How Airway Shapes A Child’s Facial Development And Future

How Does Airway Health Influence Facial Development In Children?

Your child’s face might be telling you how they breathe at night—and what their future sleep and health could look like. We unpack the core idea that form follows function, showing how muscles, posture, and breathing habits sculpt the bones of a growing face. From long, narrow jaws to swollen turbinates and crowded teeth, we trace how mouth breathing and low tongue posture can reshape growth, fragment sleep, and ripple into behavior, focus, and mood.

We contrast pre-industrial skulls—wide nasal passages, roomy palates, and strong cheekbones—with the flatter, longer modern profiles that often come with constricted airways. Then we get practical. We share the five breathing competencies every child needs: nasal breathing most of the time, lips together, tongue to the palate, a quiet non-collapsing airway, and diaphragmatic breathing. You’ll learn how to spot early red flags, from latching issues to restless sleep, and why crowded teeth are a late symptom rather than the root cause.

We also lay out a clear, parent-friendly assessment roadmap: validated pediatric sleep questionnaires, short home videos during sleep, chewing and swallowing clips, gait observations, high-resolution overnight pulse oximetry, and targeted 3D imaging when needed. The goal is early, noninvasive intervention that restores function so growth can follow—wider arches, more tongue space, better nasal airflow, and deeper sleep. Along the way, we explain when collaboration with ENT, allergy, or sleep specialists makes sense, and when mechanics and habits are the real drivers.

If you’ve wondered whether snoring, bed-wetting, “allergies,” or daytime crankiness might trace back to the airway, this guide gives you the why and the how. Subscribe for more practical airway-focused dentistry insights, share this episode with a parent who needs it, and leave a review to help others find the show.

To learn more about Dr. Mark A. Cruz, DDS. visit:
https://www.MarkACruzdds.com
Dr. Mark A. Cruz, DDS. 
32241 Crown Valley Pkwy #200  
Dana Point, CA 92629  
949-661-1006 

Transcript

Welcome And Big Idea: Airway

SPEAKER_00 0:03

Welcome to Airway Focused Dentistry with Dr. Mark A. Cruz, the show where better breathing leads to better living. If your nights sound like a lawnmower course or your energy stuck on low battery, you're in the right place. Hosted by Dr. Mark A. Cruz, we explore how the airway impacts your sleep, your health, and your smile. So you can breathe, sleep, and be well. Take a deep breath, and let's get started.

Form Follows Function Explained

SPEAKER_02 0:32

When a child's airway struggles, their face often tells a story long before symptoms are recognized. Welcome everyone. I'm Julie Schwenzer, co-host and producer in the studio with Dr. Mark A. Cruz. Dr. Cruz, it's great to be back with you.

SPEAKER_01 0:47

Likewise. Thank you so much, Julie.

SPEAKER_02 0:49

Thank you. So let's dive right in. How does airway health influence facial development in children?

SPEAKER_01 0:57

Well, let me just say that the best way of describing it is with the phrase that form follows function. That actually is a famous um quotation related to architecture. But it also relates to biologic systems. And we just need to understand it. And it's not just for kids, it's also for adults. But let's just focus on the pediatric population, which is the growing child. And what that means is that while you're growing, it's dynamic that you have the opportunity to guide that growth if you have, if you catch the problem early enough. Whereas an adult, it's more of a static system, if you will, that's in homeostasis, meaning that the growth process is done. And so if you want to change form, it usually requires uh more uh aggressive intervention, if you will. You can call it aggressive, but to change it, um, you can't use growth because it's done. You have to take surgical, typically surgical or other means to try to change that. But let's just focus since the question is on kids, it's on the pediatric population. So when you say form follows function, another way of saying it is if the face looks well balanced and attractive, it's probably functioning well. So examples counter to that would be like a long face, so it's called adenoid faces, which is super common. Um, flat uh faces and profiles where the jaw is down and back when you're looking at a profile. So what is the optimal growth pattern that we want to see? What we want to see is downward and forward growth, a straight profile where the upper and the lower jaws are aligned in a straight path and and and they're wide enough. And the reason why we want them wide is that mostly it addresses the nasal part of that complex, not so much the uh the the palate side, although that tends to be the focus, but it's what's above the palate, which is the nasal side. And I could show you

Ancient Vs Modern Faces

SPEAKER_01 3:20

some images. So what we're looking at here are two uh facial skeletons. So on the left, it's what we're calling a uh a pre-industrial skull. It's the way our faces or facial skeleton used to be, say, 500 years ago and before. And what we're seeing more and more now in quote unquote the modern era. And when we say modern era, we're saying post-industrial, meaning after the industrial revolution, we're seeing these um flatter, longer faces with a steep angle. And and then what more importantly, when we look at this image here straight on uh where the these teal arrows are, that teal-colored arrows, you're seeing the nasal fossa.

SPEAKER_02 4:10

Oh my gosh, what a difference.

SPEAKER_01 4:12

It's a huge difference.

SPEAKER_02 4:13

Oh wow.

SPEAKER_01 4:14

So this is the problem that we're seeing, and why this problem is so pandemic. Is and this these studies have been well documented, they've been largely ignored. And I'm actually um in the process of publishing a study where we actually look at middle-aged uh skulls from the Middle Ages, about uh early Middle Ages, to comparing uh to the modern skulls using uh radiography, 3D radiography, as you see here. And you could see the problem here is that the turbinates are swollen and narrow. Whereas where we used to be, we were much wider, we had more tongue space. And um, and so that goes with this uh this facial type, if you will, where we want the more paleolithic face. I'm gonna stop my my sharing here so I can get back. That's the problem, and why this is so common has to do with our anthropology.

Health Fallout Of Narrow Airways

SPEAKER_01 5:18

It's also it's uh given rise to modern diseases that we didn't have before, what are called non-communicable inflammatory diseases like type 2 diabetes, cardiovascular disease, Alzheimer's, um, obesity, et cetera, et cetera. So form follows function. So if we've got a good facial skeleton, which means that we can breathe easily and well, that means we're gonna also sleep well. So a paleolithic face, as an example that we might relate to would be that I use commonly, would be, say, someone like Angelina Jolie or Brad Pitt, high cheekbones, these are called the zygomatic process, high cheekbones up and then a big square jaw forward, big square jaw. And then you look at the profile, it's just attractive. But what that also means is the airway is big, it's more forward and more

Reading Kids’ Faces Early

SPEAKER_01 6:12

open. So if we have a child that is four years old, five years old, even as early as that, you could start seeing the trend of how they're gonna grow. And although they may see the pediatrician, they're not looking at that. They're looking at vaccine schedules, they're looking at other issues that the parent may have, a complaint, where they are in the height and weight compared to um their own peers. But what we need to really be looking at is really reading the face. But we want our kids to have the most aesthetic expression of our genes from both parents. And yes, we they may look like their parents because there are certain things, no question, have a genetic um contribution, but it's not the whole game. It's also the environmental influences on how that face grows. Things like if you're thumb sucking, if you're using a binky for too long, if you're mouth breathing, if you're um tilting your head forward, all these things that influence how the face grows. And so what happens typically is it manifests when you're preteen and teen in the form of teeth that are crowded, they're not straight. And so we treat that as if that's the problem. Actually, that's just a symptom of an upstream problem that's much bigger. But if you're not asking those questions, you're not aware of it, you don't think about it, right? So, um, but there are no question that they're uh they're integrated. So for a kid like my kid, it wasn't until he was in the emergency room at, you know, five years of age, six years of age, that I started connecting those dots. And I walked away with a great understanding that he was misdiagnosed with asthma because it wasn't really asthma. That was really a breathing problem that went along with the bed wetting

Environment, Habits, And Crowding

SPEAKER_01 8:14

and the lethargy and things like that, moodiness and things like that, that were we were able to create by giving him more tongue space, able to breathe better, he was able to sleep better, he was a better version of himself like an adult would be if you sleep really well that next day, you're in a better mood, you can concentrate. So, yeah, if you catch it early with our kids, there are many things that we could do relatively non-invasively to foster organic growth. So we have this whole timeline from when you're born all the way through adult, where you can use different approaches depending on the age and the magnitude of the problem. So I hope that answers the question.

SPEAKER_02 9:00

Yeah, I think so. And you mentioned ages four or five. Is that when parents may be able to see that you know there is something going on with the facial structure and not before that, as the baby, you know, develops into a toddler, it's just too early then?

SPEAKER_01 9:15

Well, I think the public is being becoming more and more educated. I'm I'm seeing moms that really they're more in becoming more informed because they know that something is not quite right with their kid. And actually, at four years of age, it's already well established. What when you really understand what's going on, you could you could see it um almost at birth. And that's another another discussion for another podcast. Very early on, you could start seeing things that portend to poor poor growth. It has to do with um how you're uh feeding, whether you could latch to nurse or not, as an example. Um, can you you know breathe through the nose easily? So very early on you can find out if you're really informed, but usually by about five years of age, the problems are manifest enough to where, you know, there there's concern with, say, even autism, right? That the kid all of a sudden is not really engaging very well emotionally, or they're they're they're they start screaming at the smallest little issue.

A Parent’s Wake-Up Call

SPEAKER_01 10:30

Those are all manifestations. We call it central sensitization. Um, we could talk about that in another podcast, but there are many, many, many signs that when you understand how to read the tea leaves, you could really pretend to better health for your kids. It goes way beyond the food supply and what you're eating. Yes, that is a problem, but it shouldn't be the focus, in my opinion. I think there are other things that are antecedents, if you will, to the problem.

SPEAKER_02 11:01

When that happened with your son, were you already specializing in, you know, airway focus, or did you shift to that because of what happened?

SPEAKER_01 11:10

Yeah, I I don't even like to use the word, to be honest, specializing because what what I try to explain to my colleagues in my courses and lectures when I talk about this is this should not be a specialty to what we do as dental providers. It should just be a way of looking at the problem, which is root cause versus symptom management. So, having said that, um, at the time I had only been focused on adults. My practice the previous 25 years at that time was just adult patients. So it's I started connecting the dots of where the problem started with my own kid, uh, where it started, and then I started looking at where I was. You know, I was a bed wetter late. I was a stomach sleeper. I uh always had an open mouth. If you look at family pictures when I'm, you know, three years old, four years old, five years old, you know, there was a joke. Oh, hey, Mark, are you catching flies? You know, and at the time you kind of joke about it. Um, I struggled in school probably till, you know, around third grade, fourth grade. Um, and it's because I wasn't, I was sleepy. You know, I didn't know, and I loved sleep, and I would fall asleep at the drop of a hat. So you start looking backwards and you start connecting some dots, you go, aha. So that's how I learned.

SPEAKER_02 12:36

Well, thank you for sharing that. You know what's interesting as a parent, too, you know, when you're looking for some kind of resolution with your kids if you think there's an airway health issue. And, you know, I'm speaking for myself too. We don't immediately think of dentistry, we think of pulmonologists or allergists. So this is great that you're doing

Why Dentists Belong In Airway Care

SPEAKER_02 12:57

this because you could be helping so many people right now.

SPEAKER_01 13:00

Yeah. And so I work with uh those those uh uh professional specialties, but it's when it really truly is required. So a lot of quote unquote allergies are not really allergies. Again, topic for another podcast. Um, with the pulmonologist in sleep medicine, uh the focus in pulmonology and sleep medicine is really what we call an end stage disease, meaning it's like late stage. What we want is early intervention before it gets to that point. So obstructive sleep apnea in the adult didn't just happen from one night to the next. It really was a slow process that was missed until it became very uh like the snoring became such a nuisance that something had to be done about it. It happened way before that.

SPEAKER_02 13:53

And you know, going back to the the kids, what about mouth breathing? How does that alter jaw posture and development?

SPEAKER_01 14:01

No question about it. So I always say there are five competencies that we

Five Breathing Competencies

SPEAKER_01 14:05

want our kids to have. The first one is nasal breathing always. So that's, you know, 95% of the time. Unless you're on the soccer field at the end of the game and you're huffing and puffing, you might go to what's called oral tidal breathing. But the best best athletes um or the athlete that is at their best is nasal breathing for the most part. Um, um, and uh that's super well documented. And you even see that less in less in professional athletes, athletics. The second is lips together always. They're touching with the tongue on the roof of the mouth, and then the airway in the pharynx that does not collapse, that means there's no snoring, very, very quiet breathing and diaphragmatic breathing. So those are what we call competences. Those are things that we are genetically engineered to have as a competence. But a lot, if any one of those competences is lacking, then you it portends to problems, like the lips are apart, that means the tongue's not on the roof of the mouth, and the tongue helps to grow the face prop uh face properly. So we swallow about 1,200 to 1400 times a day. And when you have a proper swallow, it's on the roof of the mouth. And that muscle that the tongue is actually pulses the bone growth outward to be wide. If it's if you're have a tongue thrust or side thrust or a problem with the swallow, it pertains to a longer face, narrower, which affects breathing, as an example. So, yeah, so the muscles of the facial skeleton are what largely determines how our facial skeleton grows.

SPEAKER_02 15:58

And what types of interventions, and I mean you did mention some things, but you you touched on this.

How We Assess Children

SPEAKER_02 16:04

But interventions or evaluations do you recommend uh when there's airway-related growth concerns, parents are suspecting something's up with their kids.

SPEAKER_01 16:14

Yeah, there are a a lot of things that we do. It's is I first it's really about the diagnosis and proper assessment. So I get as much uh data, if you will. So for example, um, with a kid, there are a number of things. One is a pediatric sleep questionnaire, which is a validated questionnaire to ask the parent about their birth birth history. Um, does a uh, you know, does the kid snore, mouth breathing, open mouth posture, um, they do they have uh hyperactivity? Can they focus? Are they fidgety? Things like that. Okay, so that's one data set. The other is a chewing video. So I will actually videotape how they chew and swallow. And that tells me a lot. Um their gait, believe it or not, how they walk. So how they balance themselves in an environment of gravity to compensate if uh if there's there's a problem because they're going to walk, but is it efficient and is it based on an upstream problem? So without getting too much into the detail, that's another data set. I asked the parents to take one to two videos of the child while they're sleeping, you know, maybe an hour after they fall asleep. You take a video and then you hone in from looking at the bed. Is the bed messy? Is their neck hyperextended? Are they using an animal to prop themselves up? Are they on their stomach? Um, you know, are they snoring? And then maybe an hour before they wake up, two different halves of the night. And that gives us valuable information. And so, uh, and then I use a high-resolution pulse oximeter. I want to see what the autonomic nervous system is doing to maintain their breathing throughout the night. I'm less interested in whether they're, you know, what are called the apneas and the hypopneas, those are important, but more important, more sensitive, is looking at what their autonomic nervous system is doing. And I could see that with a high-resolution pulse oximeter. And at times, not always necessary, but at times, three-dimensional radiography to look at the development of their airway and their facial skeleton, looking at adenoids and tonsils. How swollen are they? So those are some of a few things that really give us some information. The last thing I'll mention is what's called catnometry. Uh, it's what anesthesiologists will use when a patient's under a general anesthesia, you're looking at the CO2 levels in the lung. Uh, that's super important. People tend to ignore CO2. They're always looking at oxygen, but CO2 is really important. So there are a number of things objectively that are well validated, well studied, and uh cited in the literature that gives us really good data to evaluate the patient objectively.

SPEAKER_02 19:15

Oh, wow, that's amazing. That's very thorough. Yeah. Um, thank you, Dr. Cruz, for breaking that down for us. We appreciate it. And you taking a look

Closing And Resources

SPEAKER_02 19:24

at children and you know, their health in, I think, a new way that a lot of parents have not yet. And this is very helpful to many moms and dads out there. So thank you.

SPEAKER_01 19:36

Yeah, my pleasure. Thank you.

SPEAKER_00 19:41

That's today's breath of fresh insight from airway focused dentistry with Dr. Mark A. Cruz. Remember, small changes in your airway can spark big changes in your life. Breathe, sleep, and be well. For more information, visit markacruzdf.com. Or call 949-661-1006. If this helped you, share the episode and maybe give your pillow a quieter night. See you next time.