1322 W. Kathleen Ave., Suite 1, Coeur d'Alene, Idaho 83815
208.518.0770
The science in health and dentistry is constantly evolving, and we are looking at old issues with new eyes. What we labeled as a “small mouth” or “bad genes” in the past, we now know may be the result of poor growth, which we now know can be improved with the right interventions at the right time. What we labeled as ADHD, restless kids, or stress, we now know may be the result of poor sleep due to a small airway, which is the result of poor growth. We also now know that growth of the entire oral complex (including the airway) is directed by function. To put it as simply as possible, when a growing human functions properly, they will grow better. The oral complex should grow big enough to fit all of the teeth without crowding. It should also be big enough to contain the tongue so that it doesn’t take up space in the back of the throat, big enough to contain tonsils that occasionally become inflamed because that is what tonsils are supposed to do, and big enough to tolerate some inflammation due to the odd allergy and still breathe through the nose.
What does “functioning properly” mean? Functioning properly means breathing only through the nose and using the muscles of the face to chew hard, real food and swallowing properly. Muscles that function properly will place the correct forces on the bones to direct growth. Muscles functioning improperly don’t optimize growth and can even inhibit it.
If we can improve function and influence growth to be optimal (or at least improved), we get a 2-fold benefit. First, we get to grow a mouth that will require less dentistry in the future, including orthodontics. A mouth that is big enough to fit all the teeth and a face that is big enough to breathe properly puts so much less stress on the teeth (not to mention the whole body) over a lifetime. Secondly, (and arguably more important), we get to grow a healthier, happier human.
This is where sleep comes in. To put it simply, a mouth and face that are developing too small will be harder to breathe through. Getting oxygen to our brains is the single most important thing that our brains do and we will prioritize it at the compromise of almost everything else. When an airway is smaller, it is more easily obstructed and requires more compromise. This can look like any combination of inflamed tonsils and/or adenoids, inflamed nasal tissues making nasal breathing hard, a tongue that is forced into the throat because it has nowhere else to go, and floppy soft tissues around a small framework. When the airway is obstructed (or more commonly, partially obstructed), the body will work harder to keep breathing. This looks like increased stress on the body. This looks like poor quality of sleep because the brain continues to “wake” the body up to maintain the airway. This looks like a kid that can’t get the rest/recovery that they need during sleep to grow, learn, store memories and clear out their brains, regulate their nervous systems, regulate their hormones, and grow into the best human they can be.
So, how does the dentist come in? Once we evaluate symptoms and the development of your child’s oral complex, we can discuss whether intervention is necessary or not and what that may look like. Depending on age, we will be looking to see if we can “guide” your child’s growth in any way.
At very young ages, we will just be looking to make sure your child is functioning properly. This means ensuring that your child is breathing through their nose all the time, swallowing properly, and eating hard foods. We will evaluate tissue ties to ensure they aren’t restrictive and referring appropriately if this is the case.
After about age three, we may suggest the use of a “growth guide” which is a silicone appliance that your child wears at night. It is built to support proper muscle function, including swallowing and nasal breathing and to gently guide the wide and forward direction of growth that is so often lacking.
After about age 8, we are running out of time to guide growth. If your child is struggling to breathe through their nose, has any of the symptoms mentioned in the questionnaire or is significantly deficient in arch size, we may talk about using an expander and/or clear aligners to help with arch development.
As dental professionals, we see the effects of poor growth and function in adults. Small mouths and noses that don’t work very well look like TMJ issues, sleep apnea, worn teeth because clenching is how our bodies stay awake to keep breathing, headaches, migraines, unexplainable decay, crooked teeth, broken teeth, premature loss of teeth, unexplainable periodontal disease, recession, sensitive teeth, and so much more. Poor sleep can lead to other serious health issues as well. These things can be hard to give our patients good solutions for and it can be frustrating. It turns out that looking beyond the teeth makes dentistry so much more powerful, and when kids are still growing we have the opportunity to do our best to set them up to avoid these frustrating and hard to solve issues. We look forward to working with you and watching your child breathe better and grow better!
All the details Your insurance can help with exams and evaluations, and if orthodontic intervention is necessary, there is often some insurance coverage for kids.
Myofunctional therapy is like physical therapy for the tongue and the muscles of the face. This therapy will focus on improving nasal breathing and muscle use that will support optimal growth. It will not be covered under dental insurance. It will usually be with an outside provider, often a dental hygienist with extra training. It most likely won’t be covered under medical insurance either, but it can be paid with HSA or FSA funds. The cost is usually spread out over the treatment time and is usually very manageable. Myofunctional therapy will be absolutely necessary if your child requires a frenum release. Learning to use the muscle appropriately is important to ensure that the frenum doesn’t just scar back into place.
Growth guides will not be covered under dental insurance. There is no code that is applicable. The cost of the first guide is $150. If the guide gets lost and requires a replacement within a year, the cost is $125. If we recommend changing the type of guide within a year, the cost of a new guide is $125. If your child begins to wear a guide at a very young age, they will go through a succession of a few different ones as their function improves and as they grow, but usually not more than about 3 different ones. First guides for very young kids are $75. It’s unfortunate that insurance doesn’t help with this treatment. If used correctly, it will prevent the need for costly dental treatment in the future. Our mindset needs to shift away from allowing insurance to dictate the care that we chose for ourselves and our kids. The monetary cost of the guides is minimal, especially when we consider the positive impact on dental and overall health. The real cost is in compliance and follow through. These guides and therapy don’t work unless they are used, and they aren’t used unless the parents and kids understand the why.
If we determine the need for orthodontic intervention like clear aligners and/or an expander, there is usually some dental insurance coverage. It’s important to know that most insurances will cover up to a certain dollar amount of orthodontics per patient per lifetime. Intervention before about age 10 is traditionally considered “phase one”. There is no guarantee that early intervention will totally prevent the need for phase two orthodontics, but it will certainly lessen the time and severity of the second phase.
So why intervene early if we know we will probably still need some type treatment later? Why not just wait until they lose all their baby teeth? Because your child is growing and developing their brain now! Kids' upper jaws complete about 60% of growth before age 8 (and almost all of the growth in the width direction is complete by this age). The size of your upper jaw is the size of your nose! There are two main reasons that we want to optimize that growth, dental health and overall health. Dentally, we want to grow a big enough complex that will fit all of the teeth and allow the TMJ to function appropriately. If the jaw is locked behind a deep bite or too small of an upper jaw, growth will not be optimal and we will be fighting to fit all the adult teeth into too small of a frame later. For overall health, a child that is sleeping better because their tongue fits in their mouth and their nose is big enough to work properly is a healthier kid, mentally and physically. The cost of these treatments can be spread over the time that they take and will prevent the need for costlier interventions later.
Ultimately, we will use your dental insurance for what we can, but there will be some out of pocket cost. Some orthodontists will say that phase one treatment is a waste of money (and benefit use) because there will still be a need for phase two. If we are only thinking about the teeth, that may be sort of true. But even if we consider “only the teeth”, we see adults every day with their teeth crammed into too small of a mouth. These are the adults with never ending dental issues, not to mention tmj problems and poor sleep and all associated health issues. But we are looking beyond the teeth. We know that these conservative, non-invasive, non-pharmaceutical interventions can make a big impact down the line in the lives of our children.
