S10|11 - Mouth-Breathing, Behaviour Issues and Jaw Growth with Dr. Ben Miraglia

Did you know that years ago our mouths were big enough to fit wisdom teeth comfortably? And that jaw growth has decreased significantly over the last 100 years? You’ll be surprised to hear how jaw growth, mouth-breathing and behaviour in kids (including ADHD-like symptoms) are all interconnected. 

Today we chat with Dr. Ben Miraglia, a graduate of SUNY at Buffalo School of Dental Medicine and the United States Dental Institute, who has been in private practice for over 20 years. 

In addition to his clinical practice, Dr. Miraglia serves as the Chief Dental Officer at Toothpillow, a preventative, pre-orthodontic system designed to correct and support proper jaw development, promoting nasal breathing and preventing many health problems. Toothpillow addresses the root causes of misaligned teeth, often without the need for braces or tooth extraction. 

In today’s conversation: 

• How most children (and adults) have undersized jaws, and what you can do to grow your jaw 
• Why mouth-breathing makes a difference in sleep, bedwetting, behaviour and more (and what to do about it) 
• How braces only fix a symptom, and don’t treat the cause (and don’t often work long-term) 
• 3 steps to start the healing process, starting at the root cause 

Dr Ben’s Links: 

Toothpillow Instagram HERE

Dr. Ben Miraglia's Instagram HERE 

Website: https://www.toothpillow.com/

**Use the code "Parenting Coach" to receive a complimentary evaluation from a highly trained Airway Dentist and $250 off treatment when you book between March 24th-31st, 2025 

If you book outside of these dates, you’ll still receive 50% off the consultation and $100 off treatment!

Make sure to mention "Parenting Coach" in the referral section when booking**

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Links to Crystal’s work, to help on your own inner journey: 

Intuitive Journaling Prompts HERE and a somatic meditation (Move through frustration in 15 minutes or less) HERE, The Art of Non-Attachment Workshop HERE

Get started on this work with daily practice in a journal, Burn This Book (a great intro to mental and emotional wellness) HERE

Work with Crystal 1:1: www.coachcrystal.ca/miracle or in group: www.coachcrystal.ca/creationroom

Grab your copy of Crystal’s feelings wheel here: www.coachcrystal.ca/wheel

 

Full Transcript

 

This transcript has been created to provide a text-based version of the podcast episode for accessibility and convenience. While effort has been made to ensure its accuracy, it may contain errors or omissions. Please note that the exact words and intended meaning of the speaker(s) are best understood by listening to the original audio recording.

To experience the full conversation in its authentic form, please listen to the episode directly on your preferred podcast platform.

Introduction 

 

Crystal: [00:00:00] Welcome to the Parenting Coach Podcast with Crystal. Over seven years ago, I felt like I was stuck in this cycle of yelling and reactivity in my parenting that I did not want to be in, but I didn't know how to get out of, I knew how I wanted to parent pretty much exactly, and I'd spent hours reading books, but not finding a way to show up how I wanted to.

That's when I started to turn inwards. My own inward journey was what my family needed. As I changed everything around me, changed my kids' meltdowns, decreased by 90% or more with no medications or therapy. I stopped yelling. Sibling fighting became almost entirely nonexistent, and I found that this change flowed into other areas of my life too.

My intuition increased. I started to run my life in business in a very different way. If this sounds like something you want, Sue, I can help. Join me each week as I share my journey, including the laughter, fun, hard times, and tears. Tune in for support, guidance, and fun conversations. With my favorite experts and really anything else that interests me too.

Hello everybody. Welcome to the podcast today. today is a [00:01:00] guest interview. I know we've done a couple monologue episodes, but we have a couple guests coming up and they're all gonna be great. They're gonna be fabulous. This one's actually very different than my normal, so, if you're listening, we're not talking about emotions or feelings or thoughts or connection or any of those things that we typically talk about.

But I think it'll be a great episode and it's something that I. Specifically deal with in my own family. So I'm actually really excited to, interview Ben today. So Ben, why don't you introduce yourself and tell us a little bit about what you do.

Meet Dr. Ben Miraglia

Dr Miraglia: sure. Yes. Hello Crystal, and thanks for having me. I am a dentist in New York.

I have been practicing for 31 years, but for the last two decades we've been doing earlier treatment on children between the ages of three and 12, all geared towards helping the jaws grow a little better, which helps the teeth kind of go to place a little better, but it's also connected to breathing and sleeping.

And so that's kind of the reason we're on today to have a nice conversation about. Early intervention to help a child as opposed to what the traditional model that everybody's familiar with is, Hey, when you're 11 or 12, get some [00:02:00] braces for a couple years. Yes, everybody knows that model. So we'll, we're, yeah, we're happy.

I'm happy to be here. Thank you for having me.

Crystal: Yeah, I'm excited too. So I have a kiddo, he's 11 right now, and, I even my 15-year-old too, when he was about this age, like went to like three different dentists with like three different like treatment plans. Like, it was just like, let's do braces here, let's wait and then do braces, let's whatever.

And, feel the same ways as you do where braces kind of seem like a. Not necessarily an end result. I mean, unless you have a kiddo that like is gonna wear a retainer forever. For sure. My boys are not gonna wear retainers forever. Right. They'll forget. They'll, you know, not keep up with it. And, I've met adult people who've had to have braces again because they didn't wear the retainer long enough and their teeth kinda went out of shape.

But, what I'd like to dig into first is why this actually matters. Like if our, you know, the breathing and the sleeping and like, before we pressed record, I actually wrote this down 'cause I thought the quote was so good. But you said almost every symptom in the body comes from breathing. Well, like it's all connected to our [00:03:00] breathing.

So, let's start there. Tell us about breathing and why it's so important.

The Connection Between Sleep and Breathing

Dr Miraglia: Yes. So it turns out there's a very big difference between nose breathing and mouth breathing, and that's really where it all breaks down for a child. So we're gonna work our way in because most parents look at their children and recognize, Hey, those teeth are crowded.

They're not where they belong. My child will need braces. If you back up to the baby teeth, most parents would look in their child's mouth between three, four or five and say, Ooh, those baby teeth are all together. There's no spaces there. And so when we see baby teeth that have no spaces, and then permanent teeth that have crowding.

We think braces, but braces really just address the symptoms. The teeth are a symptom temporarily, like you mentioned, if you don't wear your retainer, they shift back. So what we're getting towards is we see teeth that are crowded and would need braces, but now we recognize if the teeth are a symptom, what's the real problem?

The jaw size? Well, our upper and lower jaws, when they're too small, our teeth don't fit well. So in the baby teeth, it looks like baby teeth together. No spaces in the permanent teeth, it's just crowded teeth. [00:04:00] Well, if the jaws are too small, the crowded teeth is like our 10th problem. Because way before that, when the jaws are too small, it affects how we breathe.

The human being is an obligate nasal breather. So we are built to breathe through our nose. It's the only way to get what I'm gonna call fuel. So fuel a human being needs fuel. So we gotta breathe. We need the air fuel, number one. Number two, we gotta drink water 'cause water's like the best fuel in the liquid category.

And then we have to eat food, nutrition, so, air, water, nutrition. That's how we fuel ourselves. It turns out if we're breathing through the nose, will prepare that air perfectly for the lung. Then the lung gets to do its job making the exchange. So it's just an exchanger brings in the good, gets out the bad, and that maintains a perfect balance.

So the body gets fed the right oxygen throughout everywhere. Everything runs well. Well, when your jaws are too small, it becomes difficult to breathe through the nose. If we can't breathe well through our nose. All of a sudden we start to mouth breathe and it is automatic. It's not a choice. Basically your brain knows the air's not flowing well through the nose.

You know what it [00:05:00] does? It separates the lips and it's not like jaw hanging open, dragging on the ground. It's just that your lips are apart. Lips apart means the air leaks in to supplement 'cause the nose doesn't breathe well. But the mouth was not built to clean and filter and prepare the air for the lung.

So breathing through the mouth brings an air into the lung that the lung can't deal with appropriately. So now we don't get the best exchange rate. We get less of the good in and we get less of the bad out. So now we're giving ourselves bad fuel, breathing through the mouth. So the smaller jaw size that we see in the teeth being crowded are not fitting really means the smaller jaw size.

We have less room to breathe through our nose and we have less room for our tongue to live. And our tongue meets a perfect chamber to live in so the air can get right behind it. So now we've got this breathing issue. So I like to give parents like an analogy on the breathing nose to mouth. 'cause a lot of people don't understand how unhealthy it is to breathe through your mouth.

How Poor Sleep Affects Behavior

Crystal: That's what I was gonna ask. Actually, my next question was gonna be like, why is it so bad? Like we're getting our air in still. Like what is the difference between the nose and the mouth breathing and why is it so [00:06:00] significant?

Dr Miraglia: Yeah, so the difference is when we're breathing through our nose, it's usually driven from the diaphragm moving up and down.

So when the diaphragm moves down, it helps pull the air to the bottom of the lung. You get to use your whole lung, you get a better exchange. But mouth breathing changes the pattern of breathing to the chest muscles. So now the chest muscles start to expand and contract, and the air doesn't go all the way down to the bottom of the lung.

So we're not really utilizing the whole lung changes the exchange rate. Not to mention the fact that when the air comes in the mouth, it doesn't get cleaned or filtered, warmed humidified and no ingredients get added to it. So one of the big ingredients that gets added when we breathe through the nose is called nitric oxide.

And once people start digging into nitric oxide and its benefits, it's tremendous. So what nitric oxide does is it's called, and the professional word is a dilator, but it means open. So dilate is open and constrict is tight. But the, nitric oxide, when we breathe in our nose, that goes into the lung and it basically opens all of the little tubes to get all the air [00:07:00] further in.

Better, better inhale, better exhale with the exchange. But nitric oxide is also antibacterial, antiviral, and antifungal, so it kills everything on the way in, so you only breathe in beautiful air. So children who nose breathe predominantly have much less infections in the ear, nose, throat, and lung category than children who mouth breathe.

Predominantly, they are seen with the ear, nose, throat, lung infections, including asthma and all this stuff. So the mouth breathing brings in all the bugs that we're not really handling, on the way in. Whereas breathing through the nose cleans it all. So what I teach parents is if you had a high performance race car, so whatever your favorite race car is, we'll say Ferrari.

If you had a Ferrari, it would require a specialized gasoline. You're going to put the proper gasoline so that car can not only perform on the track, but be at peak performance and then win the race or have an opportunity to win the race that's nose breathing in a human. So your child is a Ferrari, but nose breathing is the right fuel.

You breathe through the mouth. That's [00:08:00] take your Ferrari and put average low grade gasoline in it. If you put a Ferrari sports car on a track with an average low grade gasoline, it might drive around the track. It is no way going to reach peak performance and it'll start breaking down sooner.

That gasoline is not meant for that car that's mouth breathing in a child. So all of a sudden the symptoms start to creep in and the difference really happens while we're sleeping in that breathing through the mouth. Your brain doesn't like it. And when your brain knows that's not good breathing going on, you're not breathing well through your nose, you're breathing through your mouth.

Now your brain does other things to try to improve your breathing while you're sleeping. But that's what ruins the quality of sleep. So mouth breathing takes a child out of proper sleep cycles. Right. I've that

Crystal: before too. I've like heard, I knew that it affected your sleep somehow, but I didn't know how.

I was like, I know that numb breathing at night's not supposed to be great. But tell us about why. Why that is.

Symptoms of Poor Breathing in Children

Dr Miraglia: Yes. So now that we've got the air coming in the mouth. We're not getting the right exchange. It's not being cleaned or filtered. Now your lung is technically struggling. You don't feel any of this because you can breathe through your mouth with [00:09:00] comfort, but when the air comes in your mouth, it's not doing the right exchange rate.

Your brain knows this is not good. So it starts to take over. It wants to improve. Now our brain has a job at night when we're sleeping and breathing through the nose, we are in a proper sleep cycle, and there are different stages you go through and in those stages when you're breathing well through your nose, what your brain is doing is cleaning itself and the whole body for the rest of the day.

Why Mouth Breathing is Harmful

It's like basically doing a rejuvenation center all night long. The problem with mouth breathing is that the brain shuts off the cleaning mechanisms. It can't do both at the same time, so now your brain can no longer clean itself or you, it has to focus on the poor breathing and the things that your brain does at night to try to improve your breathing are kind of very common symptoms that parents might not know are connected to poor breathing, which we're gonna go through in a second.

Yeah. Yeah. Once your brain takes over and starts to do things to help you breathe better. It's not cleaning you anymore. Now, if you don't get your brain cleaned and yourself cleaned overnight, it's like waking up without having slept. It's a, what they call sleep fragmentation. But what [00:10:00] parents will, what will register more for parents is sleep deprivation.

It's like being woken up every so often at night and then getting up the next day and being expected to perform and be happy and ready and well-regulated. Instead, you have a dysregulated child the next day because. The brain spent its time trying to help you breathe better instead of cleaning you and setting you for the next day.

Crystal: Do they not get into the same like sleep wave cycles, like, you know, all the different like layers of sleep? Yes. When they're mouth breathing, is that kind of what's happening? They're not getting into the deepest Yes. Like REM cycles. I.

Dr Miraglia: Yeah, they can't hit the cycle. So it's like a normal sleep cycle has a stage one and a stage two.

And when they draw it in a graph, it looked like a staircase.

Crystal: Yeah.

Dr Miraglia: It's like a little staircase. Stage one, then stage two, then stage three, and then stage four. And then you come up to REM a little bit. You do a little time in rem, and then you come back and you repeat it every 70 to 90 minutes. So there's this beautiful sleep cycle that exists and that's what is involved with cleaning you and resetting you for the next day, however.

You really can only be in a proper sleep cycle if you're nasal breathing all night. The moment you have some mouth breathing going on, your sleep cycle [00:11:00] gets fragmented and now it's all broken up. So they say sleep fragmentation because we're disrupting a normal sleep cycle. And you could call it like sleep deprivation, because now you're not getting proper quality sleep.

Crystal: Yeah

Dr Miraglia: We, talk about this to parents because it's, there's two categories for good sleep. One is quantity. That's just the right amount of time, you know, at different ages. We know from the pediatricians, like, oh, your child should have eight hours or 10 hours or 12 hours, you know? So you know the timeframe, but the crazy part is that the more important parts, the quality, because a child who is mouth breathing at night has no quality of sleep because they're not in their sleep cycles.

They're not getting reset and rejuvenated in the brain that doesn't clean itself is really a disaster. The next day, we'll go over that in a second, but if the quality is wrong, there is no quantity of sleep that can make up for poor quality. So it wouldn't matter if your child slept 14 or 16 hours, they're gonna be the same symptom struggles going on because the quality of sleep is missing.

So we've gotta get the quality of sleep back through the breathing.

Crystal: Yeah. It's interesting because it's, yeah, I'll just like imagining like the nights where I like sleep [00:12:00] all night long except I'm not actually sleeping. You know when you're like waking up and you look at the alarm clock and you're, yeah.

Like your sleep's just not very good and you're like, you're rested. And you can like handle the next day 'cause you're, you know, an. A fully developed prefrontal cortex adult. but imagine just like sleeping at night on your body, like never being able to get into that deepest cycle. Like it's gotta affect like, for sure behavior, which we're gonna talk about, but like it's gotta affect other systems also.

Dr Miraglia: Oh yeah, absolutely. So one of the systems, that's involved is the digestive system. A lot of kids are struggling with digestive issues today, and the biggest reason is because we were talking about that sleep fragmentation, you know, having a proper sleep cycle is being in like a, rest and digestive state.

So When we have proper sleep cycles, the digestive system's running very well at night, things along the digestive system are moving along. If we're in proper sleep cycles. Once the brain shifts its mode over to oh, helping the breathing, the digestive system loses its ability to do the digestion at night.

So children have anything from reflux to stomach aches, [00:13:00] constipation, diarrhea, anything that is digestive will be the result of poor breathing while sleeping really at a number one cause it's not the spicy wings, you know, the spicy wings are not doing what's happening to the digestive system. It's really, your brain's not focused on that.

And the reason this is all going on, that poor breathing. A lot of parents start to get it when you put the pieces together, when your brain is in the other mode of trying to help you breathe better.

It's called fight or flight. When you're protecting yourself from bad breathing, anything that the body does to protect itself is fight or flight.

So that's the sympathetic nervous system. Basically, the sympathetic nervous system, fight or flight is supposed to be off when you're sleeping.

Crystal: Yeah.

Dr Miraglia: We're supposed to be in the other one. The other one's called the parasympathetic nervous system. That's the rest and digest mode.

Crystal: Yeah. 

Dr Miraglia: It turns out you can only have the parasympathetic mode on and running when you're in nasal breathing all night long.

You have proper sleep cycles through nasal breathing. You have rest and digest running. Your brain cleans itself and you for the next day, but as soon as your mouth breathing, you are in. Fight or flight, and that sympathetic drive shuts off all the things that are supposed to [00:14:00] be cleaning you for the next day.

So probably, I mentioned some of the symptoms. I should list those. Like what would parents see?

Crystal: yeah, that's what I wanted to ask you about. It's interesting that you talk about the nervous system because you said like it's impacted behaviorally, right? So not only are they not getting, yes, good quality of sleep, but their nervous system's actually dysregulated while they're sleeping at night.

Yes. And it's not resetting in the way that it needs to. So it makes sense that during the day you're gonna have behavioral issues, but before we press record, you would list it off like a bunch of other issues besides just behavioral. So I'd like to hear more about Sure. Like what the behavioral issues might look like, but then also what the other kind of physical symptoms you see are connected to this mouth breathing.

Dr Miraglia: sure. Yeah. So the, kids who are mouth breathing at night, some of the symptoms parents might notice that are related to mouth breathing would be, restless sleep, lots of movement, bedwetting, grinding your teeth. Waking in the middle of the night. You can't even stay asleep the whole night.

You wake up during the middle of the night having night sweats, having night terrors. So [00:15:00] that's a list of things that go on when you're in fight or flight all night long. Those are things you might witness and parents struggle with that list, you know, between bedwetting and nightmares and night sweats and, the restless sleep, thrashing around, waking up, grinding your teeth, like all of these things are going on with a lot of children.

Really it's, they're all tied to the poor breathing. The poor breathing makes the brain do those things to you to improve your breathing. So when you're thinking about restless sleep, moving around a child who doesn't breathe well, when I say the brain is focused on trying to help you breathe, we call restless sleep. It's really the brain moving your body, repositioning you to get better airflow. So I like to talk about un kinking the hose you, you take the hose out from the shed and you pull it all the way out. And you go to spray, no water comes out and you look back, oh, there's the kink.

What do you do with the hose? Then you rattle it around and you circle it and swirl it, and you shake it till you get the kink out. Right. That's a child trying to breathe. The kink is the smaller airway from the smaller jaws. Sure enough, what your brain does is it starts moving your head around.

It'll tip you back. It'll turn around moving the head [00:16:00] around to try to get the air in and out better. When that doesn't work, when that's not enough, now the body starts moving, the legs start moving, the arms start moving. Everything we describe as restless sleep is basically your brain trying to un kink the hose and help your air get in and out better.

But it isn't so much a kink as it is smaller jaws, which is why restless sleep is repeated all night long. Every night. Kids can't get a break from it 'cause there's really no good spot where the airway's big enough, the jaws are too small. Grinding the teeth is another big symptom. Your lower jaw gets moved side to side.

So grinding the teeth is this lower jaw going back and forth when your lower jaw is going back and forth, sos your tongue, it's right in there. So it turns out when you're moving your tongue side to side, the air gets by better. So the crazy thing is your brain knows if you're not breathing well, you're better off grinding your teeth because the air can sneak by better when your tongues are moving target.

So moving the lower jaw around, shuffling the lower jaw we call grinding your teeth. It's really your brain trying to help you get the air in and out better. So grinding the teeth is a direct result of poor breathing underdeveloped jaws. So this list of symptoms that parents might struggle with, bedwetting night terrors, nightmares, night sweats, [00:17:00] all of this related to poor breathing is being in sympathetic drive, or fight or flight all night long.

And fight or flight produces all of these changes, cortisols being released instead of growth hormone, and that child's in a world of trouble now. Behavior. Yeah, we go right to the behavior because with sleep fragmentation and poor breathing at night, it is very difficult to behave well during the day.

‘Cause now you're dysregulated not only at night, but now it spills into the daytime. So there's highs and lows. So a traditional pattern would be in the morning. It's very difficult getting up to get going 'cause you've had such a bad night's sleep. The morning is, I am exhausted. I didn't sleep well.

So typical description would be we are, we have a slow start. It's slow. Start getting outta bed, getting moving along. We're slow. Yeah.

But then all of a sudden there's a point in the day where it kicks in and then you've got hyperactivity. So the child goes from high to low hyperactivity. They may crash again for fatigue in the afternoon, maybe some don't.

Some, the hyperactivity goes all the way until midnight. They can't fall asleep 'cause they got so much hyperactivity, they can't even fall asleep. But the dysregulation is the child going high and low instead of being balanced. [00:18:00] 

The Link Between Mouth Breathing and ADHD

So it sets in motion what people call ADHD. Attention deficit hyperactivity disorder, that's a, OR disease.

But this is a letter, a bunch of letters. And when you look at the list of symptoms that make that up, because it's diagnosed by symptoms over time, school parent, they get together, they look at the symptoms. Does the child have this many symptoms for this many months? Oh, you have this. Take a closer look at that list for parents who are listening and think about the things on that list.

And the things on there are really a list of sleep deprivation symptoms. If you deprive someone of sleep, you're gonna hit those lists. You're gonna hit that this is a sleep dysregulation issue. So these kids who don't breathe well, there's no chance to behave during the day. 'cause your timing it where I gotta go to school and sit still.

Impossible because in the morning you can't get going. So you're in that sluggish mode. But what happens is your body knows, well, the sun is out. I'm supposed to be awake 'cause we have this circadian rhythm awake during the day, sleep at night. Well, during the daytime, when the sun comes up, your body is primed to get going, but your brain is still trying to finish the cleaning job.

So the crazy part about in the morning is [00:19:00] your brain is saying, wait, I didn't clean yet. You can't get up and go yet. It makes you wanna stay asleep longer. So the slow routine in the morning, but the rest of you knows no, it's daytime. The sun is up, we have to go. What happens is you get dumped in extra ingredients to get you going, so the adrenaline and the epinephrines come a little higher to wake you up and get you out the door because the brain is trying to keep you asleep, but your body knows, no, it's daytime.

We have to get up and go. And all of that times to when you get to school, now you're at school and you're bouncing off the walls 'cause you've got all these extra ingredients. You cannot sit still. You cannot focus on anything. 'cause basically you just got charged by a lightning bolt. Now I gotta run, I gotta run and I can't.

So it makes for this bad combination during the day.

Crystal: Have you seen, because you've been doing this for a while now, that as you start to help people and these issues start to go away, that over time the ADHD symptoms will lessen. Have you noticed that in your own practice?

Dr Miraglia: Yes. So I've been treating children now for over two decades, and in the two decades of time I've been treating the kids, [00:20:00] it is very common that in our pattern of getting started earlier, treating the cause, the underdeveloped jaws, when we start to grow your jaws earlier and then retrain your muscles and breathing, nasal breathing, proper tongue muscle.

And the tongue has to be resting and functioning properly. The lips and cheeks have to be resting and functioning properly. When you get all of that balance going with jaw growth, you breathe better. When you breathe better, you sleep better. So it has been my experience over the two decades to see the behavioral problems fade away.

Children that were told, you need medication, never get it. Children that got medication can come off medication as the symptoms fade away. Bedwetting goes away. Ear infections go away. the waking up at night, having night terrors, those go away. Night sweats go away. basically the child begins to breathe through their nose, sleep through the night, and the pound will report the symptoms are fading away.

Some kids are luckier. It could be days to weeks. Other kids, it's weeks to months. But the point is, once you get the jaw growth back and your muscles behaving properly, you start breathing better and you heal. It's a pathway to heal the child. So I have been [00:21:00] lucky enough to experience healing in almost every single medical category you could name, based on two decades of helping the kids early, as young as three.

We get started as young as three. When you notice the symptoms are there.

Crystal: Yeah. That's really fascinating. I have a couple more questions about it As you've been talking, I've been thinking like, what about adults? So adults that maybe didn't have this happen? Right? Like I, I don't know if I mouth breathe.

I probably do, but I can hear my husband do it sometimes. And so I'm curious about the like mouth breathing thing for adults. 'cause I don't know if there's like, you know, if it's like too late by then, 'cause you're saying like three to 12 probably because the jaw's a little bit more malleable so you can do things that help it grow still.

Yes. what about a person who already has a fully developed jaw?

Dr Miraglia: There are opportunities. And so when you're thinking about kids, just like you said, the jaw is softer and more malleable, you can get involved. It's easier to help a child, but it doesn't mean there aren't choices for adults. In the adult category, we have non-surgical interventions and surgical interventions.

And for an adult it's probably more appropriate to get a sleep test to see like, well, how bad is my sleep? 'cause if an adult had sleep apnea already, you [00:22:00] probably should get like A-C-P-A-P machine while you're pursuing the opportunities to grow your jaws. 'cause a CCP a P really treats the symptom not so much the cause.

Yes, there are doctors around and you would basically be looking for a doctor that treats adults in the sleep category. And so whether they're doing nonsurgical or surgical opportunities, there are offices that do this. We are less common. You know, most of dentistry is still tooth focused, which isn't a bad thing we need to fix and help the teeth too.

But this category we're talking about airway and sleep and breathing. It's more foundation focused. It's more about the jaw size and shape. So yes, there are choices for adults out there. You just have to dig a little bit.

Crystal: So more than just mouth tape. 'cause I've heard of mouth tape have not tried it yet.

But that's not, that's more just kind of fixing the symptom, not necessarily the cause of what's happening. Well.

Dr Miraglia: Yes. I'm not opposed to mouth tape. I don't want to come across as anti mouth tape. But if the jaws are too small and you struggle to breathe well through your nose, taping your mouth shut is working against the sympathetic nervous system, which is opening it to let the air in.

You really have to have a clean nasal passage if air can [00:23:00] flow in and out of your nose easily. Mouth taping is a good choice. It'll support the lip closure at night. But if the air's not really flowing well through your nose, you don't wanna force bad nose breathing. because it's bad nose breathing that triggers the lips to separate.

That's part of the first flight or flight step. If your brain knows the air's not going through my nose very well, I should separate your lips to allow leakage here. So, yes, melt tape comes in circles where your lips can separate if it gets bad enough. So it's kind of protective. It's not like it's a bad choice.

For me, it's more of the mouth tape alone, as the only opportunity or only choice would be more of the treat and the symptom. I'm gonna force my lips to stay together versus, Hey, maybe I should pursue jaw growth and development of some sort first, or pursue all the options and then choose.

Crystal: Okay. The other thing is, how common is this?

Like we're talking about like smaller jaws or whatever, like, are there people that have bigger jaws and people that have smaller jaws, or are we just looking at like, everyone has two smaller jaws.

Dr Miraglia: I know, And it's so bad to say all I, know that, [00:24:00] but I'll say it this way. How many children do we know grow up, turn 12 years old and all their teeth are right where they belong. Perfect. Don't need braces, but we have to go one step farther. Will those children go to 18 or 20 and their wisdom teeth will come in and they'll have 32 teeth without anybody doing anything because the child who's growing really well is going to go through all of these steps and end up turning 20 and have 32 teeth right where they belong with no help.

Where's that child today? So that’s a way of me saying, I think every child is underdeveloped. And so if you can't develop your jaws big enough to hold 32 teeth where they belong without intervention, you're not growing well enough. But when your jaws are small and you have baby teeth together or crowded adult teeth and your wisdom teeth are not gonna fit.

The jaws being small affects your breathing, so there's really no way around having smaller jaws with good breathing because the upper jaw does dictate the size of the nose on the inside. That chamber is based on the upper jaw growth. If your upper jaw grows full, you get a big chamber to breathe the air, it goes through [00:25:00] nicely.

If your upper jaw doesn't grow well, you can't get the air through your nose as well. You become a poor nasal breather. But when both jaws are underdeveloped, there's no room for your tongue, so the nose doesn't do well because it's smaller inside and with no room for your tongue. When you close your mouth, it can only be one place backwards.

But when the tongue sits backwards, it blocks the air from going behind it.

Why Jaws Are Underdeveloped Today

Crystal: Why does everybody have too small of jaws? I mean, maybe you don't know the answer to that question. 

Dr Miraglia: I'm glad you asked. I have the answer. Interesting. I have the answer. So the fascinating thing is that eventually most people ask because, well I, since I see this everywhere now, crowded teeth and bad bites, and you know, no one has fully grown jaws.

Why do we have smaller jaws? It turns out hundreds of years of anthropology research have that answer. And so once you start digging into anthropology research, you learn that it's a very simple answer, but it'll build it out a tiny bit. It's the early soft food. So the simplest answer I can give in the one minute timeframe would be early soft food, baby food, or mush.

Every culture, every culture, pre-industrial, pre western living transitions to harder food earlier. So the cultures go [00:26:00] from breastfeeding to hard food, and the harder food, the consistency between six and nine months old is when they notice it's starting and it coincides with an infant who can hold their head up and grab and bring to the mouth.

If you can meet those two criteria, you can like throw stuff in, chew and gnaw on it.

Well, six to nine months old, when that gets going, you start having your normal and that, that, normal culture's diet is without processing, preserving, or refrigeration. Nothing is pureed or blended. There's no spoons or forks or knives.

You grab and you gnaw. Early gnawing works, the musculature and the muscles grow the bone. So in a human being, the upper and lower jawbones grow by muscle activity. So you're not programmed to grow your jaws by your genes. You're programmed to have jaws by your genes. How they grow is determined by the early diet.

When your early diet is hard, like the pre-industrial cultures, and it's everywhere, the entire world, please soft food as fully grown jaws and all the grave sites and all the archeology and all the anthropology research shows. Everybody's got big jaws and 32 teeth with no, bad teeth. Incredible. [00:27:00] But as soon as the soft food starts, culture start to trade, you're basically taking baby steps to become industrial, western living, trading the food processing, preserving, softening the food.

Then what we say malocclusion or small jaws and bad teeth, that increases rapidly. And so it only takes about a hundred years to have most of the population with early with malocclusion. 

Crystal: Okay. This is interesting too because I have an aunt who lived for a short time in, I think it was Trinidad and Tobago.

I'm not totally sure, but I'm pretty sure that's where it was. And she said that like nobody gets their wisdom teeth out there. She was like, people thought it was like so weird that like they were like, what people in North America just like get these teeth out? So are you saying that if you are able to catch it early, get the growth proper, the jaw gets bigger, that you wouldn't have to get your wisdom teeth out?

Dr Miraglia: That's correct. If your jaws grow like pre wow. For the entirety. For the entirety of the human race. Wisdom teeth weren't extracted up until industrial Western living The entirety of the human race, all of the skulls and all of the grave sites that have ever been [00:28:00] studied by anthropologists have 32 teeth.

They have 30. Wow. So it was 99% of the population has 32 teeth. Where are we today? We're 99% have crowded bad teeth. 'cause of small jaws. Yeah. And so the early soft food is the trigger that starts the problem off right there. And then with Indu, industrial western living, we've added a couple of things to the mix that don't really help out.

And so bottles and pacifiers are the second and third kind of stones thrown at the glass. So sure enough, early saw food is the trigger for weaker muscles. 'cause when you have softer food going on, the muscles don't need to be active or strong. So your, the muscles of your body are based on what you do with them.

So like, let's say, you know, if you lay down bedridden for three weeks, you'd have no musculature left. It would all go. Yeah. But if you go to the gym and you worked out with a trainer for three months and you were pushed like bootcamp, wow. Those muscles change fast. Right? the muscles, adapt to what you're using them for.

Early soft food, muscle weakness, bones don't grow. So in a human being, the weird thing is that the bone yields to the muscle. I. [00:29:00] If your muscles are weak, your bone doesn't grow as much, which is why the upper and lower jaws are smaller and the teeth are crowded. So yeah, in a perfect world, you would, we would get back to the model of an early harder food would be nicer to work that through, but it was with natural living, today it's not easy to do that because there's actually,

Crystal: there is a concept around that. Like I did that for some of my kids, which I, think they call it baby lead weaning, but it's basically like instead of feeding them the pureed stuff, you just give them like chopped up pits of things and they kind of just touch it and play with it and eventually get some of them in their mouth.

So I think there is some transition to like, you know, not using the pure stuff, but, that process makes sense. yeah. My next question is, I have a kiddo that has really bad congestion, so his nose is always so if you do something that's why I didn't really do mouth tape. 'cause I'm like, well if we do mouth tape, then how does he breathe?

Or whatever. Yeah. So, yeah. Fair enough. And this, I guess, takes us to my last question too, would be, how do you fix this issue and can you fix it in [00:30:00] somebody who has really, you know, clogged up nasal congestion stuff happening?

Addressing Congestion and Nose Breathing

Dr Miraglia: Yes. And so that, that is the progression. So the body is like a use it or lose it kind of a mode.

And with the nose, as soon as we have some mouth breathing, it gets worse over time. But basically the less that you use your nose, the less you breathe through your nose, the more it closes off. So it's starting to kind of close off on the inside. That's what we call congestion, so it's hard to get that back.

So this is not a sprint, it's a marathon. So just like we slipped from nose breathing towards mouth breathing and have congested nose, it didn't happen overnight. It wasn't a one day thing. Yesterday I breathe through my nose with ease, and today I clogged up and I can't breathe. It's usually a slow deterioration.

We gotta earn it back. So one of the things you can do early on to start earning back that nasal breathing is to clean the nose more often. So we talk about nasal hygiene getting ramped up. Which means, you know, learning how to blow your nose appropriately, like trying to get the stuff outta there, but then also getting nasal spray in there.

And I'm a big fan of natural sprays. We don't like to put the chemicals in [00:31:00] the pharmaceuticals in there. You know, getting simple saline or the clear products have a little xylitol. That's a healthy choice if you use a, like a simple saline nasal spray. But what we ask kids to do is. Pretty much every hour when they're at home.

So you have to work at keeping that nose clean. You clean your nose every hour on the hour at home until it starts to improve. And that could take days to weeks. So you blow your nose first, then you put the nasal spray in there, which loosens things up, and you blow again. And if you did that every hour for a while and the days are going by, you go to, 

Crystal: You're saying, clean your nose out every hour, like as far as the nasal spray?

Dr Miraglia: Yeah, the kids who are congested should be cleaning their nose every hour. So if you're really congested, you wanna clean your nose every hour of the day. And what you're trying to do is you're trying to work towards a pattern of just doing it twice a day. We would love to clean your nose twice a day, morning and nighttime.

That would be ideal. But in the beginning, when the kids are really kind of congested and they're not breathing well through their nose, and now they're already conditioned to letting the mouth do the breathing. We have to earn that back. It's like training for a marathon. You know? You can't just say on Tuesday, hey, no, the New York City Marathon is this weekend, I'll go do it. [00:32:00]

No, it's gonna take you months to prepare for a marathon if you'd like to jog through it, of course. But. Oh, I want to be a nose breather full-time forever now. Not exactly. We're gonna have to earn it. So we don't get, nobody gets to decide. I'll just close my mouth now and keep my lips together.

Yeah. And I'll breathe through my nose. No, we have to earn it. So getting it clean requires a lot of attention early and then we can work towards the, you know, once or twice a day as the routine. But we've been treating kids for two decades in my office. The good news is that so many kids had so much benefit from, in getting involved early, we were combining three things, the nasal hygiene products and techniques.

Get that nose clean. I'm glad you sent that,

Crystal: saline too, because we've been recommended. Yeah. The steroid spray and he's been using it for so long and I'm like, oh, this can't be like a healthy thing to continuously put in your body. So yes, saline's great. I know.

Dr Miraglia: Yes, I would be okay for a week or two, like if you wanted to use that, get a jumpstart.

I know the steroid will shrink a little quicker, but try not to use that long term. Maybe one or two weeks, but then you gotta get outta that, and the other stuff [00:33:00] works just as well. You just have to do it more often to get the nose breathing more. As the nose breathes more, it starts to open up, like it starts to heal.

It wants to do it. It's like running more as the days go by, the weeks go by, you're more conditioned to run more. Yeah. So, the, three things we were doing in the office for two decades are the nasal hygiene and then what we call guidance appliances. Guidance appliances are built to use between three and 12 years old, and these guidance appliances can be worn for an hour a day plus overnight.

And it looks like at a glance it would look like a sports guard, but it's built, it's redesigned. It's designed so that when you wear it, you have to breathe through your nose. So it starts to retrain the breathing. So we do the nasal hygiene and we put our guide in. We wanna wear it an hour a day plus overnight to start retraining the nose, to do the breathing.

When your guide is in, you can't breathe through your mouth. So it really starts to put the focus on, I'm gonna get that air through my nose and regain my nasal breathing. But when the guide is in, it also repositions the tongue appropriately. A big part of jaw growth and development is, is the tongue in the palate up high and working up and down, kind of compressing into the palate with a good [00:34:00] like chewing swallow we would call it.

Well, when the guide's in your mouth, your tongue has to rest appropriately up high, and it also has to swallow appropriately. So kind of the shape of the guide on the inside redirects your tongue to function properly. Proper tongue function grows the jaws. Your tongue is your body's natural jaw grower.

So we want the tongue back. We lost it with the early soft food. The early soft food puts the tongue low, and it's a drinker. Gimme the mush. No problem. Tongues do nothing. So our jaws don't grow. We need the tongue back. The guide gets the tongue back action, back into action. Working to grow the jaws.

Also, when the guide is in, it pushes away the lips and cheeks. So the tongue that got the soft food that did nothing, it stayed low to drink. Well, the lips and cheeks start working overtime. They help force the food down. So we don't want the lips and cheeks working over time against us that's growing the wrong way.

That'll shrink us instead of grow us. We need the inside strong and the outside not involved. So when the guide goes in, it pushes back on the lips and cheeks so they're not working against the jaws or teeth to grow wider and forward. So basically the guide helps your nose breathe and helps redirect your jaw muscles to be [00:35:00] appropriately functioning so your jaws can grow again.

Crystal: And when you say three to 12, do you mean, like, I'm only curious about this because my 11-year-old is almost 12. Can you use it for the duration of the 12th year?

Dr Miraglia:  If he's almost 12, then yeah, you can. Yeah. A 12-year-old can still have benefit, like a 12-year-old has benefit. 13 is getting a little too late because the jaw growth.

And we're passing into puberty and we're maturing. Right. So the guides have better action when the bone is still in a growing phase. Yeah. Yeah. So from three to 12, better age grades for the guides. Okay. The third item, so nasal hygiene, guidance appliances, and the last item, myofunctional therapy.

Myofunctional Therapy for Adults and Children

Yeah. And you've probably come across this at some point already. Yes. Yeah. It's becoming much more popular and it should be like household talk every day. Now is that myofunctional therapy is very important for every child because really when we talk about early soft food causing this disaster, the early soft food gives you the weaker and dysfunctional muscles, and the weaker and dysfunctional muscles need to be retrained and the guides can help.

And the myofunctional therapy is basically physical therapy for the head and neck. Reworking those muscles so they behave properly to grow the [00:36:00] jaws. So myofunctional therapy is about breathing better, growing your jaws through muscle work, and also with posture. So all of this is put together to help that child grow.

So for two decades of using nasal hygiene guides and myofunctional therapy. Treating people from all over, kids from all over a couple of years ago, few people like myself who were doing this were few and far between. We were like, you know, there's a lot of people who have no access to this. You know, I got people flying all over to be doing this in my office, which is crazy.

Tooth Pillow: A Remote Treatment Option

How do we solve for access? We built a company called Tooth Pillow to do just that. So Tooth Pillow is a new company, but it is based on things that have been used for decades. Guidance appliances have existed for decades. Just very few dentists use them. Myofunctional therapy has existed for decades, and now it's just starting to become really popular and, every child should have that by the way.

But when you combine these things, tooth Pillow was built to deliver it remotely. A parent in the middle of nowhere that has a, there's no dentist that does these guides or does early growth and development. They just do braces at 11 or [00:37:00] 12. Well, now you have an opportunity to do it remotely. So tooth pillow, there's a website, tooth pillow.com.

A parent can go there. There's a lot of information in there. All of the things we're talking about are built out, you know, pretty in depth there. Good education. But there is a, is my child a candidate tab? And what we do is we ask, there's a full list of sleep breathing questionnaire items in there. We ask all about the child's history and for parents to write everything in there that they might be struggling with or what's going on so I can learn about the child.

The symptom category basically. And then the next category is the photographs. So we built an app and in the phone with a little silhouette, you can see like what kind of pictures I need of your child, like a face photo, a smile, a profile picture. Also the upper and the lower and a. A big cheesy smile.

If a parent uploads photos to me, I can screen that child remotely and determine, oh, that's a child I could treat remotely. So we built measuring devices that a parent can take pictures with to scale so I can send them the right guide. So we have all of this built to basically solve for access and affordability.[00:38:00]

So now a parent anywhere could see if their child qualifies for remote treatment, especially if there's no one local. If there's someone local, you should go to them because there's nothing wrong with going in office. We have no problem with that. We just want every child to have an opportunity.

Dr Miraglia: You don’t have an opportunity from three to 12 when you're 13. And so we just want everybody to know what you have available to you. And if there's no one near you, we're happy to help you. If there's someone near you, we're happy, you go to them. So now we've got this child who I can treat remotely.

Just to give you some numbers. 'cause not everybody qualifies. I can't do, every single child can't be treated remotely. We have some that need to go in office. So roughly percentages and it follows the two decades I've been in practice. From three to seven years old, most children can be treated with the remote pattern, nasal hygiene, guidance, appliance, myofunctional therapy, and myofunctional therapy is done via Zoom, just like you and I are doing now.

The myofunctional therapist, one-on-one, meets with the child. The parent can sit there and they demonstrate exercises they're gonna do, and then the child repeats it back. So it's just like being, you know, a foot away from the trainer at the gym. Do it this way, and then you do it that way, you know?

If a, parent, finds us, you're [00:39:00] gonna find about 99% of the kids from three to seven can benefit from this, and it's an opportunity for them. But from eight to 12 it drops. I can only treat about two thirds, maybe three quarters of the kids remotely. There are eight to 12 year olds that are so narrow and so crowded and have such poor breathing and sleeping that they need expanders.

So there are some kids who need expanders. So when I have to deny a child, 'cause I know, oh, tooth pillow is not gonna get you there, you're too severe. We then try to locate who's the best practice around you that's been doing expanders for a long time. We try to give you guidance to find the right office because some offices say they're using expanders, but they don't really do a good technique.

And other offices are very skilled at doing expansion very nicely. So we try to help you find the right office 'cause your child does need attention. But what they don't need is braces.

Braces address the teeth, and it's a jaw size issue, which is why most kids who are getting braces at 12 years old, their symptoms don't go away.

They're still poor breathing, poor sleeping, struggling with the list of things we talked about, but when you grow [00:40:00] the jaws and you get your breathing back, that's when your symptoms go away. I. So we don't treat the symptoms like all these things we're talking about and what I've observed go away. I don't treat bedwetting, I don't treat ear infections, I don't treat behavior.

It just so happens I'm treating the underdeveloped jaws. So treating in our lane, we treat your underdeveloped jaws, and when you have the right jaw size and you breathe better, you heal. So symptoms downstream go away. So we built tooth pillow to basically solve for access. And when you take away going to a dental office, which has a number of expenses to run. Yeah. It turns out this can be half the cost. So it costs about half to do this remotely as it does to go, come and see me in my practice to do this.

And now we have, you know, we have thousands of kids in treatment across the country who didn't have access to this beforehand, and they're doing very well.

We built, there's a nice Instagram page to follow for tooth pillow, at Dr. Ben Morale is mine, where you can see all of these things we're talking about, built out even bigger and, the website. So I, would encourage parents to take a look at it only because, yeah. Now at least you, you can learn enough to know that, hey, all these symptoms I'm struggling [00:41:00] with on a daily basis are rooted in a cause where I could address early and give my child a chance.

And when you learn all about it, it can be a match for you or not. But we are definitely here to help those who are interested in getting early attention. 

Crystal: Yeah. One last quick question is, myofunctional therapy helpful for adults, or is that past the time when it's effective? Yes.

Dr Miraglia: Yes. It's wonderful at any age.

So at any age, you can retrain your muscles of your jaw to behave better, and when they're functioning properly, you breathe better. So even as an adult, we were talking about non-surgical and surgical interventions. And things you could do with the jaws, but the number one item would still be myofunctional therapy, because as soon as you work those muscles again.

And it's not unlike going to the gym. You know, at any age, if you went to the gym, you would be benefiting yourself. You know, even if you've let it go for a long time, at any age, you go to the gym and you get your trainer and you do it right, you can make an improvement. And the same thing at the jaw level.

So yes, myofunctional therapy has wonderful research showing a big change in breathing and sleeping with doing myofunctional therapy. It absolutely helps. The jaws, we're a big fan of it. [00:42:00]

Final Thoughts and Where to Learn More

Crystal: Awesome. Thank you so much. This has been an information packed session, so thanks for coming on and telling us all of that.

Like even the history, anthropology and whatever. You are obviously very knowledgeable with this and I think this will be really helpful for everybody. I know it is for me, I'm already like thinking like, oh, what am I gonna do next? So thanks a bunch, and, people will connect with you.

For all of those listening, we're gonna have all of these links in the show notes that you can go check out and you can go follow him on Instagram and check out the tooth pillow situation and see if it's. Something that would be helpful for you. And I'm excited to see changes that potentially would happen in my own kids with this.

So, thank you so much for coming on.

Dr Miraglia: Oh, my pleasure, crystal. Thanks for having me.

Crystal: If you enjoyed this episode as much as I did, I would love for you to help spread the word by getting this message of support and guidance out to as many people as possible. So text it to your best friend or tag me on Instagram and share it.

Leave a review, rate it, subscribe it, or follow on your favorite platform. Send me a DM on IG letting me know which parts have impacted you or what you'd like to see on future episodes. We'll see you next [00:43:00] week.