Mouth Breathing

For years and years at Fiddlehead Dental we have been seeing children who's facial growth has been obviously effected by "mouth breathing". These kids have a classically long looking face. They always have a very high vaulted palate (roof of the mouth), narrow dental arch, and steep angle of the jaw. In medical terms this is called "adenoid facies". They also have a very tough time closing their lips over their teeth. All of these can develop into fairly unusual "cosmetic" problems as the child ages to adulthood.

These kids just don't breath (or can't breath) through their nose so the sinuses do not develop fully and extensively. I always use the analogy of the gymnast: Their bodies were not naturally going to be shaped like a pixey's, but because they start training at the age of 4, their bodies develop to match the stress and strain of gymnastics - form follows function. Usually, the "adenoid facies" kids can't breath and their sinuses don't develop because of large adenoids permanently blocking the airway. They almost always have a history of frequent ear aches and cold/sinus infections.

I'm sure our local pediatricians have wondered why a couple of dentists have been telling these kids' parents that they should consider having the adenoids removed...... What does a dentist know about ear, nose and throat problems, anyway?

Well,.. several months ago, I came across a professional journal article that adressed this precises topic and here is the abstract from a recent study:

"It has been maintained that because of large adenoids, nasal breathing is obstructed leading to mouth breathing and an 'adenoid face', characterized by an incompetent lip seal, a narrow upper dental arch, increased anterior face height, a steep mandibular plane angle, and a retrognathic mandible. This development has been explained as occurring by changes in head and tongue position and muscular balance. After adenoidectomy and change in head and tongue position, accelerated mandibular growth and closure of the mandibular plane angle have been reported. Children with obstructive sleep apnoea (OSA) have similar craniofacial characteristics as those with large adenoids and tonsils, and the first treatment of choice of OSA children is removal of adenoids and tonsils. It is probable that some children with an adenoid face would nowadays be diagnosed as having OSA. These children also have abnormal nocturnal growth hormone (GH) secretion and somatic growth impairment, which is normalized following adenotonsillectomy. It is hypothesized that decreased mandibular growth in adenoid face children is due to abnormal secretion of GH and its mediators. After normalization of hormonal status, ramus growth is enhanced by more intensive endochondral bone formation in the condylar cartilage and/or by appositional bone growth in the lower border of the mandible. This would, in part, explain the noted acceleration in the growth of the mandible and alteration in its growth direction, following the change in the mode of breathing after adenotonsillectomy."

So,... if your child has a very long looking face. They don't breath through their nose when sleeping. Their lips at rest cannot passively close and cover thier teeth. This might be something you want to look into. This is one orthodontic problem that is much better treated by age 8 before all the bones of the face are fully formed.