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Orthodontics/Mouth breathing

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Question
Dear Mr. Paul Supan

I have a question for you regarding mouth breathing. My question is the following: can all the negative effects of mouth breathing on facial growth be treated surgically too? What I actually mean is that if the mouth breathing problem and effects on facial growth are discovered too late (like at 20-25 years old), can all these negative effects be treated surgically? If yes, how? Will the face look like it should have developed by breathing through nose?

Answer

Dear Iasi,

Thank you for your question. It is a complex question so I took extra time to ask a few colleagues and to think about this before answering. As always, what I write here are only my opinions based on very limited information. My comments should not be viewed as any form of diagnosis, definitive or otherwise,  or any form of  treatment recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should  only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Okay… having said  that…  your  questions focused on changes due to mouth breathing. You asked:

"...can all the negative effects of mouth breathing on facial growth be treated surgically too? What I actually mean is that if the mouth breathing problem and effects on facial growth are discovered too late (like at 20-25 years old), can all these negative effects be treated surgically? If yes, how? Will the face look like it should have developed by breathing through nose?... "

Basically, four of the most significant negative effects include:

1) Narrow upper jaw. A person who mouth breathes allows the lower jaw to drop in order to ope the mouth for breathing. Doing so also will permit the tongue to drop down from the roof of the mouth. There is an equilibrium or balance of the cheek forces pushing inwards and pressing against the lip and cheek sides of the teeth. The tongue in an opposite fashions in pushing outwards and pressing against the inner tongue sides of the teeth. In mouth breathing this equilibrium is changes and more pressure from the cheeks makes for a narrowing of the upper jaw . Imagine the upper jaw and teeth as a horse shoe shape. Pressing against the sides of the horseshoe makes the for a narrower and more constricted arch. This is precisely what happens on the mouth when the cheeks press in against the teeth more dramatically than the tongue can balance and push outwards. In growing children this can have a dramatic impact.

There have been cases of small children chewing on electrical cords and severely injuring the tongue. A small tongue due to such an injury resulted in a very small and constricted upper arch again due to the small injured tongue not balancing out the inward pushing forces of the cheeks.


2)  Strong and/or excessive vertical jaw angle. If you look at the human jaw in profile from the side, there is a slight resemblance to the letter "L" or a hockey stick. The vertical part is called the ramus of the jaw and the horizontal part the corpus or body. Here is a helpful link http://education.yahoo.com/reference/gray/subjects/subject/44 . In a mouth breather the angle between the corpus and the ramus can become slightly larger (more oblique). This can affect the bite  or occlusion. It can also affect the appearance of a person namely resulting is a slight vertical looking  or "long"  face. When viewed in profile, the inferior border of the body or corpus of the mandible may show a slight bend. That is, not only does the angle between the ramus and the corpus  increase, but the inferior border of the lower part of the jaw (corpus) may exhibit a downward bending.


3)  The development of a skeletal open bite may be also sometimes be related to mouth breathing. Not if the anterior teeth do not meet and a tongue thrust develops, the anterior teeth may not be in a correct position. Lip posture can dramatically change, and a person's profile as viewed from the side can display  non-ideal characteristics.

4)  Impact on the floor of the nose. It makes sense that a person with a narrow upper jaw and narrow upper dental arch will have a narrow floor of the nose. The effect on nasal appearance while perhaps minimal, can not be rules out.


As to whether surgery can address these problems, I would say yes, but whether this is recommended will depend on a diagnosis by doctors who have evaluated you in person and can better understand your needs, appearance standards,  and aesthetic goals.

I would recommend that you consult with an orthodontist and an oral surgeon. I hope that this somewhat technical discussion has proven helpful Iasi  

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Paul Supan, DDS, MA, MPH

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First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

Organizations
American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Publications
Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

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