
Braces Have Made Snoring a Modern Health Problem - pmcpinto
http://nautil.us//blog/braces-have-made-snoring-a-modern-health-problem
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bla2
The article says that jaws got smaller due to agriculture making food softer,
and this evolutionary change causes both snoring and crooked teeth, which in
turn braces are a bandaid for. The point made in the heading isn't really
discussed except in a parenthetical ("braces may also make this worse"). Baity
headline.

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

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

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

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

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

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

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0xcde4c3db
This seems pretty tenuous. As the article alludes to, snoring is considered a
key symptom of obstructive sleep apnea. As far as I know, the strongest known
independent risk factor for obstructive sleep apnea is neck circumference.
Obesity has a larger raw correlation, but that's because it's both a cause and
a symptom (sleep disruption impedes physical activity and alters metabolism
and appetite); with neck circumference the correlation is still present even
when it's measured at birth.

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Hydraulix989
It doesn't seem so tenuous to me.

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

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

~~~
0xcde4c3db
I'm not sure what your objection is. What I find tenuous is the link between
snoring/apnea and jaw size, not the link between snoring and apnea.

~~~
Hydraulix989
Assuming the link between snoring/apnea and jaw size -- not the link between
snoring and apnea -- is actually what you originally found tenuous, consider
that the most effective surgical treatment for OSA: the maxillomandibular
advancement (MMA) with 80% to >90% success rate wrt some measure of a
"successful" outcome. MMA is a procedure that literally increases the jaw size
by moving the jaw forward, which enlarges the airways.

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

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0xcde4c3db
I'd never heard of this procedure, just the approach of using a dental
appliance to advance the jaw, with poor success rate (something like 20%). The
only surgery I've seen widely referenced is turbinate reduction, which
supposedly also has a < 50% success rate in treating OSA. I'm surprised I'd
never heard of MMA since it apparently does have a very good success rate even
without diluting the analysis with practically meaningless effect sizes (mean
AHI reduction of 47.8 in a recent meta-analysis [1]).

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

~~~
Hydraulix989
Do you have a reference RE poor success rate of mandibular advancement dental
appliance? I'm curious because I also had the same poor result when I tried
one.

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

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

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

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

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

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

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

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

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

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abandonliberty
How much pressure exactly? How is it sustained?

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mchannon
Ridiculously absent is the lack of mention of the fork.

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

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

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c54
Oh this is interesting, do you have more I can read about the possible evo
effects of forks?

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mchannon
Mailed you a chapter from my upcoming book.

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hycaria
This is an hilarious response.

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zackmorris
moretai mentioned Orthotropics:

[https://news.ycombinator.com/item?id=17284090](https://news.ycombinator.com/item?id=17284090)

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

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

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

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

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

[http://www.aafo.org/](http://www.aafo.org/)

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

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

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

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

[https://www.youtube.com/channel/UC6eh59CVGAMTjxo6q9gCMZA](https://www.youtube.com/channel/UC6eh59CVGAMTjxo6q9gCMZA)

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

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

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

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

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Henk0
Surprised to see no mention whatsoever of sleeping position. My experience is
that very few people snore when sleeping on their side, but that back-sleepers
are highly overrepresented among snorers. My father suffered, unknowingly,
from sleep apnea. I recommended that he teach himself to sleep on his side
instead, by propping himself uo with pillows or sewing a ball into the back of
his pajamas. He taught himself without tricks like that, and he no longer has
sleep apnea. To end a bad habit of mouth breathing, another simple trick is to
simply tape ones mouth shut with surgical tape in the evening. I’ve done this
myself to get back to nose-breathing after bouts of rhinitis. Simple
behavioral modifications often trump overpriced hitech solutions and invasive
procedures

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lawlessone
So we're pugs...

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jgalt212
Interesting, lots of children at school now seem to be using palat expanders.

[https://en.wikipedia.org/wiki/Palatal_expansion](https://en.wikipedia.org/wiki/Palatal_expansion)

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

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everyone
Actually the whole 1st sentence..

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

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

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

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

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

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

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

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

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

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

Also what is a 'technobro' ???

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everyone
I thought of a nice analogy.

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

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

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

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

