Normal nasal breathing plays a crucial role in craniofacial development, dental arch formation, and sleep quality. When children develop a persistent habit of mouth breathing, significant functional and structural alterations may occur.
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This article reviews the causes, oral consequences, treatment options, and systemic effects of mouth breathing in pediatric patients.
✅ Causes of Mouth Breathing in Children
Mouth breathing may result from functional, anatomical, or habitual factors, often acting simultaneously.
➤ Upper Airway Obstruction
▪️ Adenoid and tonsillar hypertrophy
▪️ Chronic allergic rhinitis
▪️ Deviated nasal septum
▪️ Chronic sinusitis
These conditions increase nasal airway resistance, forcing the child to breathe through the mouth.
➤ Orofacial Muscle Dysfunction
Low tongue posture and altered lip seal compromise nasal airflow and promote mouth breathing.
➤ Prolonged Oral Habits
Pacifier use, thumb sucking, and bottle feeding beyond early childhood may predispose to altered breathing patterns.
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Persistent mouth breathing disrupts the equilibrium between muscles and skeletal structures.
Key craniofacial consequences include:
▪️ Long face syndrome (dolichofacial pattern)
▪️ Narrow maxillary arch and high-arched palate
▪️ Posterior crossbite
▪️ Retrognathic mandible
▪️ Increased lower facial height
These changes result from altered tongue posture and reduced lateral forces on the maxilla during growth.
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Mouth breathing negatively affects oral health due to continuous airflow and reduced salivary protection.
Common oral manifestations include:
▪️ Anterior open bite
▪️ Increased overjet
▪️ Dental crowding
▪️ Higher caries risk
▪️ Gingivitis and periodontal inflammation
▪️ Dry lips and angular cheilitis
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Mouth breathing is strongly associated with sleep-disordered breathing, including pediatric obstructive sleep apnea.
Sleep-related consequences include:
▪️ Fragmented sleep
▪️ Snoring and nocturnal hypoxia
▪️ Daytime fatigue
▪️ Reduced attention span and learning difficulties
▪️ Behavioral problems
Chronic sleep disruption can negatively affect growth hormone secretion and immune function.
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Diagnosis requires a multidisciplinary approach, combining:
▪️ Clinical examination
▪️ Parental history
▪️ Nasal airflow tests
▪️ Cephalometric analysis
▪️ ENT evaluation
Early identification is critical to prevent irreversible skeletal changes
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Effective management focuses on eliminating the underlying cause and restoring nasal breathing.
➤ Medical and Surgical Management
▪️ Adenoidectomy or tonsillectomy (when indicated)
▪️ Management of allergic rhinitis
▪️ Nasal obstruction correction
➤ Orthodontic and Orthopedic Interventions
▪️ Rapid maxillary expansion to increase nasal airway volume
▪️ Functional appliances to guide jaw growth
➤ Myofunctional Therapy
Exercises aimed at correcting tongue posture, lip competence, and swallowing patterns.
📊 Comparative Table: Key Clinical Aspects of Mouth Breathing in Children
| Clinical Factor | Clinical Implications | Clinical Considerations |
|---|---|---|
| Adenoid Hypertrophy | Primary cause of nasal obstruction and mouth breathing | Requires ENT evaluation for surgical indication |
| High-Arched Palate | Associated with reduced nasal airway volume | May require orthopedic maxillary expansion |
| Sleep-Disordered Breathing | Impairs cognitive development and behavior | Often underdiagnosed in pediatric patients |
| Myofunctional Dysfunction | Maintains altered breathing pattern | Requires long-term therapy and compliance |
Mouth breathing represents a multifactorial condition with significant orthodontic, functional, and systemic implications. Its impact on facial growth is well documented, particularly when it occurs during critical growth periods. Early diagnosis and interdisciplinary management are essential to prevent long-term skeletal alterations and improve sleep quality.
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Chronic mouth breathing in children adversely affects facial development, oral health, and sleep quality. Addressing its causes early allows for more favorable craniofacial growth, improved airway function, and better overall health outcomes.
🎯 Recommendations
▪️ Screen children early for breathing pattern alterations
▪️ Refer to ENT specialists when airway obstruction is suspected
▪️ Incorporate orthodontic and myofunctional therapy when indicated
▪️ Educate parents about the importance of nasal breathing
▪️ Monitor sleep quality and behavioral changes
📚 References
✔ Guilleminault, C., Huang, Y. S., Monteyrol, P. J., Sato, R., & Quo, S. (2013). Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Medicine, 14(6), 518–525. https://doi.org/10.1016/j.sleep.2013.01.016
✔ Harari, D., Redlich, M., & Miri, S. (2010). The effect of mouth breathing versus nasal breathing on dentofacial and craniofacial development in orthodontic patients. Laryngoscope, 120(10), 2089–2093. https://doi.org/10.1002/lary.21045
✔ Katyal, V., Pamula, Y., Martin, A. J., Daynes, C. N., Kennedy, J. D., & Sampson, W. J. (2013). Craniofacial and upper airway morphology in pediatric sleep-disordered breathing. American Journal of Orthodontics and Dentofacial Orthopedics, 143(1), 20–30. https://doi.org/10.1016/j.ajodo.2012.08.020
✔ Souki, B. Q., Lopes, P. B., Pereira, T. B., Franco, L. P., & Becker, H. M. G. (2009). Mouth breathing children and cephalometric pattern: Does the respiratory mode affect craniofacial growth? Angle Orthodontist, 79(3), 430–436. https://doi.org/10.2319/021508-77.1
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