Infants and children naturally breathe through their noses. However, internal and external stressors may often cause them to begin to breathe through their mouths. In a world where stressors are becoming increasingly ubiquitous, many children are developing a bad habit of mouth breathing. But unfortunately, many parents are not aware that habitual mouth breathing can cause changes in the way their child’s face and teeth develop, resulting in crooked teeth, a narrower jaw, a receding chin, and a constriction of the airways in the nose and throat.

John Mew, an English professor and odontologist, states that: – More than 50 per cent of four-year-olds today breathe through their mouths most of the time!

Allergy led to mouth breathing and poor facial development

Images published with agreement of Professor John Mew.

The photograph on the left shows a boy at the age of ten. He breathes through his nose and has a well-developed face. Everything is proportional and the boy has well-defined eyes, cheekbones, lips and chin. When he was 14, he got a gerbil and developed an allergy that left him with a stuffy nose, which caused him to start breathing through his mouth.

The photos in the middle and on the right show the same boy at the age of 17. Breathing through his mouth caused his face to grow downward instead of forward, making his face long and narrow. His nose looks larger and his chin is narrow because his upper and lower jaws did not grow forward.

Facial changes caused by mouth breathing lead to constricted breathing passages that in turn may lead to snoring and sleep apnea.

Braces and pulling teeth will not solve the underlying problem

When prominent Australian dentist John Flutter noticed that the corrections he made to his patients were not having a lasting effect, he started looking at alternatives to braces and pulling teeth.

Dr Flutter, who has lectured in 65 countries all over the world, says:

– I no longer pull teeth or install braces. Pulling teeth leads to smaller jaws and airways. Braces prevent the jaw from growing forward, which also leads to smaller airways. The single most important thing you can do to improve a child’s health is to establish nasal breathing.

The conclusion Dr Flutter and many other dentists and orthodontists have arrived at is that the way we breathe and swallow, as well as our posture, can affect the development of our jaws, teeth and faces. The five most important factors for the healthy development of the face, teeth and airways are:

Breathing should be in and out through the nose. At rest, the mouth should be closed with the lips together. The tongue should rest against the palate. Only the tongue should be active when swallowing. Posture should be erect.

The sooner nasal breathing is established, the better

The earlier in life that the bad habit of breathing through the mouth is established, the bigger the risk that the face, teeth and airways will be affected negatively. The development of the face is 90 percent complete by early adolescence. It is, therefore, desirable to establish nasal breathing, correct swallowing, and good posture as early in life as possible.

Images published with agreement of Dr. John Flutter.

An article by Yosh Jefferson in the publication General Dentist reports:

– Children who are not treated for mouth breathing can develop long, thin faces, thin mouths, high palate, crooked teeth, exposure of the gums when smiling, etc. These children sleep worse at night due to the blocked airways and the lack of sleep can affect their growth and academic performance negatively. Many of these children are incorrectly diagnosed with ADD and hyperactivity.

Jefferson further states:

– If mouth breathing is treated early, its negative effects on facial and dental development, and their associated medical and social problems can be reduced or avoided.

The bone in the upper jaw (maxilla) gives the face its form

The upper jawbone (the maxilla) is a large bone that sits in the middle of the face and runs from the teeth up to the eyes, and hence largely determines facial appearance.

A common consequence of mouth breathing is that the upper jawbone grows downward and backward instead of forward and to the sides, resulting in a narrow upper jaw and face.

Since the maxilla comprises 85% of the nasal passages, an underdeveloped upper jaw results in more constricted nasal passages. This creates a vicious circle, in which it becomes harder and harder to breathe through the nose.

The tongue affects the shape of the maxilla

A well-developed upper jaw has a broad palate and low arch. The tongue’s natural resting place is up against the palate, where the tip of the tongue rests behind the front teeth. The teeth develop around the tongue and the upper jaw develops to the front and sides, stimulated by the tongue’s position behind the teeth and against the upper palate.

In mouth breathing, the tongue is placed in the middle of the mouth, or down in the oral cavity in order to allow air to pass in and out through the mouth, which has a negative effect on the development of the bone in the upper jaw.

Instead of being U-shaped, the palate becomes more V-shaped, making it hard for the teeth to fit. This also leads to the teeth not closing tightly against each other when biting.

U-shaped maxilla V-shaped maxilla

The tongue and lips affect the position of the teeth

The tongue is one of the strongest muscles in our body. Even the cheeks and lips are strong muscles. Every day, a person swallows about two thousand times. When we swallow normally only the tongue is active. It already rests against the palate, and when we swallow it presses up against it, stimulating the upper jaw.

Considering that the powerful tongue pushes up towards the palate each time we swallow with a force of up to half a kilogram, we can see that the upper jaw is stimulated with the pressure of quite a few kilograms over the course of a day.

The muscles in the tongue, cheeks and lips determine the positioning of the teeth in both the upper and lower jaw. These muscles work in a similar way that braces do — light pressure applied over longer periods has the ability to move a tooth.

When swallowing incorrectly, we use more muscles than just the tongue, and the tongue’s force is directed elsewhere rather than up against the palate.

This not only leads to under stimulation of the palate and a more crowded upper jaw, it can also affect the positioning of all the teeth in a negative way, which can result in crooked teeth.

Test your child’s swallowing pattern: Ask your child to drink a glass of water. If the water “swirls around” once or more in the mouth before being swallowed, this is an indication that the lips, cheeks and/or tongue are being overused when swallowing, which has a negative impact on the development of the teeth, face and airways in the nose and throat.

Dr Raymond Silkman states:

– The most important braces we all have with us, 24 hours a day, is our tongue.

Another dentist with long experience of the impact of breathing on dental positioning is is Dr, William Hang. Dr Hangs opinion is:

– Don’t wait to start treatment until teenage years. By that time, the majority of the face has finished developing and changes are harder to make. The earlier good breathing and swallowing habits are established, the better the results.

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What can I do for my children?

Improve your own breathing . Since children tend to do as we do, not as we say, you can inspire your child by following the advices below to establishing good breathing habits for yourself.

. Since children tend to do as we do, not as we say, you can inspire your child by following the advices below to establishing good breathing habits for yourself. Inform . Help your children become more aware of their breathing in different situations. Encourage them to pay attention to the five important factors listed above – keeping their mouth closed and breathing through their nose as often as possible, resting their tongue up against the palate, swallowing in a relaxed manner, and maintaining an upright posture.

. Help your children become more aware of their breathing in different situations. Encourage them to pay attention to the five important factors listed above – keeping their mouth closed and breathing through their nose as often as possible, resting their tongue up against the palate, swallowing in a relaxed manner, and maintaining an upright posture. Tape their mouths at night . Tape your children’s mouth with Sleep Tape. It is important this is done without coercion, as the aim is to lower their stress, not increase it. Try to make your child curious and keep the whole thing playful. For example, you could tape up your mouths at the same time. Let them try it for a bit before going to bed, to get used to it. I do not recommend taping the mouths of children under the age of five. Read about 13-year-old Lisas experience – Lower jaw is back in place and no braces needed thanks to the Sleep Tape. Please note! All mouth taping at night is done at your own risk.

. Tape your children’s mouth with Sleep Tape. It is important this is done without coercion, as the aim is to lower their stress, not increase it. Try to make your child curious and keep the whole thing playful. For example, you could tape up your mouths at the same time. Let them try it for a bit before going to bed, to get used to it. I do not recommend taping the mouths of children under the age of five. Read about 13-year-old Lisas experience – Lower jaw is back in place and no braces needed thanks to the Sleep Tape. Prolong exhalation . Exhalation is linked to relaxation and recovery, which is very important in today’s stressful society. Improved exhalation usually leads to improved inhalation. Using the Relaxator Breathing Retrainer helps you inhale a lower (not bigger) breath and prolongs the exhalation, promoting a more rhythmical breathing pattern. It is an excellent way to improve breathing, especially when in front of the computer, TV, doing homework, etc. The Relaxator is not recommended for use by children under the age of five.

. Exhalation is linked to relaxation and recovery, which is very important in today’s stressful society. Improved exhalation usually leads to improved inhalation. Using the Relaxator Breathing Retrainer helps you inhale a lower (not bigger) breath and prolongs the exhalation, promoting a more rhythmical breathing pattern. It is an excellent way to improve breathing, especially when in front of the computer, TV, doing homework, etc. The Relaxator is not recommended for use by children under the age of five. Reduce the amount of foods that constrict the airways . Foods that lead to increased phlegm production result in more constricted airways, which can cause throat clearing or a runny nose. Wheat, dairy products, candy, ice cream, cookies, and refined carbohydrates, such as pasta, are examples of products that could cause increased phlegm production.

. Foods that lead to increased phlegm production result in more constricted airways, which can cause throat clearing or a runny nose. Wheat, dairy products, candy, ice cream, cookies, and refined carbohydrates, such as pasta, are examples of products that could cause increased phlegm production. Inspire the children to chew the food . The muscles in our jaw are very powerful and they need to be used or else they will be under stimulated. When we chew we stimulate the jaw (and also the other 28 skeletal bones in the cranium). We also release enzymes that facilitate digestion and improve nutrient uptake. A lot of the food we eat today is too easy to chew and/or we eat too fast to keep up with our busy schedule. This makes our jaw under stimulated which can lead to poor nutrient uptake and grinding teeth while sleeping. So inspire your children to eat slow, chew the food and eat food that exercises the jaw, for example vegetables.

. The muscles in our jaw are very powerful and they need to be used or else they will be under stimulated. When we chew we stimulate the jaw (and also the other 28 skeletal bones in the cranium). We also release enzymes that facilitate digestion and improve nutrient uptake. A lot of the food we eat today is too easy to chew and/or we eat too fast to keep up with our busy schedule. This makes our jaw under stimulated which can lead to poor nutrient uptake and grinding teeth while sleeping. So inspire your children to eat slow, chew the food and eat food that exercises the jaw, for example vegetables. Cut off the tongue frenum . Between 5-10 precent of all children are born with a tongue cord that is too short, also called tongue tie. When the movement of the tongue is restricted it cannot rest in the roof of the mouth as it is supposed to. This has a negative impact on breathing and swallowing and consequently the development of the teeth and face. A newborn may have problems breast feeding and get stomach pain because it swallows too much air when eating. As the child grows older speech problems may occur. To cut the tongue tie is a quick procedure. Is it cut by a scissor or by using laser. No anesthesia is needed.

. Between 5-10 precent of all children are born with a tongue cord that is too short, also called tongue tie. When the movement of the tongue is restricted it cannot rest in the roof of the mouth as it is supposed to. This has a negative impact on breathing and swallowing and consequently the development of the teeth and face. A newborn may have problems breast feeding and get stomach pain because it swallows too much air when eating. As the child grows older speech problems may occur. To cut the tongue tie is a quick procedure. Is it cut by a scissor or by using laser. No anesthesia is needed. Physical activity with a closed mouth . If your children spend a lot of time in front of a computer or TV, encourage them to participate in physical activities with their mouths closed. Children who already participate in high intensity activities like football or basketball, may play with an open mouth, which can become a habit also outside of the training arena. Try to stimulate them to exercise with a closed mouth as often as possible. Helping them shift into the habit of nasal breathing usually goes faster than you would think.

. If your children spend a lot of time in front of a computer or TV, encourage them to participate in physical activities with their mouths closed. Children who already participate in high intensity activities like football or basketball, may play with an open mouth, which can become a habit also outside of the training arena. Try to stimulate them to exercise with a closed mouth as often as possible. Helping them shift into the habit of nasal breathing usually goes faster than you would think. Improve the posture . Make your child aware of their posture when sitting, walking, running, eating, reading, studying, watching TV, sitting in front of the computer, playing video games, using the cell phone etc. A great (and fun) exercise to improve the posture is to fill a half a saucepan with water and then put it on the head and a) walk around with it for one minute and b) sit down and rise up from a chair ten times, without spilling out the water.

. Make your child aware of their posture when sitting, walking, running, eating, reading, studying, watching TV, sitting in front of the computer, playing video games, using the cell phone etc. A great (and fun) exercise to improve the posture is to fill a half a saucepan with water and then put it on the head and a) walk around with it for one minute and b) sit down and rise up from a chair ten times, without spilling out the water. Avoid bottle feeding over breast feeding . It is easier to get liquid from a bottle compared to the breast. The flow from the bottle is faster and doesn’t require the baby to hold steady to be able to suck. With a bottle the child can eat and then abort in order to breathe through the mouth in a much easier way compared to the breast, which require a constant sucking. If a child refuses to breast feed there is a great chance that they have a blocked nose.

. It is easier to get liquid from a bottle compared to the breast. The flow from the bottle is faster and doesn’t require the baby to hold steady to be able to suck. With a bottle the child can eat and then abort in order to breathe through the mouth in a much easier way compared to the breast, which require a constant sucking. If a child refuses to breast feed there is a great chance that they have a blocked nose. Avoid pacifier and thumb sucking . Although at first sight, a pacifier or sucking the thumb might seem like a good idea since the mouth is closed and the breathing occurs in and out through the nose. It is indeed true, but the negative impact overrides the positive. The tongues is forced back and doesn’t rest up in the palate as it is supposed to, instead the pacifier or the thumb takes its place. This establishes erroneous sucking- and swallowing reflexes. When the child wants comfort with a pacifier or by sucking the thumb try instead to get him or here to close the mouth and let the tongue rest in the roof of the mouth. This stimuli of the palate, with the tongue, makes the child feel safe.

. Although at first sight, a pacifier or sucking the thumb might seem like a good idea since the mouth is closed and the breathing occurs in and out through the nose. It is indeed true, but the negative impact overrides the positive. The tongues is forced back and doesn’t rest up in the palate as it is supposed to, instead the pacifier or the thumb takes its place. This establishes erroneous sucking- and swallowing reflexes. When the child wants comfort with a pacifier or by sucking the thumb try instead to get him or here to close the mouth and let the tongue rest in the roof of the mouth. This stimuli of the palate, with the tongue, makes the child feel safe. Expanding the upper jaw. The width and length of the upper jaw can be changed at any age, and you can accomplish this by using a so-called expander, which is fitted and placed in the palate by an orthodontist. A slow expansion over a six to eight month period is preferable to a fast expansion over a two to three month period, as the latter runs the risk of regression. Be sure to research the available options if you decide to see an orthodontist about this. Crooked teeth are a symptom, not a cause, so it is not just about straightening them out; the specialist should also be able to see and determine the effects of the treatment on the development of the face as a whole. Another option is to use the Myobrace for Kids and Teens™ that can be purchased on the Internet. This is a removable appliance that is placed in your childs mouth during sleep and 1-2 hours during the day. The treatment period is usually 12 months.

Prevent crooked teeth and breathing difficulties in children

Below is a highly interesting 15-minute video with Dr John Flutter when he gave a speech at the Karolinska Insitute in Sweden (where they issue the Nobel Prize in Medicine) in 2014 “Mouth breathing has negative impact on our teeth, smile and facial development”

What can be done for adults?

Since up to 90% of facial development is concluded by early adolescence, the chances of making lasting changes is better if begun before adolescence. However, adults may also be helped with an expansion appliance for example Myobrace for Adults™, taping the mouth at night, chew more and several of the other advices listed above for children. Veronica Ingemarsson is an example of this, and you can read about her experience here – Taped mouth at night straightened out my front tooth!

This article is based on the book “The Power of Your Breath“

For those who want to find out more