Mouth breathing means that most of the breathing is done through the mouth instead of the nose. When it becomes persistent in children, it can affect the balance of the tongue, lip and cheek muscles; in some children this may go along with a narrow upper jaw, crowded teeth and changes in facial development. However, not every case of mouth breathing leads to an orthodontic problem, and not every orthodontic problem is caused by mouth breathing. This page helps families and adults understand the relationship between mouth breathing and orthodontics in general terms; it does not make a diagnosis.
This information is general; the decision for you is made after an examination.
What is mouth breathing, and how can it be recognized?
In a healthy breathing pattern, air is taken in through the nose; the nose warms, moistens and filters the air. In mouth breathing, the mouth stays open constantly or frequently, either during the day or during sleep. Signs that families may notice include the following:
- The mouth hanging open while resting or watching television
- Breathing through the mouth during sleep, snoring, a dry mouth in the morning
- Dry, cracked lips and frequent lip licking
- Frequently recurring nasal congestion, postnasal drip or throat complaints
- Tiredness during the day, poor concentration, a sleep-deprived look (these can also have other causes)
Keep in mind that these signs alone do not prove mouth breathing; some children also keep the mouth open out of habit. The distinction is made at a doctor's examination.
What causes mouth breathing?
The most commonly mentioned causes are a temporary or permanent narrowing of the nasal airway. These include nasal congestion due to allergies or infection, enlarged adenoids (the tissue at the back of the nose), large tonsils and a curvature of the wall between the nostrils (deviated septum). A narrow upper jaw can also affect the nasal airway, so the relationship is thought of as working in both directions. Determining the cause is the field of the ear, nose and throat (ENT) doctor; an orthodontist does not treat nasal congestion but assesses the situation by looking at the jaw and tooth structure.
How does it affect facial and jaw development in children?
At rest, the tongue normally rests against the palate and applies a light, constant shaping pressure to the upper jaw, while the lips and cheeks balance it from the outside. When the mouth stays open, the tongue may drop lower and the cheek muscles can press the upper teeth and jaw inward more. In some growing children, this is seen together with the following findings:
- A narrow, high palate and lack of space in the upper jaw
- Crowded teeth and a tendency toward crossbite (see the crossbite page)
- An open bite in which the front teeth do not touch (open bite)
- A longer, narrower facial appearance and a lower jaw that sits farther back
Not all of these findings appear in the same child; genetic makeup, habits such as thumb sucking, and tongue behavior also play a role. For this reason, mouth breathing is not blamed alone but is considered as one of several factors. For habit-related situations, you can take a look at our article on habit-breaking appliances.
How do the orthodontist and the ENT doctor work together?
When mouth breathing is suspected, the most sensible approach is to consider the orthodontic assessment together with an ENT examination. If the nasal airway is not open, widening the upper jaw alone may not make breathing easier; on the other hand, the old habit may continue even after the nasal airway has opened. For this reason, the division of work is usually as follows: the ENT doctor looks into the cause of the congestion and plans treatment if needed; the orthodontist follows the development of the teeth and jaws, the bite and the tongue–lip balance; and muscle exercises for breathing and swallowing habits may be suggested when appropriate. Rather than relying on the opinion of a single specialist before deciding, the specialists involved are expected to share information with each other.
What is the role of expansion and appliances?
If the upper jaw is found to be narrow in a growing child, a palatal expander can be planned while the midpalatal suture can still be opened. This method aims to create room for the teeth and improve the fit between the upper and lower jaws; it is explained in detail in the articles on jaw expansion treatment, MARPE and the rapid upper jaw expander. It is reported that expansion can affect the nasal airway to some extent, but this is not the same in every child, and it is not used alone with the aim of treating mouth breathing.
In some children whose lower jaw sits farther back, removable or fixed appliances that guide jaw growth may come into question (functional appliances). All of these options are planned according to age, growth stage and examination findings. For a broader overview, you can look at the early orthodontic treatment page.
Can findings related to mouth breathing be corrected with clear aligners?
Clear aligners are a system that moves teeth; they do not treat nasal congestion, enlarged adenoids or the habit of mouth breathing. Results at the tooth level, such as crowding and mild lack of space, can be addressed with aligners in suitable cases (crowding). In children, systems such as Invisalign First may be considered in selected cases during the mixed dentition period with the aim of widening the upper jaw (Invisalign First). However, if skeletal narrowing is marked or the nasal airway problem continues, the doctor may recommend expansion or an ENT assessment first. It is also important to have adequate nasal breathing so the mouth can stay closed while wearing aligners; for this reason, aligner use in people with nasal congestion is discussed separately at the examination.
Does mouth breathing in adults affect orthodontics?
In adults, jaw growth is complete, so mouth breathing does not create new changes in facial development; however, it may be seen together with an existing narrow jaw, a tendency toward open bite and gum problems. A dry mouth can reduce the protective effect of saliva and increase the risk of cavities and gum inflammation. Because tongue and lip habits can also play a role in whether teeth stay in place after treatment, the retainer process is monitored from this angle as well. If snoring or pauses in breathing during sleep are suspected, this is outside orthodontics and should be assessed by a sleep or ENT doctor. For adult treatment options, you can look at the Invisalign for adults page.
Points families can pay attention to at home
What can be done at home is limited and does not replace an examination. Observing for a few days whether your child keeps the mouth open while resting, noting snoring or a dry mouth during sleep, and writing down when allergy and runny nose complaints get worse gives the doctor concrete information. Do not use medication or sprays on your own to open the nasal airway; that decision belongs to the doctor. If there are habits such as thumb sucking or tongue thrusting, it is more effective to make a plan together with the doctor without blaming the child.
When should you see a doctor?
| Situation | What it may mean | What is done? |
|---|---|---|
| The child breathes through the mouth all day | It may be a narrowed nasal airway or a habit | ENT examination first; an orthodontic check is planned as well |
| Snoring during sleep, frequent waking, sleepiness during the day | Possibility of a sleep-related breathing problem | ENT or sleep assessment; orthodontics alone does not decide |
| The upper teeth are crowded and the palate looks narrow | There may be a lack of space in the upper jaw | Orthodontic examination; expansion may be considered depending on age |
| The front teeth do not touch each other | Open bite; a tongue or finger habit may be present | Orthodontic assessment and habit follow-up |
| Dry mouth and bleeding gums in an adult | Mouth breathing or other causes | Dentist assessment and, if needed, ENT assessment |
A first orthodontic check for children is generally recommended at around age seven; if mouth breathing is suspected, you can go earlier. The orthodontic examination question list may be useful for the questions you can ask at the visit.
What happens at the examination?
At the examination, the history of the child and the family is taken: topics such as nasal congestion, allergies, snoring, thumb sucking and tongue thrusting are asked about. The facial profile, lip closure, palate width and bite are assessed; if needed, a panoramic film and a lateral cephalometric film are requested. Depending on the findings, one of the following is recommended: referral to an ENT doctor, observation, treatment with an appliance, or following growth without early intervention. A real diagnosis and plan can only be made after this stage.
Assessment at the Funda Sarıkaya Oral and Dental Health Polyclinic
At the clinic, Funda Pekyılmaz Sarıkaya, specialist orthodontist (Uzm. Dt.), carries out orthodontic examinations for children and adults; the Invisalign system is used for clear aligner treatment. The clinic is located at Park Oran Ofis, Kudüs Cd., Oran, Çankaya/Ankara (next to Panora Mall); you can make an appointment on 0312 911 60 36 Monday–Saturday between 09:00 and 20:00. Service languages are Turkish, English, German and Russian. For other treatment options, you can look at the orthodontic appliances and bite classes pages, and for general information the orthodontist in Ankara page.
This information is general; the decision for you is made after an examination.