Beauty is breathed through the nose | Johan Nouwen | TEDxNouméa

NOTE FROM TED: Please do not look to this talk as substitute for medical advice. Claims in this talk around breathing, childhood development, and disease remain on ongoing field of study. TEDx events are independently organized by volunteers. The guidelines we give TEDx organizers are described in more detail here: http://storage.ted.com/tedx/manuals/tedx_content_guidelines.pdf

At birth, the baby’s skull is almost fully formed, as Johan Nouwen explains to us. The lower part of the face, however, is not developed at all. Its progress will depend on several key details, such as nasal respiration, the opening of the mouth and the position of the tongue. These aspects will determine both the appearance and the health of the child, and of the adult they will become. Discover how the face develops. Understand why enlarged tonsils and adenoids, allergic rhinitis, a blocked nose, a tongue tie or various other granular details can unsettle everything. Problems of dental development, sad eyes, sleep disorders and all the issues associated (snoring, nightmares, obesity, hypertension and diabetes) will be very clearly explained, and crucially, shown to be completely avoidable. Observe the natural process of teeth growth and how the smile is built to avoid orthodontic treatment. Discover how to monitor the proper development of the face, and in doing so ensure that this little collection of features becomes a beautiful, well-rounded, balanced face, all essential factors which contribute to the physical and mental health of the child and of the future adult. You will want to tell everyone about it! Johan Nouwen is a doctor and the father of three children. His education and professional experience have given him the understanding to help his children to grow in a natural and healthy way. In his work, he treats specifically children who snore, have trouble sleeping, experience breathing difficulties and are tongue tied, and he treats them with great energy and enthusiasm, giving them the best chance to grow properly. He regularly teaches on the subject and raises awareness among health care personnel of the importance of breathing in the development of the face. It is his aim to make this a topic of conversation in public health.

This presentation was given during a local TEDx event using the format of TED conferences, but was independently organised. To find out more, visit: http://ted.com/tedx

When my daughter was eight years old,
she always had a blocked nose.

She would breathe through her mouth.

She also used to suck her thumb
which made her teeth push forward.

She was cute but she did have
quite an unusual look.

Her face got longer but didn't get wider.

It was so long that, when she smiled,
you could see her gums.

At night, she snored.

I started to get really worried.

I knew that there was a problem.

Being a doctor, I went back to my notes

and I did research to find out
what was wrong,

and then I found out.

So, we unblocked her nose.

As she wasn't able to stop
sucking her thumb,

an orthodontist put a device
between her teeth to make her stop.

That worked really well.

She did speech therapy

to learn to position her tongue correctly.

She slept with a plastic
retainer in her mouth.

Believe it or not, but in six months,
her face became perfectly balanced.

Her teeth became vertical,
her face opened up.

Now, she is gorgeous.

It didn't take much at all

but this little change was enough
to completely revolutionise her growth.

I am speaking to you this evening
so that none of you here miss out.

If we analyse the skull of a newborn
and compare it to an adult's,

the size of the cranium,

in other words, where the brain is,

at the point of birth,

has reached almost
three quarters of its total size.

It's because the brain
has developed hugely

during pregnancy
and so the skull has done likewise.

However, at birth, the lower part
of the face is completely squashed.

In the mother's womb, the baby's skull
does not serve any purpose.

The baby does not feed itself, or breathe,
so its face does not develop.

But at birth, there is a great shock.

The child must feed by itself,
breathe itself, and communicate.

Its face, therefore, must develop.

Okay, so how does that happen?

Well, the different bones of the skull
are connected by what we call sutures.

When the sutures are put under pressure,
the bones stretch out.

That's how the skull develops,
in response to stimulation.

An essential stimulation
in the face's development -

which was lacking with my daughter -
is the position of the tongue.

The tongue is located in the mouth.

Above that is the palate,

which is formed by the fusion
of the two maxillary bones.

The maxilla are important

because they determine the position
of the jaw, the opening of the nose,

the shape of the cheekbones and the eyes.

The tongue is larger than the palate.

So, if the tongue slides
against the palate,

it puts pressure on the sutures
which widens the two maxilla bones.

The tongue opens the maxillae.
If the maxillae open,

the palate, which is triangular at birth,
spreads out, becomes horizontal.

That makes space for the teeth
which will develop.

The 20 milk teeth,
then the 32 permanent teeth.

If the maxilla opens, the nose opens.

That allows the child to breathe
increasingly large amounts

as they grow.

The cheekbones spread out,
which gives the face a nice shape

and, it pushes the eyes upwards

which allows the eyelids
to stretch out and slim down.

If the tongue rubs against
the palette, the mouth closes.

You're all trying it now!

(Laughter)

It's very important
that the mouth is closed

because that allows the teeth
to grow properly.

They are pushed forward by the tongue
but held back by the lips.

So they grow straight.

And they aren't too long
because their growth

is stopped by the teeth
which come from the other side.

Because opposite, they face resistance,
these teeth lock in tightly in the bone.

It's great.

(Laughter)

And if the mouth is closed,
the teeth and the gums are protected

and washed by the saliva.

Everything goes well,
everything goes marvellously well.

The growth is harmonious.

But watch out: this balance is fragile.

What happens if, like my daughter,
the child grows with a blocked nose?

They could have an allergy, a deformity,

enlarged tonsils or adenoids.

If the child grows with a blocked nose,
they breathe through the mouth.

So the mouth opens,

the tongue drops
to give a passageway of air

and it no longer sticks to the palate,

and so the tongue no longer causes
the opening of the jaw.

That is where the problems begin.

Another example: under the tongue

a small string connects the tongue
to the bottom of the mouth.

We call this the frenulum,
it's easy to see.

What happens
if this frenulum is too tight?

The tongue is forced downwards,
it is no longer stuck to the palate

and no longer causes
the opening of the jaw.

That can be catastrophic.

If the jaw doesn't open,
it remains triangular and narrow.

When the teeth come, they don't have space

they grow on top of one another,
we say that they overlap.

This man is 40 years old.

His maxilla, his upper jawbone,
has not developed at all.

It's very narrow,
so there is no space for the teeth.

And rather than making space,
he had eight teeth removed.

Do you realise, eight teeth
is a quarter of his whole set.

After all that, the remaining teeth
are crowded anyway, they overlap.

To begin with, this man's problem was
that he grew up with a blocked nose.

That's all.

He consulted doctors and dentists.

Not a single one thought
to make him breathe through his nose.

If the jaw doesn't open the nose,
the nasal cavities don't open either.

The pathway which brings air
to the lungs does not develop.

So it's a vicious cycle: the less a child
breathes through the nose

the more difficult it becomes
to breathe through the nose.

Likewise for sleeping,
because sleeping requires breathing.

Especially as, when you sleep,
your muscles relax

meaning that the airways contract.

If there is also a blockage inside,
it's very difficult to breathe.

So, the child develops sleep problems.

They snore, sleep open-mouthed.

They have a very disturbed sleep.

They spend the night trying to find
a comfortable position

so that they can breathe easily
but they don't find it.

So they have nightmares and sleep terrors.

They wet the bed.

Look, this is the typical position
of a child with enlarged tonsils.

The poor child has to sleep on their back,
head tilted back, mouth wide open

to try to make as much space as possible.

The child who grows with a blocked nose

condemns the adult to never being able
to breathe through the nose.

Never, because their nose
hasn't developed.

The adult also develops
sleep disorders.

These adults experience
more car accidents,

they are more often diabetic,
obese, and hypertensive.

Some need machines to help them sleep.

It's really serious.

The cheekbones don't open either.

The eyes don't slim down
but become rounded.

That gives the child a sad, tired look.

As the tongue rests on
the mandible, the lower jawbone,

the jaw lengthens.

In addition, the maxilla doesn't open,

that causes the face to stretch out.

When the child smiles, you see their gums.

It's Ronaldinho's smile.

(Laughter)

It's unexpected.

(Laughter)

If the nose is blocked, the mouth is open

and so the teeth cannot grow properly.

They are pushed forward by the tongue

but they are not held back by the lips.

Typically, a child who
develops a blocked nose

has teeth which push forward,
like a rabbit.

It's not funny.

The comparison doesn't end there.

As these teeth don't meet other teeth
from the other side, they are long.

They don't stop growing
and so they stick out.

Because opposite, there is no resistance,
they are poorly aligned.

Teeth which are long, which push forward,

which are not well aligned,
which are not protected by the lips,

are fragile and they break.

Especially when children run,
jump and fall over.

If these teeth last childhood,
there will be problems in adulthood.

Being poorly aligned,
they become loose very easily.

When the mouth is always open,
it is dry, there is less saliva.

Now, saliva protects.

Less saliva means more cavities,
and more gum disease.

A foul breath.

All of that because of enlarged tonsils,

a blocked nose or a tongue tie.

Still, it's not too difficult to sort out.

At the same time,
we all know children like that.

Children who snore,
always with their mouths open.

They look exhausted,
their teeth push forward

or overlap each another,
have "gummy" smiles.

Or worse, children who wear braces
and yet still have their mouth open.

This girl is 10 years old.

She comes to see me because
she can't breathe through her nose.

She has a problem with
pronunciation: she has a lisp.

For the last two years,
she has received orthodontic treatment.

It is unbearable.

With a tongue tie like that,

how can you expect
the tongue to work properly?

Obviously she has a blocked nose,
it is not developed.

Of course she snores.

Okay, she has nice teeth,
but there is so little space

that the braces have pushed the teeth
outwards to the extreme.

Normally, the teeth
are in the middle of the bone

not on the sides where they don't stick.

If we had cut just the frenulum,
nothing special, it takes 10 seconds,

it doesn't require any specific skill.

It is risk free.

If we had cut the frenulum,

this little one could have
suckled her mother.

You cannot suck with a blocked tongue.

She would have slept, breathed,

she would have spoken properly.

As it is, people mock her
every time she speaks.

She wouldn't have done dozens and dozens
of speech therapy sessions

to learn how to speak well,
to speak better.

You can't speak well
with a blocked tongue.

It's like learning to drive with
the handbrake on, it's ridiculous.

She wouldn't have done
two years of orthodontics.

It hurts and it's also expensive.

If we had looked for
the frenulum at birth,

when consulting paediatricians
or general practitioners,

or on school trips,

or during these numerous
speech therapy sessions,

or, even more obviously,
before starting orthodontics,

If we had cut it or had it removed,

her growth would have been
completely different.

The frenulum serves no purpose,

it's an embryonic vestige
like the appendix.

It's rather surreal that
a problem which is so easy to fix

is ignored to such an extent by nurses.

So, when you see a child who,
by all accounts,

has problems with
the growth of their face,

you must treat them.

If it's not your child,

you must explain to the parents
why it must be treated.

Treating it means first of all
restoring nasal respiration.

The doctor must make the child breathe.

They will treat allergies, deformities,

remove tonsils and adenoids
if they are too enlarged,

cut the frenulum if necessary.

Then, you must teach the child
to position their tongue correctly

against the palate, while doing
a serious speech therapy re-education.

When all of that is done,
orthodontic treatment can be done

to accelerate the normalisation
of the face's development.

It is useless before.

So,

it is not normal to have

a child who always has their mouth open
because they have a blocked nose.

Nor is it normal to have
a child who snores

in other words, a child with respiratory
problems when they sleep.

It might seem trivial
or benign, but it isn't.

It's a public health problem.

You must treat this child

to optimise the development of their face.

Now, at least, you, all of you, know it.

Thank you.

(Applause)