Why So Many Women Have TMJ, Anxiety & Insomnia | Dr. Hilary Fritsch, DMD

Hinzugefügt: 2026-05-31

[00:00:00]Can sleep disordered breathing wreck your libido?

[00:00:03]>> When cortisol spikes, testosterone drops and estrogen and progesterone also drop from that cortisol spike. So, it can absolutely kill your libido. Not only do you not have enough energy, but your hormones are just not there.

[00:00:15]>> So, your wife is not not into you. She's mouth breathing and she needs to see an airway dentist.

[00:00:20]>> Absolutely.

[00:00:21]>> Do women with airway issues tend to have higher cortisol?

[00:00:24]>> Yeah. So what's happening is if our airways are collapsing in the night, our bodies get into fight or flight and that spikes our cortisol in the middle of the night. Those women really suffer and feel like their sleep is terrible and they are HRV is impacted and they're in fight or flight all the time and they don't get into rest and digest and their digestion is affected and they feel irritated and stressed and that's what's leading to a lot of depression and anxiety as well. And then everybody just thinks, oh, it's your job and motherhood when really it's absolutely structural.

[00:01:15]your TMJ, tired mom syndrome, facial nerve pain, lack of libido, shrinking jaw, hormone issues, and more may all be caused by one thing, airway issues in mouth breathing. We've talked on the show about the problems that will arise if your child is mouth breathing and why it's important to correct that as soon as possible. At 3 years old is ideal.

[00:01:36]But what if you're an adult who has an underdeveloped jaw, sunken face, and more. Dr. Hillary Frri is an airway focused biological dentist and one of the leading voices exposing why modern humans are developing smaller jaws, crowded teeth, and widespread sleep apnea. She specializes in non-surgical approaches that help children and adults improve breathing, sleep, and jaw development. Today, she will educate families on how modern diets, lifestyle, and outdated orthodontic approaches may be contributing to the epidemic of airway dysfunction affecting millions.

[00:02:07]So whether you are an adult mouth breather or you have a kid who is one, this episode is going to tell you exactly what to do to correct it and get your life back. Watch this episode on the Culture Apothecary Spotify or Real Alex Clark on YouTube. obviously pause, leave a fivestar review if you've listened to the show uh just a few times or have been listening for years. That is like the number one way to help support me, my team, the work that we do. It helps us chart, helps us become discoverable, helps bigger guests come on the show. So, it really means a lot.

[00:02:35]It takes like 5 seconds to do. Please welcome airway dentist Dr. Hillary Frri to Culture Apothecary.

[00:02:44]Are we literally becoming less attractive as human beings because from birth we are chewing less food?

[00:02:51]>> Yeah, this is an actual problem that our faces are changing because of the way that we eat. So when we chew hard foods, we develop the muscles and then the muscles develop the bones. And when we breastfeed, we have to put our lower jaw forward, breathe through our nose and use all those muscles. And that whole system helps develop our baby's faces.

[00:03:12]And our adult faces too can start to lose bone and shrink and teeth become collapsed and crowded when we don't use the muscles.

[00:03:20]>> How does your jaw form if you're not chewing very much?

[00:03:23]>> It just doesn't form enough. It doesn't form forward or wide enough. Basically like this whole midface where our maxilla is is all attached to this cheekbones, lip support, that whole thing. When it grows forward and wide, it makes your face look really beautiful. That's why people do that duck face to look good in their Instagram pictures is they're basically faking a good airway and good jaw development.

[00:03:44]>> That is crazy because I do and maybe this is the millennial in me and I know Gen Z they don't do that. They kind of do this sunken dead eyee look. It's millennials who do the duck face and you're right like we are like elongating our face doing that. And I do feel like I look cuter when I do that.

[00:04:01]>> Yeah. It's really popular also to get fillers to make your chin look like it's more forward. And all of that is mimicking good jaw development and good airway development. But that all comes from chewing hard foods and breastfeeding and epigenetic changes since breastfeeding and baby formulas came out.

[00:04:20]>> When should we be giving babies steak?

[00:04:22]>> That you should be giving baby steak when as soon as they start to eat hard foods.

[00:04:26]Because like the the problem is when you transition your baby onto solids, a lot of the time we're just giving them more mush, right?

[00:04:32]>> Yeah. Yeah. This was like what basically got pushed through when Gerber came out and they wanted everybody to eat everything pured and they came to the doctors and said, "Your baby's going to choke. You got to teach them how to eat this pured food. Tell the mothers. This is the best thing." And then it became the new normal was everything was pured all the time.

[00:04:52]>> So this was propaganda just to sell products.

[00:04:54]>> Yeah. Jeez. And I mean, we've got these pouches, these applesauce pouches and yogurt pouches, these squeezy tubes. Are those also super problematic?

[00:05:04]>> Trash. I mean, it's easy, right? Like, you can lean on them when you're traveling, but if the baby's not using their jaws and everything is squeezed in pouches and even the hard foods, crunchy foods, just melt in your mouth, then we're not going to develop a a beautiful face. We're not going to develop a beautiful airway. And that means we're not going to sleep and breathe well, which is a foundation for health. So really, really important that we dial this all back and help moms learn more of like a baby led weaning technique where we give kango pit to chew on or like a chicken bone or a big piece of steak and let them gnaw on it. And they can also then learn how not to choke because they get exposed to chewing those foods early on. And they will only take as much as they can handle if you follow the directions properly and kind of like pay attention to what they're what they're capable of chewing. So, when you're like cutting grapes in half and all this kind of stuff or or biting the ends off of French fries and all these things, like this isn't something we're supposed to be doing long term. I mean, cuz some parents are doing that and their kids are like 3 years old.

[00:06:05]>> That's honestly a recipe for a prop improperly grown face.

[00:06:11]>> Really? So, when do you think a kid should be able to eat a whole grape?

[00:06:15]>> I mean, grapes are probably one that I would be careful with, but like a nice mango pit is a really good one. Um, a whole carrot is a really good one.

[00:06:24]Basically, anything ancestral that we were eating, you should be able to give your kids. And if you follow a baby le weaning protocol, you can introduce the same foods that you're eating at home to your babies.

[00:06:34]>> I've seen this face on Tik Tok. It's like this is the Tik Tok mouth breathing face. Is that real?

[00:06:41]>> Yeah, that is definitely real. Mouth breathing face is what happens when the the So, the tongue is the architect of the face. So when the tongue is up on the roof of the mouth, it helps us grow forward and wide. And so if we have our tongues low, hanging down, it actually grows the face down and narrow instead of developing cheekbones and forward growth that everybody wants to see. And so mouth breathers usually get like this sunken under their eyes cuz they don't have that that midface development and their face is literally longer and usually pretty flat. So we want to have the lips out in front of the forehead and mouth breather faces are often really flat. And what that means is that this whole system of the upper and lower jaws, the tonsular pillars, they don't grow forward and out of the airway. So then the airway becomes really narrow because you have to picture there's a tube from going through the nose behind the soft pallet behind the tongue and down into the lungs. And if this part of the face doesn't grow forward, that tube gets really skinny. So what year, what decade did we start seeing this problem really come to a head? 400 years ago, royal families started to have jaw development issues. And that was because I believe they had chefs and everything was soft and puddings and cooked and easy to chew. And that was the beginning of some jaw development issues when we look back at skulls. But in you know everyday mainstream life when we introduced baby formula was when epigenetic changes happened that really caused jaw development issues. And we're now seven generations in. And this is why every child that you know needs braces and their wisdom teeth out because no one is growing the jaws that they were meant to have anymore.

[00:08:22]>> The reason we're told that people in Britain have worse teeth is because they have socialized healthcare. But does this actually have to do then with just cultural trends of eating soft foods because the royal family was eating soft foods? They have basically had a modern diet longer than probably any other population on the in the on the planet.

[00:08:43]And so when you eat a modern diet, your teeth become crowded. So do you know about Weston Price?

[00:08:49]>> Yes.

[00:08:49]>> Okay. So he studied people in third world countries that were living on an ancestral diet to try and figure out why do they have these big beautiful wide smiles? They don't have any cavities. They have enough room for their wisdom teeth. And what's happening with a modern diet? And what he found was that one generation of a modern diet will start to collapse the jaws and cause more cavities and more mouth breathing which is they all three go hand in hand. And so in Britain they've been on a modern diet for probably longer than anyone. And >> why?

[00:09:22]>> Well, because they have been more, you know, westernized and more processed foods and they're not living off the land, you know, for the long time now.

[00:09:32]And it maybe it does stem from like royal families generationally coming down the line. And because if you have someone in your family that didn't breastfeed, that's going to change your jaw development. And so a lot of uh families will do try and do everything right. Like the crunchy moms that come into my office are like, I'm feeding them raw milk. We only get food from the farmers market. This kid has never had sugar. I breastfed for 3 years. How could this happen? And it's because we have these epigenetic changes down in the line and you are pushing up against that. Now, >> how can you look at somebody and see chronic illness in their face?

[00:10:09]>> If you don't see if you if they have forward head posture, they have a recessed chin or a recessed maxilla, it's really obvious that they're not going to be getting good sleep. This is something that I pay attention to every day. So, it's really sad actually to walk around in public and see how many people are mouth breathing and can't breathe through their nose. And what that means is that they aren't going to get good sleep because they don't have enough room for their tongue in their mouth. So, their tongue is going to fall back in their airway that much faster every night, especially if they're mouth breathing. And then that means they're going to have fragmented sleep. And that means they're not going to get good deep sleep and they're not going to get good REM sleep. And they're not going to get the hormone cascade that they need. And what happens is they get into fight or flight during night because they could choke and die. And so their body's cortisol bumps up. And when that happens, it affects all the other hormones. And so those people suffer big time from a lifetime of bad breathing and bad sleep.

[00:11:09]You know, when I think about it, I can't think of like a newborn baby that I've seen that was mouth breathing. when they're sleeping, their mouths are closed and you know, they're just like so angelic and they're just sitting there and they're breathing through their nose. So then, but I see a lot of toddlers that are mouth breathing. Yeah.

[00:11:27]>> And so what is changing between the newborn stage and the toddler stage that is causing a lot of these toddlers to all of a sudden not be able to breathe through their nose?

[00:11:35]>> Maybe they had a tongue tie. So a t if the since the tongue is the architect of the face, if the tongue is tethered down, it can't help them grow forward like they need to. And so those children will not develop their pallet nice and wide and the roof of the mouth is the floor of the nose. So if their pallet is narrow, then their nose is going to be affected and then the there's a domino effect of mouth breathing.

[00:11:57]>> So what happened in like olden days when people were born with tongue ties?

[00:12:01]>> They say midwives used to keep one fingernail long and just slice it right at birth. Gosh, >> I could not be a midwife. I could not be a doctor. I could not work in medical field. I'm going to tell you right now, I am so squeamish with stuff. But yeah.

[00:12:13]Okay. Okay, so that makes sense. So people were aware that you don't want to have that for a long time. This isn't like a new phenomenon. I just feel like I hear about it all the time now.

[00:12:20]>> Yeah. No, it's not a new phenomenon. And babies can be born in mouth breathing. I have moms all the time that are like, "This baby's been mouth breathing since birth." Like, oh, really?

[00:12:27]>> Yeah. So that's again the just epigenetic changes. And moms need to be paying attention when they are pregnant that they are getting enough oxygen because that can affect jaw development.

[00:12:38]And when we're pregnant, we are 30% more likely to develop sleep apnea. So, it's a real situation where we should be checking for hypoxia and low oxygen and apnea events in pregnant women.

[00:12:49]>> How do you check for that?

[00:12:50]>> You just need to do a sleep study. And then if you do have apnea events or sleep fragmentation or oxygen dropping, then we need to intervene and help these moms get enough.

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[00:17:00]Why do so many people all of the sudden, I mean, need jaw surgery or braces or retainers, wisdom teeth removal or Botox for TMJ? If they have sleep fragmentation or hypoxia, which means low oxygen during the night, they need intervention so that they don't get really sick as the years go on because this can cause like everything from headaches and migraines and TMJ and neck pain to, you know, diabetes and high blood pressure and heart disease.

[00:17:29]>> So TMJ could be because of mouth breathing.

[00:17:32]>> Absolutely. So TMJ is almost always airway related and it's really really common in our female patients. What happens is we're compensating for our airway collapsing during the night. So our bodies know when our when we're mouth breathing and our tongue falls back and close off our airway. If we clench all those muscles, it's a way to open the airway again. Those patients have constant head and neck tension because all night long they're doing little compensatory things to help their airway stay open. So if they didn't get good jaw development and they do have maybe 2 millm of airway behind their soft pallet, it doesn't take much when you're asleep and unconscious for that 2 millime to close off. And so we got to get those patients to grow forward and restore the airway. But they end up with chronic head and neck tension, TMJ pain, clenching and grinding. It beats their teeth up and a lot of times like back of the neck pain from having a forward head posture. So when we tip our heads forward, uh, it becomes way heavier and harder on the back of the neck. So if you imagine if you hold a bowling ball on a stick straight up and down, you can hold it like that fine. But if you tip it 5 10° forward, it gets way heavier. So that causes a lot of strain on the back of the neck. And if you walk around and look in public, everyone's got a forward head posture. And we always say that it's because they're looking at their phones, which probably does play a part.

[00:18:53]But also, if you have a small airway and you stand straight up, it's going to pinch right off and get about half as big. And so, those patients tend to keep their heads forward in order to maintain their airway. This is such a pearl of wisdom because I see women my age constantly talking about, "Hey, I have TMJ. I'm thinking about getting Botox to help it. I, you know, Botox was suggested to me. What do you guys think?" You know, asking for opinions online. And nobody is saying to them, "Oh, are you mouth breathing?"

[00:19:21]>> Yeah. I mean, Botox is a band-aid on that for sure. It's not looking at the root cause. So, that's great. We'll put some Botox in there, but you're still choking in the night and not getting enough oxygen. It's really important that we dial that back and look at the root cause. And the night guard is the same thing. I mean, people like everyone I know is in an $800 night guard to protect their teeth when nobody was like, "Why are you clenching and grinding?"

[00:19:45]>> Everybody wants to say, "Oh, it's stress. You're too busy or you're working too hard. It's motherhood." All of these things. when in reality it's structural.

[00:19:53]>> Can bad breathing actually make you less attractive over time as you get older?

[00:19:59]>> Yeah, for sure. People come in all the time and say, "I feel like I don't look like I used to. Like my face is more shrunken in." And they say, "Look at my crowded teeth. They didn't used to be like this." The tongue is kind of like God's retainer. It's meant to be pushing on the pallet and maintain your architecture. And if you're mouth breathing, then the whole face can kind of shrink back because there's nothing pushing. So the tongue and the lips kind of do this game. That's God's plan to help us grow forward and wide. And if they aren't in balance and we just have the face, the lips and cheeks pulling in, then the actual jaw will decrease and the chin can come back and the the maxilla can shrink back as well. And then the teeth will come with it and become crowded again. And that's happening to pretty much everyone. If you talk to women in their 40s, they're all doing Invisalign again.

[00:20:51]>> Everybody is doing Invisalign again.

[00:20:53]Even my makeup artist is doing Invisalign again. And I did Invisalign a couple years ago. So, I I never had braces as a kid. Um I have a slight overbite. My top teeth are all very straight. I have no problems with my top teeth. My bottom teeth I have a little bit of crowding. Um have worn Invisalign and I am really good about wearing my retainer every single night, but still.

[00:21:15]And I had them do a metal bar for many years, um, one of those permanent retainers on my bottom teeth because I was like, they move. Like if I forget one night, >> they will move. And sure enough, I think I had about 5 days out of town. I had forgot my Invisalign. It was like the first time I'd ever done that. Came back and my bottom teeth are all starting to crowd again. So I'm like, do I have to do Invisalign again? I mean, is it normal for them to shift that easily?

[00:21:39]>> Yeah. So the lower arch is a victim of the upper arch. So if your upper arch is a little bit too narrow, then the lower arch is going to not really have enough room for all the teeth and they become crowded really quickly. So we usually those kind of patients, we need to really restore their arch width to, you know, what it should have been before modern diets and epigenetic changes. And when we make enough room for the teeth and have a little extra space in there, they're way less likely to collapse in.

[00:22:06]So, if your upper jaw is locking in the lower and it's a little bit too narrow, your lower teeth are really prone to collapsing.

[00:22:14]>> That's what's happening to me.

[00:22:15]>> Yeah, we should probably like get you just a little bit wider. Kick out the canines a little bit. So, your lower jaw has a little bit more room to come forward. So, a lot of patients think like my chin is too far back. Their chin is too far back because it's trapped by the upper arch. So, if we kick out the canines and the molers a little bit more, we can give the lower arch room to come forward. And a lot of people have a trapped mandible where it's really if you look at a CT scan you can see the TMJ is like really close to the ear and jam back and when they go to talk they come forward and you can see their jaw like comes forward when they speak and then they go back into their bite in that retruded position. So if we widen the maxilla we can give them room to be in a more comfortable position and it releases a lot of tension in the joint but it also makes their profile look better and gets their tongue and their lower jaw out of their airway. Do you reach a point of no return as an adult where look if you're mouth breathing and you reach 38 years old you're toast kind of a thing like you can't fix it a after a certain point?

[00:23:13]>> No absolutely not. I fix people in their 70s. We can go back do expanders we can do clear liners. We can do myofunctional therapy. We can retrain the jaws to the tongue to get in the right spot and regrow the jaws. And it's way easier to do for children while they're growing.

[00:23:31]But it's not impossible to fix in an adult.

[00:23:34]>> Okay. So, what are the devices that somebody can be asking or treatments or whatever that somebody can be asking an airway dentist in their area for if they are an adult who is mouth breathing and they want to stop this and they want to fix it and they want to look more attractive and have a better jaw. Well, if you're mouth breathing, I would really point people towards expanding their pallet. So for me, I was a mouth breather my whole life and I had an expander as a kid, but it was an upper only expander and it didn't do enough and I still didn't really have a big enough pallet and a big enough nose. I had surgery on my nose 10 years ago that didn't really work and it relapse that happens to a lot of people if you talk to them about getting sinus surgery done. Um because if you don't establish a nasal breathing habit afterwards, the tissues get congested and inflamed and swollen again because we need air going through there all the time, all day and all night. I mean, if you really want to remodel the nose, you have to open the pallet up. And so that is typically a MARPY or a Vivos expander. And that can be a game changer because it also it not only opens the nose, but it also makes more room for the tongue. So you have to picture your mouth as the garage for your tongue. And if your tongue doesn't fit all the way in the garage, it's going to hang out the back and that is what's causing airway collapse. So uh the other tool that's really great that Toothpill is doing is a clear liners with an airway protocol. So like whenever someone says, "Oh, you know, like my makeup artist is doing Invisalign." I am immediately like, "This is probably not going to be enough." Because regular old Invisalign just lines up the teeth and it doesn't take airway into consideration at all.

[00:25:04]But Toothpill has a program for adults where you can get a free assessment and find out if you're a good candidate for clear liners that have an airway protocol that's going to make that garage bigger, so you have way more room to get your tongue up in there. And it also makes your smile look really beautiful to have it nice and wide. And like I was saying before, when we go wider, we can also make room for the lower jaw to come forward.

[00:25:24]>> So if humans actually were evolving correctly and we were breastfeeding and we were not doing formula, we were not eating soft foods, we were chewing from an earlier time, would our wisdom teeth fit?

[00:25:37]>> Yeah, absolutely. So they went back and looked at skulls in these caves from ancient humans and they had all their wisdom teeth straight in a line. All the teeth were beautifully developed and into the jaws and not trapped. And now I'm seeing a lot of children don't have room for their second mers even.

[00:25:54]>> That's really I mean I did not know that. That's very weird.

[00:25:57]>> This actually really upsetting because we're at such a point with this airway epidemic that we're now getting to the second mer is means our faces are not developing how they should be and we are not going to be sleeping and breathing well. And it's something that has changed in the 20 years that I've been dentist in dentistry. I never really saw children with second mers that didn't fit. Now it's kind of like the norm. I see it at least once a week.

[00:26:23]>> So, what are they doing? Yanking them out.

[00:26:25]>> Yeah, sometimes we're yanking them out or we're pulling the third mers and hoping that that can as they're developing under the bone, we're hoping that getting them out of the way will help it erupt. And sometimes that does help. But really, those kids should all be in an expander or a tooth pillow, you know, helping them grow.

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[00:29:06]How many women do you think are being told that they're just hormonal when really they're chronically sleepdeprived, which is causing hormonal problems because they're mouth breathing? I think that's happening to pretty much every woman that goes to the doctor because everybody that comes to me and says, um, yeah, oh, I'm tired all the time because I make everyone fill out a questionnaire and I'm like, you are really tired. Are you doing okay?

[00:29:28]And she's like, no, I'm I sleep terrible. I have insomnia or I, you know, I can't sleep past 3:00 a.m. or I just don't feel like I have restful sleep and I went to the doctor and, you know, they blame it on motherhood or stress or their job or their homes and nobody's sleep testing these women because they are young and fit and skinny or in shape and accomplishing too much. And we have it in our mind that only old fat men have sleep apnea. So, they're not even getting tested. And if they do get lucky enough to get tested, a lot of them aren't getting getting diagnosed with any kind of a problem because women have a totally different sleep profile than men. And the way that we score sleep apnea has been designed around men. So you have to stop breathing or your oxygen has to decrease by for 10 seconds or more in order to get that to be called an apnea event.

[00:30:21]And we add up all the events that happen over the night and divide it by the number of hours you slept and give you an average. If it's over five events an hour where your oxygen dropped or you stop breathing, then we say, "Okay, you have apnea." But women have a lower threshold for arousal. So, we won't stop breathing for 10 seconds. We might have five or 8 seconds and then we have a little microarousal where we wake up and do something to get our airway back. And so, it doesn't look like apnea, but it's still massive sleep fragmentation where we could be having 30 microarousals an hour and they say, "No, you don't have apnea." and send you on your way. That's been a real problem in my practice because people think, well, I checked that and it's fine. I don't have it. But that sleep fragmentation and all those microarousals are causing major problems for those women. They don't get good deep sleep. They don't get REM sleep and then they have depression and anxiety or they have fatigue like chronic fatigue issues and their progesterone and estrogen and testosterone, cortisol, every hormone gets impacted by that lack of sleep. And so they are feeling horrible and getting blamed on stress and motherhood. And then they're spending thousands on Botox and supplements and and hormone therapy and peptides and skincare. And meanwhile, it it really just could be they're not ox o o o o o o o o o o o o o o o o o o o o oxygenating properly at night.

[00:31:44]>> Yeah, it's actually structural. It's none of those things. And sometimes it is layered like we need to get some HRT.

[00:31:50]Some women they're actually as women get older um after menopause hormone replacement therapy can cut their risk for sleep apnea in half. So progesterone is really protective for the airway. It actually helps with the upper airway, keeping it toned, and it helps us promote good breathing. And estrogen keeps our tissues elastic and strong.

[00:32:11]And so those two are really important to protecting the airway. So after menopause, women are way more likely, three times as likely to develop moderate to severe apnea. Hormones are really important and but if we don't look at the structural issues, then we can really miss the big picture. So, I had a patient come in last week who's 74 year old woman, and she had a trigeminal neuralgia, which is like a severe pain to these facial nerves. It feels like you're getting a hot poker in your face.

[00:32:41]For 15 years, she's had this.

[00:32:43]>> It's really horrible. She was describing to me how much discomfort that she's in and all these drugs that she's on to manage the pain. And she also had basically every tooth in her mouth had been root canaled and all of her back teeth had been pulled because she was in so much pain all the time that people were like maybe it's this tooth and they'd pull it or maybe we need to do a root canal and they'd pull it and they just kept taking her teeth to try and get rid of the pain.

[00:33:08]>> Oh my gosh.

[00:33:08]>> Yeah. And she we did a CT scan on her and she had 1.9 millm of airway behind her soft pallet. Her airway was so small. She had like a coffee straw to breathe through.

[00:33:21]>> Oh my gosh.

[00:33:22]>> Yeah. And we were like, if someone had identified that for her, you know, 20 years ago even, we could have maybe helped her keep all her teeth. We could have gotten rid of this trigeminal neuralgia. And so all the pain and discomfort and dental issues that she's been dealing with, not to mention like the headaches and the inability to lead a normal life with that severe pain was all coming from airway and nobody looked at it. Do women with airway issues tend to have higher cortisol?

[00:33:51]>> Yeah. So what's happening is if our airways are collapsing in the night, our bodies get into fight or flight and that spikes our cortisol in the middle of the night. This is really common where people feel like they can't sleep and they're have insomnia symptoms and really they're getting airway collapse and then their bodies know like when I get into deep sleep or I get into REM, I don't get enough oxygen and so then they won't allow their body to get into deep sleep or REM. And cortisol and melatonin directly oppose each other like a seesaw. When one is high, the other is low and vice versa. And you cannot have cortisol high and melatonin high. So, if your cortisol is spiking in the middle of the night because you feel like you're going to die and you're underwater and you're not getting enough oxygen, then your melatonin will drop and then the whole sleep cycle gets out of whack. So, we want we want our cortisol to spike in the morning. That's really important to like getting going with the day and having lots of energy and then as this cortisol drops throughout the day, melatonin rises in the night and then we sleep really well, right? And if those two get messed up and the cortisol is spiking at 3:00 a.m.

[00:34:52]because you're in REM sleep and your body's paralyzed and none of your compensatory clenching and grinding is working to keep your airway open, then your cortisol is going to be all out of whack and there's like a domino effect for days from even one night like that.

[00:35:06]Those women really suffer and feel like their sleep is terrible and they are HRV is impacted and they're in fight or flight all the time and they don't get into rest and digest and their digestion is affected and they feel like irritated and stressed and like that's what's leading to a lot of depression and anxiety as well and then everybody just thinks oh it's it's your job and motherhood when really it's again it's just absolutely structural. Can sleep disordered breathing wreck your libido?

[00:35:37]>> Oh, absolutely. So, when cortisol spikes, testosterone drops and estrogen and progesterone also drop from that cortisol spike. So, it can absolutely kill your libido. Not only do you not have enough energy, but your hormones are just not there. So, your wife is not not into you. She's mouth breathing and she needs to see an airway dentist.

[00:35:58]>> Absolutely.

[00:36:00]She'll look better, too, if we can fix her airway. Is there any evidence that mouth breathing and poor airway development can lead to infertility at all?

[00:36:07]>> Well, yeah, because if we're dropping those hormones off and not getting good sleep, the whole the whole body suffers.

[00:36:15]So, you've got to remember this is like 30% of your life you're spending with not enough oxygen and not getting through the sleep cycles properly and not getting good deep sleep, your fertility will absolutely be impacted.

[00:36:28]>> Can airway issues cause anxiety symptoms in women? Yeah, absolutely. So, when we don't get good sleep or we have a compromised airway, then we will not get good REM sleep, especially that's the one that's impacted the most because during REM sleep, you're paralyzed because, you know, we aren't supposed to be acting out our dreams. And when you're paralyzed, you can't do any of the compensation techniques that we do to keep our airway open, like jing your jaw forward or clenching your jaw. So, that airway collapse happens way more.

[00:36:56]And so when we don't get good REM sleep, then we don't get to process our emotions and we don't get that healing brain sleep. That's what REM sleep is for. And that can really lead to depression and anxiety symptoms. So I actually don't think anyone should go on an anti-depressant without checking their sleep first.

[00:37:11]>> Could all of this poor oxygenation also be causing panic attacks?

[00:37:15]>> Yeah, absolutely. So, if you don't get into rest and digest and you're always in fight or flight because your body feels unsafe, then that is way more likely to lead you to panic panic attacks. This is also making me think about kids in foster care that have gone through a lot of trauma, probably difficulty sleeping, but if they're also mouth breathing on top of dealing with that mental stress and trauma, how much worse their symptoms could be with anxiety, depression, or panic attacks?

[00:37:45]Yeah, for sure. I mean, unfortunately, those kids probably didn't get the early intervention with dentistry that they needed either, and nobody's looking at whether they're mouth breathing or nasal breathing, and they have crowded teeth.

[00:37:57]And so, they they're having to juggle all of that. But PTSD symptoms are massively impacted by good REM sleep.

[00:38:05]And if we're not getting good REM sleep, then it's really hard to process all of that trauma. And that's been really obviously shown in the research. We need pallet expanders uh for our military veterans. Absolutely.

[00:38:17]>> You know what I mean? Like that could really be helpful. They're talking about all these psychedelics and all that, which is super cool. And I know that they've seen a lot of promising stuff with that for uh for PTSD, but I mean, we should also be looking at their airways.

[00:38:29]>> Yeah. We need to be making sure they're getting enough sleep.

[00:38:31]>> Yeah.

[00:38:31]>> I see veterans all the time who the the uh military gets everybody sleep tested before they retire them. And almost all of those guys have apnea. But the solutions that they give are a CPAP which isn't really helping your REM sleep. Usually people taking their CPAP off when they get into REM sleep because that's the most uncomfortable time to have it on. And so we're really not helping them get into a REM with a CPAP.

[00:38:56]And so we need a more comprehensive approach for those kind of patients.

[00:38:59]>> How can you get your spouse to stop snoring?

[00:39:01]>> We'll take him to the airway dentist.

[00:39:05]There's a few strategies that we have and I see patients all the time that are like, I don't know why I'm here. My wife told me I have to come. And people are sleep divorced where they're not sleeping in the same bed anymore. And so we can do nightlays where we laser the soft pallet. We can do expansion. We can do clear liners. A really great place to start is to go to toothpill and get assessment because it's totally free.

[00:39:24]Even if you just want >> as an adult cuz we know about toothpill for kids, but you guys also have toothpill for adults now.

[00:39:29]>> Yeah. Like just take your husband's pictures, fill out the questionnaire and submit his information. you can get a free second opinion even and find out what it's going to take for you to help him or wives too. There are a lot of women who are embarrassed to talk about it, but they're snoring because they didn't have good jaw development and they also need a lot of support to sleep better and get back in their bed with their husband. I don't mouth breathe. I mean, what do you think? Do you think I'm a candidate for this still if I'm experiencing this crowding in my bottom teeth a little bit? you know, like should I do this and like walk my audience through it and and try it out?

[00:40:04]>> Yeah, absolutely.

[00:40:05]>> Like do you I mean are there are some people that you're going to be like this is not going to work for you?

[00:40:09]>> Yeah, some people are going to get denied because they need more support and they need to go in office to an airway dentist. But for you like you have beautiful forward growth. That's why you have those nice cheekbones and a nice jawline and good lip support.

[00:40:20]>> Oh, >> I like I like your forward growth. But we could go wider and if we went a little wider with your smile, we could unlock that lower jawline. my smile wider. I'm going to put Hillary Swank to shame. I mean, I have the biggest mouth on planet Earth. You think it needs to be bigger?

[00:40:36]>> A little bit. I would I would actually go It's funny like the numbers that a Caucasian should have are 40 millimeters between the mers across the palette if you measure out the gum line. And almost no one has that. I mean, you have a big wide smile for sure and way more than most people, but I bet that you're not at 40.

[00:40:53]>> Wow. Okay. No, I'm very interested in this. I want to try it out. I know one of my best friends, um, Allison, she's the owner, creator of Branch Basics. Oh, yeah. She just went and did this. She just did some kind of crazy pallet expanding thing as an adult. So, I've heard of people starting to do this. Um, and she's always like on the forefront of all things, you know, crunchy health and wellness or whatever. My audience knows that. So, like when she starts telling me, "Oh, I'm doing this, whatever," then I'm like, "Well, maybe I need to be doing it." Like, she's like the coolest. Let's talk about kids who mouth breathe. Why is this such a big deal? Because I think a lot of people think like they're kids, like they're going to grow out of this.

[00:41:28]>> Yeah. Unfortunately, they're probably not going to grow out of it. So, if they're mouth breathing, they're not going to get the jaw development that they need because their tongue is not on the roof of the mouth pushing forward and wide to get their face, their whole midface to grow forward and their lower jaw can be trapped and it can cause a recessed chin, which is all going to downstream cause airway issues and sleep issues. So, 90 to 95% of facial development is done by age 12. So, we are waiting way too long. Traditional orthodontics and they're not looking.

[00:41:58]Traditional orthodontists aren't looking at your way at all. They weren't trained to look at it. They don't they don't ask you whether you're nasal breathing. They don't teach you to get your tongue up on the roof of your mouth. It's all just getting ignored basically. And we need to be looking at those kids when they are three to help them grow that face that they were meant to have, but also to help them get good sleep. So, if you're not getting good sleep, that's actually going to affect your brain development. And what the research shows is that even once we fix the airway, we can't correct for the years of poor sleep that affected brain development.

[00:42:27]>> What does chronic mouth breathing do to a child's brain?

[00:42:29]>> It's going to affect their ability to develop their brain properly because they're not getting the right hormones that they need and they're not getting the right deep sleep and REM sleep that they need. And so that fragmentation when you look at their sleep study and they're jumping in and out of the sleep cycles all night and they're not getting enough oxygen, it's actually preventing proper brain development. And so I have a thing on Instagram where I share how a lot of psychopaths and assassins and people are going shooting in schools.

[00:42:56]They're all mouth breathers.

[00:42:58]>> You know what? And they do have a look.

[00:43:01]>> They all have a look. I mean, I'm thinking about the the, you know, President Trump's attempted assassination with at the Butler school shooting. I mean, gez, even Charlie Kirk's killer. Even Tyler Robinson has that recessed jaw. Yeah. Um he absolutely I mean if you look at somebody was like you're a mouth breather. He uh the Coline kids um the the shooter in Aurora, Colorado, that movie theater shooting. I mean remember that he had like orange hair, whatever.

[00:43:31]All of those kids look a certain way.

[00:43:33]That Nicholas kid from Parkland, Florida, that shooting.

[00:43:37]>> Yeah. They all have a mouth breather face. The long narrow face, sunken under the eyes. And I think that hypoxia is causing brain development issues that can lead to being a sociopath.

[00:43:47]>> And then they're all being put on SSRIs because they're like, "Oh, you have these symptoms of anxiety and depression. Let's put you on these." One of the biggest uh uh side effects of anti-depressants and anti-anxiety medication is more depression, anxiety, suicidality, right? So, it's like it's the this whole chain leading to one another. This is crazy.

[00:44:06]>> Yeah. This is something that I've been on the war path with because I think we could potentially decrease the amount of sociopaths in the world if we just started looking at everyone's airway.

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[00:47:09]What are the signs that parents are missing when it comes to their kids mouth breathing?

[00:47:14]>> Yeah. So we kind of normalize to a lot of things like snoring and mouth breathing and dark circles under the eyes and restless sleep and ear infections and throat infections and it's people just think this is kids normal stuff. But when you fix the airway, all those things go away. Even like my youngest kid, I thought he looked pretty good. He had spaces in between his baby teeth. We're supposed to have two to three millimeters of spacing in between all the baby teeth.

[00:47:37]And they shouldn't be grinding their teeth and they shouldn't be wetting the bed. They shouldn't have dark circles.

[00:47:42]All of that is like clues that we don't have good jaw development. But he he looked really good. But he would he basically needed to get some expansion because I was starting to put together the clues and I thought, well, he I'm going to intervene a little early just cuz I can. A week into having his expander in. His whole life changed. He stopped kicking like if he was in our bed, he would kick us in the night. He stopped doing that. He stopped wetting the bed. He just started naturally nasal breathing. And he was basically like a different kid, like a little bit calmer, a little bit more able to focus.

[00:48:17]>> And how old was he?

[00:48:18]>> He was five when I first started him.

[00:48:20]Okay.

[00:48:20]>> And then so lately after his expander, I just got him in a tooth pillow now that he's wearing to sleep.

[00:48:26]>> And cuz he started to relapse a little bit and he was mouth breathing again.

[00:48:31]And we cuz he hasn't done hisofunctional therapy yet, which is where you do exercises to get the tongue and the lips strong to make sure you're nasal breathing at night. And because we hadn't done that yet, he started mouth breathing again because that's part of a comprehensive package. We have to structurally change the jaw and then do the myio. And then I got him wearing a tooth pillow at night which forces him to breathe through his nose and it gets the tongue on the roof of the mouth so that it can maintain all the growth that we have. I use it as a retainer after an expander. You can use a tooth pillow by itself but in his case it's a retainer.

[00:49:00]And all of those symptoms went away again like overnight. It's wild to me how much of a difference the mouth breathing actually makes. So, when you've got this precious little toddler and their teeth are all coming in, they have this like perfect smile and you're like, "Oh my gosh, my kid has perfect teeth." That's actually a red flag.

[00:49:16]>> Yeah, that's a red flag. We have to have gaps, 2 to 3 millimeters, which is significant, pretty big gaps in between all the teeth in order to have proper jaw development.

[00:49:25]>> What is the ideal way for parents to navigate pacifiers and sippy cups?

[00:49:29]Pacifiers are not my favorite because they do constrict the jaws and we see the teeth kind of tipping in lingually makes the garage too small like we were talking about earlier and in extreme cases we can get an open bite where they don't even can't even pull their front teeth together. Um, but in a way, a pacifier is a little bit better than a thumb because when we can't take the thumb away, some of these kids like develop really big jaw problems with a very narrow vated pallet. They can't breathe through their nose at all and everything's tipped in and shrunk. I'm a big fan of trying to push through those early times with nothing because the tongue is basically what they're trying to do is soothe themselves and trigger uh vag nerves. So, the Vegas nerve is the master switch for rest and digest.

[00:50:15]And when we get vag nerve stimulation, we can relax. And good tongue posture and good nasal breathing will stimulate the vagus nerve. So if we can train babies early to get good tongue posture, we can substitute for the paci.

[00:50:30]>> Is it okay for a parent to get their kid braces without checking their airway first?

[00:50:35]>> Not at all. I think this is one of the big mistakes that we're making right now. Dentistry knew a hundred years ago about mouth breathing and airway development and western prises research and that all kind of got thrown out the window in favor of fast orthodontics where we wait until they're 12 and all the permanent teeth are in and then we line everything up. Sometimes we're pulling teeth. A lot of times we're doing retractive orthodontics and making the airway worse and we could be actually giving this patient sleep apnea with our orthodontics that doesn't look at airway. It's really damaging. In fact, my oldest, I didn't know all the stuff that I know now when we were starting to do orthodontics on her, and she had what we call a tongue thrust.

[00:51:13]So, tongue thrust is when you your tongue is kind of pushing forward and creating gaps. And we thought her tongue was just misbehaving, and we put a device in to teach her tongue to not go forward. But really, her tongue was trying to get out of her airway, and her tongue was trying to help her grow forward. So, we went nice and wide, but we didn't get her enough forward growth, and she had a really small airway behind her soft pallet. So, I've had to completely rework her case. And if it weren't for the fact that she's my kid, no one would have noticed this at all.

[00:51:42]And so, kids have apnea really easily because they they only have to have one event a night or an hour for them to be diagnosed with apnea. When we start sleep testing kids, it's kind of shocking how many of them have apnea.

[00:51:54]It's because we're not getting the jaw development that we were meant to have and then we just slap braces on and line everything up. We are doing a major disservice to generation after generation. now. And parents are probably wasting tons of money on braces. I think this is why so many girls that I went to high school with are now an adult braces and they had they had braces in high school, too. So, it's like they never fix the issue.

[00:52:18]Their teeth go right back to where they were. Is is that why? Because they're not fixing the pallet issue.

[00:52:22]>> Yeah.

[00:52:23]>> Yeah.

[00:52:23]>> And we haven't addressed the tongue. So, even if they wear their retainer every day, they're so prone to relapsing. And so, that that's like my story about my youngest. We haven't done malfunctional therapy yet. and he's basically starting to relapse quickly. So myofunctional therapy is the tongue posture, the lip strength, the getting the tongue strong, making sure the tongue can actually get on the roof of the mouth, create a big seal and lock into place so that it's not falling back in the airway, but also that tongue is going to be like your natural retainer that you were built in with. So if we don't address tongue posture and we don't address nasal breathing and we're just like wear this retainer forever, that's a recipe for relapse. So, what is the difference between going to an appointment at an airway dentist versus your conventional dentist that we're used to?

[00:53:07]>> So, at an airway dentist, we're going to usually test your sleep. We're taking a CT scan, looking at the airway, and we know what it's supposed to look like.

[00:53:15]So, a regular dentist doesn't really know how to look at airway. And we're also going to look at your nose. Do you have an how much volume do you have in there? Can you breathe through it? Do both nostrils work? If you taped your mouth shut at night, could you actually keep the tape on all night? Or is your nose closing up in the night? cuz some people think that they can sleep all night through their nose and they're not really. And we're looking at how much room do you have for for your tongue?

[00:53:37]There's basically four elements to a good airway and we look at all of them.

[00:53:40]One is does the nose work? Two, do you have enough room for your tongue? Three, is your tongue strong enough to stay up and out of the airway? And then four is how big is the airway itself? So we also looking for tongue ties. We're looking for the u volume of the tube that you're breathing through. Is it the coffee straw of my 74 year old patient or do you have a nice big garden hose back there? And then we kind of put together the pieces of what do we need to do to get this structurally where it's meant to be and train your tongue to get nice and strong. Like sometimes we add laser therapies in to tighten the soft pallet up. There's like a whole host of things that we can do that regular dentists do not know how to do >> with adult mouth breathing. How do you go about fixing this? like first step like first, you know, give us like three things you need to do after this episode ends.

[00:54:28]>> Well, I would definitely go to Toothpillow and get an assessment. It's totally free and they can point you in the right direction. They know who the best airway dentists are in the country for one thing if they aren't able to help you and they can say this is a clear aligner case or this is an expander case. And so the other big piece of it is that myofunctional therapy that we talked about and that they can also help you find a good myofunctional therapist and they have online courses for you to take so that you can it's basically mewing like structured mewing with a PT that understands mewing at its depth.

[00:55:01]>> So so like for me you know if I'm doing tooth pillow as an adult right now I wear this retainer every single night you know that is my leftover Invisalign or whatever. So, do I replace that with the tooth pillow and then I just wear the tooth pillow?

[00:55:12]>> Well, for an adult that that um appliance is different. So, the appliance that we talk about as a tooth pillow that is for kids. For adults, we would be doing a clear aligner therapy and doing it with an airway protocol because regular I did Invisalign for 20 years and it's really hard to move the mers in the way that you need to to actually get the volume for the tongue.

[00:55:37]So the protocol that we're using for tooth pillow for adults is clear liners but designed by the best airway dentists in the country and with a protocol that is going to actually get that volume change.

[00:55:49]>> And is this something that you have to wear every night for the rest of your life like how I have to wear my retainer every single night or whatever or do you only do this for a short period of time?

[00:55:57]>> You have to wear the aligners 24/7 pretty much.

[00:56:01]>> 24/7. Not even just at night. Well, yeah, because we're trying to move the teeth like when you're an active Invisalign.

[00:56:07]>> Yeah. Yeah. Okay. You know, so >> so for like a few months or something.

[00:56:09]>> Yeah. It depends. Everybody's different.

[00:56:11]Some people it's three months, some people it's a year, some people it's two years. So, know depending on how much movement that they need. But then we go into malfunctional therapy and then a retainer phase, which I always give patients a retainer because I I don't know how strong their tongue's going to be. I'm not sure they're going to be nasal breathing all night because that that soft tissue piece is harder to identify. So, we we will still give you a retainer just to make sure that things aren't relapsing. But it's way easier to maintain what we did when we make a lot more room and the teeth aren't just fighting for every little they're so tight in there that it's doesn't take much for them to slide out of place.

[00:56:46]>> And then toddler through teenage toddlers, little kids, you're doing tooth pillow. What about I don't know 10 and above.

[00:56:54]>> So tooth pillow goes all the way up to age 13.

[00:56:56]>> Okay. And after 13, that's when you, you know, go see an airway dentist or do the adult tooth pillow protocol.

[00:57:03]>> Where can people follow you?

[00:57:04]>> I'm on Instagram at HillaryFritch DMD.

[00:57:07]And my website for my office is Saddle Peak Dental.

[00:57:09]>> You practice in Montana?

[00:57:10]>> I practice in Bosezeman, Montana.

[00:57:12]>> Um, I ask every guest this. If you could offer one remedy to heal a sick culture, physically, emotionally, or spiritually, what would it be?

[00:57:19]>> I'm going to get on the nasal breathing train. You got to breathe through your nose and that will help you sleep better, which is 30% of your life and it affects every single hormone. So, I'm a huge proponent of that being the foundation for good health.

[00:57:34]>> And if people want to find out about the adult version of toothpill or the toothpill for their kids, they just go to toothpill.com, use code Alex to get a free assessment, right?

[00:57:43]>> Yeah. Use code Alex, get a free assessment, and find out if you're a good candidate for a tooth pillow or if you want to get a second opinion on the local airway dentist. Although there's so few of us that know what we're doing, I think it's a great it's a great place to start.

[00:57:59]>> Cool. Thank you so much, Dr. Hillary, for coming on.

[00:58:01]>> Thanks for having me.

[00:58:05]>> We've been told mouth breathing is harmless, that snoring is normal, that crowded teeth are genetic, that everyone just needs braces. And if you learned anything from this episode, it's all a lie. New episodes come out every Monday and Thursday at 600 p.m. Pacific, 9:00 p.m. Eastern, anywhere you get your podcast. Please leave that fivestar review on Apple or Spotify. If it's been a while or you never have, just let me know which episode is your favorite one.

[00:58:28]It takes a couple seconds to do and it really helps us out. This content is forformational purposes only and is not intended to be taken as medical advice.

[00:58:35]Always consult with a qualified healthcare professional regarding any questions or decisions related to your health or medical care. I'm Alex Clark and this is Culture Apothecary.