MOUTH BREATHING AND FACIAL DEFORMITY

Breathing to humans is like sunlight to a tree. It is necessary for life. A tree normally grows straight toward the midday sun; therefore, it is easy to recognize a tree that has received sunlight only from the west. The trunk and its branches adapt to the need for additional sunlight by bending to the west. This adaptation causes a bend in the tree trunk and there is little foliage on the eastern side of the tree. Soon the bend is permanent, and even if obstruction of sunlight is removed, the tree is permanently deformed.

Humans breathe to survive, and when the normal nasal mode of breathing is diminished, the survival system automatically programs us to breathe through our mouths. Much like the tree and its needs for sunlight, there is a total adaptation of the system to enhance the intake of air. The tongue, which is normally placed in the roof of the mouth, drops to the floor of the mouth to allow air to pass into the back of the throat. When the mouth opens, all the muscles that control head, neck, jaw, and tongue posture must adapt. As a result, the affected parts grow abnormally. The earlier in life this adaptation occurs, the greater the alternation in the facial growth of the child.

The medical and the dental professions have long championed disease prevention. Children are inoculated against whooping cough, tentanus, typhoid, small pox, diptheria, and measles. Fluoride and plaque-controlling techniques have done much to control dental disease. We are also protected from disease by water purification and pasteurization of milk. However, most of these preventative measures were not readily accepted. It took years for fluoride to be recognized as a safe and effective method for controlling dental decay, just as it took years for immunization to become routine medical practice. Likewise, the recognition of the ill effects of chronic mouth breathing in the medical and dental professions has lagged behind the acquisition of knowledge on the subject provided through research.

When a child is unable to maintain a consistently healthy nasal airway, a number of unhealthy things happen to that child. These include middle ear infections, sinusitis, upper airway infections, mouth breathing, head, neck, and face pain, and sleep disturbances. The inability to maintain a consistently healthy airway may also lead to heart and lung problems. Snoring is a clear indication of mouth breathing problems and is often associated with a decrease in oxygen intake into the lungs. A recent study published in the British Medical Journal by Canadian researchers shows that people who snore are more likely to suffer from high blood pressure and coronary artery disease.

Breathing through the mouth affects the entire system and most particularly, the face. If you detect that your child constantly breathes through his or her mouth during the day or night (snores or breathes heavily at night, think about the adaptation that the body must go through to allow this ABNORMAL breathing pattern to take place. Then picture in your mind what is happening to the development of the face and jaws as a result.

All parents appreciate that the greatest increments of growth occur early in the life of a child. From birth to six months, weight doubles, and in the first three years of life, height doubles. These increments are never duplicated again in in such time spans. At birth, 30% of facial growth is completed; by age one, 50%; by age four, 60%; by age eight, 80%; by age twelve, 90% and by age eighteen, 100%. If a child has chronic nasal obstruction during these early critical growing years, facial deformities result, some subtle, some gross.

Parents understandably do not want to put their children through unneccessary or unwanted treatment and will often seek a physician that will tell them what they want to hear: "This child does not need this treatment." Unfortunately, this situation can be likened to a popular oil filter commercial: "Oil filter now versus whole engine overall later." You pay now (provide the child with a good nasal airway) or you will pay later (compromised facial appearance). Untreated airway problems may later require corrective jaw surgery in addition to the necessary procedures required to produce an open airway.

Some parents will deny that their child is a mouth breather, thinking that they are protecting the child from untoward criticism or treatment. In addition, once the problem has been identified, they may seek the opinion of other professionals who may not understand or appreciate the significance of the problem, and a state of confusion sets in. This dilemma can only be resolved by a careful evaluation of the facts:

1. Mouth breathing is abnormal.
2. Mouth breathing causes facial deformities that are often too severe for orthodontics alone to correct. These require jaw surgery to correct.
3. Mouth breathing causes sleep disturbances in many children and adults.
4. Mouth breathing is related to head, neck, face, and jaw pain problems in children and adults.
5. Mouth breathing is associated with high blood pressure and coronary heart disease in adults.

Care of the developing face begins at birth. Parents should be just as concerned about how their children breathe as they are about how well they walk, talk, and learn.

There has been a rather dramatic change in the last 20 years in the treatment of the middle ear, and adenotonsillar infections. Middle ear infections are now commonly treated with ventilation tubes, and adenotonsillar infections with antibiotics. The net result of this conservative treatment has been a dramatic increase in nasal obstruction due to prevalence of enlarged tonsils and adenoids in young children. The enlargement of these structures coupled with allergic enlargement of the turbinates results in blockage of the air passages within the nose.

Severe undiagnosed nasal obstruction problems can clearly be implicated in infant crib deaths of unknown origin. Nearly all otolaryngologists can cite a case of a midnight adenoidectomy necessary to save a child suffering from severe airway obstruction. In spite of the voluminous research which has indicated nasal obstruction to be a major health problem for growing children and adults, the effects of nasal obstruction are still widely recognized. In addition, the problem may cause severe facial deformity in children.

Research in growth cancers in Europe, Canada, and the United States has shown that nasal obstruction contributes directly to facial deformity in children. Nasal breathing is the most physiological form of breathing. Infants are obligate nasal breathers because they cannot suckle and breathe through their mouths at the same time.

The body is often divided into physical, dental, and psychological division. As a result, we often overlook the fact that all parts are interrelated and that what happens in one system directly affects other systems.

No one is better trained in the growth and development of the face than the highly trained orthodontic research specialist. Yet a serious communication problem exists. Pediatricians and many otolaryngologists often do not understand nor appreciate that long term mouth breathing problems during the critical early facial growth period

often results in permanent facial deformity and abnormal bites (malocclusions) some of which may require jaw surgery to resolve. Hopefully, in time, recognition by the medical community will come. In the meantime, what happens to children with undiagnosed and untreated airway problems?

One can clearly see that if a young, rapidly growing child has chronic, untreated nasal obstruction and must breathe through his mouth all day and all night, then the normal muscular activity of the face and jaw muscles will be altered. We breathe an average of 20 times per minute or 30,000 times a day, and we swallow an average of 2,000 times a day. These events are life sustaining, and the body accommodates to allow these to occur at the expense of the systems that must adapt. In mouth breathing, the adaptation may occur in the muscles of the face, jaw, tongue, lips, neck, back, shoulder, ribs, and diaphragm. The abnormal pull of these muscles on the growing bones of the face and jaws slowly deforms these bones, causing mismatched jaws and maloclussions.