Braces Have Made Snoring a Modern Health Problem | Hacker News Reader

Braces Have Made Snoring a Modern Health Problem

nautil.us

89 pointspmcpinto64 comments

The article says that jaws got smaller due to agriculture making food softer, and this evolutionary change causes both snoring and crooked teeth, which in turn braces are a bandaid for. The point made in the heading isn't really discussed except in a parenthetical ("braces may also make this worse"). Baity headline.

what was really surprising was that they made the connection that modern day hunter gathers do not have the teeth problems we have, but then jumped to stating our jaws evolved smaller faces/jaws.

Evidence does not seem to coincide with that hypothesis, and even their statements are contradictory. There is growing evidence that because we eat soft food as children now, our jaws do not grow to their evolutionary designed size.

Indeed. "Evolution" would imply that humans with bigger jaws were somehow disadvantaged and died before they could pass on their genes. Really bad article.

I don't have an opinion on whether the subject is a case of gene selection or gene expression, but your binary caricature of evolution is misleading. A trait can be weened from the gene pool simply because it costs energy without providing a benefit, causing those with that trait to underperform compared to those without it. Even if individuals are living and passing on their genes, a trait might fade from the gene pool over time because competitors are able to claim a bigger proportion of resources, reproducing quicker and more often.

The human appendix is like that: it isn't directly harmful, but it's shrunk simply because it's a waste of energy.

The point is the trait hasn’t been lost at all. If people with this problem had a kid and fed them hard foods from the get go then, supposedly, they would grow the larger jaw and not have the problem with cramped teeth.

If you don't mind, what kind of evidence is there?

I read an article like this a while back on hn: https://aeon.co/ideas/its-not-that-your-teeth-are-too-big-yo...

Thanks. A quick to the point summary like this is why I usually go to the comments section first for semi-interestingly seeming posts.

This seems pretty tenuous. As the article alludes to, snoring is considered a key symptom of obstructive sleep apnea. As far as I know, the strongest known independent risk factor for obstructive sleep apnea is neck circumference. Obesity has a larger raw correlation, but that's because it's both a cause and a symptom (sleep disruption impedes physical activity and alters metabolism and appetite); with neck circumference the correlation is still present even when it's measured at birth.

It doesn't seem so tenuous to me.

The entire working mechanism behind snoring is predicated on the airway narrowing enough to vibrate, producing sound.

As you know, obstructive sleep apnea is a condition where the airway narrows so much that it collapses, causing cessation of breathing.

I'm not sure what your objection is. What I find tenuous is the link between snoring/apnea and jaw size, not the link between snoring and apnea.

Assuming the link between snoring/apnea and jaw size -- not the link between snoring and apnea -- is actually what you originally found tenuous, consider that the most effective surgical treatment for OSA: the maxillomandibular advancement (MMA) with 80% to >90% success rate wrt some measure of a "successful" outcome. MMA is a procedure that literally increases the jaw size by moving the jaw forward, which enlarges the airways.

FWIW, I've spent a lot of time researching OSA since I've had severe sleep apnea (AHI ~30 apneas/hour) since childhood. Some startup really needs to figure out a more comfortable way of treating sleep apnea than CPAP or highly invasive (and $100k not-covered-by-insurance) jaw surgery...

I'd never heard of this procedure, just the approach of using a dental appliance to advance the jaw, with poor success rate (something like 20%). The only surgery I've seen widely referenced is turbinate reduction, which supposedly also has a < 50% success rate in treating OSA. I'm surprised I'd never heard of MMA since it apparently does have a very good success rate even without diluting the analysis with practically meaningless effect sizes (mean AHI reduction of 47.8 in a recent meta-analysis [1]).

[1] https://www.ncbi.nlm.nih.gov/pubmed/26606321

Do you have a reference RE poor success rate of mandibular advancement dental appliance? I'm curious because I also had the same poor result when I tried one.

I don't know about > 100 years ago, but I strongly suspect that the reason snoring is more common now than it was in the early- and mid-20th-century is because it's so much less common now to have one's tonsils taken out. In my grandparents' and parents' generations, it was typically a standard practice, at least in the places where they lived.

I'm well within the "healthy weight" band, but I had sleep apnea until I was 25. I was finally able to find a doctor who was willing to take out my tonsils after years of problems with them, and got amazingly improved sleep as a side-effect.

My father in law has really bad snoring problems. At least in the beginning it wasn’t sleep apnea, he likely has it now due to weight issues.

He had his tonsils removed and it didn’t help. They even removed the dangly thing (Uvula) at the roof of his mouth. Both didn’t help.

Removing his Uvula caused way more issues than it solved. He is constantly choking on small drops of water and forgot spicy foods.

I had my tonsils out a decade ago and I still snore and wake myself up all the time. For me, it seems that weight has more to do with snoring than my tonsils did. When I'm thinner, I don't snore. When I let myself go, I do.

Considering how increasingly important sleep is, that sounds like a pretty good reason for you to get back into shape.

It's not by choice. I partially crippled myself in an accident and am still recovering. I had to learn to walk again and I still cannot lift anything with my left arm.

I had the idea of using my tongue to simulate the forces of braces. Did you know the tongue should rest against the roof of the mouth? No dentist or ortho consult ever mentioned that one but one little web page did. It’s working, my teeth fit together better and jw shape is changing, after at least 8-12 months. I’m keeping photos for record. I found out my fundamental problem is an obvious tongue tie... instead of fixing that, the dentist took his cut and extracted my top molars due to ‘crowding’... technically true, of course. But you can uncrowd them yourself.

Pretty much everything dentistry is a scam, er, free market capitalist endeavor with A monopoly... it’s all on the Internet. Is saying this illegal? I’m not a dentist, this is for comedic relief... Fruitarian warrior diet is the only way (eat mostly fruit, with some veggie based food like Huel for mass building). I doubt I’ll ever go to a dentist again, except to fix problems they’ve already created if I can’t avoid it (non-interventialist).

This sounds really interesting if true but also sounds somewhat dubious, would you be able to provide any links to find out more about what you're talking about or any images of the jaw growth?

My dentist actually recommended using the tongue after my braces was removed, to avoid regression. She said it was a good way of applying the same pressure.

How much pressure exactly? How is it sustained?

How do you hold your tongue otherwise ? I don't think I ever did it differently (and my teeth are okayish but not great, I refused to have braces for one lightly spinned bottom canine, but had an apparatus to widen the palate because my upper right teeth were wrapped by the bottom ones).

> free market capitalist endeavor with A monopoly

Free market, monopoly, pick one.

Ridiculously absent is the lack of mention of the fork.

Europe got the fork about a millennium ago, and children now use forks to spatula unchewed and underchewed food down their gullet, leaving the lower jaw to atrophy. Nobody notices because everybody grows up this way.

Not that complicated a concept, but a ridiculously difficult social norm to overcome, even if you want to do better by your own kids. By picking my battles, I guess I'll just start saving for the orthodontist and oral surgeon (wisdom teeth!) now.

I chew my American food cut with a knife and fork much more than my South Indian food that I eat with my hands (curries and rice are already in small pieces and meat is picked off the bone by hand).

You could make some argument about cutting food into bite size pieces vs biting it off a larger piece, but I don't think the fork plays the pivotal role here.

Oh this is interesting, do you have more I can read about the possible evo effects of forks?

Mailed you a chapter from my upcoming book.

This is an hilarious response.

moretai mentioned Orthotropics:

https://news.ycombinator.com/item?id=17284090

But it deserves to be on the main thread. The idea is to expand the upper jawbone to provide room to advance/restrict growth of the lower jawbone with appliances to correct an overbite/underbite, instead of moving the teeth with braces. In other words, orthotropics corrects the mismatch in the bone, whereas braces are a cosmetic treatment that doesn't always fix the underlying problem(s).

I had braces for many years too long, which left me with a small mouth and narrowed pushed back canines (babyface). I've been wondering why I've been so tired lately, and just discovered that it's likely due to my lower jaw continuing to grow as I got older, but stopping against my top teeth which were moved back by braces (so it grew towards my throat). So I have an appointment scheduled with a sleep apnea specialist.

I've done a lot of research on this and my feeling is that orthodontics needs to be reviewed. I'm 40 so caught the braces craze in the 80s, which means there hasn't been enough study to know the long term effects of restricting the growth of children's upper jaws with headgear. And the fact that orthodontists are recommending braces for younger and younger children is a huge red flag (just like medicating ADHD instead of fixing the lack of creative outlet in our "modern" education system).

It looks like orthotropics may provide some relief for adults but I'm having trouble finding a practitioner locally (Boise, ID).

Braces is not the problem. Orthodontists are the problem. Most of them are just doing "cosmetic surgery" without thinking about its consequences on your teeth, jaw and more... You want to go visit a Functional Orthodontist instead.

http://www.aafo.org/

This is so interesting! Since my braces I was always frustrated that my teeth were more aesthetically 'correct', but less functional.

The article advocates changes to how children are raised — encouraging more chewing of tougher food — as a way to improve the situation. But is there any suggested intervention for adults? Perhaps more adults should be encouraged to have jaw adjustment surgery, instead of regular orthodontic treatment? Right now it seems like braces are considered the first choice, and surgery the last one, but perhaps this should be reversed?

"Get a bigger jaw" doesn't seem feasible, and would probably not be very appealing (for aesthetic reasons) anyway. "Get a smaller tongue" isn't much better. It does seem like there might be some kind of retainer that could work. The fact that there isn't already someone making billions from that idea suggests that no alternative has been found that's both effective and convenient. Anything that could keep the tongue from sliding back is also likely to trigger a gag reflex. Or maybe there is a solution in that area, but nobody has quite hit it yet.

It can be done, but it's extremely painful. They basically break your jaw, then slowly force the pieces apart over a period of around 6 months. I had this done when I was in 7th grade, before I got braces. It was extremely painful at first, then kind of settled into a dull ache. There were 3 screws on the bottom and 1 on top. Made talking & eating very difficult (the hardware across the roof of your mouth makes it hard to swallow and enunciate clearly).

It was either this, or they'd have had to pull adult teeth to make room for the remaining.

There is this guy John Mews, and his son, who advocate something called Orthotropics. It's basically forcing yourself to push your tongue onto the roof of your mouth. I recently got braces, like a few weeks ago, as a 26 year old male adult, and have been doing this. I've been pretty consistent daily, not all day, about keeping my tongue on the roof of my mouth. I really recommend just reading it. It probably is just a placebo, but the cool thing is that I can feel the difference in my breathing. It feels smoother and less forced coming out through the nose. Just the idea of keeping your lips together seemed to have helped. Hopefully over time it improves.

https://www.youtube.com/channel/UC6eh59CVGAMTjxo6q9gCMZA

Braces will train you to avoid pressing into the front teeth with your tongue because of the pain once the teeth are loose and migrating. I still keep my tongue on the roof 20+ years on.

I have a mouth guard that keeps my mouth open and pulls my jaw forward (via rubber bands connecting the top and bottom pieces) that helps cut down on snoring. It works less well once the bands are stretched out a bit (you can swap them out though), but overall it's helped improve my and my girlfriend's sleep considerably.

I have one that was custom molded but it looks like you can get OTC mouth guards as well.

>Anything that could keep the tongue from sliding back

They do that procedure of small electric burn to the soft palate and/or back of the tongue - it supposedly creates scar tissue which firms those areas. Had it to the palate 14 years ago and snoring is still significantly lower - was told that the effect may be temporarily as/if the scar tissue goes away.

The jaw seems like a pretty complicated joint in its function. Not necessarily as complicated in movement as some of the other joints, but as far as clamping force required, and necessity to have proper alignment to function (pain-free).

I don't think that surgery on the jaw itself should be an option in cases other than severe pain limiting function of the joint. If the teeth are crowded, remove a couple - that definitely seems like the choice with the least potential for complications that could essentially ruin someone's everyday life anyway.

> If the teeth are crowded, remove a couple

When do you propose to do this? You can't do it until the final set of teeth have come in. If you do it later, then it might address the overcrowding of the teeth themselves, but it's too late to do anything about the size or shape of the jaw itself. Maybe you can affect the position/alignment of the jaw somewhat. That can be beneficial in many ways, but I'm not sure it would address the snoring issue.

Good point - not sure I thought it through to be honest.

This is ridiculous but when I had snoring problems my research led me to 2 things. Weight loss and the didgeridoo.

Really its a weight/bmi thing from what I've read. All that fat presses down on the different soft areas of your throat and mouth. This causes the rattling and flapping which we hear as snoring.

Now I'm the proud owner of a gym membership and https://www.amazon.com/Meinl-Percussion-DDG-BOX-Didgeridoo-M.... All thumbs up here.

It's not always a weight thing. Dude I know has pretty bad apnea despite being super active (hiking, etc) and being thin as a post.

I'm only slightly overweight and hike a lot. I'm 43 and not known as a snorer. Got my CPAP a few weeks ago. Snoring isn't always obvious and doesn't require being fat.

If you wake up tired and have low energy with daytime sleepiness try getting checked for sleep apnea. The home test is pretty easy (pulse oximeter followed by a slightly more involved test with a chest strap and a cannula).

didgeridoo?

When I was a kid (France, west of Paris, the 80'), there was that I'd kid who would wear braces.

Today there is this odd kid in my children class (same place, same age) who does not.

I honestly wonder whether dentistry standards changed /evolved that much or if it is just fashionable (and financially interesting, at 1000 EUR the brace). I just hope it is not actually harming the children.

Surprised to see no mention whatsoever of sleeping position. My experience is that very few people snore when sleeping on their side, but that back-sleepers are highly overrepresented among snorers. My father suffered, unknowingly, from sleep apnea. I recommended that he teach himself to sleep on his side instead, by propping himself uo with pillows or sewing a ball into the back of his pajamas. He taught himself without tricks like that, and he no longer has sleep apnea. To end a bad habit of mouth breathing, another simple trick is to simply tape ones mouth shut with surgical tape in the evening. I’ve done this myself to get back to nose-breathing after bouts of rhinitis. Simple behavioral modifications often trump overpriced hitech solutions and invasive procedures

So we're pugs...

Interesting, lots of children at school now seem to be using palat expanders.

https://en.wikipedia.org/wiki/Palatal_expansion

2nd word in article = 'apotheosis' Great clear writing!

Actually the whole 1st sentence..

"The apotheosis of my five-year orthodontic torment was a sad admission from the orthodontist: After thousands of dollars invested in what felt like medieval technology, my braces had not only failed to ameliorate a complex situation but created a new problem for which, even today, there is no solution."

This is extremely flowery and pretentious writing (especially for an article about snoring and braces, and not, a literary review or something) + it doesnt even make sense!

'Apotheosis' = The glorification of a subject to divine level.

So.. the glorification of her orthodontic torment to divine level was a sad admission from her orthdontist ?!?!?!?!

There's alternate definitions to apotheosis and the first definition from google seems pretty fitting: apotheosis - the highest point in the development of something; culmination or climax.

The average capaciousness of a person's vocabulary has diminished in recent years, where people today pompously decry all but "marketing speak" as senesless and pretentious.

For business purposes I strive to use simpler words and speech, but I still get noticed for using a complex vocabulary :(

I do the same. In my case, an extended vocabulary would be counterproductive in business, as I work with people in a number of different countries. The dialects of English differ significantly across the globe. Also, people in some cultures will say they 100% understand items, even when they do not, so it is incumbent upon me in those cases to communicate as effectively as I am able.

Words have multiple definitions and "apotheosis" makes perfect sense there.

There's a good reason technobros (most, any, a few can turn a phrase) are not consulted as editors of writing meant to be enjoyed, not merely to inform. Complaining about "flowery and pretentious writing" is, itself, middlebrow crap (see? unpretentious and unflowery, no less) that leaches voice and delight out of a piece of writing--the act of writing is the performance of art as well as the performance of trade and letting words out to play is fun and good.

This is in an article about snoring and braces. The purpose of the article is to relay these new theories about such to the reader. The writer is definitely sacrificing clarity in favour of an ornate, pompous and pretentious writing style imo. There are genres (eg. literature) where word-play and creative use of language and so on are acceptable for the writer and the reader. But its entirely inappropriate for this sort of article.

Also, getting back to "apotheosis"...Almost any other choice (climax,peak,culmination,zenith) would have been more apt and clearer.

"apotheosis" is ambiguous. Its also a relatively obscure word most readers will not clearly know the various meanings of, and even the more appropriate meaning is not as apt as some of the words Ive listed. Its even hard to discern its meaning from context as the entire sentence is such an overwrought mess, full of necessarily big words.

Thus, the only reason I can fathom the author chose this particular word is to attempt to appear superior.

Also what is a 'technobro' ???

I thought of a nice analogy.

Do you also think this article should have been written in extremely ornate calligraphy? With the letters forming little animals and demons like in an illuminated manuscript?

Maybe you find that idea ridiculous, which is my intention.

You might think that the particular font used is irreverent compared to the words themselves. If someone used such an ornate font as to render the words unreadable that may seem self-defeating on the authors part.

That is analogous to using such ornate language as to render ones meaning unclear. It is the content, the information and ideas generated in the readers mind that are important, not the font used, or the words used.

Agreed. A few more parentheses is all the sentence needed to convey its meaning.

Or a few less trips to the writer's thesaurus.

And there's a good reason sexism is called out and vilified.

The correct word would be 'climax' but that's shading increasingly naughty in modern parlance.

I grew up on Hardy Boys novels and they were verbally ejaculating all over the place. You don't see that anymore.

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