Sleep, Airway, and Craniofacial Growth: Reaching Our Genetic Potential.

I just had a very inspired conversation with Dr. Charles E Jones from Jones Family Dental. For over an hour we talked about his continued work and study around craniofacial growth, airway management, sleep apnea and epigenetics. This is not the typical conversation you have with a dentist, but Dr Jones has really set himself apart in this field of study and treatment.

What is airway management and craniofacial growth? More than 20 million American adults have a blocked or impaired airway while sleeping, known as Obstructive Sleep Apnea (OSA). There are an estimated 60-80% of these people not yet diagnosed. The underlying cause of OSA is associated with abnormal anatomical features associated with improper growth and development.

OSA numbers in children are hard to estimate but some sleep disordered breathing is prevalent in up to 20% of children, and these children have an 50% increased risk of ADHD. This was a fascinating conversation that was both very informative and educational. I think you will find it quite interesting.

Dr. Jones, hello and welcome back to LocalsGuide. How are you today?

I’m doing great. We are all weathering the storm of this pandemic and look forward to a time we aren’t all at risk. Nonetheless, I’m still so grateful to live in such a beautiful community, and I’m excited to share what we’ve been up to.

Great to hear it. To begin with please give us an update on your practice. It’s been almost 7 years now….

We have really settled in here in Ashland. We have grown steadily and have continued to work hard to constantly improve the quality and standard of care as well as patient experience at Jones Family Dental. We are so grateful for the continued support and trust that our patients offer us.

Dr. Jones, please tell us more about where you are today with your practice.

As well as providing all the same services: Single visit esthetic crowns with digital impressions, sedation, laser, and cutting-edge digital technology, we have added a 3D Cone beam or CT. All cone beam machines are not created equally and ours boasts the lowest radiation with the best image on the market. As well as screening for OSA we are also offering Home Sleep Testing and cutting-edge craniofacial growth and airway management procedures. We will be the first to introduce the Vivos system to the valley.

This sounds interesting. What specifically is craniofacial growth and airway management? And what is the Vivos System?

Well, what we have learned is that modern craniofacial growth has changed significantly, and the new norm is not actually representative of our true genetic potential. If you consider the skulls studied from 500 years ago we see practically no crowding, and often all 32 teeth are fully erupted and fit in the arch ideally. We saw significantly more downward and forward growth in both the upper and lower jaws and mid and lower face. We saw more nasal airway volume potential and wider upper palates. Crowding of the teeth was rarely seen. The Vivos system leads the world in craniofacial growth and development appliances and protocol. Dr. David Singh is the brain behind the system but clinicians worldwide have contributed to this treatment.

So if that’s what things used to look like, what are we seeing today?

We are seeing jaw sizes that are smaller with crowding and malocclusion occurring in most children. We are seeing more developmental issues in children and long-term problems with smaller blocked airways in adults.

For some time now we have said, “We have evolved” to have smaller jaws and to not have enough room for all our teeth. This is not exactly true. What we now realize is that function is crucial to fully realize our genetic growth potential. It is theorized that with less breastfeeding and softer modern diet we lack the appropriate function that our ancestors experienced. This leads to a cascade of issues.

What is traditionally done for these underdeveloped jaws in children?

Dental Surgery and/or Braces:

Regarding dental treatment, we are often left with few options once we see severe crowding and malocclusion (poor jaw and teeth alignment.). In the past we were forced to extract teeth and apply orthodontic treatment. We almost always recommend wisdom tooth extraction but sometimes need to extract 2 or even 4 premolar teeth to make space for the teeth to erupt or be properly aligned. We have some incredibly talented orthodontic clinicians in our valley, but they are limited by the size of the arch when they utilize orthodontics alone. Sometimes we utilize jaw surgery where we can disconnect the jaw from the skull and move it to positions that will allow them to align or function in a better way. Obviously, this last method is quite invasive.

Ear Nose and Throat Surgery:

Often with poor development of the lower and mid face, we see less nasal breathing and more mouth breathing. Mouth breathing is associated with enlarged tonsillar tissues. With inappropriate craniofacial development and enlarged tonsillar tissues we see more fluid in the ears and ear infections. Tubes in the ears and tonsil removal are usually utilized to help reduce airway obstruction and manage the ear issues.

Behavioral Therapy and Medication:

There are also behavioral issues often present. As parents we do our best for our children. We often think there is something we should have done to help. Often for bed wetting, poor school performance, or other problematic behavior we try to mentor our children to help them. When trying to improve things like poor growth, bedwetting, or ADHD we might turn toward medications to help. These may not be wrong answers but what I’m saying is that these problems may be exacerbated or even entirely caused by poor airway development and we might be able to help.

So, Dr. Jones this appears to be bigger than simply having nice straight teeth?

Absolutely. When our jaws, and especially our upper jaws and mid face, don’t grow and develop downward outward and forward it can have a dramatic impact on the airway and the soft tissues that cause OSA. In OSA patients we see a narrower maxilla, mandible, and a soft palate and tongue that sits further back in our throats. Also, we see more mouth breathing which we already talked about. All of which increases the risk of tissue blocking the airway especially when we are sleeping both as a child or later in life as an adult.

Tell us more about what happens when the airway is blocked while we sleep.

We call this sleep disordered breathing (SDB) or obstructive sleep apnea (OSA) and it is confirmed by utilizing a sleep study. We determine the severity by using the measure of reduction in air and complete stoppage of air flow per hour (AHI). I have seen patients that stopped breathing 75 times per hour, sometimes for 10-30 seconds per event. Every time this happens, we are aroused from a deep and necessary stage of sleep and are either awakened completely or are left in a light stage of sleep. These deep stages of sleep are necessary for proper brain development, maintenance, and function. It is also important for other physiological functions throughout our bodies.

Heare are 14 signs your child may have OSA:

1. Frequent and Loud Snoring and /or Snorting

2. Pauses in breathing, choking sounds and small gasps for breath

3. Frequent open-mouth breathing

4. Agitated sleep with frequent posture changes

5. Excessive sweating

6. Abnormal Sleep positions

7. Night Terrors

8. Sleepwalking

9. Bedwetting

10. Morning Headaches

11. Poor Appetite

12. Complaints of waking up with dry mouth

13. Eary morning rising

14. ADD or ADHD medications are not helping.

Dr. Jones, what are YOU doing differently to help children that may have some of these problems?

Obviously, we are screening at our office, but we are also working to inform and partner with relevant groups in our community. Pediatricians, Primary Care Providers (PCP’s), teachers, therapists, etc.

Since children are still growing and developing the simplest and best solution for children will both alleviate current symptoms while also facilitating appropriate growth and development that can prevent future risk and complication. The solution we offer is noninvasive and involves a functional appliance that comes in and out of the mouth that we use to widen and grow the jaws to provide appropriate space for normal eruption and jaw positioning. We also incorporate myofunctional therapy to create and maintain the ideal development. If growth is facilitated early enough, often orthodontic (braces) prognosis can be improved or avoided altogether while protecting a child’s airway.

Tell us more about Myofunctional Therapy.

We talked earlier about how function helps us reach our genetic potential. Myofunctional therapy involves training and exercises for the tongue and oral muscles to function in a way that creates or maintains necessary development of the bony hard palate. Closed mouth nasal breathing along with appropriate tongue position and swallowing technique are also crucial. Myofunctional therapy is crucial for both adults and children.

What are you doing for your adult patients?

Regarding OSA, we are interested in screening and educating our patients. We are partnering with PCP’s, sleep centers, and sleep physicians to get our patients the help they need. Sometimes we facilitate a patient getting to their provider to treat the symptoms of OSA by getting them a pressurized “breathing machine” called a CPAP.

For patients who can’t or don’t want to use a CPAP we can offer a lower jaw appliance to treat the symptoms of OSA.

Then the latest treatment we are offering involves treating the underdeveloped jaws by reactivating stem cells found in the maxillary sutures and around the teeth. This is the treatment that is so revolutionary. We utilize the Vivos proprietary removable appliances. This treatment has been researched and protocol developed since 2010 and is currently being reviewed by Stanford University, the sleep medicine leader of the world. (See Research link at the end of the article) This appliance and protocol is painlessly being utilized to slowly grow the jaws wider and more forward to treat the underlying cause of obstructive sleep apnea. For many who can’t or won’t wear a CPAP machine, this solution is often the best solution where we are able to treat the underlying cause of OSA.

What children are good candidates for this treatment?

Nearly all children can be served by facilitating craniofacial growth. The well-developed child with proper jaw size and space for eruption is rare. Children who have very tight or crowded teeth and deep bites where you can’t see the lower teeth should be screened for treatment, but certainly children that are demonstrating signs or symptoms of OSA. As a parent I wish I could go back in time for my 4 children and utilize these appliances. Ideally, we want a solution that both treats the immediate sleep and airway issues as well as the long-term growth and development to create a healthy adult. This is about realizing our genetic potential.

Are there any cases that demonstrate the power of this kind of treatment?

There are numerous cases for adults and children but two of my favorite cases are children’s cases.

Case 1 10-year-old girl – note the severe crowding that is commonplace today, sleep disordered breathing, severe asthma no sports allowed, and 0 percentile on the growth chart. This child was about to get growth hormone injections and used her inhaler daily when she presented. After appropriate diagnostics an oral appliance was utilized and worn 16 hrs per day.

In 5 months, daily inhaler usage is reduced to as needed.

In 10 months, no inhaler was needed and a sport was allowed.

In 15 months, she had grown 4 inches and gained 18 lbs.

18 months, no longer asthmatic and beautiful arches with practically no crowding only with a functional appliance and no braces.

This young lady went on to be a college long-distance runner.

Case 2 This 10-year-old boy that we watched on video, unable to say his ABC’s, suffered from night terrors, night sweats, snoring, mouth breathing, bed wetting almost every night. His mother was a schoolteacher and spent numerous hours a week tutoring and mentoring her son. Myofunctional therapy and an oral functional appliance was used.

In 8 weeks, he slept through the night, no accidents

Within 10 months, he stopped having night sweats, started dreaming, silently breathed through his nose, and could read a Harry Potter Book. Ultimately 6 months of removable clear aligners were used but as pictured only a removable functional appliance was used and nearly all his symptoms were alleviated.

Research Reference:

Here are some videos from Vivos Life.

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