More people than ever seem to be suffering from one or more of these mouth conditions: overcrowded teeth, obstructive sleep apnea, teeth grinding, and mouth breathing.
They are all red flags that some medical and dental experts say are evidence of a pervasive problem related to our modern lifestyle.
The human jaw is shrinking, they say, and it’s not simply a cosmetic concern. It’s often rooted in childhood, and while symptoms sometimes appear early in life—particularly overcrowded, crooked teeth that are addressed with orthodontics—it’s usually not until adulthood that other problems arise.
A small but growing vocal group on the fringes of health care say these symptoms can be traced back to changing facial bones that are constricting airways.
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Stunted Facial Bone Growth
The argument is that habitual mouth breathing can interrupt the widening growth of the jaws and palate. Breathing orally drops the tongue out of its proper posture high in the upper palate. It’s especially problematic at night when it causes the upper airway to collapse, creating increasingly tighter respiratory passageways, and leading to obstructive sleep apnea and other diseases.
One theory published in a 2020 article in Bioscience blames tongue posture for the problem, saying a lazy tongue not thrust upward in the anterior palate during rest causes the upper palate to form more narrow and high as bones fuse. And that would cause the tongue to no longer fit at all.
In a response to the article, Dr. G. Dave Singh traced the root cause further, saying tongue posture is likely a response to nasal obstruction, which might occur due to anatomical deformities, allergic congestion, obesity, or habits. Singh’s former company, Vivos Therapeutics, markets treatments for dentofacial abnormalities and mild-to-moderate obstructive sleep apnea.
A 2018 study of 98 children published in the journal of the Brazilian Society of Pediatrics found distinct differences in the nasopharyngeal dimensions between children who breathe through the nose and those who breathe orally. In the teenage group, there were also differences in palate length, face shape, and the hyoid bone, which aids in tongue movement.
Further, radiograph scans showed even among those children whose faces appeared to be developing normally, there was evidence of constricted airways. “[W]hen compared with nasal breathing individuals, oral breathing children present differences in airway dimensions,” according to the study.
Studies and scientists say health woes connected to changes in the jaw are entirely the effect of the human lifestyle, or more specifically, the shift from hunter-gatherer to agricultural/industrial societies. Even comparing archaeological mandibles over thousands of years seems to confirm the observation.
It’s concerning because obstructive sleep apnea is responsible for serious illnesses such as congestive heart failure, stroke, arrhythmias, and asthma. It is associated with cardiovascular disease risk factors like obesity and diabetes and appears with comorbid conditions like kidney disease, thyroid disease and psychological comorbidities including stress and depression, hypertension, fibromyalgia, excessive drowsiness, stroke, diabetes, pain, anxiety, and many others.
One 2011 study of 301 patients found that up to 98 percent of sleep apnea patients were found to have abnormal mouth and jaw features.
Correction Without Surgery
There is no official medical, dental, or orthodontic recognition of the jaw condition, but there are plenty of practitioners who are coming up with treatment strategies nonetheless.
Many practitioners believe that addressing the shrinking airway using palate expansion appliances as part of a holistic plan or last-ditch solution can help address the root cause of many mouth problems. Other issues they say can be helped include jaw pain, sleep quality, brain fog, poor digestion, low energy, and even pain in other areas of the body.
Oral appliances work by anchoring to the teeth with a metal bridge across the palate that can be adjusted with a key to widen the appliance, and along with it, the upper jaw. Treatment can take six months for children, who have more pliable bones, and up to two years for adults. It’s been used in all ages.
A Major Pivot in Thinking
Dr. Steven Park, author of “Sleep, Interrupted,” told The Epoch Times he was blown away when he first heard of how much dysfunction might be linked to the jaw. It’s the kind of information that calls into question medical protocols that treat seemingly unrelated conditions symptomatically. But it made sense to him.
“I was never taught this in medical school,” Park said. “A lot of the things we do to treat these diseases are a consequence of this problem.”
Besides the symptoms listed, other signs that the human mouth is changing include a receding chin, malocclusion (misalignment of teeth), the rise in impacted wisdom teeth, and middle-aged adults in need of orthodontic work—sometimes for a second time.
But even a perfect smile can camouflage a restricted airway, Dr. Felix Liao, holistic family dentist and author of “Six-Foot Tiger, Three-Foot Cage,” told The Epoch Times. He’s worked with many patients who have straight teeth but suffer jaw pain that leaves them suicidal. Many were subjected to a once popular orthodontic approach—pulling overcrowded teeth, which Liao said can cause even more jaw shrinkage.
“When medicine and dentistry don’t evolve, sometimes the lessons are painful,” he said.
Liao calls the collection of symptoms “impaired mouth syndrome”—crowded teeth jammed into short, narrow jaws with jaw joint dysfunctions and blocked airways. In his book “Licensed to Thrive,” he describes ideal mouths as having fully developed jaws with room for all 32 teeth to line up naturally straight. An ideal mouth includes a wide-open airway to support sleep, providing all the oxygen the body needs.
Seeing Narrow Airways
These specialists use CT scans as part of their diagnostic workups. This allows them to measure the width of the airway to assess whether breathing may be an issue and to follow up after treatment to compare.
Oral appliances often expand an airway to two to three times the volume, Liao said. In a recent case, Liao said a woman’s airway volume was 120 square millimeters before treatment, and 276 square millimeters afterward.
Previously, I interviewed a dentist, breathing expert, sleeping expert, and a functional medicine family physician who all mentioned the jaw epidemic. They are seeing the evidence of patients who had teeth removed as children suffering from sleep apnea. And then the issue reared itself in my personal life.
At a recent pediatrician appointment, I brought up concerns about my daughter’s snoring and recurring illnesses since she began losing baby teeth. The pediatrician took one look inside her mouth, noted a very steep palate, and referred her to a dentist who follows a diagnostic and treatment model similar to Liao’s.
Among the issues I was surprised to see on her scan were: a very narrow airway indicative of childhood sleep apnea, jaw misalignment, swollen adenoids, a severe lip tie, and one sinus cavity entirely compressed, despite not being sick at that time.
The Controversy
Programs to expand palates are readily available, but not in most orthodontist’s offices, despite the procedure being considered orthodontic in nature. Most who offer it are dentists.
Wouldn’t the orthodontics profession identify the cause, cure, and prevention for jaw disorders and constricted airways? That’s what a dentist, orthodontist, and three Stanford University biology professors wrote in a 2020 Bioscience article calling out the profession for its lack of updated training in the “jaw epidemic.”
“Orthodontics is a big and successful business, and, in an era of genetic determinism, it is convenient to blame malocclusion on genetics, avoiding the complexities of prevention,” they wrote. “As a result, orthodontic techniques tend toward symptom management with temporary relief of aesthetic concerns—teeth straightening for teenagers, with lifelong management strategies (retainers) usually required for permanent success.”
The orthodontic profession is rather silent on the issue, though the book “Jaws: The story of a hidden epidemic,” did stir a reaction on the Orthodontic Professors, a blog on evidence-based practices by three professors. These professors are skeptical of claims that there is a jaw epidemic and their critical review of the book took aim at the evidence.
“Often, collaboration of individuals from different scientific disciplines can create great synergy. In this instance, it has instead produced an exercise in mutual delusion,” they wrote.
The book is full of weaknesses and contradictory findings, they say. They also pointed out that it’s not a new idea, that it was a theory posited 100 years ago by Alfred P. Rogers. Chairman of orthodontics at Harvard and once president of the American Association of Orthodontists, Rogers coined the term myofunctional therapy—exercises to straighten teeth and correct jaw relationships—in an article published in 1918 in the International Journal of Orthodontia.
The blog writers said he never presented evidence that it worked.
The Big Picture
Meanwhile, clinicians continue to treat conditions related to jaw issues. Tongue and lip ties can be surgically corrected to open up space in the mouth and improve malocclusion. Park said he may also refer clients for orofacial myofunctional therapy, like physical therapy for the mouth that helps strengthen the tongue, jaw, and lips to achieve proper tongue posture.
“My philosophy is not just to treat the breathing problem but to address everything else,” Park said, adding that the solution is often a multi-pronged approach often seen as less appealing than a quick fix. “This is why Americans don’t do well with our health. People get so confused they get paralyzed. They don’t do anything.”
Park and other holistic practitioners might offer coaching and resources for improved diet, stress management, breathing exercises, and better sleep habits.
Liao pointed out that as much as we are what we eat, we are also a product of how we sleep. Dentists, he said, are on the front line for identifying patients who struggle with sleep apnea because of the mouth symptoms. He’s training them with his airway mouth doctors program.
“We always should be thinking how can I put this patient back together who’s in front of me,” Liao said. “You have to restore their body’s ability to self-govern.”
