The nose has a purpose, and we need to use it. I have previously discussed common causes of mouth breathing in kids. However, many people do not understand that there are long-term consequences of mouth breathing.
One of my favorite ways that I have heard mouth breathing described is that it is an incorrect form of respiration! That gets right to the point. It is not normal to mouth breathe. It is indeed common, but that does not make it normal.
I frequently hear that kids mouth breathe out of habit, but I believe that should be considered rare. Infants are born breathing through their noses, so something happens along the way to teach kids to keep their mouths open.
Of course, there are structural jaw problems at birth that always require kids to keep their mouths open. This diagnosis would have been readily made and treatment plans discussed.
Regardless of why the mouth is open, it is important to understand that there are significant health consequences.
It is very common for parents to be unaware of whether their children chronically breathe through their mouth or not. When I interview parents, I often ask if their child mouth breathes.
After they tell me “no”, I simply say “take a look at your child’s lips that are open now”. Often a surprising discovery for parents.
Parents sometimes become so used to their child’s mouth being open that they do not see it anymore.
I strongly suggest you simply acknowledge whenever you see your child’s lips parted. It does not have to be a mouth gaping wide open because parted lips are still mouth breathing! When you look for it, you may notice it occurs much more often than you think.
It is important to identify that chronic mouth breathing is present because parents can then seek medical help to attempt to find the cause and treat it before significant consequences of mouth breathing occur.
Common consequences of mouth breathing
When the nose is stuffy, mouth breathers are often very loud eaters because they try to chew and breathe through the same opening. Many parents have not considered this and later feel bad for constantly reprimanding children for chewing with their mouths open or smacking while eating. Kids are often just figuring out how to eat without suffocating!
In general, mouth breathers are noisier. You can often hear them breathing when they are sitting still. Constant vibrations of the soft tissues in the mouth can be disruptive in school or embarrassing for older kids.
Dry Chapped Lips
When we breathe in and out through our mouths, air is constantly traveling over our lips. Our lips are supposed to be moistened so when they become dry, they crack. Who has not experienced the misery of dry, cracked lips?
We often address this problem by using vaseline, which is fantastic for this situation, but please remember to NEVER put vaseline IN your nose! Dry chapped lips launched the chapstick industry! Most of us only use chapstick when we have a cold, during temporary mouth breathing. However, chronic nasal congestion leads many people to use chapstick almost daily.
My daughters both have severe allergies which have been treated their whole lives. Early in life, they were mouth breathers and often had chapped lips. I am a Pediatric ENT physician and was NOT having it! So my girls learned that an important part of getting dressed each day included applying chapstick.
As they got older, they carried it in their purses. Their allergies are now well controlled but….chapstick is still a staple for our family. My daughters have told me that I made them addicted to chapstick. I guess that is better than cracked and raw lips.
As they travel around the world, they have learned that chapstick is not always easy to find. So, like a good Momma Addict, I made sure to buy some in bulk. I guess there are worse problems to have!
Dark Circles Under the Eyes
Everyone has their own explanation for why they think dark circles are present. In adults, an extremely common reason is poor sleep! We understand that we get bags under our eyes when we are tired.
But when our kids get these same dark puffy areas under their eyes, we get concerned. Pediatricians are often asked if a serious medical problem is causing them. Dr. Kristen Stuppy, an experienced pediatrician, has discussed the many causes of this problem in her post entitled: Dark Under Eye Circles.
Many people call the dark circles “allergic shiners”, but anything that causes nasal congestion can cause the same result. Sometimes, allergy symptoms are present that you have not considered or counted as true allergies. But they are and may need to be addressed!
I must tell you the great majority of my pediatric ENT patients have parents concerned about these dark circles. In looking back at old pictures, the size and darkness can be seen as worsening over time. Parents often report that their kids look tired all the time despite sleeping well. The dark circles are readily seen, but mouth breathing is often overlooked.
My simple way of explaining this issue to parents is that blood vessels in the skin under the eyes drain into the blood vessels inside the nose. So when we have a cold or sinus infection, we expect to see dark puffy tissue under our eyes. As the nose congestion improves the swelling and dark circles disappear.
But when we have chronically congested noses, the blood “sort of” stays backed up all the time. Like the dark varicose veins in the legs. (Okay, so it is not really the same thing but when a vein does not drain the way it supposed to, it fills up and turns the overlying skin bluish). After I treat the allergies or other nasal problems, it is amazing how quickly the dark circles fade.
Dental health problems are a major group of consequences of mouth breathing.
Normally when the mouth is closed, saliva continuously washes bacteria from the mouth. When the mouth is held open, saliva dries and bacteria can more readily take hold and cause problems like cavities. Saliva is important in removing bacteria and neutralizing acids, so when the amount is reduced, tooth decay increases.
Gingivitis and Gum Disease
As mentioned above, the consequences of mouth breathing include a dry mouth with reduced saliva function. Just as dry lips can crack, dry mucous membranes also crack and allow bacteria to penetrate. Mouth breathers often have chronically red and inflamed gums, even if their oral health is otherwise good.
Sometimes, gingivitis can progress to bleeding gums and ultimately losing teeth. Some dentists have recommended rubbing vitamin E on gums at night to prevent drying and promote healing! Long-term, gum disease has been linked to serious health issues like heart disease, strokes, and even dementia.
Saliva has many functions to help keep our bodies healthy. One major function is to fight infection by killing or washing away bacteria. Mouth breathers have increased bacteria build up which can lead to bad breath.
A dry mouth has a much greater risk of bad breath. Many people are used to bad breath in the morning when they have collected bacterial all night, however, mouth breathers often have bad breath all day.
According to one study, over 50% of mouth breathing children had strong bad breath while many others had mild to moderate odor. Less than 25% of mouth breathing children had no bad breath at all.
Abnormal Jaw Development
When the mouth is held open chronically, the muscle pull changes the way bone is formed. Dentists believe that the open posture encourages the upper jaw to grow more than the lower jaw. This can result in a large overbite and “gummy” smile.
Additionally, kids who mouth breathe chronically are more likely to have long faces and jaws which are not lined up evenly.
Poor jaw positioning due to mouth breathing may also lead to jaw pain, teeth grinding or cause abnormal teeth alignment when biting.
Abnormal Teeth Development
Chronic mouth breathing may lead to permanent changes in the jaw as mentioned above, but it also can directly impact the teeth. When the mouth is held open, the tongue is not placed in its natural place next to the roof of the mouth.
Normally the tongue is positioned in a closed mouth so that the dental ridge of bone forms around it in a U-shape. When the tongue rests only in the bottom jaw and does not press against the upper jaw, the dental ridge often forms a V-shape.
Since a V is more narrow than a U, there is not enough room for the teeth to grow, so there is a greater chance of overcrowding. Sometimes this overcrowding can be so severe that before braces can be placed to straighten the teeth, a palatal expander is needed to covert the V to a U to make more room.
Mouth breathing can dry out the entire airway, not just the mouth. If the vocal cords become dry, a hoarse-sounding voice can occur.
Remember the abnormal tongue position that I described with mouth breathing? Well, mouth breathers have an increased incidence of speech problems, especially a lisp. A lisp commonly affects a person’s ability to say the letter “s,” making the letter sound more like “th” when spoken.
There are many types of lisps and other speech disorders due to abnormal control of muscles in and around the mouth. I have partnered with an amazing orofacial myologist who specializes in helping children with a variety of speech issues due to chronic mouth breathing. If you are in the Atlanta area, be sure to check out Meredith White to help your child!
Can poor behavior and school performance be consequences of mouth breathing?
An important study found that mouth breathing and snoring in kids as young as 6 months can lead to a significantly increased risk of the development of behavioral and social problems by the age of seven.
The reason is felt to be related to the poor quality sleep during this early critical period of brain development when a child needs the most sleep.
The study helps to stress the importance of investigating and managing mouth breathing in children as young as 6 months old!
Mouth breathing alone is bad but when combined with snoring, it makes long-term problems more likely. If your child has these issues, you might want to seek an evaluation to discuss this with your child’s pediatrician.
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