Beginnings of a Bad Bite: How Purees Impact Jaw Growth with Ben Miraglia, DDS

Katie Ferraro (0s):

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Ben Miraglia (1m 44s):

When you have the breastfeeding followed by the hard food, the musculature is prepared to handle that load. It can chew and work that food we don't choke.

Katie Ferraro (1m 54s):

Hey there, I'm Katie Ferraro, registered dietitian, college nutrition professor and mom of seven specializing in Baby-Led Weaning. Here on the Baby-Led Weaning with Katie Ferraro podcast. I help you strip out all of the noise and nonsense about feeding, giving you the confidence and knowledge you need to give your baby a safe start to solid foods using Baby-Led Weaning. Since you are listening to a podcast about Baby-Led Weaning, my assumption is that you are already probably pretty aware or well briefed on the benefits of getting your baby to learn how to eat real food, right? There's the variety, okay?.

Katie Ferraro (2m 34s):

They're gonna have a lower risk of severe picky eating when they eat a greater variety of foods and Baby-Led Weaning allows for that. There's the exposure to all of the potentially allergenic foods earlier, which helps prevent food allergy. We've got the benefits of taste and texture and flavor opportunities that come with exploring real food. There's the cost saving of not having to buy processed period foods, the convenience of not having to short order cook for one kid because everyone in the family eats the same thing as a dietitian specializing in infant feeding and Baby-Led Weaning. I'm all for all of those benefits. However, I am increasingly interested in another avenue, a different benefit of Baby-Led Weaning that I don't think we're talking about enough.

Katie Ferraro (3m 15s):

It hasn't been fully explored and I know a lot of parents that that I encounter are like, ah, makes sense, but I never thought about it. It's the impact that harder foods have on your child's jaw growth and their airway development, which is then in turn tied to the spacing of the teeth in their mouth, their sleep patterns, sometimes behavior issues. And so much of the stems back to the way that we're introducing solid foods to babies. If babies are taught to suck swallow liquified foods and not allowed to explore with harder textured foods, their jaws have the potential for underdevelopment that leads to crowded teeth, obstructed airways, sleep disruption growth, faltering possible behavioral issues.

Katie Ferraro (3m 59s):

It's fascinating how the anatomy of the jaw impacts health down the road. My guest today is preaching the importance of harder foods earlier on in the weaning process in order to help maximize jaw strength and jaw growth. His name is Ben Miraglia and he's a dentist and you do not get a lot of big Baby-Led Weaning fans coming out of the dental space. But Dr. Meraglia always recommends Gill Ripley's book about Baby-Led Weaningg. Gill Rapley is the original co-author of the Baby-Led Weaning book. I call her the founding philosopher of the Baby-Led Weaning movement. And every family that comes into his dental practice, if they have a baby, he's like, you gotta check out Baby-Led Weaning.

Katie Ferraro (4m 41s):

You've gotta read this book. I heard him talk about this on another podcast and then a couple parents sent me that same episode like, you've got to have this guy on your show. So for that reason I wanted Ben Miraglia to come on the podcast and talk a little bit about the Beginnings of a Bad Bite and how purees negatively impact jaw growth. So in this episode today Ben's gonna be talking about why purees were not historically fed to babies and why they're not necessary for you to offer to your baby either. He'll talk about how the jaw develops when it's exercised appropriately with breastfeeding and then harder finger foods and then what to do if your baby's teeth are spaced too close together because ultimately down the road he doesn't want you to have to pay for braces either.

Katie Ferraro (5m 24s):

So Dr. Ben Miraglia is also the co-founder of a company called Tooth Pillow. It's an online program for the remote treatment of some of the overcrowding issues that he sees in his dental practice. I'm personally very interested in this intersection between the physiology of the draw structure and the foods and the practices that shape it and help grow it because not only do I teachBaby-Led Weaning, but I also have school age kids and the dentists are telling me like, oh, they're gonna need braces. And he's gonna talk a little bit about why there's things that we can do to help reshape the jaw so that we don't just have to default to fixing crooked teeth. So you might not be thinking about braces. I got braces on the brain right now.

Katie Ferraro (6m 5s):

I literally have my daughter's first orthodontic like evaluation today and I'm considering some alternatives after this conversation with Ben Miraglia is all I'll say. So with no further ado, we're doing an interview the Beginnings of a Bad Bite, how purees impact jaw growth with the dentist Dr. Ben Miraglia.

Ben Miraglia (6m 27s):

When my kids were born twenty four, twenty three and 17 years ago, we were doing it all wrong as we learned it now. So we started out with my wife having to go back to work. So she did the breastfeeding as much as she could, but then with going back to work, it was reduced to a couple of times a day and then jumping in with the bottles and formula and stuff like that. Then of course blending everything, you know, we went right to the farmer's market and we thought that we were doing it all right, like we'll get the freshest ingredients, but then I pureed that to a pulp. And so, you know, the only way I knew that it was blended enough was if the blender was starting to smoke and catch fire. That's how I knew, you know, that's my judgment was if the blender's catching fire, it has to be pureed enough to be a liquid. Meanwhile, what I was doing was feeding the children liquid and so I didn't know it at the time.

Ben Miraglia (7m 10s):

You think you're doing the right thing as a parent. And so years and years later we start to learn and now I recognize that through, you know, coming across anthropology research, it's really profound to learn that cultures that are pre-industrial, pre western living, they transition from breastfeeding to hard food much earlier and the infancy begins the hard food like six to nine months old in a lot of those cultures where they don't have then the issues with the jaw growth and development and the crowded teeth and the bad bites and all this other health issues. So I learned the hard way, the backwards way that oh my goodness, my kids have crowded teeth and bad bites and poor breathing and sleeping because I gave them softer foods versus harder foods early. I just did not know.

Ben Miraglia (7m 51s):

And now I know and the the good news is that when you still have a teenager left, you, you know that you're doing a lot of things wrong still 'cause they're the first ones

Katie Ferraro (7m 58s):

Because they remind you of it on a daily basis. Remind how long.

Ben Miraglia (8m 2s):

You're doing everything.

Katie Ferraro (8m 3s):

I'm so interested in that anthropological standpoint. I'm a nutrition professor, I teach a cultural foods class at San Diego State University and we spend a lot of time kind of delving into looking at the history of, of the human jaw and how things have changed over time. Can you talk more about what you just said there, like chewing versus purees, how does chewing real food and cultures that start a little bit earlier, like the hard food start at six to nine months of age, how does that differ from what we traditionally do in western food culture, which is like force our kids to suck on purees? How does that affect jaw development and eventual teeth alignment.

Ben Miraglia (8m 36s):

Basically is that the, the jaw growth and development is very highly dependent on muscle function and particularly the tongue. So how the tongue, lips and cheeks are functioning do dictate how our jaws will grow and develop. Now, anthropology research, I've been a big follower of Dr. Robert Fortini and Dr. Jerome Rose. Those are two of many anthropologists that have studied the head and neck and the malocclusion related issues or jaws. And they, along with all of their other colleagues across anthropology really teach us that with the research as they studied cultures going forward and backwards through, you know, all the records that they have and track pre-industrial, pre western and what we would say is natural isolated aboriginal style cultures.

Ben Miraglia (9m 19s):

They do transition from breastfeeding to earlier hard food. So they call it an early hard diet where the child can grab and gnaw and they recognize that's about six to nine months old. Now the earlier the child transitions to the harder food, the better the musculature will be developing and the stronger the muscles, the bigger the bones grow. So it turns out for a human being, form follows function and your form will follow the function. If you're functioning properly at the muscles, then your bone formation will be appropriate. But then also bone yields to muscle. And so we don't grow because the bones grow to a certain size and then our muscles follow those. It's that the jawbones actually are kind of following what the muscles are doing.

Ben Miraglia (10m 0s):

So the earlier hard food strengthens the muscles and it forces them to function properly. So it sets up the difference between hard and soft food, which is the difference between a like a, a chewing, a compression style swallowing pattern or a just a drinking, a liquid kind of sucking swallowing pattern. And that liquid or softer food leaves us with weaker muscles that are then dysfunctional and our bones won't grow. We end up seeing crowded teeth with bad bites, but really underneath the crowded teeth and bad bites is that we don't have the best room to breathe anymore. So it changes our breathing patterns.

Katie Ferraro (10m 37s):

And I wanna segue into this whole notion, you kind of opened up my eyes to this world of airway health and I know there's other experts working in this space, lots of different credentialed people. We've had speech language pathologists, you're a dentist, you've had pediatric dentists, come on. Can you talk about airway health and this theory? Like how does early diet and chewing habits affect airway health and dental development in babies? Because I think like, I don't know as a parent, like airway health, like my eyes kind of glaze over like what does that even mean? But then when you break it down, I'm like, oh my gosh, this is literally like everything that parents complain about is being problematic in their children.

Ben Miraglia (11m 11s):

Right? So it turns out a human being is an obligate nasal breather. So we were built to breathe through our nose and only our nose. So 24 7 365 we're supposed to be nose breathing. Mouth breathing is unhealthy. It is a compensation, it turns out it's a safety valve. We open our mouth to breathe when we can't breathe through our nose. But breathing through the mouth is different. And what that does is it changes how the ingredients in the lungs are gonna be exchanged. So we go towards unhealthy. But what parents recognize is maybe symptoms. They might see symptoms with sleeping and breathing. And now in dentistry and medicine a little bit, we start talking about this word airway. Now airway is like a, basically a common general lay term describing a space.

Ben Miraglia (11m 52s):

Your airway is your pathway to breathe and the airway is a space that's left behind by how your jaws grow. And so the way we could think about it is the air starts at the nostril and the air has to go up in the nostril and then it turns around. So our airway is like an upside down letter J. And the airway is a tube. We'll think of it as a tube, it's not a tube, it's not a structure, it's a space, but it's kind of like a hollow chamber. Now, from the time the air gets in the nose, this is our upper jawbone and our upper jawbone, its growth determines how big the nose or chamber inside will be. Fancy words or professional terms would be nasal cavity the inside of your nose. Now the nasal cavity is like a triangle inside. And that triangle inside, it's either this size, this is what you get when you have full growth of your upper jaw.

Ben Miraglia (12m 36s):

But this is what you get when you don't have full growth of your upper jaw. So it turns out our upper jaw makes up the sidewalls of the nose. And if our upper jaw grows wide, they're far apart, better room for breathing. And if the upper jaw doesn't grow, well it's narrow but also vaulted. So we look in the mouth and we say, Hey, is the pal higher up or is the palette shallow? Now a shallow palette, the pal is the floor of the nose. It's the same bone. So the same bone that goes across the top of our mouth, we look inside, we see palette, but we look from the top down, it's the floor of the nose. So it, instead of having this to breathe through, we have this to breathe through.

Katie Ferraro (13m 11s):

And can you explain for listeners, 'cause we're videoing this, but also for the podcast side, this and this, you're saying like a large triangle that you're showing and then you're showing like a.

Ben Miraglia (13m 21s):

Right. So the, the big triangle would be I'm representing the inside of the nasal chamber. Like if we were to take away the nose that you physically see on the outside, we have a triangle here where the air's gonna go in to breathe and I'm, I'm representing it by my fingers. And my thumbs are basically the roof of the mouth or the floor of the nose depending on how you're looking at that. So if we're looking up in the mouth, we would see the roof of the mouth. But if we're down looking down on this, it's the floor of the nose. It's the same bone that's our upper jawbone in our professional words maxilla. But the upper jawbone has side walls like this that make up or frame our nose on the inside. Now if our jaw grows beautifully, it's a bigger triangle for us. But if we have a smaller jaw, then that triangle will be smaller, but it'll be visible inside by a vaulted palette or higher palette.

Katie Ferraro (14m 4s):

But I always thought it would be the opposite. And this is where I get confused again, I'm a, I'm a dietitian. I know very little about the actual like bones of the face. If the jaw grows big, my thoughts were always, well that would push the airway and make it smaller. But you're saying that's not the case. The larger, healthier, more robust jaw actually opens up the airway, is that correct?

Ben Miraglia (14m 24s):

Yeah, the, the upper jawbone is two halves. There's one on each side, they're connected in the center, but the bigger they grow, the wider, the farther apart these walls are. So the side walls of your nasal chamber are basically part of the maxilla. And if your maxilla is narrow, they're closer together. So if your maxilla is narrow, that's squeezed in here. Now squeezed in here means harder to breathe through the nose. Whereas when your upper jaw grows really wide, this is a wide open chamber to breathe through. The farther apart those walls are the more space for the breathing. So wider jaw bones, bigger breathing in the nasal chamber.

Katie Ferraro (14m 59s):

Hey, we're gonna take a quick break, but I'll be right back.

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Katie Ferraro (15m 37s):

Okay, what does bigger breathing in the nasal chamber, that is a good thing. Why is it good? And besides promoting this obligate nose breathing, which I like that you said that humans are born to be obligate nose breathers. I wish someone would tell my husband that he's like the worst mouth breather. I wanna, I want to get look inside his airway or have someone do it now. But why does it matter besides maybe sleep patterns, which is very important. Like what are the other ways in which the structure of the airway can impact health that we might not think of?

Ben Miraglia (16m 7s):

Yes. So we just covered the nose only. Now we're looking at the upper jaws too small and then that affects the inside of our nose being too small. We can't breathe well here. But when the lower jaw is also too small so they're both too small when we come a little bit lower, if the lower jaw's too small, well the upper and lower jaws are too small means there's no room for our tongue. Now there's less room for the tongue and less room for the tongue means when you close your mouth, the wall of teeth is kind of like the cage that sets the tone for where can my tongue be. But a closed mouth, when the jaws are too small, meaning narrow and back when you close your mouth, your tongue only has one way to escape backwards. It can't go forward 'cause the teeth are there, it can't go sideways. So the teeth are there. So a closed mouth breather with a mouth that's too small, the tongue is now backwards.

Ben Miraglia (16m 49s):

When the tongue is further back it blocks the air from getting behind it. So now we have this trouble with the smaller jaws. We can't breathe well through our nose because it's too tiny thanks to the upper jaw being too small and the tongue is too far back because bulk jaws are too small and the tongue is now too far back. Now when we can't breathe well through our nose, automatically your brain separates your lips and gives you your mouth breathing. So mouth breathing is subconscious, it is basically because, well I don't breathe well through my nose. My, my, my brain knows that it will open the mouth to be a relief valve. But here comes the difference between healthy and unhealthy. The nose was built to filter warm humidify, basically purify that air and then accelerate it as it passes through the chamber into the lung.

Ben Miraglia (17m 31s):

So when the nose prepares the air for the lung, that air enters the lung beautifully and then the lung gets to do its job optimally, meaning make the exchanges. So the lung is an exchanger, it brings in the good stuff, gets out the bad stuff. But the proportions and the rates are important and that only happens well when we breathe through our nose. You can breathe through your mouth but it's not healthy because the mouth doesn't filter warm humidify or clean the air. It does not prepare it for getting into the lung properly. So the air goes through the mouth, it gets in the lung, but now we don't have the same exchange rate. We get less of the good stuff in and maybe not enough of the bad stuff out or too much of the bad stuff out creating an imbalance. So I like to describe the difference between nose breathing and mouth breathing as having a high performance car.

Ben Miraglia (18m 13s):

If you've got a high performance car and you put the right gasoline in that car, it's going to perform optimally. But if you take that high performance car and you put a very low grade or even watered down gasoline into it, it will not perform the same. So I'm telling you, the human being is like a Ferrari and it has to have the right gasoline which is nasal breathing because mouth breathing is a difference. And then every system after that runs poorly because you're fueling yourself with air, the oxygen coming in. So basically when we say the word airway, it's loosely describing the space that is left behind from the amount of jaw growth we got. The better the jaw growth, the bigger the space or bigger the airway.

Ben Miraglia (18m 53s):

Like a garden hose might be the worse the jaw growth, the smaller the airway, like a coffee straw. And when you can't breathe well you can't exchange well and when you can't exchange well you cannot function well. And it does affect almost every system in the body downstream. Here comes the symptom list.

Katie Ferraro (19m 7s):

Okay, now what about the jaw growth rate? Like when does the jaw obviously starts growing at birth. So I would assume breastfeeding, which requires a lot more musculature and action to extract the milk from the breast is probably promoting better jaw growth than if we were just squirting milk out of a bottle. But let's talk about the solid food era 'cause that's where our audience listening like whether if you breastfeed great, continue doing it. If You don't breastfeed, that's fine. You're now entering the next phase where you're starting solid foods, continuing breast milk or bottles. If that's the case, what can parents do to promote optimal jaw health in the second half of infancy, which is when we generally begin the introduction of solid foods?

Ben Miraglia (19m 43s):

Yes. And so the, it turns out that the majority of our jaw growth, 54% comes during the first 24 months. So even though we're only gonna be two years old from zero to two, we get 54% of this growth and we get another 10 to 15% from two to four. So the majority of the jaw growth is early. And like you just mentioned with the breastfeeding, that would be the best choice because you have the activity of the muscles. And with breastfeeding we get the training and musculature. So the compression compression with the vacuum swallow, all of that develops the musculature and it takes a nice strong musculature to have successful breastfeeding. So that basically I like to try to go with the analogy of the gym. You know we, we go to the gym for a year with a trainer and you come outta there and you're gonna be very happy with the results.

Ben Miraglia (20m 28s):

So a trainer for a year is excellent, right? But do you get to keep it if you stop going to the gym and then don't have the trainer, your body fades back to the start. So what happens with the, the transition is that in the, the breastfeeding mode delivers that strong musculature and function. But when you shift to softer foods after we lose the muscle strength, just like leaving the gym, we've now left. So the breastfeeding is basically the gym with a trainer. So now we've got the physique and the proper strength and function, but the moment we go home and don't go anymore, we start to fade back to where we were. Well going to soft food early leads to the weakness in the muscles coming back. So we don't get to maintain the strength of that musculature and the function with soft good foods.

Ben Miraglia (21m 9s):

However, transitioning to harder foods early, well now we've got the trainer and the musculature all set up perfectly from the breastfeeding. The handoff is the harder foods early and the harder foods early maintain the muscle strength. And when the muscle strength and function is maintained, the jaws continue to grow perfectly. And this is why we do not see crowded teeth and bad bites in cultures pre soft food.

Katie Ferraro (21m 28s):

Now can you talk about this harder food early because obviously as a proponent of Baby-Led Weaning, I'm a huge advocate for offering, you know, age appropriate. We generally say soft finger foods but there's some texture there. There's more resistance. It's not squeezing a liquified vegetable fruit into a baby's mouth for parents. There are though parents who are just, they're even mortified of offering their baby purees. They're so scared the baby is going to choke. Could you talk a little bit about what we would expect a 6, 7, 8 month old baby to be able to do with regards to those harder foods and how the anatomy is actually inherently developed to prevent choking and to protect itself, to protect that airway? That's what we always say. That baby has the ability to protect the airway, convince the mom who's scared to even do purees that she should be doing harder food 'cause she's so worried her baby's gonna choke.

Ben Miraglia (22m 13s):

Sure. And this is another fascinating topic, the choking incidents and also related to anthropology research. 'cause there's a significant stack of anthropology research that shows there is no incidence of infant choking prior to the early soft diet. And what we think about is this, when you have the breastfeeding followed by the hard food, the musculature is prepared to handle that load. It can chew and work that food. We don't choke. Here's the difference if we switch to softer food, once you switch to softer food and you lose the musculature, it's not prepared for the harder foods. So switching to something harder than can result in a choking incident. So we only see the incidences of choking at in cultures that have switched over to the softer foods.

Ben Miraglia (22m 54s):

So early soft foods deliver a choking incidence but not from the softness. It's from then trying to go to hard to soon the muscles aren't prepared for it. And I say the analogy, it's like going to the gym. If you, if you went to the gym for a year with a trainer and you did a wonderful job and you came out with a physique and a strength level, but then you laid down in your bed for two months or three months and then just let all the muscle go to waste, you can't go back to the gym and start at the ending point with the heavy weights. You'll hurt yourself. So basically taking an infant from purees to harder immediately is where you get this choking incident showing up in the anthropology research.

Katie Ferraro (23m 28s):

And even if you ask feeding therapists, they'll tell you straight up most of what they see in a second year of life from a feeding therapy standpoint is largely preventable. Had the child been able to explore with and self feed harder finger foods earlier, it's those 10, 11, 12 month old babies who've never had anything in their mouth except liquids or purees. It's very challenging to go backwards and reteach this skill that to be frank they should have had six months ago.

Ben Miraglia (23m 52s):

And it makes sense because all this early time we've kind of trained the mouth to be a drinker, like a sucking swallower. And if you're a sucking swallower, you're basically from the moment it gets to your lips, you're bringing it right in. But when you put something hard there, you can't suck swallow that. So now you have something with consistency, you're supposed to be chewing, swallowing that. So that's why when you switch from that kind of softer to then transitioning at an older age, which could be 10, 12, 14 months, that child puts it in their mouth and they automatically are doing the same reflex they were doing before the drink. They, they're trying to drink that they're not trained to eat that. And next thing you know it can give you that choking incident. The solution for that is starting earlier because you already have the musculature and the training from the breastfeeding.

Ben Miraglia (24m 35s):

So now we're just trying to continue with the harder foods and that anthropology research is just brilliant that shows we don't really have a choking incidents until after starting the sofa foods.

Katie Ferraro (24m 43s):

And that's what we say in Baby-Led Weaning, that if you wait until your child is truly ready when they're demonstrating the core strength to support a safe swallow of something other than infant milk and you prepare the foods safely for their age and stage and you seat them properly in a place with a flat foot rests where they can stomp their feet down if they gag on the food, use them also that they have to push that food forward and protect their own airway. Those three things in unison, your baby will not choke on food. And it's interesting to see that that is also supported by the anthropological researchers. The baby's in choke on food when they were eating real food at the right age. I mean we can, this doesn't work for a three or four month old who can't sit up on their own. If you're slumped over the way your airway works is you're gonna have a higher risk for aspiration. But once they can sit on their own, which correlates with being around that six month mark, we see that they have the strength as long as they're in a safe space and the food is prepared properly, they can swallow that food.

Katie Ferraro (25m 29s):

And I think it's important for parents to hear that 'cause they just, they just automatically assume because their baby's only ever had infant milk in their mouth that that's all they can, it's important to hear, no, from a developmental standpoint, these things start to change around the six month mark and, and we can challenge them with some of those harder foods.

Ben Miraglia (25m 44s):

Yeah and that's the right frame. The six to nine month frame is where the challenge should come and then therefore you have the proper way to do it. And I, I ref, I refer a lot of patients to the Baby-Led Weaning book, Jill Rapley, Tracy Marquette, we refer to that book. We said, look, that's an instruction manual that that's here to help us kind of transition to the harder foods earlier. And I think they even have it on the cover, an introduction to introducing solid foods to your infant. You know,

Katie Ferraro (26m 8s):

I love that as a dentist you're recommending Baby-Led Weaning. It's important. I think we have a lot of pediatricians who don't even know what it is. I, I heard you on a podcast and then I was like, this guy loves Baby-Led Weaning and then a couple parents sent me the same interviews like, you have to get 'em on your show because you don't normally hear that from a dentist, to be honest with you. You know, like you said, when your children were babies, the, the idea of offering modified versions of the same foods the rest of the family, it's like this is nothing new. You know, I always say, what did you think cave mama fed cave baby before there was a whole aisle of pouches at Target to squeeze in your baby's mouth. Like they, we've always done this. It's just, it's okay to do because we've had the huge advent of commercial, you know, baby food, enter the, the game and all the marketing dollars that go with it and the retraining of doctors and teaching them, oh your baby needs white rice cereal and they need to suck this stuff and, and they're not actually chewing if it's highly processed food.

Katie Ferraro (26m 57s):

So I love this idea of kind of going back to basics and using history and anthropology to inform, you know, current modern day practices. 'cause this is, we don't want parents to think that this is something unusual. My hope is that in the future it would be unusual to watch a baby being force fed by spoon. Like babies should be able to feed themselves just like we want them to be responsive feeders when we're breastfeeding or bottle feeding. We want them to be responsive eaters when they start solid foods too. And they can do a lot more than we give them credit for, but it's reminding them that they're anatomically equipped to do this.

Ben Miraglia (27m 26s):

Oh yeah. And the, the anthropology research is fascinating as far as how far it is the other way. Meaning in cultures that are pre-industrial, pre western, basically for the eternity of the human race, it's been breastfeeding followed by hard food, soft baby mush the purees. That's really a new invention. But when you think about hard and soft back then prior to industrial, you know western foods, even the food today we would think as solid isn't hard. So what the cultures would do there was the meat would be cured with a little salt. I know not everybody's a meat eater and that's fine, but when you're looking at the anthropology research way back when in cultures that are natural aboriginal living off the land, the meat product is cured with a little salt and that's what we call jerky.

Ben Miraglia (28m 7s):

But when you cure meat with a little salt, it becomes like a leather and the infants start to gna on that at six to nine months old. So they're gnawing on the leather early and that's really what a hard diet used to be. And there's a difference between hard and solid. We're just trying to get back to solid, which is one level closer and not necessarily have them chewing on a leather shoe, but that's what it used to be. The eternity of the human race was brought into a hard food early and that hard food was really natural and solid and they had to work at it. And the more you work at it, the more your bones grow. Hey,

Katie Ferraro (28m 41s):

We're gonna take a quick break, but I'll be right back.

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Katie Ferraro (29m 13s):

Now let's talk about the older child. 'cause I know we have families listening that are like okay fine, but with my first kid or other kids, yeah we did do purees there. There is a lot of mouth breathing, there is disrupted sleep patterning, there might be associated behavioral problems. Now there's teeth overcrowding. If you do have a child three to five, the ones that you are seeing in the dentist office, you know, rather than maybe being like do Baby-Led Weaning with your next baby, is there corrective action that we can take for children other than just braces to help don don't know restructure the mouth. Can you continue to grow the jaw? Is there anything the families of older, you know, 3, 4, 5 year olds can do?

Ben Miraglia (29m 48s):

Yes, you can recover the jaw size. You just have to recruit the breathing and musculature to be appropriate. Again, just like if you went back to the gym, you okay, oh I let myself go downhill and now I look at me, I have the dad bod, I better go back to the gym. You can earn it back but you have to get the breathing and musculature correct. So for three to five year olds we would look at of course the teeth, are they together, meaning no spaces. And when there's no spaces in the baby teeth that will be severe crowding in the permanent teeth so we know what's coming. Then of course symptoms, you know, what kind of symptoms might the child be struggling with because mouth breathing at night can lead to a symptom list that could be anything from night terrors or bedwetting or night sweats or even just a little behavioral issue that starts to creep up into the the picture.

Ben Miraglia (30m 28s):

So you have symptoms, you have teeth that are together, we know the jaws are too small when the jaws are too small and the breathing isn't right. We can have a, you know, unhealthy child. Well to redirect the breathing and musculature. We do things like nasal hygiene instruction and technique with natural products. So we're using simple saline type rinses. Then we go to guidance appliances. And when I say guidance appliances, it's mostly unknown to people that they, these things have even been around for decades. But for the last two decades we've been using these guides and they look like a little football mouth guard. But when the child wears it for one hour a day plus overnight, it redirects the breathing to be through the nose and it redirects the tongue to function against the palate. So you start getting back a proper rest and swallow pattern out of the tongue.

Ben Miraglia (31m 8s):

The guide also pushes back on the lips and cheeks so we're not overusing them 'cause we're really not supposed to be using the lips and cheeks for swallowing. And yet when the guide redirects all that musculature, you slowly have the child growing outwards. 'cause now the tongue is working properly and the lips and cheeks are pushed away. So now the child starts growing out instead of in. And then aside from the nasal breathing and nasal hygiene with the guidance appliances is myofunctional therapy. And we rely on the myofunctional therapy community heavily because they basically do physical therapy for the head and neck and it's in the breathing musculature and posture category to help that child and parent with exercises to get the muscles back on track to being properly strengthened and properly functioning. Because again, if the tongue and the muscles of the head and neck are functioning and strengthened properly, we get better jaw growth and development.

Ben Miraglia (31m 54s):

So that's the direction we head with the little ones.

Katie Ferraro (31m 55s):

Okay, I wanna ask, go back to the spacing in the baby teeth 'cause it blew my mind the first time I heard you say this, that don don't wanna cause additional anxiety for parents who are now like analyzing their baby's teeth. But you're saying if there are spaces between the baby's baby teeth, that's good, but if the baby's teeth are touching, that's an indicator that there will be overcrowding later. Is that correct?

Ben Miraglia (32m 16s):

Yes. Yeah, that's like a hundred percent guarantee. Three to 5-year-old you can look at the teeth and know automatically how the permanent teeth are gonna go. There was a lot of research done in dentistry to show that early crowding of teeth is from baby teeth being together. So when we think about baby teeth being space apart there, there was a ruler, believe it or not, way back when, a hundred years ago, that they knew what was the space between the baby teeth that would lead to permanent teeth coming in where they belong. That ruler happened to be a nickel, the thickness of a nickel. So if you think about a nickel's thickness, if you meet an infant from three to five or child from three to five, if you can fit a nickel between all their baby teeth, they're gonna grow up and have all their teeth go to place. And no one knows that now because it doesn't exist today.

Ben Miraglia (32m 57s):

Is

Katie Ferraro (32m 57s):

It also putting the thought of putting money in a baby's mouth? That's gross. But I, I get what you're saying. Is it then safe to assume or to suggest that the more jaw exercising that a baby has with hard foods when they start solid foods, does that lead to larger jaw space for the teeth to then have that nickel size space between them?

Ben Miraglia (33m 18s):

Yes. Yeah, we don't use a nickel to measure the teeth. That's the idea. You look at a nickel and then you can look at your child because if you go to the mouth with a nickel, it's gonna be like a parking meter, it's gonna end up right in the throat of the lung. So don't put nickles in the mouth cautionary note, don't put nickles in the mouth but you can easily look at a nickel and see that thickness and say, does my child have a nickel between all these teeth? And then you'll know, well there'll be crowded teeth and braces needed later on. Now the difficulty with braces later on is that braces just address the teeth. They don't address the foundation. So braces are forcing teeth to be straight, but that's not really where they belong because the wrong foundation is there, which is why you take those braces off and you still have the muscles being dysfunctional so the teeth go back. So almost everyone who has braces their teeth are gonna shift back because they don't have the retainer of the tongue being shaped appropriately and spread out in its place by proper function and strength.

Ben Miraglia (34m 6s):

So we're not looking for braces later, we're looking for earlier work to grow the foundation better. And yes, parents, when they look at three to five year olds could see uhoh don don't have a gap between all these teeth and it's a significant gap like the width of a nickel, there'll be crowding and there's braces in my future, but braces treat the symptom.

Katie Ferraro (34m 22s):

I know it's so annoying to hear anecdotal advice in parenting, but I have seven kids and my oldest, like literally today, three hours after this interview, I'm going to the orthodontist with her for the first time ever because the dentist told me enough like that she was the oldest, we struggled so much with spoonfeeding and purees and she's got this mouthful of teeth and I gotta do something and I have a set of quadruplets in and a set of twins and I did Baby-Led Weaning with all of them. And the doctor, the dentist has told me like, I think those ones are gonna be fine. And I was like, how do you know? But now what you're saying does make a lot of sense. And I know there's lots of benefits to Baby-Led Weaning and having babies eat real food. But I'm literally paying the price today going to the orthodontist with the one that did purees and, and she's just, I'm like there, there's too many teeth in your mouth for how big your jaw is.

Ben Miraglia (35m 6s):

And how old is she?

Katie Ferraro (35m 8s):

It's she's 10.

Ben Miraglia (35m 8s):

Okay, so listen, at 10 years old there's still time to catch up. And so the last thing we wanna do is take any teeth out. That's always bad because now you're subtracting to the smaller foundation. We don't want to do that. So you're not interested in doing extractions. That's always bad for the last 20 something years I'm doing this, we have never extracted a single tooth, not one baby tooth from a child or a permanent tooth. And all of these kids that we treat, we're well over 50% of them later on. 'cause when you're in two decades you get to follow 'em all the way into high school and college. So most of the kids that we treat have their wisdom teeth fit in. So they have all 32. 'cause when you grow the right size foundation, you can fit all the teeth in. So your 10-year-old needs foundation approach, not tooth approach.

Ben Miraglia (35m 49s):

So yes, the teeth look like there's more than can fit. It looks like there's too many teeth there, but she has the right number of teeth.

Katie Ferraro (35m 56s):

Is 10 too old to start using a guidance appliance? Like what is the age range that you would recommend that for?

Ben Miraglia (36m 2s):

The guidance appliances can be used from three to 12, but in the ages of eight to 12 there are kids that are so narrow and so crowded that the guide can't get the job done. So for those children we use expanders first. So expanders can help you catch up nice and slow. Expansion can help you catch up the foundation. And then we switch them to guides afterwards because the expanders don't correct the musculature and we do want the muscles next. So we would use expanders first then muscles. So your 10-year-old were to come into my office, we'd be looking at a number of things to measure and see, but ultimately it's about the foundation and what will it take to get the foundation to be the right size so that we can keep all of the teeth and have a chance to fit the wisdom teeth later on.

Ben Miraglia (36m 46s):

And so it's not a tooth focused approach. So you're looking to hear about guidance appliances, very few offices offer them. So I'll tell you, you probably will not hear about them and if you even ask, they will probably answer. Those don't work. That's what you'll hear. Now the next level is, while I know 10 year olds can use guides beautifully and I have done that for two decades, if your child was narrow enough and too crowded, I would tell you, you know the guide isn't gonna be enough to get us there. We need expanders first. Here's another piece of information that will help you. You're going to need both an upper and a lower expander. Not an upper only. An upper expander only is near useless according to the research. And when you use an upper expander only and take it away, it's gonna shrink back to the starting point.

Ben Miraglia (37m 27s):

So there's no gain from an upper expander. Only braces don't change the foundation, they just move the teeth. So you're not interested in hearing about braces, you're not interested in hearing about upper expander only your two choices are gonna be guidance appliance with myofunctional therapy or we do fixed expanders, top and bottom and then move to a guidance appliance. That's what gets you the foundation and all of the teeth to fit beautifully. And then on top of that you have your best airway 'cause an upper and lower expander followed by guides gives you back your breathing and musculature and now your child can breathe through the nose, sleep through the night with no symptoms. So you're looking for a full heel of any symptoms your child might have.

Katie Ferraro (38m 2s):

I'm gonna be on the lookout because this is what I tell parents too. Same thing for Baby-Led Weaning. When you go to the doctor and if you ask about it, the ones that don't know anything about baby lead, we are gonna say, oh that doesn't work or that's not safe and your baby's gonna choke. Neither of which is supported by the literature and the research. It's just the practice that's been utilized, you know, generation after generation after generation. And we still have doctors telling parents things like, oh you need to wait three to five days between new foods. It's like why You don't have to do that. You wanna take advantage of the flavor window when they'll like and accept a wide variety of foods. And so I appreciate your insight and I don't mean to turn this into an entire, you know, episode about my kid's orthodonture, but I'm also like you're only 10. Like I feel like you're still growing.

Katie Ferraro (38m 42s):

I don't want to do anything permanent yet. How long can you impact these changes? Like up until what age? You said 12 is the upper age for the expanders or for the guidance appliances.

Ben Miraglia (38m 52s):

The older you get it is tougher to do it. So we prefer younger if the needs are there. But while she is still growing, that's height not jaws. The jaws grow differently during different times. And the majority of the jaw growth was done at four. And the smaller percentages that are coming from 10 on for female, the jaw growth is only one and 2% per year. So there's very little left from 10 to 20 for a person. So height, yes she'll be taller over time, but our skull and our jaws and our body grow differently according to, you know, the ages and at 10 where we've missed the window for jaw growth and development. So you wouldn't wanna wait for that, you'd want to intervene.

Ben Miraglia (39m 34s):

Hey

Katie Ferraro (39m 34s):

We're gonna take a quick break but I'll be right back.

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Katie Ferraro (40m 4s):

Dr. Ben, you have a three, four, or 5-year-old a parent who's listening who's like yes. Oh my gosh, my babies', toddler's, teeth are really close together. They are mouth breathers, they do have disrupted sleep, some behavioral stuff, you know, restricted eating and only preferring, you know, very soft foods. If they come to you, what is the system that you use and recommend? I know I've heard you speak about tooth pillow. I, I believe it's a guidance appliance. How does it work and what course of action would you take for that family?

Ben Miraglia (40m 30s):

Yeah, definitely. So we basically modeled it after the two decades that I've practiced in my office. So if you came to my office we would be offering from three to 12 a pathway of treating you. But then we realized that, you know, there's so few of us and we're so few and far between that most parents don't have access to this. So can we solve for access by doing this remotely? Make it a teledentistry model where the parent doesn't have to find or travel to me, they can just be treated remotely with their child. And the answer is yes. So we built tooth pillow to be a remote treatment where we can incorporate the nasal hygiene products and techniques for support there. The guidance appliances can be mailed to a patient and then they can be sized by a card that they take a picture with. So I know what size everything should be.

Ben Miraglia (41m 10s):

And then of course the myofunctional therapy can be done via Zoom. So remote basically tooth pillow is three things. Guidance appliance, nasal hygiene and myofunctional therapy all done via Zoom and or you know, an app that we have. So we have parents learn about us through tooth pillow.com. So basically we, we go out there, we educate the community that you have options for your children between three and 12. You don't have to wait for 12 and have braces and a lot of times that's not a best choice anymore. So go to tooth pillow.com and then when you submit your child, you'll see first of all there's a full website of information, a lot to learn to explore and think about what this option means. But you submit information about your child and we even do a full sleep breathing questionnaire to learn about what are the different symptoms you might be noticing. So we see what, what does that child struggling with maybe?

Ben Miraglia (41m 52s):

And then the parent sends photos and photos of the mouth and all different positions. We had a little like a grid that shows what to take the picture of. They upload and it all goes through me. So I screen it. So I screen most of the children. We also have my, my co-founder, Dr. Kelly Hale does some screenings too. But the idea is we're gonna screen those children to see are they a good candidate to do this remotely. And once we approve them it goes back to the parent and our support team to then figure out is this a good choice? Do I wanna do this for my child? And it turns out a lot of people don't have access to this anywhere in their communities 'cause most of the dental practices are doing teeth work or fixing teeth, which is good and noble. But the growth and development is a smaller segment.

Ben Miraglia (42m 32s):

So through tooth pillow.com you can be have an assessment, a screening by a, a licensed dentist obviously. And then if you decide to go forward with treatment, we send everything to you and we monitor and we have daily, weekly and monthly and quarterly progress updates and monitoring through the app. So we stay connected with the parent the whole time and there's a doctor behind the scenes and there's a myofunctional therapist as well assigned so we can have, you know, the exercises to be done as well. So tooth pillow basically is remote opportunities to do something that I've been doing in my office for two decades but recognize that very few communities have access to this. And we had a little team meeting and said we should probably make this something that is more agreeable and accessible elsewhere. But another thing you could do, just to have my opinion for your daughter's case is you could submit her into tooth pillow and I could then evaluate her.

Katie Ferraro (43m 13s):

I'd love to do it 'cause I've heard other people who've done it and they were like, I was driving my kid all over tarnation to, you know, 'cause there aren't these specialists always in your area. And if, if some of it can be done remotely, how long is the typical course of treatment?

Ben Miraglia (43m 27s):

We, we do two years. So we do a 24 month treatment, which should be enough to get your breathing and musculature functioning properly over time so that you then grow and develop normally on your own after that. So two years is the program and then if you're much younger, like a three to 5-year-old, we are putting into place a little monitoring over time. Like every six months or a year we can kind of check in to make sure you're doing well after your two years is done. 'cause a 4-year-old that goes into treatment technically would be done at six. But meanwhile we'd like to make sure we monitor them till 12 with a little bit of a follow package afterwards. We're working on that. 'cause we don't, we would like to stay connected enough to know you did all the way through and when you go all the way through the program, you can do very well. We've had a lot of success in the office and now we're kind of exploring the opportunity for kids elsewhere to have this opportunity.

Katie Ferraro (44m 11s):

Well thank you so much for sharing and I would encourage you, please keep up the, you know, positive reinforcement about Baby-Led Weaning because I think that is so important that this is a whole other stream of benefits from, I mean honestly the idea of you know, teaching your baby to eat real food, it shouldn't be so revolutionary. But like you said, we're trying, you know, we're even trying to get parents back to just like feed your baby solid food for gosh sake. So I appreciate from the dentistry side that you're helping to promote baby lesbian and I also appreciate so when your kids eventually have kids, you'll be all pro Baby-Led Weaning for your grandkids.

Ben Miraglia (44m 42s):

I'll try, I'll try.

Katie Ferraro (44m 44s):

Wonderful. Thank you so much. And tell our audience where they can go to learn more about Tooth Pillow and your program.

Ben Miraglia (44m 51s):

Yeah, it's simple. www.toothpillow.com.

Katie Ferraro (44m 52s):

Well, thank you so much. I really appreciate the conversation, all the information you shared with us.

Ben Miraglia (44m 57s):

Thank you very much for having me. Appreciate it.

Katie Ferraro (45m 1s):

Well, I hope you guys enjoyed that interview with Dr. Ben Miraglia. I love his passion for jaw strength and jaw growth and jaw health. And I feel like we need more dentists out there promoting Baby-Led Weaning. I love that he recommends reading Jill Ripley's original Baby-Led Weaning book. This is a follow up because I went and rerecorded this outro a couple weeks after the original recording because after going to the orthodontist with my daughter and they said, Hmm, wait a little while for braces, I actually went through and did all of the whole tooth pillow submission So this is not paid sponsored for by them. I just wanted to like see what it was and my daughter was down for it. So we like went through. They have like a cool app where you send all the pictures from these different angles of her mouth. 'cause I wanted to see if the tooth pillow would be an alternative for her to help space some stuff out in her teeth.

Katie Ferraro (45m 45s):

Long story short, it was the coolest experience. Like it was super easy to get her into the app and Dr. Miraglia himself reviews all of the submissions. But what's cool is he wrote back and was like, she's not a candidate. Like you should wait a few more years. Her mouth isn't fully done growing and so it's not one of those services where a hundred percent of the people who apply need the service. Like he really gave me a thoughtful response about why my daughter would not benefit from this. But if some of the stuff that he was talking about resonated with you and you think you have children that might benefit from this.

Tooth Pillow (46m 12s):

The team at Tooth Pillow did give me a discount code. I do wanna stress, this is not an affiliate discount code. I make absolutely no money from this, but if you want to try it out and save some money, if you use the code babyleadLED, it will give you a free evaluation from a highly trained Airway dentist and $250 off the treatment. If you submit it by September 12th to the 19th, 2024 after that date, you can still use the code, babyleadLED. It will work for 50% off the consultation instead of a free consultation and give you a hundred dollars off the treatment. Again, not an affiliate. I don't receive any affiliate revenue from Toothpillow. I really liked going through it. It wasn't a good fit for my daughter, but I think they're onto something for certain families who it may be a good fit for. Check them out at toothpillow.com with the code babyleadLED.

Katie Ferraro (46m 58s):

I'll also put a link to the resources that Ben was talking about in this episode on the show notes, which you can find@blwpodcast.com/466. Thank you to our partners at AirWave Media. If you guys like podcasts that feature food and science and using your brain, check out some of the podcasts from AirWave. We are online at blwpodcast.com. Thank you so much for listening. I'll see you next time.