Self-Assessment Checklist that may identify compromised growth, development, and function

Age group: 13 Years Old+ (Teenagers and Adults)

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Key Signs and Symptoms that You can Assess

If you have answered Yes to multiple items below, we would encourage you to schedule a comprehensive airway, tongue, and lip assessment for your loved one at Little Bird Pediatric Dentistry by calling 905-876-2473 (BIRD) or visit our website (www.littlebirddental.ca) for further information.

*For specific findings, click on “” to see a picture example and the reasoning (or why) behind.

*For specific findings, click on to see a picture example and the reasoning (or why) behind.

While Awake

 Mouth open/lips apart (when not talking, playing, etc.) most of the day or routinely throughout the day

Why: At rest (when not eating or speaking, etc.), our mouths should be closed with lips sealed, and teeth slightly apart (~3-4mm). If mouths are open routinely, it increases the tendency to mouth breathe. Learn more about the importance of nasal breathing.

Mouth Open Awake Teen Adult - image001

 Difficulty breathing through nose and/or avoidance of breathing through nose

 Dry, cracked lips and/or regularly licking lips

 Current or history of frequent ear infections, strep throat and/or tonsillitis

 Surgical removal of tonsils and/or adenoids

Current or history of speech difficulties (mumbling, lisp, and/or hard to understand)

 Difficulty waking up in the morning and/or always tired, not rested

 Falls asleep inappropriately during the day

 Relies on caffeine during the day to stay awake and/or be productive

 Regularly have bags (dark circles) under eyes and/or complains of sore eyes

Why: Bags or dark circles under eyes are due to venous pooling, and is a sign that a child is not attaining a necessary length of quality (deep) sleep. This may be found in association with open mouth posture (mouth breathing while sleeping), snoring and/or heavy breathing (aka. breathing disordered sleep). Please see sleeping section below for further signs and symptoms that you can assess.

 Crowding of teeth (no spaces) and/or anterior open bite (space between front teeth when back teeth are touching)

 Forward head posture (center of ear lobe in front of middle of shoulder)

Why: Good, correct posture requires amongst other aspects, that your tongue’s position at rest is up against the roof of the mouth (palate) just behind your upper front teeth. One of the possible causes of forward head posture may be if the child has a tongue restriction (tie) and/or the tongue rests downwards towards the floor of mouth. For every inch that your ear is in front of the middle of your shoulder, 10 pounds of weight is added to your cervical (neck) spine. Over time, this weight may reveal itself as neck pain, stiffness, and/or neck spasms in addition to headaches and/or sore eyes.

Regular neck pain, stiffness, tension, and/or spasms

 Suffers from frequent headaches and/or migraines

 Hyperactivity throughout the day and/or limited attention span (difficulty concentrating/focusing, etc.)

 Highly spirited (poor emotional regulation)

While Sleeping

 Mouth open/lips apart and/or drool on pillow (regularly)

Why: When sleeping our mouths should be closed with lips sealed, guaranteeing that we are breathing through our noses. Learn more about the importance of nasal breathing.

If mouths are open (whether due to muscle memory, tongues trained to be down, tongue and/or lip tie, nose obstruction, etc.), it increases the likelihood of mouth breathing. Mouth breathing, snoring and/or heavy breathing are all possible audible signs of a compromised airway. In order to achieve optimized growth, development and sleep, the lips must be sealed at rest with the tongue up against the roof of the mouth (aka. palate).

Man sleeping and snoring, overhead viewmouth open sleeping and snoring

 Snoring with mouth open (more than 3x/week)

 Gasp/stop breathing

 Regular teeth grinding and/or wears night guard

Grinding Restless Sleep- adult bruxism-teeth-grindingWhy: Teeth grinding, restless sleep and/or sweating heavily can all be possible indications that your sympathetic nervous system (fight or flight) is being activated causing micro (small) arousals (that typically do not wake you) in attempt to maintain your airway (breathing). If this is occurring, you may not be achieving consistent deep sleep with full muscle relaxation (parasympathetic nervous system – rest and digest activation) that is necessary for optimized growth, development and function.

 Frequent awakenings and/or needs to go to the bathroom (>1/night) and/or regular nightmares (>1/week)

Why: Amongst a list of possible causes, awakening more than once per night may also be an indication that your sympathetic nervous system (fight or flight) is being activated causing a macro (large) arousal (that will wake you) in attempt to re-establish and maintain their airway (breathing). We must remember that the number one goal of our bodies is to keep us alive – keep us breathing; therefore if there is any airway compromise while asleep, our bodies will be triggered to awaken.

If this is occurring on a regular basis, you may not be achieving consistent deep sleep with full muscle relaxation (parasympathetic nervous system – rest and digest activation) that is necessary for your optimized growth, development and function.

 Restless sleep (always moving around and/or restless legs/arms)

Grinding Restless Sleep- restless-sleep adultWhy: Amongst a list of possible causes that includes stress, etc. Restless sleep, and/or regular nightmares or night terrors may also be an indication that your sympathetic nervous system (fight or flight) is being activated causing a macro (large) arousal (that will wake you) in attempt to re-establish and maintain their airway (breathing). We must remember that the number one goal of our bodies is to keep us alive – keep us breathing; therefore if there is any airway compromise while asleep, our bodies will be triggered to awaken.

If this is occurring on a regular basis, you may not be achieving consistent deep sleep with full muscle relaxation (parasympathetic nervous system – rest and digest activation) that is necessary for your optimized growth, development and function.

 Sweating heavily while sleeping (pajamas and/or sheets damp)

 Glass of water (or drink) at bedside, as frequent awakens thirsty (throughout night or in morning)

 Current or history of regular bedwetting

While Feeding (Current or History of Challenges)

a) Reported History of Breastfeeding and/or Bottle Feeding Challenges

 E.g. poor/shallow latch, gumming, reflux symptoms, poor weight gain, etc.

b) Reported History of Mom’s Breastfeeding Challenges (as applicable)

 E.g. cracked/creased nipples, pain with latch or with nursing, poor/incomplete breast drainage, etc.

c) Eating and Drinking Signs/Symptoms

Picky eater (e.g. avoidance of crunchy/fibrous foods and/or specific food textures)

Smacking sounds when chewing/swallowing (mouth open when chewing)

Difficulty swallowing (e.g. tongue thrust swallow, pushing food out of mouth, sensitive gag, etc.)

Regularly feels the need to eat before going to bed

Teen diffculty swallowing pillsWhy: One of the possible reasons that should be investigated if you gag easily and/or have difficulty swallowing pills is if you have a restricted/tethered tongue (tie) and/or compromised swallowing pattern (tongue thrust). As the tongue’s ability to function optimally is compromised, you may gag more easily and/or have difficulty swallowing pills. Upon attempting to swallow pills, you may say, “the pill keeps coming forward, it won’t go back”.

Teen picky eaterWhy: There are many reasons for picky eating, however one that must not be overlooked is if you have a mouth-breathing (open mouth) tendency, commonly seen in conjunction with a restricted/tethered tongue (tie) and compromised tongue thrust swallowing pattern.

In this case, the individual will tend to prefer a soft food/processed or refined diet that does not require much chewing as it is very challenging to breathe and eat with our mouths (humans are designed to breathe through our noses and eat with our mouths). Recall the last time you were sick with a congested nose, your diet too, likely consisted of soups, eggs, and soft foods.

Another possibility is if your diet has been limited to soft foods that require minimal use of your muscles for chewing, and/or do not cause any muscle tiredness leading you to have a compromised preferential side of chewing. In both of these cases, a soft food diet may have become a preference of ease.

A diet that requires you to chew using your muscles and both sides of your mouth (right and left) for a minimum of 10 minutes a day is recommended for optimized health.

Why: If your tongue rest posture and function are optimized along with lips sealed, nasal breathing, and teeth slightly apart (~3-4mm), your palate (roof of mouth) will likely develop to be flat and wide, allowing for adequate space for teeth to erupt (without crowding). However, if one of these elements is not followed (i.e. tongue resting low in the mouth, compromised tongue thrust swallow, open mouth tendency and/or mouth breathing), the palate (roof of mouth) will likely develop to be narrow, high arched (can fit a thumb up in the area) without adequate space for teeth to erupt, resulting in crowding.

Dental crowding permanent teeth

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