References | Medical Literature

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Some more in-depth information available from the orthodontic and medical literature is below. Much of this information was originally compiled by Dr David Page. For more information about FJO treatment and/or Your Jaws Your Life please see www.SmilePage.com

The Jaws & Teeth

  • The presence of teeth provides critical jaw and airway support.  Jaw support is necessary to maintain tongue space, airway space and basic life support.
Various backward forces on the jaws and teeth can prevent proper jaw growth, and can decrease the size of the jaws and then the airway.
  • Breastfeeding, bottle-feeding, swollen tonsils and adenoids, and nasal obstruction influence proper jaw growth and tooth alignment.  Few people have a broad understanding of how these complex processes relate because the many relationships are not generally taught.
  • The first year of life, is the strongest period of jaw growth. By age 6, about 90% of head growth, and about 80% of jaw growth has already occurred.
Facial Growth and Facial Orthopedics – 1986.
  • Breast suckling can promote proper jaw growth.  Bottle and pacifier sucking can work against it.
The Functional Orthodontist – 2001



A small upper jaw can hold back proper lower jaw growth. Proper jaw development is the most critical factor influencing whether a malocclusion (bad bite) develops.
Maxillofacial Orthopedics: A Clinical Approach for the Growing Child – 1984



  • Save your teeth and extend your life!  Good dental function is significantly associated with better brain function, better vision, hearing, lung volume, heart volume, muscle strength, bone mineral content, less heart attacks and longer life.
British Medical Journal – 1989
Community Dental Oral Epidemiology – 1990

Mouth Breathing

  • Mouth breathers tend to have lower levels of blood oxygen and higher levels of carbon dioxide, especially at night. Mouth breathers tend to be sicker and have more heart trouble. They rarely catch up in health or I.Q. to breastfed infants who are frequently nasal breathers.  Mouth breathing commonly causes crooked teeth (malocclusion).  Mouth breathing tends to cause open-bite jaw deformation, which can then negatively affect the airway and overall face.
Mouth breathers can become nose breathers.

  • 80% of those who were mouth breathers before treatment became nasal breathers after only 1-3 months of dental treatment.
Treatment can cure or improve:
  • Recurrent ear and nasal infection
  • Asthma
  • Ability to breath properly
Journal of Laryngology and Otology – 1975


Functional Jaw Orthopedics provides non-surgical hope for enlarging a small airway and it should be considered.

Bed Wetting (nocturnal enuresis)

  • Research shows a lack of oxygen due to upper airway obstruction can cause bed-wetting.  Reversing the airway obstruction or increasing blood oxygen levels may stop it.  Some children “grow-out-of” bed-wetting as their jaws and airways grow.
Early Functional Jaw Orthopedic treatment,  can reduce or stop bed-wetting in about 80% of those from ages 4 to 31.

  • Doctors sometimes dismiss nocturnal enuresis (bed-wetting) as a minor problem that the child will grow out of.
Nursing Standard – 1998


  • All medical approaches to date (in 1993) reflect the lack of sufficient knowledge of the underlying true causes of nocturnal enuresis, commonly known as bed-wetting.
Clinical Paediatrics – 1993


  • Drugs make up a good portion of bed-wetting treatment although results are less than desired, and real risks exist.  Bed-wetting relapse occurs at very high rates once drug therapy ends.
Clinical Paediatrics – 1998


  • Children with ADHD – are 2 ½ times more likely to be bed-wetters.
Southern Medical Journal – 1997


  • Adolescents aged 12 – 16 years, referred for psychological pathology study, (depression, ADHD, etc.)  were 7 times more likely to wet the bed than controls.
Journal of Paediatrics and Child Health – 1995


  • 10 out of 10 chronic bed-wetters stopped after just a few months of starting rapid palatal expansion.
Angle Orthodontist – 1990


  • 7 out of 10 chronic bed-wetters, aged eight to thirteen, who failed to respond to conventional treatments improved within one month of rapid palatal expansion.
Angle Orthodontist – 1998

The Jaws & Breastfeeding

During breast suckling, the undulating rhythmic elevation and lowering of the jaw stimulates lower jaw growth, during the most rapid period of jaw growth.
Handbook of Facial Orthopedics – 1982


  • A strong association has been found between exclusive bottle-feeding and malocclusion.
Journal of the Canadian Dental Association – 1991


Research shows children breastfed about 1 year rarely develop dummy or finger sucking habits.
Swedish Dental Journal – 1998


Non-breast sucking habits such as fingers and dummies (pacifiers) are strongly associated with crooked teeth and/or jaws (malocclusion).

Acta Odontologica Scandinavica – 1993


  • The forward forces of breast suckling cause down and forward growth of the jaws, enlarging the room for the tongue and airway.
Backward constricting forces of bottle and pacifier sucking can cause dental malocclusion and jaw deformation, which also can reduce tongue and airway space.

The Jaws & Dentures

Removing complete dentures during sleep promotes breathing disorders and increases both the risk of hypertension and cardiovascular disease.
Minerva Stomatologica – 2000


  • This is because the dentures usually support the tongue space.  As tongue space is lost, the tongue has to go into the throat during sleep.  This blocks the airway and the result is that blood oxygen levels can drop to below 40% of normal levels.  This forces the heart to overwork all night to get oxygen to the brain.

The Jaws & Ear Disease

Patients with inner ear dysfunction, of unknown cause, should have an FJO dental exam.  Dental treatment may improve ear symptoms.

HNO – 1993


  • At times 30% of all annual prescriptions distributed have been for ear disease.
American Journal of Diseases of Children (1960) – 1987


Otitis media is currently the most common diagnosis made by clinicians, which has a major impact on managed care.
Current Allergy Asthma Reports – 2001



The origin and cause of acute otitis media and otitis media with effusion is not yet understood.  The limited insight into the disease process restricts rational and appropriate therapy.
Pediatric Otolaryngology – 1996



Acute otitis media is the most common disease for which pediatricians prescribe antibiotics.

Journal of Microbiology, Immunology and Infection – 2001


  • Ears that appear to be infected are often found to be “sterile.”  Therefore, antibiotics cannot treat these cases. The Philadelphia Inquirer – 1998


  • The future solution to otitis media, acute or chronic, does not lie in current therapy regimens. Otorhinolaryngology Head and Neck Surgery – 1996


  • Craniomandibular (jaw to skull) disorders are frequently overlooked in the medical profession as possible causes of hearing problems. The Functional Orthodontist – 1995


Children with deep dental overbites are 2.8 times more likely to have ear tubes (ear grommets) placed or recommended by a pediatric otolaryngologist.
The Laryngoscope – 2001


The greatest cause of otitis media is an over-closed or improper dental bite.

The Functional Orthodontist – 1990


  • Dental treatment is an effective method to change the bite, and reduce or eliminate otitis media in young children between the ages of two to six years of age.
Journal of Clinical Pediatric Dentistry – 1998



  • Patients with ear pain, dizziness, tinnitus, or ear fullness may have jaw-to-skull disorders.  A dental bite plate placed to change the bite creates a new jaw-to-skull relationship and can significantly reduce ear symptoms. Laryngoscope – 1991


  • Meniere’s disease patients have a much higher incidence of jaw disorders. Journal of Orofacial Pain – 1996



The Jaws & Early Orthodontics

Early orthodontic treatment can be simpler, shorter and more favorable than treating at a later age.
The Bulletin of Tokyo Dental College – 1995


The first year of life is the strongest period of jaw growth.  By age 6, about 90% of head growth and about 80% of jaw growth has already occurred.

Facial Growth and Facial Orthopedics – 1986



The Jaws & Headaches

  • Migraines and headaches can be caused by an imbalance within the jaws.  If a lower jaw is compressed back by a narrow upper jaw it can lead to jaw aches (TMJ problems) and headaches.
  • Headache and migraine sufferers lose more than 157 million workdays each year and industry loses 50 billion dollars per year.
National Headache Foundation – 2002


There remains a specific lack of public and professional awareness of the epidemiology of migraine and headache disorders and their impact on individual sufferers, their carers, family and colleagues, and on society itself.

World Health Organization – 2000


  • There is no known cure for the migraine disease, only treatments for the symptoms, which are not yet wholly effective.
Migraine Awareness Group – 2002


Dental appliances have been found to reduce the number of migraine attacks by about 60%, especially in those who get frequent attacks.

British Dental Journal – 1996

References to support soft tissue dysfunction and mouth breathing claims made:

  • Angle, E.H. Dr. – The Treatment of Malocclusion of the Teeth. Ed 7. Chapter 2. Saunders Philadelphia: 1907.
  • Graber T. – The Three M’s.Muscles, Malformation and Malocclusion. Am J Ortho Dentofac Orthop. 1963 June 418-450.
  • Wienstein S. – Minimal Forces in Tooth Movement. American Journal of Orthodontics 1967;53:881-903
  • Sakuda M. Ishizwa M. ? Study of the Lip Bumper. J. Dent. Res. 1970;49:667
  • Profit W.R. ? Lingual Pressure Patterns In The Transition From Tongue Thrust To Adult Swallowing. Arch Oral Biol. 1972;17:55-63
  • Harvold, E. D.D.S., Ph.D., L.L.D., Tomer, B. D.D.S., Karin Vargervik, D.D.S., and George Chierici, D.D.S.- Primate experiments on oral respiration. Am J Orthod. 1981 Apr;79(4):359-72.
  • Bresolin, D.D.S., M.S.D., Shapiro, P. D.D.S., M.S.D., Shapiro, G. M.D., Chapko, M K. Ph.D., and Dassel, S. M.D. Brasilia, D.F., Brazil, and Seattle, Wash.? – Mouth breathing in allergic children: Its relationship to dentofacial development. Am J Orthod. 1983 Apr;83(4):334-40.
  • Little, Riedel Artun, Am J Ortho Dentofac Orthop. May 1988. S. Linder- Aronson, D.G. Woodside, A. Lundstrom, and J.Mc. William – Mandibular and maxillary growth after changed mode of breathing. Am Journal Orthod Dentofac Orthop 1991;100:1-18.
  • Nevant C.T., Buschang P.H., Alexander R.G. and Steffen J.M. – Lip Bumper Therapy for Gaining Arch Length. (Am J Orthod Dentofac Orthop 1991;100:330-6)
  • Ram S. Nanda, DDS, MS, Phd, and Surender K. Nanda, DDS, MS. ? Considerations of dentofacial growth in long-term retention and stability: Is active retention needed?. American Journal of Orthodontics and Dentofacial Orthopedics April 1992.
  • Linder-Aronson, DDS, PhD, D. G. Woodside, DDSc, MSc(D), PhD(hc), E. Hellsing, DDS, PhD, and W. Emerson, DDS Huddinge, Sweden, Toronto, Canada, and Loma Linda, Calif. – Normalization of incisor position after adenoidectomy. Am J Orthod Dentofacial Orthop. 1993 May;103(5):412-27.
  • Gross, PhD, Kellum, PhD, Michas, BS, Franz, BA, Foster, MS, Walker, BA, and Bishop, DDS, MS. – Open-mouth posture and maxillary arch width in young children: A three-year evaluation.University, Miss. Am J Orthod Dentofac Orthop 1994;106:635-40.
  • Roberts WE, Hohlt WF, Arbuckle GR – The supporting structures and dental adaptation. In: Science and practice of occlusion. McNeill C (Ed). Quintessence, Chicago 1997, pp: 79-92.
  • Otopalik, Brown H, DDS., Am J Ortho Dentofac Orthop. Vol 113 No.6, June 1998.
  • Katherine W. L. Vig, BDS, MS, FDS, DOrth – Nasal Obstruction and Facial Growth: The Strength of Evidence for Clinical Assumptions. Am J Orthod Dentofacial Orthop 1998;113:603-11
  • Albert H. Owen III, DDS, MSD – Unexpected Temporomandibular Joint Findings During Fixed Appliance Therapy. Am J Orthod Dentofacial Orthop 1998;113:625-31
  • Ramirez-Ya’ez GO, Farrell C. – Soft Tissue Dysfunction: A missing clue when treating malocclusions. Int J Jaw Func Orthop (in press) 2005b.

References to support anti-in?ammatory diets claims made:

  • Seaman DR. The diet-induced pro-inflammatory state: a cause of chronic pain and other degenerative diseases? J Manipulative Physiol Ther. 2002; 25(3):168-79.
  • Seaman DR. Nutritional considerations for inflammation and pain. In: Liebenson CL. Editor. Rehabilitation of the spine: a practitioners manual. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2006: p.728-740.
  • Cordain L. The paleodiet. New York: John Wiley & Sons; 2002.
  • Cordain L, Eaton SB, Sebastian A et al. Origins and evolution of the western diet: Health implications for the 21st century. Am J Clin Nutr. 2005;81:341-54.
  • Simopoulos AP. Essential fatty acids in health and chronic disease. Am J Clin Nutr. 1999; 70(3 Suppl):560S-569S.
  • Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002; 21(6):495-505.
  • Cordain L. Cereal grains: humanity’s double-edged sword. World Rev Nutr Diet. 1999; 84:19–73.
  • Hadjivassiliou M et al.Headache and CNS white matter abnormalities associated with gluten sensitivity. Neurology. 2001; 56:385–388.
  • Hadjivassiliou M et al. Gluten sensitivity as a neurological illness. J Neurol Neurosurg Psychiatry. 2002; 72:560-63.
  • Hadjivassiliou M et al. Neuropathy associated with gluten sensitivity. J Neurol Neurosurg Psych. 2006; 77:1262-66.
  • Arnason JA et al. Do adults with high gliadin antibody concentrations have subclinical gluten intolerance? Gut. 1992; 33:194-197.
  • Van Heel DA et. Novel presentation of coeliac disease after following the Atkins’ low carbohydrate diet. Gut. 2005; 54:1342.
  • Cordain L, Toohey L, Smith MJ, Hickey MS. Modulation of immune function by dietary lectins in rheumatoid arthritis. Brit J Nutr. 2000; 83:207-17.
  • Freed DLJ. Lectins in food: their importance in health and disease. J Nutr Med. 1991; 2:45-64.
  • Cordain L, Friel J. The paleodiet for athletes. New York: Rodale; 2005.
  • Fallon S, Enig M. Nourishing traditions. 2nd ed. Washington, DC: New Trends Publishing; 2001.
  • Weaver KL et al. The content of favorable and unfavorable polyunsaturated fatty acids found in commonly eaten fish. J Am Diet Assoc. 2008; 108(7):1178-85.


References to support TMJ Problems links to pain, bruxism and sleep problems claims made:

  • Curr Opin Rheumatol. 2010 Jan;22(1):59-63.
    • Rheumatic manifestations of sleep disorders.
    • Moldofsky H.
    • Faculty of Medicine, University of Toronto, Canada.
  • J Oral Rehabil. 2008 Jul;35(7):476-94.
  • Bruxism physiology and pathology: an overview for clinicians.
    • Lavigne GJ, Khoury S, Abe S, Yamaguchi T, Raphael K.
    • Faculty of Dentistry, Surgery Department, Pain, Sleep and Trauma Unit, Université de Montréal, Hôpital du Sacré- Coeur de Montréal, Montréal, Canada.
  • Chest. 2008 Aug;134(2):332-7. Epub 2008 May 19.
    • A signi?cant increase in breathing amplitude precedes sleep bruxism.
    • Khoury S, Rouleau GA, Rompré PH, Mayer P, Montplaisir JY, Lavigne GJ.
    • Faculté de Médecine Dentaire, Université de Montréal, CP 6128, Succursale Centre-ville, Montréal, QC, Canada
  • Sleep. 2003 Jun 15;26(4):461-5.
    • Association between sleep bruxism, swallowing-related laryngeal movement, and sleep positions.
    • Miyawaki S, Lavigne GJ, Pierre M, Guitard F, Montplaisir JY, Kato T.
    • Facultés de médecine et de médecine dentaire, Université de Montréal, Québec, Canada.
  • Pediatr Neurol. 2008 Jul;39(1):6-11.
    • Polysomnographic ?ndings in children with headaches.
    • Vendrame M, Kaleyias J, Valencia I, Legido A, Kothare SV.
    • Section of Neurology, Department of Pediatrics, St. Christopher’s Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
  • Med Princ Pract. 2009;18(6):458-65. Epub 2009 Sep 30.
    • Habitual snoring in primary school children: prevalence and association with sleep-related disorders and school performance.
    • Sahin U, Ozturk O, Ozturk M, Songur N, Bircan A, Akkaya A.
  • Sleep Med. 2002 Nov;3(6):513-5.
    • Sleep bruxism related to obstructive sleep apnea: the effect of continuous positive airway pressure.
    • Oksenberg A, Arons E. • Sleep Disorders Unit, Loewenstein Hospital-Rehabilitation Center, P.O. Box 3, Raanana, Israel.
  • Int J Prosthodont. 2009 May-Jun;22(3):251-9. 
    • Effect of an adjustable mandibular advancement appliance on sleep bruxism: a crossover sleep laboratory study.
    • Landry-Schönbeck A, de Grandmont P, Rompré PH, Lavigne GJ.
    • Department of Prosthodontics, Faculty of Dental Medicine, Université de Montréal, Canada
  1. Head, Face and Neck Pain Science, Evaluation and Management: An Interdisciplinary Approach (late ’09) is by Noshir Mehta, G. Maloney, D Bana & S Scrivani.
  2. Orofacial Pain: From Basic Science to Clinical Management (’08)
  3. Travell’s Myofascial Pain & Dysfunction: The Trigger Point Manual  (Volume 1 – Upper Body) by Janet Travell, MD & David Simons, MD,
  4. Management of Temporomandibular & Occlusion (2008) by Jeffrey Okeson, DMD is a 6th Ed
  5. Evaluating & Managing Temporomandibular Injuries (3rd Ed) by Reda Abdel-Fattah, DDS
  6. Lights Out: Sleep, Sugar & Survival (2000)
  7. Sleep & Pain (‘07) by G Lavigne, DMD/PhD & B Sessle, MDS/PhD






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