Does your child breathe through his or her mouth on a regular basis? If so, he or she may be suffering from an obstructed airway. The size and shape of the jaws, throat, tonsils, adenoids, and tongue can have enormous influence on one’s health and quality of life—especially for children. A size discrepancy in any of the above can cause complete or partial upper airway obstruction and result in health issues such as ADHD, bedwetting, sleep apnea, poor growth and development, and poor academics. A complete dental exam, including a survey of the back of the mouth and the throat, can detect abnormal findings at an early age and lead to beneficial life-altering outcomes.
A normal, healthy airway allows air to proceed easily and quietly from the nose to the lungs (nasal breathing). As the air passes through the nose, it is warmed, humidified, and filtered. Nitric oxide (NO), a potent gas and a key component for human health, is continuously excreted from the adjoining sinuses into the nasal passages. With nasal breathing, NO is carried from the nose to the lungs, where it does its work: relaxes blood vessel walls, prevents clotting, increases blood oxygen levels, kills bacteria and viruses, and transmits brain signals. (The discovery of the effect of nitric oxide on cardiovascular function won a Nobel Prize in 1998).
Because of these factors, nasal breathing is presently acknowledged to be vital to good health. Any obstruction along this airway will result in a complete or partial absence of nasal breathing and cause one to breathe through the mouth (mouth breathing). But mouth-inhaled air does not benefit the lungs and the body as does nasally inhaled air and can compromise your health.
The most common conditions that lead to mouth breathing are allergic rhinitis (hay fever), swollen tonsils and/or adenoids, and deviated nasal septum. Allergic rhinitis—swelling of the soft tissues in the nose—is the primary contributor to airway blockage. The allergens may be inhaled and/or consumed in foods. Allergies to house allergens (house dust, animal dander, etc.) will cause year-round symptoms, whereas allergies to pollens will cause seasonal nasal obstruction. The more chronic the condition leading to mouth breathing, the greater will be the impact on one’s health.
In children, enlarged tonsils and/or adenoids are also important causes of airway obstruction. Enlarged adenoids block the back of the nose which can result in nasal speech, post nasal discharge, coughing, vomiting, bad breath, and chronic mouth breathing. The opening into the Eustacian tubes (leading to the ears), which are adjacent to the adenoids, can also get blocked causing ear aches, fullness in the ears, and middle ear infections. Enlarged tonsils will also cause a physical obstruction of the airway and force the tongue down and forward (in order to mouth breathe), which leads to a malocclusion (bad bite), narrow upper and lower jaws, and a postural change.
The nasal septum—the wall that separates your nose down the middle—is composed of bone and cartilage. It usually separates the nose into two symmetrical nostrils. A deviated septum is one that deflects from side to side creating a large and a small nostril. Since nasal breathing cycles from one nostril to the other every 1 to 4 hours, only one nostril is open for maximum airflow at any one time. When it becomes time to breathe through the smaller nostril, partial nasal obstruction occurs. When a septum deviates from side to side and front to back, chronic nasal obstruction occurs.
Any obstruction that results in chronic mouth breathing can have many ill consequences. In addition to experiencing dry mouth and bad breath, the air that is inhaled through the mouth bypasses the warming, humidifying, and filtering functions of nasally inhaled air. Therefore tissues are cooler, drier, and more easily infected. Also, the beneficial and protective effects of nitric oxide (NO) are absent. Blood gas studies indicate a 20 percent drop in oxygen levels and a 20 percent rise in carbon dioxide levels in mouth breathers. Therefore, mouth breathers are more easily fatigued and exhausted.
This long-term reduction in oxygen saturation can also lead to hypertension, a malfunctioning of the lungs, and an enlargement of the right ventricle of the heart. Furthermore, snoring and sleep apnea are very prevalent in individuals who mouth breath. This disruption in sleep can result in bedwetting. This breathing pattern will also influence an individual’s physical appearance. Chronic mouth breathers will exhibit postural changes (head tilted backwards), develop crooked teeth, and incur deformities of the jaws and skull that lead to the “long face syndrome.” These individuals are often well below their peers in height and weight.
Enlarged adenoids and tonsils are the primary reason for snoring and sleep apnea in children. Research at the University of Michigan has indicated that a child who snores regularly is four times more likely to exhibit symptoms of ADHD. An obstructed airway at night will reduce the amount of oxygen that gets to the brain. The consequences may be disturbed sleep (moving violently), problems waking up, being easily fatigued, getting morning headaches, and exhibiting daytime behavior problems that might include irritability, hyperactivity, and being easily distracted. One study even found that a child who snored was more likely to exhibit poor academic performance in middle school. These children are often misdiagnosed with ADHD and placed on stimulant drugs such as Adderall or Ritalin.
An obstructed airway also can lead to bedwetting. If a child has been toilet trained and suddenly begins bedwetting again, it may be due to an obstructed airway. When a child with breathing problems finally falls asleep, the sleep is so deep that they lose bladder control.
All of these health problems can usually be eliminated by correcting the airway obstruction and establishing good nasal breathing. Nine out of ten times, the removal of tonsils and adenoids will cure sleep apnea and eliminate related health and behavioral issues. When the airway obstruction is caused by allergies, an allergist should be consulted. If these are not found to be responsible for the mouth breathing, then referral to an ENT is necessary to evaluate the nasal septum.
Even after the obstruction to nasal breathing is corrected by medication or surgery, the individual may still continue to mouth breathe. In order to breathe nasally, the tongue must be positioned in the roof of the mouth. But, in cases of chronic obstruction, the individuals wind up with narrow and small jaws. If the upper jaw is too narrow, the tongue will not have enough room to rest in the roof of the mouth and mouth breathing will continue. Functional orthodontics is then required to expand the jaws and create a resting place for the tongue. When the tongue is positioned in the palate, then mouth breathing cannot occur. In some cases, myofunctional therapy is also necessary to retrain the tongue to rest in the palate so that nasal breathing can easily occur 24/7.
Talk to your dentist about your child’s breathing habits. Remember nasal breathing is the main goal and an absolute necessity for achieving good health and a long productive life.
Paul LeTellier, DDS, graduated with highest honors from Case Western Reserve University. He is a member of the American Dental Assn., the Virginia Dental Assn., the Tidewater Dental Assn., the Academy of General Dentistry, the American Academy of Implant Dentistry, and the Dental Organization for Conscious Sedation. He practices family and implant dentistry in Chesapeake. For more information, visit chesapeakefamilydentistry.com or call 757-436-0026.