Understanding Craniofacial Development in Children
It is our absolute passion to help kids sleep, breathe, and thrive. We believe in early intervention and follow the latest research to support craniofacial development in children. Because we’ve been treating adults and seeing the negative impact on their oral health due to an underdeveloped craniofacial structure, it has become our mission to assist the younger generation in preventing such issues. Our doctors are so passionate about this subject as they also have children.
There are several symptoms that are highly correlated with the underdevelopment of the jaw structure, including snoring, grinding, bedwetting, night terrors, ADHD, anxiety, TMJ issues, headaches, and speech problems. We used to see these symptoms mainly in adults, but now we see them in kids, too.
Craniofacial Development in Children
The next few minutes I’m going to talk about cranial facial development of children. And this child came to me because dad was worried that the pediatric dentists wanted to take out her baby teeth sequentially to allow the adult teeth to come in and then eventually take out her adult bicuspids. And something that didn’t sit right with her dad, and partly because he went through the same thing when he was, who was younger and then now suffering through sleep apnea. So he didn’t want this to happen to his child. So we discussed our options here and maybe there are times when it makes sense, but nowadays, knowing what we know, we would never want to take out any adult teeth if we can avoid it. So what we did for her was to expand her. So we expanded her palate to be much, much larger to allow one all the teeth to be in, and second is all the T to be in, but without crowding. So that’s always our primary goal.
And as you can see, this is a very different trajectory. I think the benefit not only not only has aesthetic benefits, but also has health benefits because we’ve been doing this for a while now. We’ve seen other kids that went through the expansion process where parents reported to us that the kids now don’t get up at night. They used to less bedwetting or no bedwetting afterwards, used to have asthma, but now it’s weaning off asthma medications, behaviorally and academically all improving. So there’s just so much benefit of making more room for breathing and sleep. And if you kind of go back to this picture where you see crowding, teeth crowding really is just a sign of under development. So whenever we have a chance to actually deal with the child to be wider, where all the teeth will come in, this is really a normal development. So we hope this video can help you. If you’re a parent watching this and you have questions about any of this, please do reach out to us. We’re very happy to talk to you about just different ways to help your child. Well, thank you and thank you for watching, and hopefully this is helpful. Thank you.
Cranial Facial development of children
The next few minutes I’m going to talk about cranial facial development of children. And this child came to me because dad was worried that the pediatric dentists wanted to take out her baby teeth sequentially to allow the adult teeth to come in and then eventually take out her adult bicuspids. And something that didn’t sit right with her dad, and partly because he went through the same thing when he was, who was younger and then now suffering through sleep apnea. So he didn’t want this to happen to his child. So we discussed our options here and maybe there are times when it makes sense, but nowadays, knowing what we know, we would never want take out any adult teeth if we can avoid it. So what we did for her was to expand her. So we expanded her palette to be much, much larger to allow one all the teeth to be in, and second is all the T to be in, but without crowding. So that’s always our primary goal.
And as you can see, this is a very different trajectory. I think the benefit not only not only has aesthetic benefits, but also has health benefits because we’ve been doing this for a while now. We’ve seen other kids that went through the expansion process where parents reported to us that the kids now don’t get up at night. They used to less bedwetting or no bedwetting afterwards, used to have asthma, but now it’s weaning off asthma medications, behaviorally and academically all improving. So there’s just so much benefits of making more room for breathing and sleep. And if you kind of go back to this picture where you see crowding, teeth crowding really is just a sign of on the development. So whenever we have a chance to actually deal with the child to be wider, where all the teeth will come in, this is really a normal development. So we hope this video can help you. If you’re a parent watching this and you have questions about any of this, please do reach out to us. We’re very happy to talk to you about just different ways to help a child. Well, thank you and thank you for watching and hopefully this is helpful. Thank you.
Untrapping the Jaw
Look at the severe friction happening in this close-up. If you suffer from rapid wear on your front teeth, a clicking jaw joint, and daily tension headaches, you are observing the early stages of a total mechanical breakdown. Most people respond to these symptoms by treating them as isolated issues. They assume the clicking is age, the headaches are stress, and the solution is a lifetime of plastic night guards or a rotating door of dental crowns. A piece of plastic wedged between your teeth only addresses the enamel wear. The immense forces driving the lower jaw upward and backward into the skull remain entirely unchanged. This damage persists because the architecture of the mouth is physically misaligned, forcing the teeth into a state of constant destructive conflict. To understand this misalignment, we have to look at the foundational relationship between the upper and lower jaw. Think of them as a simple box and its lid. The upper jaw acts as the lid and must grow wide and forward to provide room for the lower jaw beneath it. But when the maxilla fails to fully develop, the lid becomes too small. Inward-angled front teeth create a physical barrier restricting movement. Because the lower jaw is a free-moving joint, it adapts to this lack of space by retreating. It pulls backward into the neck to avoid colliding with the undersized upper arch. This forced retreat transforms the lower facial structure into a trapped defensive posture, placing the entire system under chronic structural strain. This entrapment is often diagnosed as a deep bite. In this position, the upper teeth excessively overlap the lower teeth, often hiding 90% of the lower jaw behind a vertical wall of enamel. A deep bite acts as a mechanical cage. The steep inward angle of the top teeth eliminates the horizontal space the jaw needs to slide, chew, and rest naturally. Your muscles will naturally attempt to fight this restriction. They pull the jaw forward to find a comfortable resting place. But as this side profile shows, they are met with a hard stop as the lower teeth collide with the angled upper arch. The severe jagged wear on the front teeth is the physical record of this ongoing struggle. The jaw is trying to literally grind its way through the bone and enamel that blocks its path. These flattened edges are the physical cost of a lower jaw forced to live in a state of permanent skeletal conflict. The damage ripples backward from the teeth into the skull. The force required to hold the jaw in this retreated position places immense continuous pressure on the temporomandibular joint or TMJ. A healthy TMJ requires space. In this cross-section, the joint ball is centered, surrounded by a cartilage cushion. But in a trapped jaw, that space disappears. The ball is shoved backward and upward, crushing sensitive nerve endings and cartilage, causing severe inflammation, clicking, and sharp pain. This retreat creates a secondary crisis in the throat. Because the tongue is physically anchored to the lower jawbone, when the jaw is pushed back, the base of the tongue is shoved into the airway, narrowing the corridor used for breathing. This mechanical crowding explains why jaw dysfunction and obstructive sleep apnea are frequently the same structural problem, a lack of three-dimensional volume for the soft tissues to exist. Long-term healing is impossible as long as the upper jaw remains a physical barrier. You cannot move the lower unit forward if the upper unit is blocking the path. Treatment begins with horizontal expansion. By physically widening the maxilla, we transform a narrow V-shaped arch into a spacious U-shape, moving the boundaries of the lid outward. Using specialized expansion appliances or aligners, we reshape the arch to create the necessary biological volume. At this stage, the goal is not a perfect smile, but a functional foundation. As the perimeter grows, you may see gaps appear between the teeth. These gaps are evidence that the cage is opening, creating the three-dimensional room the rest of the facial structure requires. True resolution comes from prioritizing spatial freedom over the cosmetic goal of having straight teeth. Once the upper dental arch is completely widened, the lower jaw naturally glides forward into the newly created space. It no longer has to fight the upper teeth to find a comfortable resting position. This forward movement instantly decompresses the TMJ. By restoring that equidistant space in the joint, the pressure is lifted from the nerves, and the cartilage can finally begin to heal. The breathing passage opens in tandem. As the jaw and tongue move forward, the obstruction in the throat is cleared, allowing for significantly better oxygen flow during sleep. Only after the lower jaw is untrapped and the muscle tension is resolved can we successfully rebuild the worn-down teeth. The restorative work survives because the destructive forces have been removed. Pain, broken teeth, and poor sleep are the predictable outcomes of a jaw forced to live in a space too small to accommodate it. By expanding that space, we give the body the freedom it needs to function without friction.
The problem may originate from soft tissues, such as enlarged adenoids/tonsils, tongue ties, or improper oral muscle function. If left unaddressed, symptoms may worsen.
Think of the tongue as a motor that drives the forward and sideways growth of the maxilla. There is often a direct correlation between compromised oral function and crowded teeth. Developing the upper jaw to be more forward and broader can create more space for the soft tissues to function. This can result in improved breathing and better sleep, two of the most important factors for a healthy human.
By utilizing modern orthodontic tools like removable and fixed expanders, elastics, reverse pull face masks, clear aligners, braces, and CO2 lasers; we can help our children function and develop optimally. We will also work with an ENT doctor, myofunctional therapist, and speech-language pathologist to determine the best solution for your child.
Dental Crowding Is a Sign of Underdevelopment
Dental crowding or two rows of teeth, commonly referred to as “shark teeth,” are just an indication that the jaw structure is too small. Many people assume that dental crowding is caused by having too many teeth or teeth that are too big. However, this is not the case. In fact, dental crowding is typically a sign of an underdeveloped jawbone. This is a common issue, particularly among children.
Waiting is not always the best option
Dysfunction left untreated worsens symptoms. Arch development and crowding worsened in this patient, who waited four years to seek treatment.
Noticed how the palate got narrower without treatment due to
tongue tie and reverse swallowing patterns
Below: 2023, 6 months post expansion. There is actually room for adult teeth. Bite is still deep but showing signs of improvement.
Right: Prior to expansion. Notice 100% overbite where you cannot see
lower teeth when fully closed.
If your child is experiencing snoring, bedwetting, night terrors, disturbed sleep, teeth grinding, or attention issues, these could be signs of sleep disturbances related to an underdeveloped jaw structure. By creating more space for the teeth, the foundation can be developed, and many of these signs will naturally correct themselves.
Right: Healthy and beautiful smile, post expansion, CO2 lingual frenectomy, orthodontics.
Prior to treatment at 10 years old. Deep bite, tongue tied, lack of space for tongue. Patient was a mouth breather, woke up at night, and was on ADHD medications.
Post expansion, CO2 tongue tie release, myofunctional therapy. NO orthodontics. The patient achieved perfectly straight aligned teeth, improved overall health, and academic success without medication. Notice the changes in the shape of the palate.
Please call our office if you suspect your child could be suffering from tongue tie or underdevelopment of the jaw. We are passionate about guiding you towards a healthier tomorrow.
Pediatric Dentistry FAQs
Why is it a concern if a young child has “perfectly aligned” baby teeth with no gaps?
While straight baby teeth may look nice, they are often a sign of underdevelopment. Because adult teeth are significantly larger than baby teeth, a healthy child’s mouth should have visible spacing between the baby teeth to ensure there is enough room for adult teeth to erupt later. Without this space, adult teeth will likely emerge crowded, rotated, or in double rows (often called “shark teeth”).
How does a tongue tie interfere with the growth of a child’s jaw?
The tongue is the primary internal force that develops the upper jaw (maxilla). If a child is tongue-tied, the tongue postures low in the mouth and cannot reach the roof of the palate to push against it and expand the jaw. This allows the cheek muscles to dominate, keeping the jaw narrow and the teeth tipped inward toward the center.
What is the relationship between a narrow palate and a child’s ability to breathe?
The nasal passage sits directly on the roof of the palate. If the palate is narrow and high-vaulted, the nasal airway is naturally smaller and more restricted. Dr. Ko uses the analogy that breathing through a narrow airway is like trying to drink through a tiny coffee straw rather than a wide one; it requires much more effort and often leads to mouth breathing.
What behavioral “red flags” might indicate poor craniofacial development?
Parents should look for signs of disrupted sleep, such as snoring, gasping for air, grinding teeth, or excessive sweating at night (a “fight or flight” response to restricted air). Other systemic indicators include chronic bed-wetting, frequent night waking, and daytime irritability or trouble paying attention.
Can airway-related developmental issues be misdiagnosed as ADHD?
Yes. Dr. Ko notes that sleep disorders and ADHD (Attention Deficit Hyperactivity Disorder) have highly correlated symptoms, such as irritability and lack of focus. One study showed that specialists could not tell the difference between children with diagnosed ADHD and those with sleep disorders; frequently, once the sleep/breathing issue is treated, the ADHD symptoms disappear.
Why does Dr. Ko recommend intervening at age 6 rather than waiting until the teenage years?
The traditional orthodontic model often waits until age 11 or 12 to extract permanent teeth to “make room” for crowding. Dr. Ko argues against this because extracting teeth does not create a bigger jaw; it can lead to a recessed profile and future sleep apnea. By intervening early (around age 6) with expansion appliances, the jaw can be grown to its proper size to house all adult teeth, which may even eliminate the need for braces later.
What are “kissing tonsils,” and how do they affect development?
“Kissing tonsils” are enlarged tonsils that are so close they almost touch, severely blocking the airway. When a child cannot breathe through their nose due to enlarged tonsils or adenoids, they are forced to breathe through their mouth. Because mouth breathing means the tongue never rests on the palate, the upper jaw fails to develop to its full, wide potential
We collaborate with orthodontists, oral myofunctional therapists, physical therapists, and ENT specialists to correct various issues. If you have any questions about symptoms or potential treatments, please call our office, Advanced Cosmetic & Prosthetic Dentistry at Milford, MA, at (508) 850-0686 to schedule your consultation with our doctors.
