photography by Jody Robinson
Each year, millions of U.S. children and teenagers require orthodontic intervention to “fix” crooked teeth and misaligned jaws—and, in many cases, the first intervention isn’t a long-term solution. Meanwhile, countless adults each year have their wisdom teeth pulled as a way to eliminate mouth pain or prevent damage to surrounding teeth. The anthropological record suggests these kinds of dental problems didn’t exist 1,000 years ago, or even 300 years ago.
Marianna Evans, D.M.D., and Kevin L. Boyd, D.D.S., M.Sc., have a pretty good idea as to why.
Based on their scientifically defensible research, Drs. Evans and Boyd have reason to believe these problems stem from subtle but significant changes to the human craniofacial structure—a smaller, more slender skull and weaker jaws, for example—that have occurred since the beginning of the Industrial Revolution in the mid-19th Century. Besides affecting jaw structure and the way teeth fit in the mouth, these evolutionary changes can hinder a person’s airway, thereby causing other serious health problems, such as pediatric obstructive sleep apnea and even neurological issues such as attention deficit/hyperactivity disorder (ADHD) and lower IQ.
But why did these evolutionary changes occur? The doctors suspect shifts in the human diet, such as artificial methods of infant nursing and weaning with commercially processed cereals and other “baby foods.” Centuries ago, humans in hunter-gatherer societies who foraged for their food consumed a lot of fresh, tough and fibrous foods, and they also used their teeth to make tools and process leather for their clothing. In other words, their jaws had to work harder, so the underlying muscles were stronger and their facial bones were thicker. The advent of farming— specifically the introduction of cereal grains and dairy—changed everything.
“That’s why we see these kinds of problems more often in developed countries,” says Dr. Evans, founder of Infinity Dental Specialists, which has offices in Glen Mills and Newtown Square. “When developed countries like ours changed from hunter-gatherers to farmers, our jaws got used to chewing softer foods, so those muscles weakened; and when farmers began migrating to cities during and since industrialization, the jaw and facial bones, including the bones that support our ability to carry healthy nose-breathing, rather suddenly began to get smaller and smaller. This, in turn, has led to susceptibility to all kinds of health problems associated with impaired nose-breathing, including sleep deprivation and associated chronic metabolic diseases such as type 2 diabetes.”
A Good Foundation
Such understanding has also dramatically affected how Dr. Evans—a dual specialist in orthodontics and periodontics—treats patients in her practice.
“Often in conventional orthodontics, we do not ask the questions as to why the teeth are the way that they are; instead, we try to answer the question of how to move them,” she says. “Research suggests that if we don’t address the function and the causes of these problems, the teeth will not be stable over the long term. We are not just straightening teeth in my practice, but reshaping the structures that hold teeth. Good health comes from treating the function and foundation of a healthy bite, which is not only the ability to smile and be free from jaw and tooth pain, but also chew, swallow and breathe, mostly through your nose, and especially at night. Once you put these puzzle pieces together, it will improve everything, including the beauty of your smile.”
This means starting young, working with children (and their parents) to adjust everything from their posture and breathing habits to the muscle tone of their jaws.
“Oral health is medical health,” adds Dr. Boyd, a board-certified pediatric dentist based in Chicago, who will soon be joining Infinity Dental Specialists. “We’re not just talking about healthy gums and teeth; we’re also talking about airway health and neurologic health. Whereas we used to just look for cavities, which is still important, now we’re looking at the whole issue of airway as a vital component of our already established anticipatory guidance protocols.”
Infinity Dental Specialists already treats children as young as two years old when all 20 of the baby teeth have usually come in, though the focus on re-shaping craniofacial structures starts well before that age, according to Dr. Boyd.
“A child’s first teeth usually start to come in at about six months old, but you can see signs that kids may have deficient jaw growth from day one, or even before then based on in utero ultrasounds,” he says. “Children need to be screened for jaw deficiencies, sleep apnea and ADHD shortly after they are born. Often the inability to nurse is one of the indicators of this problem. That’s why, according to the American Academy of Pediatric Dentistry, it’s so important for all children to establish their dental home before their first birthday.”
Drs. Evans and Boyd met through a joint interest in anthropology and oral health—and, specifically, the intersection of those two interests. After a shared acquaintance introduced them, they began to collaborate on various research protocols that essentially connect their clinical practice activities to the anthropological research data they have been collecting together. They have since been invited to serve a second three-year term as visiting scholars at the University of Pennsylvania Museum of Archaeology and Anthropology in Philadelphia under the tutelage of Professor Janet Monge. In addition, over the past five years, they have been lecturing nationally and internationally about the craniofacial differences between pre-industrialized and modernized cultures, as well as how those differences have affected breathing and jaw development.
“Most people are surprised to be told by an orthodontist that their issues might have to do with airway management,” Dr. Boyd says, “but most dentists just aren’t taught about it in dental school or during their postgraduate dental specialty training programs; it’s not just a matter of how straight are the teeth but how healthy is the airway. This methodology is gradually beginning to be embraced by the academic and private-practicing orthodontic community.”
Besides their soon-to-be-published research, the doctors are in the process of developing a locally based teaching institute to train orthodontists, pediatric dentists and general dentists, about the science behind their research protocol. Although most orthodontists have the technical skills needed to treat patients in accordance with their approach, Dr. Boyd says those who don’t specialize in pediatrics often lack the expertise in managing normal childhood anxiety behaviors.
Infinity Dental Specialists is currently among a select few U.S. orthodontic practices working to solve malocclusion and other craniofacial issues by addressing the underlying pathology, but it is taking bold steps to create a viable path for others to follow.
“The information we’re able to provide can be very helpful to other allied health professionals who might otherwise be outside of the dental profession’s umbrella, such as sleep medicine physicians, pediatricians, otolaryngologists, speech therapists and myofunctional therapists,” Dr. Boyd says.
“We’re also training preschool and elementary school teachers to look for signs in the classroom that may be indicative of students who have existing sleep apnea or are at risk of developing it later.” “Dentistry is changing,” Dr. Evans says. “At this practice, we are passionate about not only addressing the problems these evolutionary changes have caused but also about understanding the links between the two and then putting those dots together.”
Infinity Dental Specialists
(844) 707-2570 | InfinityDentalSpecialists.com
500 Evergreen Drive, Suite 11
Glen Mills, Pa.
3855 West Chester Pike, Suite 225
Newtown Square, Pa.
Published (and copyrighted) in Suburban Life Magazine, October, 2017.