The Importance of Nasal Breathing
Our nose is designed to prepare the air for the lungs. The nose warms, filters, accelerates, humidifies, and cleans the air, which leads to efficient oxygen exchange in the lungs. The mouth does none of this, and actually reduces oxygen absorption (1.4).
Nasal breathing also produces Nitric Oxide (1.1), an anti-inflammatory molecule that aids in immune function. Where as mouth breathing decreases immunity and causes inflammation throughout the body (1.2, 1.3).
Think about hyperventilation…what happens when you hyperventilate? You rapidly breathe through your mouth and do not receive the proper exchange of oxygen, which results in a negative effect all over. When you are mouth breathing (day or night) the body is sent into a constant fight or flight mode, which puts your adrenal glands on max 24/7.
Mouth Breathing: Concerns
Reduced Oxygen Absorption, Reduced Immunity, & Inflammation: (see previous slide)
Improper Jaw Development (2.1)
mouth breathing can lead to an elongated face, resulting in a gummy smile and/or recessed chin
it creates a narrow palate which leads to crowded and misaligned teeth; and possible airway restriction
it can change the entire structure of the face, affecting bone growth and causing malocclusion or altered bites
Snoring & Sleep Apnea - mouth breathing is often linked to snoring and can cause or worsen sleep apnea (2.1)
Dry Mouth - increases bad breath, gum disease, and cavities
Poor Posture & Pain - mouth breathing can lead to forward head posture, which puts strain on the neck and spine (2.2)
ADD/ADHD - since mouth breathing is typically associated with a sleep breathing disorder, this is one of the most common symptoms - especially in children.
Mouth Breathing: Primate Study
Two fascinating studies by Dr. Egil Harvold, published in the American Journal of Orthodontics and Dentofacial Orthopedics, observed young monkeys with plugged noses forcing them to adapt by mouth breathing.
This study found that ALL the monkeys who mouth breathed developed crooked teeth and poor jaws & facial development. Specifically, mouth breathing led to “a lowering of the chin, a steeper mandibular plane angle, and an increase in the gonial angle.” Their faces become long and narrow, with the jaw prominent and the chin recessed.
Mouth Breathing & Sleep-Breathing Disorders
Most times chronic mouth breathing is a symptom of a deeper problem: an underdeveloped jaw and a sleep-breathing disorder (these typically go hand in hand - improperly developed jaws usually result in SBDs) (3). Thankfully, this is a very correctable deformity and dysfunction in the oral and facial structure - especially if caught and treated early in childhood.
Other SDB Sypmtoms
ADD/ADHD
Bed Wetting
Delayed Speech
Overweight/Obesity
Learning Difficulties
Vertigo/Clumsiness
Restless Legs
Aggression/Defiance
Teeth Grinding
Snoring
Mouth Breathing
Daytime Sleepiness
Nightmares/Night Terrors
Allergies/Asthma
Anxiety
Frequent Illness
Stunted Growth
Crooked Teeth
Swollen Tonsils/Adenoids
Forward Head Posture
Recessed/Stunted Chin
Dark Circles Under the Eyes
Chronic Mouth Breathing: Possible Causes
An improperly functioning tongue/jaw due a tongue tie or weakened tongue
A tongue tie is a physical issue from birth, and very easily treatable. A weakened tongue and underdeveloped jaw is something that develops overtime due to a lack of proper strengthening and development, possibly due to a childhood diet of only soft foods, extended pacifier/bottle/sippy cup use, and thumb sucking, to name a few (4, 5, 6)
This is the most common, and can often times lead to the following other causes...
Sinus Polyps
Enlarged Tonsils and Adenoids
Underdeveloped Jaw
Asthma
Allergies
Deviated Septum
Mouth Breathing: Interventions
Treatment will vary depending on age and severity. If caught early during childhood, the treatment is often much more simple. Early correction for optimal child development will typically involve a TEAM approach of an airway centered & trained dentist, an ENT specialist, speech/myo therapist, body worker, and possibly orthodontist.
Possible treatments could include:
Tongue/Lip tie release
Tonsillectomy
Orthodontic/Palate Expansion
Myofunctional Therapy
Surgery in extreme cases
These are possible “band aids” that relieve symptoms in the interim, but do not solve the underlying problem:
Cpap machine (typically more so for adults)
Mouth Taping (recommended to consult provider first)
Mandibular Advacement Devices (MADs)
Mouth Breathing: Provider Resources
Tongue Tie Specific Providers:
If you are looking for a dentist specifically and extensively trained for tongue/lip ties find a Breathe Institute Affiliate near you: breatheaffiliates.com
If you are in the Woodland Hills, CA area Dr. Chelsea Pinto for babies
If you are in the Pelham, AL area Dr. Richard Baxter with the Alabama Tongue-Tie Center
Overall Jaw Development and Airway Providers:
If you are in the LA/Walnut Creek, CA area Dr. Soroush Zaghi is absolutely phenomenal for all things tongue/lip tie related, to sleep breathing disorders, to jaw development issues, and more.
Any provider who is trained under Airway Health Solutions airwayhealthsolutions.com/locator
If you are in the DFW area: Beyond Pediatric Dentistry for babies & kids; Dr. Hal Stewart for older kids & adults (they both are trained in tongue/lip ties as well)
Sources
1.1 Lundberg JO, Settergren G, Gelinder S, Lundberg JM, Alving K, Weitzberg E. Inhalation of nasally derived nitric oxide modulates pulmonary function in humans. Acta Physiol Scand. 1996 Dec;158(4):343-7. doi: 10.1046/j.1365-201X.1996.557321000.x. PMID: 8971255.
1.2 Edwards DA, Chung KF. Mouth breathing, dry air, and low water permeation promote inflammation, and activate neural pathways, by osmotic stresses acting on airway lining mucus. QRB Discov. 2023 Feb 14;4:e3. doi: 10.1017/qrd.2023.1. PMID: 37529032; PMCID: PMC10392678.
1.4 Mouth Breathing: Understanding the Pathophysiology of an oral habit and its consequences Ramirez-Yanez German O., DDS, MDSc, MSc, PhD
2.1 Lörinczi F, Vanderka M, Lörincziová D, Kushkestani M. Nose vs. mouth breathing- acute effect of different breathing regimens on muscular endurance. BMC Sports Sci Med Rehabil. 2024 Feb 9;16(1):42. doi: 10.1186/s13102-024-00840-6. PMID: 38336799; PMCID: PMC10858538.
2.2 Neiva PD, Kirkwood RN, Mendes PL, Zabjek K, Becker HG, Mathur S. Postural disorders in mouth breathing children: a systematic review. Braz J Phys Ther. 2018 Jan-Feb;22(1):7-19. doi: 10.1016/j.bjpt.2017.06.011. Epub 2017 Jul 5. PMID: 28709588; PMCID: PMC5816083.
3 Oeverland B, Akre H, Skatvedt O. Oral breathing in patients with sleep-related breathing disorders. Acta Otolaryngol. 2002 Sep;122(6):651-4. doi: 10.1080/000164802320396349. PMID: 12403129.
4 Caruso S, Nota A, Darvizeh A, Severino M, Gatto R, Tecco S. Poor oral habits and malocclusions after usage of orthodontic pacifiers: an observational study on 3-5 years old children. BMC Pediatr. 2019 Aug 22;19(1):294. doi: 10.1186/s12887-019-1668-3. PMID: 31438904; PMCID: PMC6706895.
5 Page DC. Breastfeeding is early functional jaw orthopedics (an introduction). Funct Orthod. 2001 Fall;18(3):24-7. PMID: 11799699.
6 Wagner Y, Heinrich-Weltzien R. Occlusal characteristics in 3-year-old children--results of a birth cohort study. BMC Oral Health. 2015 Aug 7;15:94. doi: 10.1186/s12903-015-0080-0. PMID: 26251128; PMCID: PMC4528377.
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