Noticing—and Correcting—Mouth Breathing
The sight of a snoring baby may be pretty cute, but it’s not always benign, says pediatric dentist Sherry Sami. Formerly a clinical instructor of dentistry at UCLA, Sami sees patients full-time at her LA practice, where she emphasizes a holistic approach to dental care. And, she tells us, a symptom that frequently gets overlooked as part of a larger picture of health: mouth breathing.
Mouth breathing—at any age—can lead to long-term implications and is often part of a constellation of other symptoms that contribute to airway restriction. But the solution is often quite simple once you’re aware of what’s going on.
A Q&A with Sherri Sami, DDS
Mouth breathing is not a natural thing for humans. Healthy human infants breathe only though their noses; mouth breathing kicks in as a survival reflex. With infants, children, and adults, mouth breathing becomes an adaptation when someone isn’t getting enough oxygen through the nose.
There are at least three main reasons why people might breathe through their mouth:
1. There’s an obstruction in the nose. That could be anything from allergies and sensitivities to gas. In our practice, we see a tremendous number of kids with allergies, whether environmental or food-related. Some of them become mouth breathers as a result.
2. Something anatomical is creating an airway obstruction: a significantly deviated septum, some kind of polyps, having very enlarged turbinates. Sometimes I see an extra tooth that’s inverted start to obstruct the nasal airway.
3. It’s become the default. If early enough in life, there was an obstruction or anatomical deviation—even if it gets corrected later—mouth breathing can become our habitual way of breathing.
The easiest way to tell early on is to simply observe. Watch your baby. See if they snort when crying, if they snore when they’re asleep, if their mouth is open or closed when they breathe. Their breathing should be silent. If you can hear someone breathing, it means their breathing is labored and they’re having a hard time getting the oxygenation they need.
A kid who’s congested and always full of mucus, or who’s always swallowing their saliva from postnasal drip, or who feels like there’s a tickle in the back of their mouth so they’re constantly clearing their throat—all are signs of airway issues. That person is having a harder time getting air into their lungs, and they tend to be an exclusive or partial mouth breather.
There are many people who are normal nose-breathers during the day, but at night, they’re mouth breathers. The minute we lie down—because we’re on a horizontal plane—all the things we have in our nose and sinuses start going to the back of our mouth. Our mandible, the lower jaw, can also go back, obstructing the airway.
I was a partial mouth breather as a child. I always had tonsillar issues, and when I slept, I was always moving around the bed and would get frequent colds. My parents would argue over whether to get my tonsils out or not. I was one of those kids who wasn’t necessarily always sick to the point I was missing school, but I was always snotty-nosed and congested.
As I grew older and started learning about all these things, I noticed my mouth was often open at night. I noticed a lot of dryness in the mornings when I woke up; I had to drink a lot of water before bed and needed to wake up in the middle of the night sometimes to go to the bathroom. As I grew older and started learning about these things, I went through a lot of eliminations in my diet; even though it doesn’t show at all in my blood work, dairy makes me feel congested and backed up right away.
The first step is noticing that your child’s a mouth breather. I encounter so many parents who think it’s normal or don’t realize it can be related to other issues.
For example: Bed-wetting is a potential sign. One of the stages of sleep makes all of your voluntary muscles relax. For some kids, the tongue goes to the back of the mouth and obstructs the airway. Their body compensates by moving around to get out of that deep sleep and unblock the airway. The bladder often also goes when they take that first full breath again.
Cavities are another sign. Filling the cavities puts a Band-Aid on the problem. When you look at the cause—especially in patients who have great diets and do a great job with oral hygiene but have cavities—I begin to suspect that saliva’s evaporating at night through mouth breathing. Saliva is a protective agent with enzymes that guard our teeth, so when it dries up, you retain more plaque. Your gums become really red, and you tend to get more cavities.
Behavior can sometimes be an indication. Kids who don’t get enough quality sleep tend to be really restless. Sometimes that lack of quality sleep is from allergies or nasal obstructions or blockages at the back of the mouth. We fix the problem by opening up the airways, and suddenly they’re no longer exhibiting those restless behaviors.
These symptoms of poor sleep are often overlooked, so I ask parents if their kids move around the bed, or if they’re grinding their teeth, which might signal a misaligned jaw or airway issues.
Long-term, the shape of your face can change. It’s very subtle, resulting in an elongated and/or narrower face. But the mandible, instead of growing in a forward motion, may grow in a downward motion. Many parents aren’t aware of it until the kids are nine or ten years old, but it makes a difference in the development of the face and jaw. That shift in jaw development then puts more strain on the neck, which then often requires you to bring your shoulders forward and develop a little hump. Sometimes we find significant spinal curvatures in kids as young as two years old. All of those can be compensatory mechanisms from an obstructed airway.
Gut health is also another indicator. With mouth breathing, our system can become more acidic, which can affect digestion and absorption of nutrients in our gut.
Babies are easier, because they haven’t developed mouth breathing as a habit yet. If you’re breastfeeding, you could look to your diet to see if there’s something that could cause congestion. In my practice, many kids are sensitive to dairy.
Clean the baby’s nose. Just like our teeth, our noses need constant cleaning. This is an important thing, especially where I practice in LA, where the air is so polluted. Imagine how much stuff we’re breathing in every day. The little hairs in our noses, the cilia, are amazing cleansers—they trap so many pollutants that we would otherwise breathe in, which makes them all the more important to clean. I recommend using nose rinses with saline solution every night. Ancient methods such as neti pots have been in place in many cultures, and I find they work as well. Xylitol rinses followed by suction with something like a NoseFrida can help.
There’s also a nasal spray called XLEAR, which is a xylitol rinse—a couple drops in the baby’s nose followed by suction with something like a NoseFrida will help.
Working with a breathing educator in specific techniques, such as Buteyko breathing or the restorative breathing method, can be beneficial, too.
There are so many ways. I use a little plastic sinus rinse bottle from NeilMed and fill it with warm filtered water, a little xylitol, and the saline mix that comes with the bottle. You just squeeze the solution in very gently. I let my kids do it themselves. When they were really little I held my hand over theirs to guide them, but you want to let them control it so you don’t go overboard on the pressure. Too much can hurt. You can get kids in the habit of cleaning their noses as well as brushing their teeth.
It’s important to start being mindful and notice whether you’re breathing through your mouth or through your nose. Does your nose feel obstructed? Do you feel congested? How easily are you breathing?
Ask people close to you if they can hear you breathing. If you’re sleeping next to someone, ask them if you’re snoring or if you sleep with your mouth open. Notice whether you feel rested or not when you wake up in the morning.
Then start doing a little investigation. Do you notice, when you eat something, that you get congestion or gas? A postnasal drip and a tickling at the back of your mouth?
I like BreatheRight nasal strips for nighttime. If the jaw really slips down, there are appliances that can help bring the jaw forward. Just make sure you work with a dentist who understands the whole body dynamic.
When I see a child in my practice, I don’t look at their symptoms; I look for the cause. Quite often, mouth breathers rest their tongues on the back of their top teeth or the bottom of their lower teeth, instead of at the roof of their mouth. When your tongue isn’t actively at the top of the mouth, it starts to overcompensate and narrow your jaw, causing crowding of your teeth or pushing your upper teeth forward and lower jaw back. Before you do anything, you have to train the tongue and muscles of your face. I tell my patients it’s a gym class for the tongue and facial muscles—that’s what myofunctional therapy is. The tongue and the lips have equal and opposite forces. Being too forceful with either can cause problems.
Dr. Shahrzad (Sherry) Sami is a dual specialist in pediatric dentistry and orthodontics. A graduate of Columbia University, she completed her residency in pediatric dentistry and orthodontics at the University of California, Los Angeles (UCLA) Medical Center. She later served as a clinical instructor at UCLA, as part of both the medical and dental programs. She is also trained in osteopathy, homeopathy, and nutrition. For her, comprehensive health care means recognizing the patient as more than physical symptoms and that mind and spirit play essential roles in our state of health. She is a cofounder of Be Hive of Healing and the Love Button Global Movement. You can follow her on instagram @drsherrysami.
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