Quite frequently I have noticed and more so in last few years, that parents come to the practice for routine checkups and as well with the main concern of children grinding their teeth at nighttime.
As a pediatric dentist, my attention goes towards checking the bite or any other dental reasons, However, it is vital to pay close attention to a child’s mouth and facial movements.
At this point in the evaluation process, I start to ask further questions like, “Does the child breath through his/her mouth or nose?”, “Do they have any trouble sleeping?”, “Do they get frequent cough or cold?”, and “Did he/she have any difficultly when breastfeeding?”., “Do they snore at night?”, “Do they drool at nighttime?”
These are essential in making an accurate diagnosis.
What is mouth breathing?
Mouth Breathing is when an individual breathes primarily through their mouth and it is currently seen in approximately 55% of children. Nasal breathing helps to filter out foreign particles from the surrounding environment and thereby delivers air with less contaminants to the respiratory system. When breathing through the mouth, the air is not filtered before it reaches the lungs, hence leading to increased likelihood of colds, infections in the nose/throat, and chronic ear infections in children who mouth breathe.
Most common causes of mouth breathing include: problems with mouth and bite structure, enlarged tonsils and adenoids, nasal congestion due to allergies, and deviated septum.
Signs of Mouth breathing in children include: chronic fatigue, hoarsenes, bad breath, dry/cracked lips, teeth grinding, snoring and irritability.
Mouth Breathing can lead to underdeveloped jaw, lip incompetence, crowding of the teeth, narrow facial features, frequent awakening at night, daytime sleepiness and increased behavioral problems.
Child lands up chewing the food with their lips apart, which can be noisier and less productive than chewing with lips closed. This can also result in digestive issues and potential choking when a child has difficulty coordinating when/how to breathe when their mouth is full of food. When swallowing, a child may protrude their tongue through their front teeth and/or compensate with tension in the muscles around the mouth or increased head movements. Mouth breathers may have reduced strength for chewing and swallowing and therefore prefer softer foods and/or use liquid to help when swallowing. Picky eating can thus be one of the signs or sequel of mouth breathing.
Distortions of speech caused sue to tongue protrusion between the teeth when making an /s/ and /z/ or low tongue placement when producing sounds such as /t, d, n, l/ are frequently noticed.
Daytime mouth breathing patterns are often seen when a child is sleeping, watching TV, reading, sitting in the car seat, during which time the muscles of the mouth and face are relaxed. Mouth breathing can be the root of sleep-disordered breathing.
How Myofunctional therapy can help?
The interdisciplinary team may include:
- ENTs
- Allergists
- Airway-centric pediatric dentists and orthodontists
- Physical and occupational therapists
Myofunctional therapy can work to establish an appropriate oral rest posture. In the correct oral rest posture; the tongue should be resting at the roof of your mouth, the teeth should be gently closed, and lips should close. A variety of exercises can be implemented to address nasal breathing, lip closure, and tongue suctioning to the palate. In addition, treatment can work on correct placement of the tongue and lips while chewing/swallowing and producing speech sounds.
Palliative measures can include disciplinary efforts such as:
- Establish sleep schedule consistentency;
- No screens at least two hours before bedtime.
- Soft music guided deep breathing exercises before sleeping.
Early diagnosis, proper education and timely guidance remain as the key factors in management of mouth breathing in young chiden.
