 Thanks, thanks Ben. Does anyone recognize these figures? They are in the hallway here. So these are probably a local Native American trap. And these arrows show the interorbital width compared to the bisygomatic width. And that's indicative of ancestral infant feeding. Something that had been discovered in the 50s by Weston Price and Pottinger. They came up with that, the relationship. And I thought, wow, what better place right here in the union building here. Can you hear me? I guess people are saying the mic wasn't strong. Okay, the incredible shrinking face. If any of you are from my era, you know what movie that's based upon that title. I am a visiting scholar in orthodontic. I'm working with one of the orthodontic faculty at the Museum of Anthropology. We're studying pre-industrial skulls. I'm focusing on children or what anthropologists call pre-adults. They've got funny names for things like teeth that are behind the canines are called post-canine teeth. We call them molars and pre-molars. So anyway, this is the movie, The Incredible Shrinking Man. And so that's how I came up with the title. What's interesting in French, anyone speak French here? Shrinking is retraction. And Mike Mew just gave a great talk. You probably were all there. I had to fight him to release his fan club to come into my room here. I'm one of his fans too. Anyway, retraction is really what it's all about in terms of therapy and in terms of what the problem is, what's been happening, why are faces getting smaller? This is a talk I'm giving in a week and a half in Salt Lake City with, we're hoping to be, will soon be a sister group of the ancestral health society, the International Society for Evolution, Medicine and Public Health. And you know, I have to condense this talk down to 10 minutes for them. But they want to see evidence for the hypothesis. So I'm going to show Mike has some beautiful results. I encourage him to show some of his, more of his results next time, because they're awesome what he does for people. And you're going to see some of my results as evidence for why we, and as Mike talked about, there's general acknowledgement and orthodontics that the cause of malocclusion is not Mendelian genetically modulated, which means a gene makes a trait. And it's an interaction between genes and environment, epigenetics. And I'm going to show you how, if we use normative standards that are based upon a pre-industrial norm, we're going to produce better faces and better airways and healthier people. And I'm going to show that you can do it. I'm essentially trying to help my, and you have to start really young to do what's called orthotropics. But you can help them turn into little chromagnons. And that's really what it is. The chromagnons are very beautiful people. And that's really the standards that we're trying to establish for everybody to use. So the whole fact that faces are retracting, getting smaller, and not just faces, but jaws. And if faces and jaws are getting smaller, guess what else is getting smaller? The airway. Okay, so we don't say craniofacial anymore. We say craniofacial respiratory. You cannot separate them. They are all connected. The back of the face is the airway. The front of the airway is the face. So that's the paradigm that might, myself and others, are trying to change. But so what? And that's what I work with Steven Sheldon, who's a pediatric sleep medicine doctor in Chicago. And every time I bring up an idea, so what, Kevin? And it's up to me. So before I even talk to him now, I make sure I've got answers. Why are human jaw bones shrinking so rapidly on an evolutionary timescale? Mike's dad, John Mew, often talks about the saddle angle from the base of the sphenoid to the solitursica, where your pituitary sits, tinesion, the junction of the forehead and the nose bone. And that angle there is getting smaller as the face is retracting. Now, from a phylogenetic standpoint, the brain was getting bigger, and the face had to come back. But it wasn't out of proportion. Now, this is something that has exceeded the evolutionary timescale, and it's accelerating rapidly. Teeth can't keep up with it. And the jaw bones and the bony airway is also shrinking. So this is a modern sample compared to a pre-industrial sample. That's, I think, Kennewick Mann, who's the oldest, yeah, the oldest American from, I don't know, 15, 18,000 years ago. But as you can see, even as the face retracts, teeth don't necessarily get crooked. Because this happened phylogenetically over vast amounts of time. You know, since agriculture, the jaws, brains have gotten smaller, too. But the teeth have kept up with it. They've shrunk just a little bit. And it's a term I learned from anthropologists. It's called allometry. It's scaling proportionally. So what? Here's another paper, self-limetric comparison of skulls from the 14th and 16th centuries. Again, looking at the bisygomatic and biorbital. But also, this is a horizontal growth. It's not growing steeply. And this point right here, it's right under your nose. There's a point to where you drop a line from where your nose and forehead come together. And in a horizontal from your ear hole to under your orbit, where your eye is. And almost nearly completely 100% of thousands of skulls we've looked at. That A point is always in front of that line. But in modern skulls, it's not. Okay, almost every patient that Mike and I see that that A point is behind that line. So to correct our patients to a self-limetric norm that's based upon a non-modern sample, where are you going to get those numbers? And that's what we're trying to establish. SNA is a measurement that most orthodontists use. That's cellular pituitary gland sits. Tenazion to A point right here. And that number, somewhere in the high 70s, low 80s, that's considered normal, depending on the age and gender of the person. But we're finding in our pre-industrial samples, they're almost always about 90 degrees. So go figure. And that means A point. It doesn't mean anything to do with selenazion. So what? This is a self-limetric database. This book, and we use it, it's the best we got. It's the closest to the pre-industrial samples that we have. But hardly anybody uses it. Most people use something called a Steiner base. So we put the bolt profile on our patients before we treat them. And this is, you know, two through 18 years old we have them for. And that's where we want them to be. It looks better, and it promotes better breathing. So what? Oh, no sound. Okay. How do we get sound? Is it, is our sound guy here? No? I'm losing time. Do I get more time for this? Oh, it was muted. Or was it muted? No, tell me. No, no sound. No sound? Is it on the computer? More time? I want two more minutes, please. I don't know. I guess I'm not going to have sound. But it worked, didn't it, before we started? I don't know what's wrong. Oh, well, I'm going to tell you what it says. This is from the BBC. And they're saying that our, we're losing our molars. And you can see from this that we're not losing our molars, right? There they are. There's not room for them. We're not losing them. And they're saying our brains are getting smaller. And that's where I put that in there. So the narration with the English, I should have had Mike do that. So anyway, origins of, we're not the first to be looking at this as being an anthropological problem. And, you know, Aaron asked some great questions about what our anthropologists and evolutionary biologists, are they interacting more in England than they are here? There's only a handful of dental anthropologists worldwide, I think, you know, relative to the whole body. And there's just, it's starting to really take off the Rick Robles North Adonis that I'm working with sometimes and lecture with. But so what? Oh, you know, we got to have sound. I'm sorry. Can this be fixed? I mean, this is like my whole talk. And again, if I can't have more time than I can't waste it. But it is what it is. I don't know what happened. What do they call this injury time and soccer? Like at the end, at the end of the match, do I get a little bit extra? Still no sound. But I don't really care about that one. Okay. Okay, good. Scientists think we are also losing our wisdom teeth and surprising brains and losing space for them. The average volume of the human brain has decreased from 1500 cubic centimeters to 1350 cubic centimeters in the last 30,000 years. 30,000 years is not a long time at evolutionary time. Any of it be prevented with a good night's sleep snoring is actually a red flag. It is a hallmark of problem ending at night. Today's study followed more than 11,000 children for seven years. Those who snored breathe through their mouths or had happier long causes between breaths, or after twice as likely to develop behavioral problems by age seven. So what comes first, the large tonsils or the posterior positioned soft pellet, which is attached to what hard pellet, which is what the maxilla. Maxillary retrosion, when we fix that structural problem, kids snoring goes away. When kids get their tonsils and adenoids out, if they get their jaws widened and brought forward, they're less likely to have relapse after their TNA surgery. So, so what? And that's the big so what? Distrophic jaws, a term I got from Mike, and faces are comorbid. They coexist. They're not necessarily causing effect, but they're almost always seen together, increased respiratory and neurological health risk. Okay, so what we say is, let's get the structural problems off the table early. Orthodontics usually begins about nine or 10 in Europe and America, everywhere. I'm treating two and a half year olds, ladies and gentlemen, two and a half year olds are being referred to me by pulmonary physicians. Orthodontists used to give me so much grief. You treat too early, boy. You're using up the orthodontic benefit. All these, not in, but since most of my referrals are coming because of respiratory related issues, and I'm not saying I'm going to cure them. I'm saying I'm going to take off malocclusion as being contributory to comorbidity with respiratory problems. That's all I say. I'm a dentist. I'm just doing dentistry. So this is just out like a month ago. And, you know, or June 7, yeah, a month ago. Association, a long term respiratory diseases with removal of tonsils and adenoids. This is not without consequence. This is the gold standard for how you deal with sleep apnea in children. You take out their tonsils and adenoids. There's a reason for tonsils and adenoids. Okay, let's try to make them shrink, do stuff with their diet. That's one thing that causes it and change the structure. Get the soft palate out of the way and help them become habitual nose breathers as early in life as possible. Steven Stearns, most of you know him. He's an evolutionary biologist at Yale. He is very much involved in this. So what? Dystrophy. Okay, dystrophic faces. You don't maybe not have to take out the tonsils and adenoids if you can do structurally something, non-surgical distraction, we call it. Okay, postoperative constant 500,000 a year, tonsils and adenoid surgeries are done on children. And these are not without consequences, especially when they're under three. They get admitted, they can even die. You know, that's very rare, but they can have significant morbidity after surgery. So we want to minimize the need for this is being the gold standard for sleep apnea in kids. Now this is the talk I'm giving in Salt Lake City. Next week, few weeks. There we go. Back of the face is the airway. Front of the airways of haste. You can't separate them. There's the adenoid. I want to get rid of this term craniofacial. It's craniofacial respiratory. It's one complex. Do not talk about one without the other. It's not scientific. This is what we're found. Look at that. Did you see that? That is a baby in utero. I'm treating that kid now. I diagnosed that kid at 20 weeks gestation. And I'm treating these four now. Compared to one of our pre-industrial skulls. Look at that. That's a fetus. That was a stillborn fetus that died about 200 years ago. And I've got lots of them. And they all have forward jaws. So this in utero retronathia is something that's pretty new. So this is something we've developed. It's an acronym assessment tool that screens for not just behavioral risks like tooth grinding, bed wetting, snoring, mouth breathing, sweating, moving around a lot, can't wake yourself up in the morning. Those are all behavioral traits. These are physical traits. Most of the physical traits that are associated or comorbid with sleep disorder breathing or apnea in kids are above the neck. So who's better to assess it? Right? Dentists? No. How about school teachers? I mean, all you got to do is look at the kid. You don't even have to be a clinician. And I'm going to go over these real quick. Even with my extra time, I'm sure I'm going to run it up to the end. So this is a tool that they have at Harvard. And they had developed one. They saw me lecture on this at Boston University in the spring and they said we have to combine ours and validate it at Harvard. So we're in the process of applying for IRB to do this at Harvard's dental clinic with sleep medicine because some of the things overlap, but mine has more pictures. So this is under way. Judy Owens is head of the pediatric sleep medicine at Harvard. And she's very interested in developing this with us. Okay. This is before and after airway anatomy. And of course I'm from Chicago, so I got to choose the acronym. Tooth grinding or bruxism. These are all scientifically validated physical traits that are known to be comorbid, maybe causative, risk factors for sleep apnea and children. High vaulted palate. You can see the difference. That's a pre-industrial, normal eye appearance, venous pooling. Those are dark circles. And then you shouldn't see any whites of the eyes. That's flat cheeks. That's a retro-nathic maxilla. But they don't have a dental underbite. So a lot of orthodontists miss it. Anteer open bite. And I'll get my slides, but it's good to print these out. And you can use them if you're a speech pathologist, a health coach, a dietitian, anybody that has opportunities with children, you can be doing this. And you might be the first person to recognize some of these problems. Okay. So here's a well-balanced face. Point A is on that line. And I showed you in the pre-industrial skulls, it's ahead of that line. This was written, what, in the eighties, McNamara's a god in orthodontic, academic orthodontics. Bill Prophet. These are guys that, they're brilliant, brilliant guys, but they're operating on norms that were developed in the fifties by post-industrial white kids, mostly. So what? Normal does not equal healthy. This is what I talked about on the dental panel last year, if some of you were there, that normal doesn't mean healthy. And I cited the example of blood pressure. Hunter-gatherers, these are Americans. Look how much lower these are. So this might be our genomic potential. This is okay for an industrial society, but we perhaps should be even lower. This is, you know, this SNA angle that I was talking about from where the pituitary is to where the nose is to that point under your nose. You know, they're calling 79.5, you know, that's normal for a five-year-old, I think. Well, we've got four, five, six, three-year-olds that, kids that died before the industrial revolution or during the industrial revolution. And they're about 90. That's about 90 degrees here, which suggests that maybe we need to redo these norms, especially in light of the fact that kids whose faces are back, back of the face is what? What's the back of the face, anybody? The airway. Thank you. So this is orthotropics. It means correct growth, correct meaning growth that's conducive to habitual nose breathing during wakefulness and sleep for a lifetime. It has to be implemented in early life. It's very difficult to do later on. Again, when does it start in utero and it persists? So my learning objectives, this is what I gave in France about three months ago. And just, you'll have all these, I don't want to go over these to use my time, but you, you'll get my slides. Okay, we did that. Here, okay, so I'm finishing with doing cases. Okay, how am I doing on time, timer? Miss, Miss Timer? Ten more minutes and plus overtime. Oh, good, bless your heart. I love that. The World Cup. Really, I was for Croatia. I love that goalie. Okay, so she was obvious. This was a blessing that this child had a dental underbite because a lot of kids have skeletal, their bones are in underbite. Like the upper jaw is growing behind the lower jaw, but their teeth have compensated. So the upper teeth stick out in most orthodontist pediatric dentists, general dentists who do orthodontics, they get fooled by it and they say, well, there's no underbites. So this isn't really a class three, which is, you know, the classification system that was in the 1900s for white kids. And it just totally doesn't, it's based on teeth. It doesn't really base much on jaws. But what we worry about, and this is a point, again, Dr. McNamara figured this out in the 80s, that this point called pteromaxillary fissure in the posterior nasal spine, and kids who have skeletal class three pteromaxillary underbites, that line is very small. Okay. And it tends to coincide with small airways. This kid was massively crowded. The permanent central's, she was four and a half maybe when we started her, the central's were completely rotated, canines completely blocked out. This will never recover. So what this suggests is she doesn't have enough room for her permanent teeth, everyone would say, but no, her tongue. Her tongue can't go up there. If her tongue had been developing her maxilla from inside in utero, and then the first two, three years of life, you'd see spaces there. And that's, it really does, it starts early on. These are, this is the pediatric sleep questionnaire of all those things like snoring, mouth breathing, grinding the teeth, bed wetting, open mouth breathing. Mouth breathing is the most, one of the most serious things that we aim to correct. And I do, this is a validated questionnaire for behavioral traits, not physical. So I combine it with physical traits. And then here's how, this is John Mu's stage one appliance. It's got hooks to hook up a face mask so that the kid will expand laterally and at night it pulls the upper jaw forward. So the tongue actually, the mandible can bring the tongue forward off the back of the throat when they're laying down and while they're awake. We also expand the lower jaw, very easy to do, best kept secret in orthodontics. Little kids are the best patients in the world because they want to please their parents. And if their parents are shelling out the bucks and bringing them here, believe me, the parents want to be pleased. So I, I'm a pedodontist, I'm not an orthodontist, nor do I play one on TV. Okay, pediatric dentists have loads of training in managing fears, anxieties, and expectations of children and their parents. Orthodontists do not have this and they're still, they're never going to get it because it's not part of the curriculum. That's why most orthodontists come out of school saying don't start till they have almost, they're all the permanent teeth in. How come? They didn't spend one minute in my department. When I was doing pediatric dentistry at Iowa in the 80s, I spent hundreds of hours in their department. So I pretty much know most of what they know, if not more so because of the airway component, and they haven't a clue how to manage anxiety of kids and their parents. So that's about to change and you'll see on my very last slide why it's about to change. So anyway, we fixed obviously the dental underbite, but more importantly, we fixed the skeletal underbite. That's how it works. Watch what happens here. The posterior nasal spine comes forward in the end here. So this whole maxillary complex comes forward and it pulls the sawpallit off the back of the airway. Huh? Go figure. Non-surgical maxillomendibular advancement or non-surgical distraction. Okay, so Brett just looked at his watch. I'm thinking he's hungry for lunch. So, okay, so here look at the difference in her face. Okay, and all those yeses turned into no's. Every one of those problems went away on her. I'll go through these real fast, but this is just in competent lips. You can see his airway. That area there is where his adenoids are. All those yeses on the pediatric sleep questionnaire. We expanded him. We protracted him. Got rid and look at this. Look at that. I mean, that doesn't happen with growth. That kid was slated to have his adenoids out. He didn't need to do it. That the adenoids didn't change in size. I just brought the soft palate forward. If I can do it, anybody can do it. You just got to know how to understand and work with children and be patient. And like Mike said, it's not a huge moneymaker. You stay in longer with these kids, but they send all their friends to you. So, you make up for it in volume. This is a kid. I didn't even do orthotropics per se. She was older. Look at her chin, okay? All I and look at all the yeses, especially the mouth breathing. That's when we pay most attention to. And look what happened to this child just by expanding her. Look at the chin. Okay? I didn't even put her in a face mask. Look at that airway. And look at all those yeses turned to nose. Okay? This is what we can do with orthotropics. And it's, you know, the aesthetic results are fantastic. The benefit that you have on their face, their breathing. How am I doing? That's the last slide. Okay. Is that five minutes for questions or five minutes to talk? Oh my god. Okay, I'm going to go back. No. We can have some more time for discussion. So, anyway, the Hippocratic Oath. Do not retract. Do not delay treatment. Okay? I say give a kid the best possible airway at the soonest age as is feasible. And that means you have got to diagnose these kids maybe while they're in utero. But, you know, that's a little out there. But certainly, you know, the American Academy of Pediatric Dentistry said all children should have their establish a dental home by age one. Well, that is, you know, okay, they don't even barely have many teeth. Okay, no cavities. Gums are healthy. You look for lip tie. You look for tongue tie. You all know about that? That little piece of skin that holds your lip. And those are all things that can predispose kids to a lot of problems. And also look at the airway and ask questions. So I'm all about doing that. Shucks, there was one slide in there that I wanted to promote. The American Dental Association on August 23rd is going to have the first pediatric airway symposium. This is, this is landmark, the American Dental Association. They pretty much set standards for the entire world. And they are saying that dentists need to get involved. Pediatric dentists primarily, because that's the specialty that sees the most kids. But orthodontists need to be seeing kids sooner. General dentists who see kids need to be seeing them sooner and need to be evaluating them for airway health risk. So if anybody is interested in knowing more about this, just go to the American Dental Association's website. And it may be sold out, but if people want to go, they're probably going to get a bigger room. But there's as many physicians, I'm speaking on on one of the days which is a huge honor, highest honor ever I've gotten to speak at the American Dental Association. In several pediatric sleep physicians are going to be there. So it's a three-day actually event. So well that's all I have. Good. Wow. I've never finished early in my life. Was I in overtime? Thanks Kevin. I don't know about you guys, but I'm going home tonight staring myself in the mirror wondering what else went wrong in my life for like two hours probably. Please line up at the microphone for questions. So thank you. That was awesome. Very welcome. And I'm curious to find out what recommendations you would make to women who are thinking about getting pregnant. Don't drink a drop of alcohol. When you make the decision to I want to get pregnant and your partner don't drink a drop of alcohol. You guys abstinence. There's new research coming out of Cal Berkeley. There's a book called Why Do We Sleep? And this research is so solid that there should be no alcohol on board and don't be around second hand smoke and certainly don't smoke. And sleep. You need to breathe through your nose while you're pregnant in utero. Now this is what a new concept is that if women do not breathe habitually through their nose as much as they can while they're pregnant the fetus is getting a signal that it's about to be born atop Mount Everest. Now this is a hypothesis based upon the Barker hypothesis which suggests that babies will adjust their metabolism based upon what the placenta is telling like starvation during the Dutch hunger winter thrifty phenotype it's called the baby's going to trap every calorie you know because throughout evolutionary history you were programming yourself in utero for a lifetime. I mean if you were born into a famine that might last 30 years well maybe you weren't going to live that long so you had well it's the same thing with oxygen oxygen I my master's is in human nutrition now we learned that not only macronutrients micronutrients phytochemicals trace elements there's one other nutrient it's called oxygen it's a nutrient but unlike the other ones that I just said like the flight attendant says put the mask on yourself then help your kid the placenta does the same thing mom has priority over oxygen over the fetus okay and the fetus is already growing in a low two environment because of cardio the way the cardiac system is developed it requires low 02 so they don't have a margin of error you deprive them of a little bit of oxygen for a little bit of time and it can lead to intrauterine growth restriction and preterm delivery and that affects not only the long bones but we think it could be contributing to why the face is shrinking is and it's not all the moms fault men have to take care of their sperm women get all the blame it's not fair so there I gave you probably more than you want to know hi there I just want to thank you for the talk super interesting I've really become fascinated with with the dentistry aspect of incestral health since the panel last year and so I'm just fascinated I actually I wanted to tell you a story I was really blessed to have an amazing oral hygienist who has retired and in a retirement has become a maxillofacial therapist wow where where she where are you located in the San Francisco Bay Area yeah I'd like to find out who she is I'd love to put you in touch with her yeah she uses butaiko breathing yeah there's who knows butaiko here besides Mike I mean yeah I mean he's Pat Pat McCune is a good friend and that's that's great I'd love to know who she is oh awesome yeah I'd love to put you guys in touch and she gets results in all of these symptoms that you're talking about just using breathing exercises tongue exercises like without surgical intervention she's seen decreases in ADHD symptoms and things like that and it's really amazing what's her name Ginny yeah and I'll get her contact info and deliver it to you and to Mike yeah I'll give you my as well that's great um Scott Solomon is a dentist from Connecticut and he was on the dental panel last year Scott will you stand up so they can see who you are so if people have questions he's also very knowledgeable in all this stuff so great hi hi hey great talk I apologize the dental area is new to me and I missed the talk earlier so I'm just curious on the other evolutionary things of you know dietary lifestyle is there evidence out there like she was asking for prenatal diet or yes children's diets yes I'll give you my card you can email me I have a whole lecture on prenatal wellness and it's more than pregnancy yoga that's good and it's more than avoiding mercury and fish and taking your you know folic acid or folate whichever one you're supposed to take it's sleep and breathing sleep and breathing the way the mom sleeps and breathes there's tons of literature on this in the obi-gyny literature so hi thanks so much I'm a psychiatrist I send a lot of my patients for sleep studies I'm an adult psychiatrist yeah um they get a lot of CPAPS and then those three thousand dollars really expensive devices do you think they'd be better off with orthodontra and breathing in conjunction with the goal of CPAP is to get them off CPAP but they don't know that most people don't say that first of all most most people don't wear them but if you get with a dentist who really knows what the hell they're doing that where are you located Boston Boston you're good I mean I can I can help you set up because I'm doing work at you know with Boston University mainly but also a little bit with Judy Owens but if you can get them in a mandibular repositioning device because that CPAP saves their life but what's it doing it's keeping the jaws back because of that pressure so there some people there's no way there's nothing you can do for them in terms of they just they're they're condemned to CPAP but there's a lot of adults that actually can be weaned off of CPAP or at least less pressure so I'd love to help you with that yeah I do I have any more time because I could give it to Mike because Mike I he had a follow does anyone have questions for Mike still I'll give Mike the mic I don't know I think we're kind of wrapped up I give you want I can take a few questions but I think you know sorry Kevin it was your moment at the moment anyway but I think what me and Kevin are saying is you know similar things on slightly different lines but it's it's a very on so something people aren't aware of you know I'm turning around to your wall and saying more or less all of you are quite affected you know who have got 32 who here has 32 teeth in their head yeah not the majority is that you know and most of you didn't aware that that was abnormal any any questions okay