The Missing Piece in Skeletal Growth and Development

Episode #299 with Dr. Rebecca Bockow

Airway dysfunction can lead to a number of comorbidities — anything from tooth decay to behavioral concerns. And to prevent them, it’s important to understand the possible causes. One of them is an undersized jaw, and Kirk Behrendt brings on Dr. Rebecca Bockow to talk about what influences skeletal growth and development, and the importance of early treatment and intervention. For more on identifying and treating tongue and respiratory dysfunctions, listen to Episode 299 of The Best Practices Show!

Main Takeaways:

Dentists may be the first providers to identify airway issues in patients.

Key things in skeletal growth and development happen as early as during breastfeeding.

Breathing and tongue placement habit strongly influences skeletal growth.

Undersized jaws can lead to comorbidities.

Ask patients open-ended questions to identify possible issues.

Look to early treatment and early intervention.

Treat the “why”. Look for tonsils, airway issues, and tongue-ties.

Understand structure, function, and behavior.

Quotes:

“When we see malocclusion, we might be, as dentists, the first providers to identify for some of these patients that they do in fact have an airway issue. So, this can present, for example, grinding. Grinding in kids and adults is a sign that airway is not great. We can pick up tongue- ties. Certainly, the easy ones to pick up would be a crossbite, open bite, underbite, overbite. These are all linked to airway dysfunction. So, once you see it, you can't not see it. And you'll start to see how prevalent it is.” (05:11—05:48)

“As care providers, we can sometimes ask open-ended questions for the patient, ‘How do you sleep?’ And it opens up Pandora’s box. ‘Oh, I wake up through the night. My child couldn't breastfeed. She’s still wearing Pull-Ups at age eight. We've got a lot of behavioral concerns, not paying attention in school, comes into my bed every night, tired during the day.’ And we, as orthodontists, see the crossbite. And so, all of a sudden, we’re tying things together for these families that they didn't even know were connected.” (05:49—06:28)

“If we think about skeletal growth and development, a lot of the key things that happen happen really early on, going back even as early as breastfeeding.” (07:20—07:28)

“Thinking about the tongue, all of those movements [when breastfeeding] require a great deal of coordination, as well as flexibility and strength. And so, if you have a child that has a condition called apraxia, and there's a lot of nuances to this, but globally thinking about a child’s ability to move the tongue in a way that's healthy, so getting that tongue up and forward, things like muscle incoordination or things like tongue-ties are going to adversely affect what's going to happen with the tongue.” (08:12—08:49)

“The nose is a natural filter. When you have the ability to breathe through your nose, the nose is going to humidify the air. It moistens the air. You filter out all the dust, the allergens, the pollens. Adenoids and tonsils are hypertrophic tissue, so if you have a child that's a mouth-breather, we tend to see bigger tonsils, bigger adenoids. And so, this cycle continues because they're more driven to breathe through their mouth, because now they have nasal respiratory obstruction.” (10:21—10:48)

“There's great documentation that links nasal respiratory obstruction with undersized jaws. And then, we start to see other comorbidities that we would notice as dentists, which include grinding, high carious incidents, hypertrophic tissue such as the gum tissue. And the cycle goes on and on. As orthodontists, we see this as crowding because the jaws are small. So, there's insufficient bone to...