Prof Dave Singh: Has Your Craniofacial Development Reached Its Potential?

Have you ever heard of the term craniofacial development? Does it relate to how well we breathe and sleep? How about cleft lip and palate? Well, today we are going to be exploring these fascinating topics. My guest today is Professor Dave Singh.

Professor Dave Singh is a US citizen who was born, educated and trained in England, UK. He holds three doctorates, including a Doctor of Dental Medicine; a PhD in cleft palate development, and a third Doctorate in Orthodontics. Dr Singh was the Founder and Chief Executive Officer of BioModeling Solutions, Inc.

He has published over 200 articles in the peer-reviewed medical, dental and orthodontic literature, has published 7 books/chapters, and is currently finishing his new book entitled “Pneumopedics and craniofacial epigenetics.”

Join me in this episode as we tackle craniofacial development, cleft lip and palate, epigenetics, the importance of nitric oxide, and so much more.


Prof Dave Singh: Has Your Craniofacial Development Reached Its Potential? Introduction

Well, today we’re going to explore craniofacial development. You might ask, why is that? Well, craniofacial development refers to what is going on in your head below your eyes. So it includes your upper jaw, your lower jaw, your sinuses, your pharynx, and your paranasal sinuses. So everything that’s going on below your eyes, in your head. 

And you might say, well, why is that important? Well, the reason it’s important is because, as any regular listener of the podcast will know, the size and shape of your mouth determine the size and shape of your upper airway. And that has implications for how well you breathe, not just during the day.

Are you a mouth breather, or are you a nasal breather? The more I learn about this, the more critically important that question becomes. And we discuss that in today’s episode. But also the amount of space that you have in your airway determines how well you sleep. And then sleep disorders and breathing conditions are serious problems. 

I mean, they certainly affect every aspect of your health – mental, physical and emotional. Getting a consistently good night’s sleep, right, which is a function of both quantity, getting enough. For 90% of the population, that’s 7 to 9 hours. But importantly, much just as important as putting your head on the pillow is breathing well while you are asleep. 

And that’s where craniofacial development, the size, and shape of what is going on in the lower two-thirds of your face is really important. And that’s the subject of today.

My guest today is Professor Dave Singh. Now, Dave has trained in England, in the UK. He started as a dentist, but he then went on to obtain three PhDs. Yes, not one, not two, but three. The first in dental medicine. Then he went on to focus on craniofacial development. But specifically looking at cleft palates.

Now, cleft palates are when the palate doesn’t join and there’s a gap in the bone in either the palate or the lip. Now, it’s not a particularly common condition, however, and it perhaps on the one end, it is an extreme of something that is actually very common in our Western world and that is underdeveloped upper and lower jaws result in crowding of teeth and narrowing jaws and narrow upper airways.

Then he went on to do his final PhD in Orthodontics. He’s published over 200 articles in peer-reviewed medical, dental and orthopaedic, and orthodontic literature. He has published or contributed to seven books and his most recent book which he discusses is Pneumopedics. Pneumopedics. 

That was a new word for me. But Pneumopedics, a combination of Orthopaedics and Pneumatics, I guess, and the Craniofacial Epigenetics, which focuses on craniofacial sleep medicine with a special interest in obstructive sleep apnoea in both children and adults, the subjects that we’ve touched on before.

He’s also written a book called Epigenetic Orthodontics in Adults. And this word, epigenetics, is a word that I think we should become familiar with because we feel that our genes are an important part of who we are, that we are not a victim to our genes. 

It’s more important is how our genes express themselves. And that’s the wonderful new science of epigenetics. And it turns out that you actually have a significant impact on how your genes express themselves through the thoughts you have. 

They are little chemicals called neurotransmitters that attach to cells and cause genes to express themselves. So that is thoughts are things, but so are nutrients and so are environmental toxins and chemicals and so are small forces, which is what we focus on in the epigenetics of the mouth.

So with Dave Singh, he is also now currently an Adjunct Professor at Stanford University. It was a wonderful opportunity to catch up with him. I have done his course in Australia over ten years ago and it was a great opportunity to reconnect with him. I hope you enjoy this conversation I had with Professor Dave Singh.

Podcast Transcript 

Dr Ron Ehrlich: [00:00:00] I’d like to acknowledge the traditional custodians of the land on which I am recording this podcast, the Gadigal People of the Eora Nation and pay my respects to their Elders – past, present and emerging.

Hello and welcome to Unstress. My name is Dr Ron Ehrlich. Well, today we’re going to explore craniofacial development. You might ask, why is that? Well, craniofacial development refers to what is going on in your head below your eyes. So it includes your upper jaw, your lower jaw, your sinuses, your pharynx, and your paranasal sinuses. So everything that’s going on below your eyes, in your head. 

And you might say, well, why is that important? Well, the reason it’s important is because, as any regular listener of the podcast will know, the size and shape of your mouth determine the size and shape of your upper airway. And that has implications for how well you breathe, not just during the day.

Dr Ron Ehrlich: [00:01:10] Are you a mouth breather, or are you a nasal breather? The more I learn about this, the more critically important that question becomes. And we discuss that in today’s episode. But also the amount of space that you have in your airway determines how well you sleep. And then sleep disorders and breathing conditions are serious problems. I mean, they certainly affect every aspect of your health – mental, physical and emotional. Getting a consistently good night’s sleep, right, which is a function of both quantity, getting enough. For 90% of the population, that’s 7 to 9 hours. 

But importantly, much just as important as putting your head on the pillow is breathing well while you are asleep. And that’s where craniofacial development, the size and shape of what is going on in the lower two-thirds of your face is really important. And that’s the subject of today. 

Dr Ron Ehrlich: [00:02:13] My guest today is Professor Dave Singh. Now, Dave has trained in England, in the UK. He started as a dentist, but he then went on to obtain three PhDs. Yes, not one, not two, but three. The first in dental medicine. Then he went on to focus on craniofacial development. But specifically looking at cleft palates.

Now, cleft palates are when the palate doesn’t join and there’s a gap in the bone in either the palate or the lip. Now, it’s not a particularly common condition, however, and it perhaps on the one end, it is an extreme of something that is actually very common in our Western world and that is underdeveloped upper and lower jaws result in crowding of teeth and narrowing jaws and narrow upper airways.

Dr Ron Ehrlich: [00:03:04] Then he went on to do his final PhD in Orthodontics. He’s published over 200 articles in peer-reviewed medical, dental and orthopaedic, and orthodontic literature. He has published or contributed to seven books and his most recent book which he discusses is Pneumopedics. Pneumopedics. 

That was a new word for me. But Pneumopedics, a combination of Orthopaedics and Pneumatics, I guess, and the Craniofacial Epigenetics, which focuses on craniofacial sleep medicine with a special interest in obstructive sleep apnoea in both children and adults, the subjects that we’ve touched on before.

Dr Ron Ehrlich: [00:03:50] He’s also written a book called Epigenetic Orthodontics in Adults. And this word, epigenetics, is a word that I think we should become familiar with because we feel that our genes are an important part of who we are, that we are not a victim to our genes. It’s more important is how our genes express themselves. And that’s the wonderful new science of epigenetics.

And it turns out that you actually have a significant impact on how your genes express themselves through the thoughts you have. They are little chemicals called neurotransmitters that attach to cells and cause genes to express themselves. So that is thoughts are things, but so are nutrients and so are environmental toxins and chemicals and so are small forces, which is what we focus on in the epigenetics of the mouth.

Dr Ron Ehrlich: [00:04:53] So with Dave Singh, he is also now currently an Adjunct Professor at Stanford University. It was a wonderful opportunity to catch up with him. I have done his course in Australia over ten years ago and it was a great opportunity to reconnect with him. I hope you enjoy this conversation I had with Professor Dave Singh. Welcome to the show, Dave. 

Prof Dave Singh: [00:05:18] Thanks, Ron. Great to be here.

Dr Ron Ehrlich: [00:05:20] Dave. We first met in Australia in about 2010. I think that was the first time I attended your three-day programme and you introduced me to a whole lot of new concepts in dentistry and in sleep medicine as well. And I want to cover some of those, but you have an incredible professional journey. I mean, tell us a little bit about your journey to this point that’s brought you to be an Adjunct Professor of sleep medicine at Stanford. 

Prof Dave Singh: [00:05:50] Well, you know, it’s is a long story, Ron, but I’ll cut to the chase and say that originally from England and did my dental training there. I opened my private practise like most people do, and it was very successful for a period of about five years. And then I got the plateau thinking, I need to do something different more, and I got a chance to do a master’s down at Bristol. 

But in fact, after the first six months, I was upgraded to the PhD programme and that was in cleft lip and palate. We did the clinics, you know, at Frenchay Hospital in Bristol as well as did my PhD…

Dr Ron Ehrlich: [00:06:25] Cleft lip. Now, cleft lip and palate. Just a very brief 101 about cleft lip and palate. It’s when… Tell us. Go on. 

Prof Dave Singh: [00:06:33] So when a child is when the foetus is in the womb, the two halves of the palate actually have to come together and fuse in the midline. And the lip does that also. But it also fuses with the nose as well. And if that process is interrupted, the two compounders don’t fuse together and the lip is separated at birth. The palate may also be separated. And so that’s a cleft lip and palate. 

And my work was to say what causes it? And if we understand that, what’s the clinical ramifications? And that is what really brought me to the US many years later. And so after my PhD, I did a postdoc sabbatical and actually, in Canada, they sent me down to the US. I met Jim McNamara at the University of Michigan. He was the President of the American Association of Orthodontists at the time.

Dr Ron Ehrlich: [00:07:31] And he was really a legend in dental, in orthodontics globally.

Prof Dave Singh: [00:07:38] Still is.

Dr Ron Ehrlich: [00:07:39] Still is, still is.

Prof Dave Singh: [00:07:40] But we were 20 papers together and he was the second author on all my papers. And long story short, when I went back to England I was offered the position in the US in a craniofacial cleft palate clinic and so it was too good to turn down. And so that’s where I went from there. 

And the interesting thing, Ron, is that one of the things that we think about with the cleft lip and the cleft palate, we see the facial deformity immediately. Facial recognition. What we don’t see is the dysfunction. And what we realised as the team of physicians, plastic surgeons, orthodontist, speech pathologists, a nice big team. 

What we realise is that these kids don’t breathe through their nose because their mouth is open. And so the idea was to non-surgically see if we could open the nose. And when we did that, the lip and palate came together slightly. We then put a device into the mouth and non-surgically close the palette. 

And then at the end of the procedure, the plastic surgeon surgically closed all the components. And what we found is that those children, those babies, if you allow them, tend to grow. You could not distinguish those who had been born with a cleft palate compared to a regular control group. And so this is where the idea of epigenetics came in, to say that there’s a blueprint that we inherit genetically, but environmentally it gets disturbed because of a different pathway. 

And what we have to do is see if we can re-coordinate it and bring it close to the body plan as much as we can, and then improve function and then take it from there. So in a nutshell, that was the kind of big starting point of the journey thereafter.

Dr Ron Ehrlich: [00:09:30] Hmm. Because you looked at the cleft palate. You then came to look at the potential to improve breathing patterns. And that has an effect. And is this true, have you had to be done three PhDs?

Prof Dave Singh: [00:09:46] I have three doctorates of Doctor of Dental Medicine… 

Dr Ron Ehrlich: [00:09:49] You’re an overachiever.

Prof Dave Singh: [00:09:52] Well, I followed my pathway, my kind of intuition. And with a PhD in cleft palate not being a plastic surgeon, there was a limited amount of things I could do clinically. And so my third doctorate was in Orthodontics to say, okay, then I can be an orthodontist working in the Craniofacial cleft palate clinic. Hmm. 

The most interesting thing Ron there was that after these babies that we’ve been treating, of course, there are other children who have been treated historically and even teenagers. And now we would see the full spectrum of what happened with these children whilst they were growing after the surgery was done when they were young. 

And I would say, you know, just give a round number. Eight out of ten. Seven out of ten had a mid-facial deficiency to say that the middle part of the face, the upper jaw, and the upper lip was set back compared to the rest of the face. And so they were planning surgeries to say, had we now correct these children as they move into adulthood?

Prof Dave Singh: [00:10:56] So that’s what I came into the equation with the 3D imaging to say what goes where. We were using MRIs in those days. And so we did a whole sequence of children, teenagers. And the group was about seven. And we did a new technique in those days called Distraction Osteogenesis, which is well known now. But what you do there is you create a preformed, preplanned fracture of the jaw. 

You then place a device, and then after a period of latency, you turn the screw on the device to actually protract or elongate the face depending on which direction you want to go. You can do for the lower jaw. We actually did it on the upper jaw, mid-facial distraction. And you know, after the review when these children came back, the first thing I notice is they were all smiling. 

Dr Ron Ehrlich: [00:11:47] They were all smiling.

Prof Dave Singh: [00:11:49] They were smiling. And I’m thinking this is very unusual because, you know, they don’t have so much self-esteem sometimes and sometimes they don’t have a lot of confidence. But seven out of seven came in with a big smile on their face, and I saw them. There’s something more going on here. 

And so I went back, reviewed the post-treatment MRIs, and in seven out of seven cases, the airway behind their jaws had ballooned. And I said, “Oh, my gosh, these kids are sleeping better. They wake up and they’re like new people.” And so…

Dr Ron Ehrlich: [00:12:24] And now, I guess this focus on cleft palate, which is an extreme form of underdevelopment of a jaw. 

Prof Dave Singh: [00:12:33] Yes.

Dr Ron Ehrlich: [00:12:33] I mean, it’s obvious and it’s an extreme form of underdevelopment of the jaw and that. And when you use the term, I should remind our listener, that when you use the term ‘devices’, what you’re talking about are plates that are fitted, custom-fitted for the upper or lower jaw, orthodontic orthopaedic plates that have the potential to expand arches. So this was an incredible insight. Actually, how common is cleft palate? 

Prof Dave Singh: [00:13:03] It’s relatively rare. And it’s a very interesting situation because here’s the epigenetics coming in again. So we did some overseas missions if you will. So we went to some of them are developing countries like Indonesia and Malaysia and a few other countries like that. One of the islands in Indonesia had a huge prevalence of cleft palate. 

Almost like every other family on the island knew someone who had a cleft. And so the international team went there. They did that investigation. And the long story real short is there was a zinc deficiency on the island.

Dr Ron Ehrlich: [00:13:42] Wow.

Prof Dave Singh: [00:13:42] They added zinc to the table salt. And in one generation, the rate of cleft palate was about the same as it is elsewhere that, say, one in 500 live births. And so here’s an idea. What we know now is that metalloproteinases which are enzymes that need specific minerals, for example, zinc, to do their work, if they’re deficient, this is where the epigenetics comes in. 

You provide a very small environmental signal and you’ll get a pretty decent clinical response if you get the signal right. And so if you look at different communities, African-American, Asian, you know, different groups of people, there is variance there in terms of the epidemiology. But the bottom line here is that we can at least work with environmental factors to, you know, decrease the chances of a child having that kind of facial deformity.

Dr Ron Ehrlich: [00:14:39] Mm hmm. But it’s interesting because although the cleft palate is an extreme example of an underdeveloped mid-face maxilla. So again, for our listener, the middle face is from the eyes down to the top and includes the top jaw, and that includes the nasal passages and sinuses.

But here’s a question. I mean, while cleft palates are unusual and a good example of an underdeveloped maxilla or jaw, we’ve evolved to have 32 teeth as humans. Right? Right. How common is it for people not to have enough room for all 32 of their teeth? How widespread is that problem?

Prof Dave Singh: [00:15:21] Depends on the papers, the literature that you read, the number that is really thrown around is like about 10% clinically or constant literature about 30% of people have sufficient room for 32 teeth fully erupted and in occlusion. And by the way, most of those people will be in what should say developed countries or less sophisticated societies where there’s less refinement of food, where the diet is more fibrous and, you know, a non-refined diet. 

But that’s a very interesting point of view because when we look at human evolution or just evolution in general, at the very earliest stages, the teeth were simple conical structures that you see and, you know, reptiles and amphibians, that sort of stuff. And as time went on, we developed, you know, through evolution, bicuspid teeth the two cusps. 

And then in evolution, three cusps that’s called the trigon and then four cusps that are called the talon. And then modern humans come along and we’ve got five cusps, five shells on each of these crowns for the teeth. That’s called a Dryopithecus pattern, first discovered in Germany, that Neanderthal kind of valley, you know?

Dr Ron Ehrlich: [00:16:40] Mm hmm.

Prof Dave Singh: [00:16:41] And so what we have is the biggest teeth in history. In evolutionary history. Hmm. According to our size. So what happened with humans is, that we got an increased number of teeth, an increased number of cusps on the teeth, and we have the thickest enamel compared to our body size for the mammals.

Dr Ron Ehrlich: [00:17:02] Mm-hmm.

Prof Dave Singh: [00:17:03] And so what we’re finding out, of course, is that the enamel thickness is ready through your lifespan. And so there’s no surprise to say that if you took all of the artificial stuff away and had to rely on a natural diet if you had no teeth, your lifespan would be shorter. 

So let’s take another example here. Let’s take an elephant which has the same or a similar lifespan to a human, let’s say about 70, 80 years. The difference in the elephant is it got three molars. Same as humans. 

The difference is the elephant’s molars erupt one at a time. In other words, the first molar erupts when they get too worn out. The second one erupts when that gets worn out, and the third one erupts when that gets worn out, the elephant can’t eat and therefore 

Dr Ron Ehrlich: [00:17:54] Right.

Prof Dave Singh: [00:17:55] And so what dental tissue shows as just an indicator of lifespan. And so. Oh, my gosh. Now we need 32 teeth, but you can’t accommodate 32 teeth if your jaws are too small. 

Dr Ron Ehrlich: [00:18:09] Mm hmm. 

Prof Dave Singh: [00:18:11] And so then that brought the question of why is it that our jaws are so small that the vast majority of people in an industrialised society will have crowding and the teeth will be crooked and they won’t erupt fully. That was the big question and debate. It’s still ongoing, but I think we got some really good clues now. 

Dr Ron Ehrlich: [00:18:30] Yeah, but in your I mean, you know, you’ve said in the developing world, you know, that’s where you will often find people on a diet that’s not processed. They’ll have enough room for 32 teeth. 

But having worked now in the, you know, in the UK and in the US and I know I’ve worked in Australia for many years, what would be your observation of people in our Western culture who have sufficient room for all 32 teeth? If you had to pick a figure off the top of your head from anecdotally… 

Prof Dave Singh: [00:19:01] Yeah. It will be the minority. But here’s what happens, Ron is that because we are in the I’ll call it a privileged situation, what happens is a lot of these people as children get good dental exposure and the dentist and refer to our orthodontic colleagues and the training is that, well, if their teeth are crooked, will remove one or two, maybe three molar teeth, and then we’ll take out the wisdom teeth anyway. 

And so now you reduce the number of teeth and you reduce the jaw size at the same time. And so it’s a little bit of a catch-22 situation where the teeth look well-aligned, but actually because the number of teeth has been reduced therapeutically. Okay. Now the question is, is that beneficial or detrimental to human health?

Dr Ron Ehrlich: [00:19:49] That was my next question.

Prof Dave Singh: [00:19:52] Well, you ask the questions and I’ll try to answer that. 

Dr Ron Ehrlich: [00:19:55] No, no, no. I’m happy for you to ask that. To post that. Because I guess the question is 32 teeth. We don’t you know, in my opinion, it’s like 95% or 90% of the population that I see don’t have enough room for all 32 teeth. And the next question is, well, what’s the big deal? Why does that even matter?

Prof Dave Singh: [00:20:19] Well, I think it’s important because our human genome goes back, you know, not 100,000 years, but several thousands of years. We are the modern human homo sapien. And so the thing about the homo sapiens you know it means wise. The wise people. 

Okay. Well, what makes you wise is this big brain. We’ve got a huge brain. Now it doesn’t come for free. This huge brain is very delicate. And so we are going to immerse it in the fluid to make sure that it looks after itself. And we’ll put a nice braincase around it to make sure that this very fragile brain is going to be well-protected.

And so what we do is because we’ve got a hard diet, at least, you know, in the default setting, every time we bite and chew and crunch, there is trauma that’s going to be exerted onto the skull and by extension, onto the brain.

Prof Dave Singh: [00:21:18] And so what we want to do, number one, just kind of, you know, empirically, is to say let’s distribute that force widely and therefore the brain will be protected. And so our teeth got larger as the human brains got larger. That’s the correlation. 

That’s an interesting correlation to say the number of teeth got bigger, the number got thicker as these human brains were getting bigger at the same time. So the idea is to dissipate, you know, the stress and the force through these large objects and also through their bony facial skeleton. So our brain is protected. 

Dr Ron Ehrlich: [00:21:56] Hmm. 

Prof Dave Singh: [00:21:57] So let’s do an experiment now to say, okay, what if we did not do that? Let’s say we didn’t protect the brain. Here’s a study that we did at the University of California, San Diego, with our colleagues there. And we had two groups of patients. We had one group of patients with multiple sclerosis and one group of controls who were just regular, healthy, normal people. 

And what we did is we measured what would happen to the flexure of the skull cap when you bite down. So when you chew or you clench or you brux, we measured the actual flexion of the cranium of the skull cap. And what did we find? And MS multiple sclerosis people. The skull was more flexible, maybe twice as much. Three times compared to your controls. 

Dr Ron Ehrlich: [00:22:49] Hmm. 

Prof Dave Singh: [00:22:49] And so part of the idea of that was that people with multiple sclerosis may have, you know, this micro-trauma chronically over a period of time, which then, you know, increases the risks of them developing multiple sclerosis at a later date. Of course, as many other factors as well. But that’s one structural thing that we kind of came across. 

The other thing that came out of the study, which was very interesting, was for the healthy individuals, we measured the width of the sutures, the joint in the skull. And surprise, surprise, it came back a magic number, 250 microns, which is a quarter of a millimetre. If you go to the other joint in the face like the mid-face, the maxilla, the width there is about 0.25mm. Then you go down to the teeth and measured the periodontal space between the teeth and the upper jaw. Surprise, surprise. It’s the same number about 0.25mm.

Dr Ron Ehrlich: [00:23:50] Mm hmm. 

Prof Dave Singh: [00:23:52] And so none of this is a coincidence because this is a thing called temporal-spatial patterning, where some space is reserved for function throughout the body. 

Dr Ron Ehrlich: [00:24:06] Well, I mean, you know, the traditional view, though, it’s kind of probably just become folklore and accepted is sutures close up. That’s it. You know, as we get older, sutures close up, none of this is obviously your response to that is not so? 

Prof Dave Singh: [00:24:24] Correct and based on evidence. And so we have to think about how science evolves because science is observation. It’s measurement. It’s showing this is the reason why, you know, and we’re not very scientifically based to say we’re going to make claims based on what we know so far. 

So the early anatomists, they had access to dried skulls. So they looked at the sutures and the, you know, the joints were kind of fixed and looked as if they were completely closed down. And that was their conclusion based on what they saw. 

Downstream, we had light microscopes for the first time and saw people started to, you know, make sections through these dried skulls. And they saw that the bones seemed to be, again, in fusion.

Prof Dave Singh: [00:25:15] The difference now is we have, you know, 3-D imaging that we do on living people. Now we go back and look at the skull and lo and behold, we find there’s a space between the bones because there’s the blood supply, there are stem cells, extracellular matrix, all the small stuff that is lost when a body decomposes and dries out. It’s very, very minute, but functionally extremely important. 

And so some of the new studies showed that if you were to stretch the sutures very gently, the stem cells will respond to that. And they will respond by making new bones and saying I want to resist that stress and strengthen the skull. 

And so we went back and looked at this clinically and we found that we could actually increase the mid-facial bone volume by gentle scratch, by wearing a device inside your mouse for about 12 or 16 hours, gentle stretch, prolonged wear over a period of let’s say 12-18 months. And so that is where the whole story really started to drive and take off because if you’ve got good bony architecture, you’re going to have a better functional response coming from that. 

Dr Ron Ehrlich: [00:26:32] Hmm. Now it’s worth also reminding our listener that the lower jaw is one bone, but the head is made up of many bones. And in fact, how many bones? 

Prof Dave Singh: [00:26:44] 28. 

Dr Ron Ehrlich: [00:26:45] 28. I knew you’d have that at your fingertips. But anyway, those bones are joined together and that’s what the sutures are.

Dr Ron Ehrlich: [00:26:54] Correct.

Dr Ron Ehrlich: [00:26:54] And you also mention because we’re going to come to that whole epigenetics in a moment. But you also mentioned that the brain is very delicate and is protected by fluid. And I think you’re referring to the cerebrospinal fluid.

Prof Dave Singh: [00:27:08] Correct. Yes.

Dr Ron Ehrlich: [00:27:09] Tell us a little bit about that. Pumps around that. How does that work? What is it? Is it a static thing? It pumps around the body. And what drives its motion? 

Prof Dave Singh: [00:27:19] Well, you know, there is a definite flow of cerebrospinal fluid and our chiropractic colleagues are masters at showing the fluid dynamics there. It’s an intriguing subject. I’m not an expert in that by any means. But the point here is that none of this structure that we have is static. It’s dynamic. Okay. And we need to have fluid flow. We have the vibration. We have spaces, functional spaces to allow the flow to occur. 

Now, the thing about the human brain is that you know, there are certain genes that we have as humans that no other mammals have. And so in the human genome was actually sequenced. They said, you know, we’ve got homology about 98% of the chimpanzee, which means that about one or 2% of our genes are completely different, which is, you know, so the question is what genes do we have that the apes and the chimpanzees and gorillas don’t have? And the answer is HAR (Human Accelerated Region) and those families of about six or eight genes. 

What they do is they allow this brain to grow rapidly and change its size and change its function. And so, you know, this is why we need the fluids and we need the braincase to protect it. And so it’s kind of unique. 

We have a very unique brain and cranial base that it sits on. And so a pretty complex, you know, structure. It’s just the way that we have evolved and we need to relook after, be cognizant of that because some of the modern diseases like Alzheimer’s, we mentioned multiple sclerosis. So much of our dementia. What is it? What’s happening to our modern brains that they tend to lose function as you get older? What’s going on there? And the big part of that picture is the airway breathing and sleep. 

And so now we’re trying to put all these bits together to say, you want a healthy brain, you better have healthy sleep. If you’re in healthy sleep, you need a healthy airway. And so this is not a coincidence. These things are kind of lining up and saying, you know, this could be, you know, the way to get people, you know, optimised in terms of the house.

Dr Ron Ehrlich: [00:29:43] And a narrow airway would predispose us to dysfunctional breathing and sleeping.

Prof Dave Singh: [00:29:51] Correct. So now when you think about a child, they’ve got a narrow airway, but their airway behaves differently from an adult who’s got a narrow airway. And so, again, there are these developmental dynamics that come in at which stage of life are you at for us to get a good working diagnosis. And so airway, the thing we’re trying to prevent in all cases is airway collapse.

Dr Ron Ehrlich: [00:30:17] Mm hmm. 

Prof Dave Singh: [00:30:17] Because if the airway collapses, the airflow collapses, you become deoxygenated. And that is when the damage is really done. And so the gold standard, if you will, is to say that we want to prevent airway collapse. So let’s say you got a really big airway. There’s no guarantee that you know how to use it. And so we can have a large nasal airway, you can have a good, you know, pharyngeal airway. 

But we have to make sure that our patients know how to use the structure that they’ve been given. So mouth breathing needs to be deterred. Nasal breathing needs to be promoted. And part of that is tongue posture and tongue position. And so we have to get all of these bits lined up together in the best possible success. 

So we’ve got airway, we’ve got breathing. And then sleep is a physiologic process broken up into different stages, as you know. And so some people have a sleep disorder, such as narcolepsy, REM disorder, you name it, as a whole, like 80, 81, different sleep disorders. 

Dr Ron Ehrlich: [00:31:28] …of which snoring and obstructive sleep apnoea are one of those 80 or two of those 80?

Prof Dave Singh: [00:31:33] Correct. Correct. Yeah. So you’ve got 80.

Dr Ron Ehrlich: [00:31:35] 80 of these. So it’s not just those, there’s a whole range of them.

Prof Dave Singh: [00:31:39] There’s a whole range. The funny thing is, Ron, that the sleep apnoea part of it is highly prevalent compared to everything else.

Dr Ron Ehrlich: [00:31:47] Mm hmm.

Prof Dave Singh: [00:31:48] And so it’s a bit like tooth decay. A lot of things could go wrong. But generally speaking, it historically was tooth decay. And so let’s fix that problem. And now what we find generically is that if you have a sleep disorder, the chances are it’s probably going to be a sleep disorder breathing such as snoring, upper airway resistance syndrome, hyperventilation syndrome, mild, moderate or severe sleep apnoea. 

And then you start getting systemic into things like fibromyalgia and chronic fatigue syndrome. And suddenly it’s a spectrum with no hard borders. It kind of merges. They kind of emerge and fuse into the different conditions. So severe UARS, Upper Airway Resistance Syndrome, might clinically present as fibromyalgia as the patient’s main kind of concern.

Dr Ron Ehrlich: [00:32:43] Mm hmm. You mentioned airway collapse as being a key factor there. And I’m guessing that there are two aspects to what would be predisposed to that. One is size and the other is tone.

Prof Dave Singh: [00:32:57] Mm hmm. Absolutely.

Dr Ron Ehrlich: [00:32:59] I think the two main things we need to address in airway collapse. Do we have sufficient space? Do we have sufficient tone of the muscles around that area? 

Prof Dave Singh: [00:33:09] Yes, absolutely. And the other thing to think about is pressure differential because you got to have airflow. And so it’s a critical collapsing pressure. And so you’ve got muscle tone, which is, you know, robust, the airway is not going to collapse. If you lose muscle tone. The pressure differential doesn’t have to be very much for the airway to collapse in on itself. So muscle tone, we know that that decreases as you age.

Dr Ron Ehrlich: [00:33:37] Mm hmm.

Prof Dave Singh: [00:33:37] And so that’s something to be aware of saying, okay, what can I do? It’s just like going to the gym, working out, getting your muscles and bones into shape, you know. The size of the airway, you know, size does matter, but it’s more about behaviour and functional. So let’s say you’ve got an airway. Some people open and close the airway from front to back. 

Some people open and close the airway side to side and some people open it like a sphincter concentric. If you take a cross-section of the airway. And so when we think about a device, we have to say, how is this patient using their airway? What’s the behaviour of the airway before we decide to say you’re a candidate for X, Y or Z? Right. 

And so these are the more sophisticated bits that we didn’t know 10, 12 years ago. We didn’t know all this stuff. We know people who neurologically don’t have very good control of breathing. It’s a feature called Loop Gain. And so… 

Dr Ron Ehrlich: [00:34:42] Loop gain.

Prof Dave Singh: [00:34:43] Yes. Okay. So think about this. You’ve got a thermostat in your room and the temperature starts to fall and the heating is going to kick in to maintain the temperature. The problem with the thermostat is that it doesn’t respond very well. So you overheat the room and then it kind of comes undershoots and it gets really cold again. Instead of having a nice, stable temperature, you get these big fluctuations. 

Dr Ron Ehrlich: [00:35:11] Mm hmm. 

Prof Dave Singh: [00:35:11] And some people, some patients have the neurological condition of, you know, high loop gain. And so these kinds of people are not going to be the best candidates for device use because it’s more of a neurological issue. But having said that, that’s the minority of these patients, as opposed to, you know, the typical patient who comes to the office for, you know, with deep concerns. 

Dr Ron Ehrlich: [00:35:36] Hmm. You mentioned also because we’re going to talk about epigenetics in a moment. But you mentioned also mouth breathing. And I know this is a topic that we’ve covered talked about a lot on this programme. Tell us what the problem with mouth breathing is.

Prof Dave Singh: [00:35:52] I’ll tell you in one word. Okay. Well, it’s actually it’s two words, nitric oxide. 

Dr Ron Ehrlich: [00:35:57] Okay. Okay.

Prof Dave Singh: [00:35:59] Yeah, this is. Go on. Yes. It’s a classic. It’s a molecule of the century. There’s so much good throughout the body. It’s got a short life, a short half-life. And so you need to produce it in a certain place at certain times to decrease inflammation, to allow regeneration. It plays so many different physiological roles throughout the body. 

And so what’s the big difference? What’s the big point with mouth breathing is that if you are a mouth breather, you bypass the largest storage site of nitric oxide in the body, which happens to be the maxillary sinuses in your top jaw.

Dr Ron Ehrlich: [00:36:40] Mm hmm.

Prof Dave Singh: [00:36:41] And so when you breathe through the nose, the air that’s coming through your nose passes by the opening of the sinuses. The job of the sinuses is to produce nitric oxide. They store it there. They concentrate it there. So when the air flows by, it picks up the nitric oxide from the sinuses and then delivers it down to your pulmonary alveoli and your lungs and you get good oxygen exchange. 

And so if your mouth breathing, you bypassed the nitric oxide pathway, and so you are breathing, but the real kind of I use what catalyst is being removed from the equation and therefore is not the best optimal breathing that you’re going to get.

Dr Ron Ehrlich: [00:37:27] Now, Dave, I mentioned before we got started recording that we’ve been reintroduced through Dr Rosalba Courtney, who we’ve had also on the programme several times. And I remember Rosalba saying to me something that was kind of a huge aha moment and that was that 60, and I think I’ve heard more figures higher than 60% of the body’s nitric oxide is produced in those sinuses. Only when you breathe through your nose.

Prof Dave Singh: [00:37:54] Correct. But it’s going to get picked up because the endothelial lining of the sinuses is the pneumocytes, it’s the job of these pneumocytes is to produce nitric oxide. We have, you know, the human body simplistically is a tube inside a tube, inside the tube. 

And so that in a tube is endothelium that line to your heart, it lines your blood vessels in line to all of the viscera and the inner organs. And the job, one of the jobs the healthy endothelium is to produce nitric oxide. And so if you have inflammation, then that system gets kind of screwed up. And so that the point here is that the largest storage site is the sinuses. Okay.

Prof Dave Singh: [00:38:41] And so it’s kind of, you know, why aren’t we using it. Well, as you get older, your endothelium becomes aged as well and doesn’t produce enough nitric oxide anyway. So what you can do is supplement that from the environment. In other words, with a nice healthy diet. And we can add some stuff to the diet in a whole bunch of foods. 

I’ll give a couple of examples – the radish, beets, beetroot, dark chocolate, I think tofu. It’s a whole bunch of these foods which are high in nitric oxide most metabolised. And so that’s another way to supplement that as part of your keep-fit routine.

Dr Ron Ehrlich: [00:39:21] Hmm. I remember. And to put another perspective on it, I read an article in the Journal of Virology, very light reading. It was about the role of nitric oxide in disrupting the reproductive cycle of the Sars-1 virus. This was back in 2003. So it also has antimicrobial antiviral functions.

Prof Dave Singh: [00:39:42] Correct. Absolutely. And this is why we prefer in the pandemic, we actually wrote a response to the American Journal of Dental Sleep Medicine. And what we said is that the devices that promote nasal breathing are more preferable to the ones that are going to either ignore that or promote oral breathing when you’re sleeping at night for the very reasons that you’ve just mentioned. And so, yeah, there’s a lot of work out there to say, here’s the reasons why we want to promote nasal breathing. 

Dr Ron Ehrlich: [00:40:14] Hmm. Now, I remember when we met about ten over ten years ago, you in passing, and I made a big note of it and I’m very grateful for this is said there was a wonderful book I should read. It’s called The Biology of Belief. It would be a great introduction to epigenetics and introduce me to Bruce Lipton, who is a wonderful person who I’ve had the privilege of having a guest on my podcast. But the book on epigenetics, thank you officially for suggesting it because it really was life-changing. Tell us about epigenetics and why it’s so important. 

Prof Dave Singh: [00:40:54] Well, it’s critical for human health. And so, you know, around 2003, the human genome was completely sequenced for the first time. So we know which genes are required to make a modern human. But that’s only part of the story because even though the genes are there, they need to be read and they need to be functional to actually do their work. 

And some of those genes, you know, they’re there, but they’re kind of dormant. And so the idea is how do we get the best response from our genes? And one of the examples, the most well-researched example is methylation.

Prof Dave Singh: [00:41:30] So we have a methyl donor there in our diet that is going to methylation of these genes. And by so doing that gene does its work so much better than it did before. And that’s just a very simple explanation of the power of epigenetics. The beauty is that we didn’t change the genomes. This is not gene editing. This is not gene, you know, transference of any type. And what it is, is your own human genome and we’re getting the best possible outcome from your own genome.

Prof Dave Singh: [00:42:04] Since that time, we have now come into the age of CRISPR. And CRISPR, as you probably know, is gene editing. And so what we can do now is go in. Let’s say there’s a gene that’s mutated.

Let’s take the example of cystic fibrosis. So the gene for lung function has been mutated and the child is born with cystic fibrosis. What we cannot do now is go into the genome and literally edit that gene and say, I’m going to take you out and replace you with a regular gene or I’m going to stop your function and it’s a done deal. And so there are many, of course, you know, 25,000 genes in the human genome. 

But now, ten years later, we have the technology to go back and edit. Now, we didn’t have that at least, you know, easily available ten, 20 years ago. So that’s a very different topic compared to epigenetics, which is much more kind of holistic, is more it’s less invasive. It’s using your own genetic potential to get a better result.

Dr Ron Ehrlich: [00:43:11] Mm hmm. I think what I found most interesting about the Bruce Lipton story was, you know, he made the point that thoughts are things. Those thoughts being neurotransmitters. And they attach to cell membranes and cause genes to express themselves. Well, if neurotransmitters can do that, so can environmental toxins, so can nutrients, so can other things have an epigenetic effect. What does epigenetics have to do with oral health and what your work does?

Prof Dave Singh: [00:43:47] Well, it comes back to the nature of the signal. And so you can use, let’s say, a chemical like I’m talking about Methylation. But the human oral structure has a very specific function. Swallowing, speech, breathing, mastication, chewing. And so we have to be very well aligned in terms of what’s in our mouth, what pressure is being exerted and what effect it’s going to have. 

So our signal is mechanical. Every time something goes into the mouth, our teeth touch something. When I’m speaking, generally, I don’t bite my tongue. And this is proprioception. I know where my tongue is in space. And I’ve learnt that when I speak in this way, my teeth will not bite my tongue.

Prof Dave Singh: [00:44:33] So our epigenetic signal is going to be a physical signal such as stretch, vibration and also a spatial signal. So when your teeth are together, that’s one signal. When they were apart, there was another signal. And so that is what we were able to do to say, let’s get a series of signals which are specific to the oral cavity, but they’re going to have an impact on human health overall.

Dr Ron Ehrlich: [00:45:02] Hmm. Because you also mentioned earlier that these sutures coming back to our discussion about sutures, because the fact that these sutures have a space of 0.25 or 2250 microns or 0.25 millimetre. And they can that it is within those sutures that there is potential.

Prof Dave Singh: [00:45:25] Absolutely. And again…

Dr Ron Ehrlich: [00:45:27] Yeah. Mm hmm. No, no, please go on. Because I think that is where, you know, these forces that you’re talking about do their work.

Prof Dave Singh: [00:45:36] Absolutely. And again, the literature has come in and really grounded and provided a very firm foundation for what we at that time were thinking. This is how it will probably go. And, you know, so here the deal is that the way you mentioned the neurotransmitters, they have to go across the synapse to the other side to excite the other nerve. There’s a space there. The suture has a similar amount of space there. In that space, there are populations of stem cells. So…

Dr Ron Ehrlich: [00:46:13] …even in adults?

Prof Dave Singh: [00:46:14] Absolutely, yeah. And so the papers, they’re all out there saying that the sutures provide a niche for the stem cells. And there isn’t a huge amount of space there. But here’s the deal about stem cells, is when they get a signal, the first thing they do is divide. The daughter cell will differentiate. 

And so the basal population is not depleted. Just think about your finger, your fingernail and the bed of your fingernail. It keeps on producing keratin, but the cells that are producing it are also reproducing themselves. And so you don’t run out of stem cells. Your nails will grow for the rest of your life. Okay. 

Dr Ron Ehrlich: [00:46:55] Hmm.

Prof Dave Singh: [00:46:56] And so with the sutures, what we know now is that they are focal points, if you will, where stem cells are kind of concentrated, where they can be recruited, where they can differentiate and when they differentiate they’ll make new tissues such as bone. But you need the appropriate signal. 

And so these stem cells have stretch-sensitive genes. Very gentle stretch, a little bit of vibration. And those genes will kick in and say, time for the stem cell to become osteoblasts. And that’s a bone-producing cell. So I can resist the tensile stress that I’m being exposed to. 

Dr Ron Ehrlich: [00:47:36] And is age a barrier here, Dave?

Prof Dave Singh: [00:47:40] Well, it is and it isn’t. Okay. The bottom line here is that the younger, the better. Obviously, the child is actively growing. They’ve got a great population of stem cells. But, you know, it’s never too late. We’ve done patients in age of 60 years old, 70 years old, and even patients, you know, into their eighties. 

And so really, it’s a question of compliance, good diagnosis, clinical adjustments, and then see how this particular patient responds. Some people respond extremely well or really fast, and some people take a little bit longer. But everyone gets there in the end. So, you know, age is not really the arbiter here.

Dr Ron Ehrlich: [00:48:20] Hmm. I know you presented recently in a published article the case of the 60-year-old male who’d had quite a few extractions. I mean, I think from memory there were about nine teeth that were extracted in total. So it obviously had orthodontics at some point in his life.

Prof Dave Singh: [00:48:38] Correct.

Dr Ron Ehrlich: [00:48:38] And he had a sleep study done. I calculated he must have been in his late forties when he had his first sleep study done. And it and it showed a pretty severe. Well, it showed severe obstructive sleep apnoea. Correct. And then he wore this snoring appliance for ten years, which basically the standard approach to a snoring appliance. Tell us about what the standard approach to a snoring appliance is.

Prof Dave Singh: [00:49:07] So we’ve got snoring and we’ve got mild-moderate sleep apnoea. And so for that group of conditions, classically they will give you a mandibular advancement device, and that’s a device that really holds your lower jaw forwards whilst you sleep in an attempt to keep the airway open and not collapse. Mm-hmm. 

And so as long as you wear that device and it keeps your airway open, you should be fine. Now, in this particular case, it’s very interesting because he heard about an alternative approach that I was teaching. Mm-hmm. And he decided to go back and get a second sleep study done? 

Dr Ron Ehrlich: [00:49:45] Yes. Without his device. Without his device.

Prof Dave Singh: [00:49:48] Right. And surprise, surprise. He was shocked to find that over a period of ten years, his basal sleep apnoea had actually gotten worse.

Dr Ron Ehrlich: [00:49:57] Yeah.

Prof Dave Singh: [00:49:58] It went from about 30 to about 68 or something, a big number. And so he became, yeah, as long as he’s wearing the sleep appliance that pulled the manual forwards, he’s probably going to be okay. But he realised that the underlying conditions had actually got worse as he’s getting older. And so he said, what’s the alternative? Well, and as you pointed out, he had several teeth extracted.

Dr Ron Ehrlich: [00:50:23] Mm hmm.

Prof Dave Singh: [00:50:23] And so, you know, we think that the burn volume was too small, and therefore, by default, the airway wasn’t at the optimal kind of, you know, condition. So the idea was to redevelop the mid-face and hold the mandible forwards, allow the airway to remodel and then see what happens. So we followed him for about a year, and in that time, the index of severity fell from about mid-sixties down to about ten or 12 after one year of proactive treatment. 

Dr Ron Ehrlich: [00:50:59] Which was extraordinary, an extraordinary result. I mean, you know, when we talk about airway collapse and with nine teeth removed, his airway size would have been reduced. But as we get older, tone and pressure differential would have got worse. 

Prof Dave Singh: [00:51:17] Absolutely.

Dr Ron Ehrlich: [00:51:17] But here he was still at 60. Well, ten months or 12 months after your appliance where there was just like about two millimetres, it was small, not a huge amount, although relative in the mouth. That was quite a big amount. He had two millimetres of expansion and like the result was quite extraordinary. I was taken aback by it.

Prof Dave Singh: [00:51:39] Yeah. And it’s not the first time. We’ve done this repeatedly. The point is this, Ron is that when we make a measurement of two or three millimetres, it doesn’t really mean a lot. But we think about is what is a functional response to that.

So let’s give an example here. Let’s think about marble and a dice. Right. So they’re both the same size because they’ve got the same volume. But if you roll the dice, it kind of rumbles. And if you roll the marble, it rolls smoothly. So the difference here is not the size differences, the shape difference. 

And so if you took two millimetres and then reshaped or remodelled, you know, the that the mid-phase, the nasal airway, and the back of the airway and you allow the air to flow more freely. That would give you a much better response in terms of breathing efficiency. And I think that’s what’s happening in these cases. It’s the size, the shape and the behaviour. This is the influence that we are having.

Dr Ron Ehrlich: [00:52:42] Mm hmm. And how would you, I mean, your appliance, I think. Timely, very timely name for it, Dave, is this mRNA appliance. It’s a term that people are very now becoming very familiar with. But what is the significance of the name first? The mRNA appliance and how does it differ from a normal mandibular advancement device? 

Prof Dave Singh: [00:53:07] That is a brilliant question, Ron. And you hit the nail on the head because the mandibular advancement devices, by definition ignore the upper jaw. And the upper and lower jaws. They are always coordinated. They have to be for function, for aesthetics, you name it. And so to say, I’m going to bring the mandible forwards and ignore the maxilla is like leaving half of the story, I’m told. 

And so the mRNA device was the first device in history that we can use, even in adult cases, to redevelop the mid-face in conjunction with the positioning of the mandible to get the results we just talked about. And so that was it wasn’t a huge difference, but clinically it’s a difference between a short, comfortable life and a longer, more pleasant life if I can put it in that way. 

Dr Ron Ehrlich: [00:54:02] You know, we’ve often said on this programme the secret to living a long life is to keep breathing for as long as you can. No big breakthrough there. But. But the secret to living a healthy life is to breathe well for as long as you can take. And there’s a big difference. 

Look, I think the whole connexion between the oral you know, between the dentist and sleep medicine is so interrelated, integrated, it surprises people that we are, as a profession involved in it, not just think your work is fantastic. I was so pleased to reconnect with you. Listen, you’re a professor there. You’re still in clinical practise, I assume.

Prof Dave Singh: [00:54:43] Well, because of the COVID, we do a lot of work from home. I actually do my teaching online. The next lecture to my residence is going to be this coming Friday and they will be done remotely. It will be done and also we relocated twice since we last spoke. 

And so I’m getting to the point where I’m going to reduce my clinical activities, but at the same time be able to mentor, advise the best we can and to help the younger generation really get to grips with the new technology, new understanding, and help a lot more people, you know, worldwide.

Dr Ron Ehrlich: [00:55:15] I wonder… I want to just finish with one question that has a lot to do with your clinical work or your research, because we are, as individuals, all on a health journey through life in this modern world. What do you think are the biggest challenges for an individual on that journey?

The Biggest Health Challenge

Prof Dave Singh: [00:55:35] That’s a really complex question. If I use one word, I’m going to say lifestyle. And so you know, this is what I noticed in a came to the US is that people are working so hard and such long hours that the quality of life tends to get faded away. 

If I guys slow down, take a deep breath and just, you know, let’s do something which is comfortable, reasonable is positive, you know, rather than try to, you know, burn the midnight oil every night. It’s about the quality of life, not really about the quantity that you have there. So simple things. 

Prof Dave Singh: [00:56:15] And again, I’m going to talk from my personal experience. Let’s look after our diet. You have a lot of different reasons. And pick a diet that works for you. Pick a, you know, a keep-fit, you know, programme that works for you. You could go running, could go swimming. You can do yoga. You can do whatever you want. 

Think about, you know, your sleep and sleep is critically important for health. Okay. And then think about a way of relaxing, you know, getting rid of stress. Meditation. Call it what you will. There are several factors that when they come together, you have a balanced life and you feel, okay, I’m in my zone. I don’t want to overdo it. I don’t want to underdo it. Where does that balance that works for me and it will be different for so many people?

Prof Dave Singh: [00:57:01] I think we’ve learnt that through the pandemic where we don’t have to rush to a 9 to 5 commute every day. We can do a lot of stuff from home and be as efficient as we were before. The difference is you can at home, I can go for a walk at lunchtime, you know, get that real, you know, sunshine, get the, you know, get that synchronisation with the circadian rhythm. 

And then I can plan my afternoon and my evening and so on and so forth. So the simpler things tend to have the most impact. And so identify those for you as individual, what works for you, and then go with that flow. And the body is very intuitive. You know, the body will never lie. If you are tired, it means you need to sleep. If you’re hungry, you need to eat. If you’re thirsty, you need to drink. 

But the reverse is also true. If you’re not hungry, don’t eat. I’m sorry. Right. And so when the body will give you a very subtle signal saying melatonin release. I’m feeling a bit sleepy. I’m not going to watch the next episode on Netflix. I’m going to go to bed and sleep. So that I think that balance, I think, is one of the secrets that we are overlooking. 

Dr Ron Ehrlich: [00:58:13] Hmm. Well, what a great note to finish on, Dave. And again, thank you. It’s been so wonderful to reconnect with you. And thank you for your fine work and thank you for sharing your knowledge and wisdom with us today.

Prof Dave Singh: [00:58:24] Well, thanks, Ron. Thanks for inviting me. I enjoyed it and we’ll certainly keep in touch. Thank you so much.

Dr Ron Ehrlich: [00:58:30] Thank you.

Conclusion

Dr Ron Ehrlich: [00:58:33] Now, it’s interesting. It may not have been that obvious to you, but Dave said that one of the causes of the cleft palate when he visited the particular area in Indonesia, they realised, the researchers realised that zinc deficiency had a significant impact on the incidence of cleft palate or cleft lip. Now that’s interesting, isn’t it? 

A nutrient has that kind of an effect. And it’s not particularly surprising because this relates back to the work of Weston A Price, whose dentist travelled the world in the 1920s and 30s and was looking for the answers to why tooth decay occurred. 

Dr Ron Ehrlich: [00:59:16] And what he discovered was much, much more than that. And that was that when he visited traditional communities living on ancestral diets that were nutrient-dense, they not only didn’t have tooth decay, but they had enough room for all 32 of their teeth in the mouth with some room behind their third molars. And that would have implications on the upper airway and a nutrient-dense diet was defined and he went around the world looking at all different diets. 

So what he found was that the nutrient-dense diet had ten times more vitamins and minerals, which zinc is an important one, of course, but there are many others. Ten times the amount of water-soluble vitamins and minerals. Four times the number of fat-soluble vitamins and minerals. Vitamins like vitamin A, D and K. And he also found, interestingly, that the best source of those fat-soluble and in fat nutrients was from animals raised on healthy pastures. 

Dr Ron Ehrlich: [01:00:23] So this is all about a nutrient-dense diet, not only reducing your risk of tooth decay but also ensuring that you have enough space in your upper and lower jaws for all 32 of your teeth and your tongue. Because if you don’t have that, if you have narrow jaws and crowded teeth, you have a problem as to what to do with your tongue. 

You have actually three or four alternatives. One is you’re a mouth breather. You keep your tongue down low in your mouth. You might have your lips slightly apart, but you would predominantly breathe through your mouth. You could, of course, walk around with your tongue sticking out, which wouldn’t be a great look. And not many people do that. But this is an option. 

And the third alternative is you keep your mouth closed, but your tongue moves to the back of the throat and blocks the airway. And that may be a factor when you’re awake, but when you don’t have control of your muscles, it predisposes you to a whole range of sleep-disordered breathing conditions of which snoring and obstructive sleep apnoea are just two common examples.

Dr Ron Ehrlich: [01:01:37] So this has tremendous importance and we touched on there the airway, the collapse of the airway being the critical factor and that being the function not just of size but also of tone and pneumatic differential. That means the difference in air pressure between different parts of your airway. 

And so it’s interesting to have a discussion about epigenetics as well and the fact that at these sutures that these where cranial bones join together, there are these still there are in adults some stem cells. They’re called undifferentiated mesenchymal cells. And if the correct amount of epigenetic pressure, be it from your tongue or an appliance is delivered to these sutures. It can stimulate growth. 

It can stimulate the expansion of the mandible. And it’s not limited to children, although, as I mentioned, you know, it’s best to get in early and take advantage of the growth spurt. But the case that I know he presented recently in the scientific literature was of a 60-year-old male and that person had had an orthodontic treatment where they’d had up to nine teeth removed. 

The teeth looked fairly straight, but the problem was the jaw was quite narrow. And by increasing the jaw with just a few millimetres, it made a dramatic impact on that person’s sleep quality.

Dr Ron Ehrlich: [01:03:15] And in our own practise, I know that we’ve done orthodontic orthopaedic treatment on people who are the oldest patient who had that done was 82. So, you know, you’re never too old. And I think this whole idea of looking at the jaw from a more holistic perspective, obviously, something that we’ve been up and focussed on professionally and some of my partners in the practise for many years brings into play the role of the jaw in sleep and breathing conditions and optimising it. 

Dr Ron Ehrlich: [01:03:52] And also the importance of nitric oxide. That thing still keeps coming up. Now I’ve heard varying assessments here of between 60 and 90% of the body’s nitric oxide is produced in the sinuses, in the paralysed sinuses, only when you breathe through your nose. So when you breathe through your nose, you produce nitric oxide and that is taken, the air is warm, humidified and filtered, but it also picks up on that nitric oxide. 

And nitric oxide is one of the body’s most important regulators. It’s a vasodilator opening up the blood vessels, reducing blood pressure. It’s a bronchodilator opening up the airways. It’s also anti-microbial and that includes antivirals. So this whole issue of mouth breathing versus nasal breathing is an important one. And it was a great opportunity to speak to Professor Dave Singh. 

Dr Ron Ehrlich: [01:04:50] I think one of the important things to realise is that there are these appliances that can go in the mouth, that can be custom made to fit exactly into an individual’s mouth that can be on the upper or the lower or it could be on both. 

And there are appliances that are used for snoring and sleep apnoea. There are appliances that are used for headaches, neckaches, and jaw pain. There are appliances that are used to retrain the tongue. That’s called Myofunctional Appliances. 

These are all sorts of different devices, of different designs that apply that either protect the teeth from wear, reduce tension and stress in the muscles of the head and neck, or actually apply light forces to those sutures and stimulate growth. I hope you enjoyed that conversation. I hope this finds you well. Until next time. This is Dr Ron Ehrlich. Be well.

 

 

This podcast provides general information and discussion about medicine, health, and related subjects. The content is not intended and should not be construed as medical advice or as a substitute for care by a qualified medical practitioner. If you or any other person has a medical concern, he or she should consult with an appropriately qualified medical practitioner. Guests who speak in this podcast express their own opinions, experiences, and conclusions.