What do teeth have to do with breathing? Let's discuss.
Orofacial myofunctional disorders (OMDs) are typically multifactorial and have several ways they present themselves. Below are common signs and symptoms of airway restrictions and OMDs associated with oral health [3].
Malocclusion such as open bites, crossbites, impacted teeth, and tooth crowding
Increased risk of tooth decay due to mouth breathing
Excessive wear and fracturing of teeth due to para-functional bruxism (clenching and grinding)
Increased risk of pathological inflammation of the gums and supporting bone structures (i.e. gingivitis, periodontal disease)
Three of the most common symptoms
1. Malocclusion
Although malocclusion can have multiple causes, it is often a sign of oral dysfunction.
As children grow, their tongue should rest lightly against the roof of their mouth and act as a natural palatal expander. When this occurs, wider dental arches and nasal passages are formed. In contrast, if a child has chronically low resting tongue posture, their tongue is not able to aid in the expansion of their upper and lower jaws, which ultimately leads to more narrow dental arches.
As dental arches fail to grow to their ideal sizes, teeth lose important spacing required for proper eruption, which leads to crowded and impacted teeth. In the past, it was common practice to extract several permanent teeth that "weren't going to fit" and close the spaces with orthodontic treatment (i.e. braces). However, we now know that in doing this, vital tongue space was removed as well, and several of these patients developed airway disorders such as snoring, upper airway resistance syndrome, and/or obstructive sleep apnea.
Additionally, as dental arches remain narrow due to improper growth from low tongue posture, nasal passages also remain limited resulting in a higher chance of developing sleep-disordered breathing.
The roof of the mouth is also the floor of the nasal passages.
When the palate grows narrow and high, the nasal sinuses decrease in size, a deviated septum may form, and the ability to nasal breathe is impacted significantly. These all ultimately lead to a decrease in oxygen absorption.
At least 75% of people today have small jaws that require braces. If you don't have enough space for your teeth, your airway is also small. [1]
Not sure what malocclusion looks like? That's okay! Find a provider in your area who is trained in airway assessments to get a full understanding of each person's unique needs.
2. Clenching and grinding
One of the top symptoms of a restricted airway in both children and adults is clenching and grinding of the teeth.
As an individual falls asleep, their muscles relax, including the muscles of the tongue. If an individual has oral dysfunction and improper tongue positioning, the tongue will fall to the back of the throat as it relaxes, which ultimately leads to a restricted airway. [3]
As a natural response, the body enters fight or flight mode and subconsciously moves the lower jaw forward in an attempt to open the airway, bringing the tongue with it. The cycle of this happening repeatedly is what leads to bruxism, or grinding of teeth, which may be experienced in conjunction with clenching due to the stress response of the body as it remains in fight or flight mode.
Over time, clenching and grinding weakens tooth enamel, leading to "flat teeth", cracks, and fractures of one or more teeth that often lead to more extensive treatment needs such as dental crowns and possibly extractions. [3]
While a common treatment option for clenching and grinding is having a patient wear a night guard, it's important to understand that this typically doesn't address the root cause of this destructive habit. Before transitioning into wearing a night- or day-time appliance for clenching and grinding, a comprehensive airway assessment should be completed.
3. Increased risk of pathological inflammation and dental decay
If a patient is experiencing sleep-disordered breathing, their body enters a state of disease at several levels.
Mouth breathing is often associated with sleep-disordered breathing and is known to cause dryness of oral tissues (i.e. xerostomia). There is ample research available showing the significant increase in oral inflammation associated with dry mouth, which presents itself as gingivitis or periodontal disease depending on how long the chronic inflammation has been present. Additionally, mouth breathing and xerostomia have a significant correlation with increased dental caries rates.
Saliva is the body's way of protecting the mouth from harmful pathogens by helping eliminate bacteria and by neutralizing oral pH levels. Without the beneficial protection of saliva, pathological inflammation and dental decay risks increase. [3]
Essentially, saliva production rates decrease in sleep, and mouth breathing causes further drying of oral structures, which ultimately leads to lower oral pH levels resulting in erosion of tooth surfaces, increased tooth sensitivity, and increased decay rates. [3]
If you suffer from dry mouth - whether at night or during the day - your risk of periodontal inflammation and dental decay is significantly higher. Check out my favorite products to help alleviate xerostomia here, and ask your dental provider for their recommendations to treat the root cause of your mouth breathing, and dry mouth.
Bonus!
A frequent but lesser-known oral presentation of airway restrictions is acid reflux, which is common in all ages, including infants.
For infants with tongue and or lip ties, insufficient lip seal is created during nursing or bottle feeding, and a dysfunctional swallow pattern leads to swallowing air, which is called aerophagia-included reflux (AIR). This often leads to colic-like symptoms and post-feed gastric distension with frequent spitting up after meals. [2]
"The increase in gastric pressure may overcome the lower esophageal sphincter pressure and gastric contents may reflux into the upper airway." [2]
If improper swallow patterns continue into childhood and adulthood, acid reflux can become a chronic symptom. The concern of frequent acid exposure increases even more when teeth begin to erupt as the oral pH decreases with every occurrence of reflux, which leads to an increased risk for tooth erosion, decay, and oral inflammation as mentioned above.
Clinicians or healthcare providers - if the above information seems to fit your patient's presentations, signs, symptoms, and/or health history, it's time to do an airway assessment! If you are uncomfortable in doing so, find airway providers in your area and form proper referral protocols.
Patients - If any of the information above sounds familiar, it's time to get checked out by an airway provider! Not sure where to start looking? Check out the forum here - ask questions, share your story, and create a discussion to begin your journey to airway health.
Talk soon,
Liz Laney, Myofunctional Therapist
*None of the information included in this post is intended to be medical advice. Please talk with your healthcare provider(s) before making lifestyle changes or starting/stopping any medications and/or diets.
Resources
1. Lin S. Upper Airway Resistance Syndrome symptoms. Dr. Steven Lin. Accessed July 15, 2023. https://www.drstevenlin.com/upper-airway-resistance-syndrome-symptoms/.
2. Siegel SA. Aerophagia-induced reflux in breastfeeding infants with ankyloglossia and shortened maxillary labial frenula (tongue and lip tie). International Journal of Clinical Pediatrics. 2016;5(1):6-8. doi:10.14740/ijcp246w
3. Tamkin J. Impact of airway dysfunction on dental health. Bioinformation. 2020;16(1):26-29. Published 2020 Jan 15. doi:10.6026/97320630016026
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