Our Skulls Are Out-Evolving Us


TThere is no easy way to turn back the evolution of our skulls. It’s unrealistic to advise parents to eschew processed food, breastfeed longer, move to open-air cabins in the country, or perhaps put children on the Paleo diet to prevent these changes taking hold in the skulls of the next generation. We are stuck with our smaller modern faces, but there are steps we can take to address the conditions that come with them.

Across the state from Hanes at Northwestern University’s medical school, sleep medicine doctor Stephen Sheldon explained new techniques — or recovered techniques — that encourage the jaw to grow wider and more forward in order to align the teeth and enlarge the airway, and often enlist myofunctional therapy to create healthy tongue and mouth habits. Traditionally, orthodontists are most concerned with straightening teeth, rather than moving the mandible forward as a primary goal.

“We really don’t know yet which is better and we really need to pursue that question and answer it in a scientific method,” Sheldon said. “We have lots of anecdotes, but depending upon anecdotes is not science.”

Last winter, I joined Boyd at his Chicago office in order to see the theory in practice. Boyd strode from the back examination area to a consultation room — a nook off the hallway — to show parents the images of their child’s mouth and describe his plan to expand the palate and straighten the teeth. “We’re rediscovering something that’s always been known, that used to be mainstream,” he told the skeptical dad. “Nose-breathers are always healthier than mouth-breathers.”


Some orthodontists wait for braces. To Boyd, any time you see crowding or potential problems on the horizon, it’s a signal to expand the mouth now. Why delay? The sooner you intervene, the sooner the airway expands and kids start to develop good habits for nasal breathing and tongue position. He’s worked with children as young as two years old, and special needs kids whom some dentists find difficult to treat. Some of his colleagues use removable devices similar to those described in Boyd’s stack of early 20th century research papers.

The problem is getting worse, not better. “More babies are born with anatomy that makes nursing and breastfeeding difficult, raising the risk of developing dysfunctional feeding habits,” said feeding specialist Bahr. “More time on their backs than their tummies, processed foods, bottle feeding, and pacifiers contribute to the misshapen jaw, impairing breathing and sleep. Once their sleep suffers, a range of other problems begin to develop.”

A huge population of children might be candidates for earlier, alternative orthodontia, such as the Advanced Lightwire Functionals appliance that some osteopaths deploy. Around one-quarter of school age children snore, meaning the upper airway is narrow and vibrating — an abnormal situation. “Even snoring can result in outcomes that are negative, neuro-cognitive deficits,” Sheldon said. “Every pediatrician is supposed to screen for snoring. Not every pediatrician does because they have so much to do in 15 minutes at a health maintenance visit.”

Even if the screening were adequate, there are only 294 board-certified pediatric sleep specialists, and just over two dozen pediatric sleep centers in the United States. The typical path for children with sleep apnea, or sleep disordered breathing like snoring, is removal of tonsils and adenoids, which often press on the upper airway, narrowing it. But for children like Micah Hanes, whose symptoms don’t resolve with adenotonsillectomy, alternative orthodontia may be the only choice.

Sheldon and some colleagues are writing a protocol for a prospective study of alternative orthodontia in young children. They need many institutions to be involved in order to capture data on enough children. Nighttime sleep studies cost a lot of money, raising the challenge. Sheldon is waiting for the publication of his retrospective study, describing results in 18 children. While the wheels of science slowly grind, parents scramble for guidance, acting as researchers, detectives, and advocates for their children.

We have to adapt, and adapt quickly, to our changing physiology — or risk the consequences.

“Often parents don’t even realize their child is having a sleep problem, because they don’t think snoring is a big deal,” he said. “They don’t realize how significant snoring can be to affect the child’s life. They’re waking frequently at night, can’t fall asleep.”

At my own children’s dental office, I found a 20-page parent education pamphlet from the American Dental Association that stresses the importance of teeth cleaning, a healthy diet, regular checkups, preventing injuries, and limits on sucking. Only one page addresses bite problems or teeth alignment, saying that orthodontic treatment usually begins between eight and 14 years of age. There’s no mention of sleep problems that could connect to a mouth and jaw issue, such as snoring, mouth-breathing, restless sleep, frequent nighttime wakings, effortful breathing, or difficulty waking children in the morning.

“There’s a relationship between sleep apnea and the health of many of our body structures,” said Margaret Rogers, chief staff officer for science and research for the American Speech-Language-Hearing Association, the professional association for SLPs. “It’s everybody’s responsibility. Pediatricians need to be screening. Preschool and classroom teachers, if there’s a kid in your class that’s falling asleep, ask why. It’s not that these kids are lazy, or not attending, or bad kids; they may be kids who are chronically deprived of sleep.”

Humans draw 28,000 breaths each day. We sleep for about one-third of our life. Changing our sleeping and breathing habits can transform our physical and mental health. It all begins in our jaw, mouth, and throat anatomy, which shape the path of each breath.

Jerry Rose, a dental anthropologist and professor emeritus at the University of Arkansas, warned that a whole generation could be impacted if we don’t change course. “In evolution, there are winners and losers,” Rose said. We have to adapt, and adapt quickly, to our changing physiology — or risk the consequences.

“There are groups of people who simply went the wrong way,” Rose said. “And then they’re gone.”

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