled trial.
It was a thought experiment.
He was riding his bike and the turn into the last century, and imagined himself overcoming
the headlight beam on his bicycle.
And he would turn into energy.
That's how he came up with E equals MC squared.
It's an observational study.
You know, scurvy, vitamin C, all those things were cholera as being a waterborne rather than
an airborne disease.
A book called The Ghost Map.
Excellent.
By Stephen Johnson, talks about all that.
But these are observation and the 1922 JAMA article talks, it's based on controlled observational
studies.
I came up with that.
Okay.
So then with regard to braces, I mean, obviously they have their place, right?
Their, our benefits for straighter teeth.
You know, as a parent, I go in with my 11 year old, the geriatric child, which I love
that.
So I go in and I'm told that there's not enough room in my child's mouth.
And we have to remove all these teeth and we're going to do braces.
Because you know, as a parent, is there something I should ask?
Do I, how, how, how do I know that that's going to be okay for my child not to do more
damage if they have an undiagnosed airway issue?
Well, most, most orthodontists don't really consider the airway complex as being all that
intimately related, you know, to the craniofacial complex.
So that, that's something, and it's not their fault.
It's the curriculum.
The curriculum does not teach anything really about it.
Now it's starting to maybe.
Orthodontists are also not taught anything about child development, behavior, guidance,
anxiety, control.
I'm a pediatric dentist.
Are you kidding?
That's, that's how I make my, my existence worthwhile, how I stay pertinent to the profession
is I know how to understand a child's fears, anxieties, curiosities.
Most of them are just curious and they're, they're maybe threatened by a novel clinical
setting.
Well, I had to demonstrate extreme competence in that before I could get board certified
in pediatric dentistry.
And at the University of Iowa, you don't get a certificate unless you're competent in
managing anxiety of children and their parents.
They don't learn that in orthodontic school because it's implied you're not going to need
those skills because you're not going to see them mostly till they're about nine, 10 or
11 at the soonest.
They say, you know, do the first visit by age seven.
But that doesn't mean start treating by age seven.
More on that later, but I just, orthodontics visit by age seven is what you're saying.
They're, they're, yeah, the AAL American Association worth of Donis has a pamphlet that they renew
every couple of years and it just says first orthodontic visit evaluation should be no later
than age seven, but it says in the same brochure, but most treatment won't begin, you know,
till they're somewhere between nine and 11.
And, you know, to me, so, so I, an answer to your question, like, well, you know, if
they say that teeth don't fit and, you know, we, how do I make them fit?
Well, you know, what, what if you go to a shoe store and you were a size.
I wear a size eight and they bring out a size six and it's like, well, um, you really like
these shoes, Dr. Kev, um, we're going to have to cut off some of your toes, but they'll
fit and you'll have them.
And it's like, that's, that's ridiculous, right?
Or even, even for a third year dental student, depending on where they train, they can look
at a kid with no space, you know, a three year old, four year old with no space between
their teeth and they'll say, you know, save up your money for braces.
And that's like an endocrinologist or a pediatrician telling the parents of a kid with high blood
sugar, save up your money for an insulin pump because guess what?
Your kid is going to be a brittle diabetic and maybe, or, or an ophthalmologist telling
the parents of a near-sighted four year old, save up your money for glasses.
You know, you don't, you don't want to do it now.
It's too early.
Wait till they're driving a car, then you'll save a lot of money and you only have one
prescription, right?
That is sound analogy, that's medically defensible.
What I just told you about myopia anyway, you know, the diabetes thing is a little extreme,
but myopia, near-sightedness, that can cause the same neurological issues as mouth breathing.
You know, a kid can be psychologically damaged because they can't see and, you know, the
behavioral issues, even cognitive issues.
Are you kidding, they can't learn if they're not seeing, it used to be the chalkboard or
they, you know, right?
So anyway, I digress, but that's kind of the 11 year old, you know, you can't go back
in time, but no, don't, you want your kid to have in three dimensions, you want them
to be wide enough so their tongue will fit, you want them to be forward enough so their
tongue will fit and you don't want them to be deficient and vertical like deep overbite
or excessive like long face, all right?
You want all three dimensions to be optimized.
It's harder to do in an 11 year old, but you can, you know, you can prevent things from
getting worse, but if you take out teeth and then you put them in headgear that pulls things
back and everything, you're going to take a suboptimal situation and you're going to
make it worse by doing retractive orthodontic procedures, dental facial orthopedic procedure
procedures.
So would this be a good opportunity then as a parent if, you know, this is what you're
presented with and you suspect, you know, you've done some of the things we've talked
about in previous podcasts, watch your child sleep so you know their mouth breather, you
know, I figured out they have sleep apnea because they're snoring.
Would this be the right time then to say, you know what, before we go down this path,
I'm going to take my child to an ENT or an airway centric dentist.
Yeah, I would do anything.
Yeah.
First of all, snoring doesn't mean a diagnosis of apnea.
It's sleep disorder, breathing, we call that apnea snoring is, you know, sort of on one
end of the spectrum and in stage is apnea and that has to be diagnosed with an overnight
polysomnograph or a sleep study.
And I don't, even I don't make direct referrals, even though I can, I'm on staff at Tertiary
Care Children's Hospital, but I always go through the primary care physician, which
is the pediatrician, is, you know, I do work with the sleep medicine service at Lurie and
I know that a lot of the ENTs, but who would you, is there anybody you like referring to
because our mutual patient and you're the primary care physician, I'm the primary care
dentist or, you know, somebody else's and they referred to me.
I want to introduce that into the lexicon too.
PCP is primary care physician.
Everybody knows that.
But, right.
How about PCD, primary care dentist, because many of us, I'm a pediatric dentist and I
can do all phases of dentistry for kids, but I've really just narrowed my focus to dental
facial orthopedics on kids and the primary dentition.
That's just because nobody else really wants to do it or isn't yet doing it as much.
So I call the referring pediatric dentist or the family dentist, general dentist, I call
them PCDs, primary care dentists.
And just so, you know, you as a mom.
Yes, you want to talk to your pediatrician, but you might be the one that's going to,
you know, say, look, would you please look at this?
There's a flyer from American Dental Association and all of a sudden we hang up, but everybody,
you can just, I give it to parents and you can give it to your pediatrician, give it
to your primary care dentist.
I'm on a task force at the American Dental Association, the pediatric airway task force,
started by Stephen Carsonson and we're coming up with our own screening, you know, tools
for dentists and physicians to use in addition to the pediatric sleep questionnaire.
But it's written in very plain English and you could be the one that could change the
course of that dentist career.
Oh my gosh, I had no idea.
You know, I didn't learn any of this stuff in dental school.
I didn't learn it even in my pediatric dentistry training and I went to one of the best programs
in the world at the time, University of Iowa in the late 80s.
And I learned that retranathic chins at four years old are always going to be retranathic.
Sam Bishara, famous orthodontist, taught us that, but he didn't really say anything about
breathing.
He just said, look, once a class two, always a class two.
You know, he's the one who talked about that.
And it's true.
It's defensible.
It's that, you know, jaws are too narrow, maxillary transfer sufficiency, with or without
a cross bite, cannot self-correct.
It cannot self-correct.
It will persist.
It will usually worsen and either is or will become a comorbidity, we say, with sleep and
breathing disorders.
So width, height and length all need to be optimized as early in life as possible to assure
a child has the best chance to be a habitual nose breather as soon in their life as is
feasible to do so.
I mean, you know, if I meet a kid at 12, that's the earliest feasible time I can try to optimize
it.
But as a pediatric dentist, I'm seeing them before their age one.
I'm even looking at it.
Really?
Yeah.
So in the Academy of Pediatric Dentistry, all children should have their first dental
visit by age one.
The American Association of Orthodontists, they should have their first orthodontic evaluation
by age seven.
You know, so no, this is something that needs to be understood by everybody in healthcare.
And you don't have to be someone who even sees kids.
You know, if you're somebody like a prosthodontist who makes dentures and does implants, well,
guess what?
You're treating the grandparents and great grandparents of little kids who may have sleep
and breathing disorders and the information may come from you.
Grandpa, I hear, you know, your daughter just had or your daughter has a two year old.
Why don't you ask her if he snores?
I mean, there's so many ways we can all share knowledge and information.
And really, it's the general public that's going to cause policy change.
And what I say is angry moms, boy, you get so many moms when I'm consulting.
And when I tell them, you know, they've already had an orthodontic console.
Oh, they said, wait for the adnoits to shrink and all this.
And then I tell them what I think after I show them, you know, the cone beam x-ray and they
all go, I thought so.
I thought there was something wrong here.
I thought there's something that could be done.
Real instinct is the most powerful force on planet Earth, I think.
And you know, I don't have many people disagree with me, especially husbands.
And they'll stand back and say, as a mom, I'm obviously going to agree with that.
So and it's funny because one of the things I was going to ask you is, you know, how do
we, how do we turn the ship and change the course of really medicine?
How it's working?
How dentist and pediatricians are being taught or in most cases not taught this information?
And how do we get it to parents?
And you already touched on part of it is advocates.
I mean, we have to be our kids advocates.
We have to trust our guts.
We have to ask the questions.
We have to do the research.
We have to fight for our kids.
So how do we handle the other part of that equation as far as just medical practice?
We have the up and coming pediatricians and dentists.
How do we get them this information and just change the course we're on?
Well, it's, I mean, I just feel it's the curriculum.
It's the healthcare professional curriculum, the medical school curriculum, the dental
school curriculum, the dietetics curriculum, the speech and language pathology curriculum.
All these, they all need to change.
They all need to be influenced by this.
And we can't work alone.
I mean, everybody needs to be talking to each other.
The OB-Gynes, they need to understand of the gestational apnea.
I know more about gestational apnea than a lot of obstetric gynecologists.
Why?
I mean, it's all over their literature, but they don't, you know, you don't read.
I don't read everything in the dental literature.
There's things there that I'm, you know, I discover every day, but I, it just, it really
is and not being judgmental.
Like it's like, oh, the orthodontist, he told me they want to pull teeth and all this.
And I used to like be judgmental.
And it's like, wait a minute, I just learned this a minute ago.
This has been a career.
It's, you know, it's been 12 years now, but I spent a long time not knowing anything about
this.
And now all of a sudden I'm going to judge other people who haven't been exposed.
So that's part of it is that we have to be understanding and raise public awareness.
And that's again, policy change and really the curriculum, the educational curriculum,
the training modules in integrating it into an existing base curriculum slowly, gradually.
There's a couple of, I mean, this is, you know, the partnership that CAF has, you know,
with Dell and in Austin at the University of Texas and the medical school and the dental
school and Leah here.
I mean, there's just so many good things, connections that can happen here.
I'd love to be invited to, to lecture the ENTs and I have been at, you know, Loyola University
Medical Center here where I went to dental school, but I got invited to do a grand rounds
in the ENT department.
It was invited by the head of ENT.
It was great.
So that's the sort of thing that we have to cross disciplinary, you know, cross curriculum
activities.
And, you know, UT Austin is going to be a leader in this.
There's another institution that's.
I think so.
I think similar.
Yeah, I agree.
So as, as we wrap things up, I always like to give our guests the opportunity to speak
directly to parents and just, you know, leave them with something.
What is it that you would tell parents specifically around.
Airway health and, you know, how to do the best for your child in this, you know, the
environment that is life today.
There's many things you can do to raise your child's optimize your child's quality of life.
Which it also enhances family quality of life.
I mean, what, what parent has a quality of life if their child doesn't.
And one in addition, you know, to getting them, you know, square meals and shelter and
education and physical activity, you know, all those wonderful things that parents can
assure that their child get is the ability to breathe through their nose habitually while
they're awake and especially while they're asleep.
How you do that?
Well, you know what?
You need to know that that should be done.
How it's done and the nuances pretty soon will be as public knowledge as is eating fresh,
minimally processed food and not, you know, living in front of a computer screen and video
games but being outdoors and playing.
That's sort of, you know, in the public domain now.
But this sleep and breathing thing is early in life as possible.
This is just not out there.
Air is there.
I still have some healthcare professionals.
Well, you know, it's oxygen.
I mean, what difference does it make if you get it through your mouth and your nose?
Most it's getting less and less, but most people, they'll say, Oh yeah, yeah, you should
breathe through your nose.
But I, you know, I just don't think they don't really understand what is in healthcare and
the public domain as well.
Yeah.
And that's, that's really what we need.
That's what we tell parents.
Your child needs to be a nose breather immediately.
It's quickly as possible.
And we have to find out why they're not if they're not first find out if they're not.
Maybe they already are, you know, but that's another thing you can feel good about.
I love it.
Thank you so much for being with us today.
Dr. Kev.
I really appreciate it.
Oh, and thank you very skillful in your questioning and interviewing.
I enjoyed it very much.
Thank you.
Thanks again to today's guests, Dr. Kevin Boyd for sharing his medical insight and to
each of you for listening to today's episode.
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Take care, stay safe and happy breathing, everyone.