Lips are normally closed together when not speaking. If the lips are seen to be constantly apart, chances are that the nasal airway is impaired and the child
is mouth-breathing. If they are, it is possible that specific face changes will happen. When the mouth is held open to breathe, the tongue drops down
because the tongue is attached to the inside of the lower jaw, so it no longer rests against the roof of the mouth. The absence of tongue pressure on the
roof of the mouth causes the upper jaw not to widen from growth. This is made worse by the tightness of the cheeks against the outside surfaces of the
teeth caused by holding the mouth open, pushing inward on the upper teeth and causing them to narrow. Constant mouth-breathers tend to have narrow
upper jaws, which are easily recognized because one or both sides will be in crossbite, biting inside the lower teeth instead of outside.
Mouthbreathing may be because the nose if stuffy from allergies, or the nasal septum is deviated, or the adenoids are large, or the tonsils are large, or the
soft palate/uvula is oversized. Dentists can recognize long soft palate/uvula and large tonsils by depressing the tongue with a mouth mirror and telling the
child to say “Ahh”.
Large adenoids can be detected by the nasal sound of the speech, and can be viewed easily with an x-ray of the head. Parents can notice if the child snores,
which often accompanies throat airway problems.
It is not usually helpful to take a child’s airway problem to a pediatrician, because they are taught that tonsillectomy and adenoidectomy are to be avoided in
order to preserve a child’s ability for immunity in adulthood. They are taught little about the growth of the face and the adverse effect of a blocked airway
on the shape of the jaws and appearance of the face. It is often effective, however, to take a child to an ear-nose-throat specialist, because in general these
doctors will consider tonsil and adenoid surgery if medication does not suffice to keep the airway open.
If mouthbreathing has resulted in a narrow upper jaw, the jaw can be widened by an orthodontist using palatal expansion. It has been shown that widening
the upper jaw also widens the base of the nose and reduces nasal resistance, improving nasal airflow, and the most common reason orthodontists widen the
upper jaw is to correct crossbite(s) caused by a narrow upper jaw.
Mouthbreathing left undetected and untreated may result in a long thin face, with the chin more backward, and with the roof of the mouth apparently high
and narrow due to the failure of the jaw to widen because the tongue is too low.
©2011 James E. Eckhart, D.D.S., Inc.
1101 N. Sepulveda Blvd, Suite 202,
Manhattan Beach, Ca. 90266 (310) 546-4724
21210 Anza Ave., Torrance, CA 90503 (310) 540-5911
