Mouth Breather Face: Can Mouth Breathing Face Be Reversed?

By Patrick McKeown and Dr. John Mew. Large parts of this article were first published in Irish Dentist in 2011.

A good-looking face is determined by a strong, sturdy chin, developed jaws, high cheekbones, good lips, correct nose size and straight teeth. With mouth breather face, these strong features may not be so apparent. When a face develops correctly, it follows that the teeth will be straight. Straight teeth do not create a good-looking face, but a good-looking face will create straight teeth. Each year, parents spend thousands of euros in an effort to straighten their children’s teeth, unaware of other contributing factors. Approaching this issue with an open mind, we believe it is possible to ensure the normal development of a child’s face and teeth by correcting habits and by applying non-invasive techniques, specifically the Buteyko Breathing Method. Read on to find out more.

MOUTH BREATHER FACE SHAPE: CRANIOFACIAL CHANGES AND MOUTH BREATHING

In 1704, a racing stallion by the name of ‘The Darley Arabian’ arrived in Britain from Syria and is responsible for 95% of today’s male thoroughbreds. (Cooper C, 2012)

Geneticist Patrick Cunningham and colleagues from my alma mater, Trinity College Dublin, traced the lineage of nearly one million horses from the past two centuries and determined that 30% of variation in performance in thoroughbreds is due to genetics alone. (Cunningham EP et al, 2001)

In the nature versus nurture debate, these results suggest that nature plays a significant part of our athletic abilities. Could humans be similar to race horses in this way? Could our genetic makeup strongly dictate our athletic prowess?

There is one area in particular where a combination of genetics and behavior has considerable influence on athletic performance, and that is mouth breather face shape, i.e. the way the face and jaws develop during childhood.

For example, take a look at the structure of the face and jaws of former Olympic successes including Usain Bolt, Sanya Ross Richards, Steve Hooker and Roger Federer. What is strikingly apparent for this group, and for the vast majority of top class athletes, is the forward growth of the face and width of the jaws.

Athletic success depends on having good airways, which in turn is dependent on normal facial structure. Spend a lot of time with your mouth hanging open or sucking your thumb during childhood and the face grows differently to how nature intended.

In fact, Michael Phelps, the most decorated Olympian of all time, is one of very few top class athletes who does not exhibit forward growth of the jaws and a wide facial structure. Based on his facial profile, there is a high likelihood that he was a mouth breather during childhood, possibly requiring orthodontic treatment in his early teens. It is also possible that Phelps chose swimming, either consciously or unconsciously, as it was the one sport that he could excel in. The very act of swimming restricts breathing to help offset any negative effects that have developed from mouth breathing or an inefficient breathing pattern.

Although the natural order of things is to breathe through the nose, many children – especially those with asthma or nasal congestion – habitually breathe through the mouth. Children who regularly breathe through their mouth tend to develop negative alterations to their face, jaws and the alignment of their teeth.

Mouth breathing affects the shape of the face in two ways. Firstly, there is a tendency for the face to grow long and narrow. Secondly, the jaws do not fully develop and are set back from their ideal position, thus reducing airway size.

If the jaws are not positioned forward enough on the face, they will encroach on the airways. See for yourself: close your mouth, jut out your chin and take a breath in and out through your nose, noting the way air travels down behind the jaws. Now do the same but pull your chin inwards as far as you can – you will probably feel as if your throat is closed up as you try to breathe. This is exactly the effect poorly developed facial structure has on your airway size. It is no wonder that those with restricted airways tend to favor mouth-breathing.

DOES MOUTH BREATHING CHANGE YOUR FACE?

The forces exerted by the lips and the tongue primarily influence the growth of a child’s face. The lips and cheeks exert an inward pressure on the face, with the tongue providing a counteracting force. When the mouth is closed, the tongue rests against the roof of the mouth, exerting light forces which shape the top jaw. Because the tongue is wide and U-shaped, it follows that the shape of the top jaw should be wide and U-shaped also. In other words, the shape of the top jaw reflects the shape of the tongue. A wide, U-shaped top jaw is optimal for housing all our teeth.

However, during mouth breathing, it is very unlikely that the tongue will rest in the roof of the mouth. Try it for yourself: open your mouth and place your tongue on your upper palate. Now try to breathe through your mouth. While it is possible to draw a wisp of air into the lungs, it will not feel right.

It follows therefore that the tongue of a mouth breather will tend to rest on the floor of the mouth or suspended midway. Since the top jaw is not then shaped by the normal pressures of the tongue, the end result is the development of a narrow V-shaped top jaw. Aesthetically, this contributes to a narrowing of the facial structure, crooked teeth, and orthodontic problems. It has been well-documented that mouth-breathing children grow longer faces. (Tourne LP, 1990/Deb U, 2007/ Harari D et al,2010)

Another way facial structure is affected by the way we breathe during childhood is the position of the jaws. The way the jaws develop has a direct influence on the width of the upper airways. Our upper airways comprise the nose, nasal cavity, sinuses, and the throat. High athletic performance requires large upper airways which will enable air to flow freely to and from the lungs. While effective breathing is crucial for high performance, having airways that function with little resistance is also very advantageous. For example, a marathon runner who has efficient breathing but airways the width of a narrow straw is not going to get too far.

It is well documented that mouth breathing children grow longer faces. A paper by Tourne (1990) recognized that “the switch from a nasal to an oronasal (mouth and nose combined) breathing pattern induces functional adaptations that include an increase in total anterior face height and vertical development of the lower anterior face.”

In another paper, Schreiner (1996) comments that: “Long-standing nasal obstruction appears to affect craniofacial morphology during periods of rapid facial growth in genetically susceptible children with narrow facial pattern.”

Deb and Bandyopadhyay (2007) wrote: “A mouth breather lowers the tongue position to facilitate the flow of air in to the expanding lungs. The resultant effect is maldevelopment of the jaw in particular and deformity of the face in general. Setting of the teeth on the jaw is also affected. All these make the face look negative. So, to prevent orthodontic problems in children, it is necessary to detect the nasopharyngeal obstruction and treat the same accordingly.”

In a study of 47 children between the ages of six to 15 years to determine the correlation between breathing mode and craniofacial morphology, “findings demonstrated a significant predominance of mouth breathing compared to nasal breathing in the vertical growth patterns studied” (Baumam I, Plindert PK, 1996). The paper concluded that “results show a correlation between obstructed nasal breathing, large adenoids and vertical growth pattern.”

Another study involving 73 children between the ages of three and six years concluded that “mouth breathing can influence craniofacial and occlusal development early in childhood” (Mattar SE et al, 2004).

Lopatiene and Babarskas (2002) studied 49 children with confirmed nasal obstruction. The researchers noted that “the main characteristics of the respiratory obstruction syndrome (blocked nose) are presence of hypertrophied tonsils or adenoids, mouth breathing, open bite, cross bite, excessive anterior face height, incompetent lip posture, excessive appearance of maxillary anterior teeth, narrow external nares and V-shaped maxillary arch.”

When the tongue is not resting in the roof of the mouth, the jaws are impeded from growing forward and are instead set back from their ideal position. This contracts the airways, contributing to breathing difficulties and sleep apnea.

In addition, the nose will seem larger, similar to that of a roman nose. The “nose is more pronounced in an ideal occlusion but in the various malocclusions where the maxilla is underdeveloped it appears larger, although in fact it is smaller” (Mew JRC, 1986).

MOUTH BREATHING FACE SHAPE: HOW MOUTH BREATHING CAUSES CROOKED TEETH

During the 1960s, dentist Egil P Harvold recognized that “oral respiration associated with obstruction of the nasal airway is a common finding among patients seeking orthodontic treatment” (Harvold PG, 1981). To determine the relationship between mouth breathing and crooked teeth, he conducted a number of experiments by blocking the noses of young monkeys with silicone nose plugs.

In 1981, in the American Journal of Orthodontics, he wrote: “The experiments showed that the monkeys adapted to nasal obstruction in different ways. In general, the experimental animals maintained an open mouth. All experimental animals gradually acquired a facial appearance and dental occlusion different from those of the control animals.”

The mouth, breathing monkeys developed crooked teeth and other facial deformities, including “a lowering of the chin, a steeper mandibular plane angle, and an increase in the gonial angle as compared with the eight control animals” (Harvold EP, 1982). Harvold claimed to be able to reproduce the equivalent of most human dental irregularities: “Any common type of dental irregularity can be produced experimentally in monkeys with normal dentition.” (Mew JRC, 1986)

In support of Harvold’s findings, Dr. Mew states that “it is hard to escape the conclusion that in monkeys, a change in the action and posture of the tongue can produce severe malocclusions.” (Mew JRC, 1986)

Given the extent of information available, it is surprising that few dentists seem to be aware of the craniofacial effects of mouth breathing. In the journal General Dentist, Jefferson (2010) noted that “the vast majority of healthcare professionals are unaware of the negative impact of upper airway obstruction (mouth breathing) on normal facial growth and physiologic health.”

“Children whose mouth breathing is untreated may develop long, narrow faces, narrow mouths, high palatal vaults, dental malocclusion (crooked teeth), gummy smiles and many other unattractive facial features. These children do not sleep well at night due to obstructed airways; this lack of sleep can adversely affect their growth and academic performance. Many of these children are misdiagnosed with attention deficit disorder (ADD) and hyperactivity.”

The paper further states that “if mouth breathing is treated early, its negative effect on facial and dental development and the medical and social problems associated with it can be reduced or averted.”

The normal growth direction of the jaws is forward. This occurs as a result of the forces exerted by the lips and tongue. It works on the same principle used in orthodontics – light forces move teeth. The lips exert an estimated pressure against the teeth of between 100g and 300g (Sakuda M, Ishizua M, 1970). When swallowing, the pressure exerted against the anterior teeth by the tongue is estimated to be 500g (Profit WR, 1972).

We swallow an estimated 2,000 times per day and, each time we swallow, the tongue pushes upwards and flattens in the roof of the mouth, exerting a considerable force that shapes the jaws (Flutter J, 2007).

The correct position of the tongue is resting in the roof of the mouth. As the child grows, the top jaw forms around the tongue. In other words, the shape of the top jaw is the shape of the tongue. As the tongue is U-shaped, it results in a broad facial structure with sufficient room to house all teeth. Nature dictates that the shape of the lower jaw will follow that of the top jaw (Flutter J, 2007).

When the mouth is open, the tongue cannot rest in the roof of the mouth, resulting in a poorer developed, narrow, V-shaped top jaw. A smaller top jaw leads to a narrow facial structure and overcrowding of the teeth.

According to Principato (1991), low tongue posture seen with mouth breathing impedes the lateral expansion and anterior development of the maxilla. In the words of dentist Raymond Silkman: “The most important orthodontic appliance that you all have and carry with you 24 hours a day is your tongue.”

People who breathe through their nose normally have a tongue that postures up into the maxilla. When the tongue sits right up behind the front teeth, it is maintaining the shape of the maxilla every time you swallow. Every time the proper tongue swallow motion takes place, it spreads up against maxilla, activating it and contributing to that little cranial motion. “Individuals who breathe through their mouths have a lower tongue posture and the maxilla does not receive the stimulation from the tongue that it should” (Silkman R, 2005).

MOUTH BREATHER VS. NOSE BREATHER FACE

When we compare mouth breather vs. nose breather face, the differences are usually quite clear. The normal growth of the face is forward, and this is achieved by the forces exerted by the tongue as it rests in the roof of the mouth.

Since a mouth breathing child does not rest his or her tongue in the roof of the mouth, the jaws are unable to be properly shaped by the tongue, and the natural forward growth of the jaws is impeded. This results in jaws that are set back from their ideal position, compromising airflow.

For correct development of the jaws, face and airways, it is imperative that a child habitually breathes through their nose. Breathing through the nose with the tongue resting in the roof of the mouth helps to establish the ideal conditions for normal development of the face.

The above illustration shows the facial characteristics of a nasal breather and is based on former Irish International soccer captain Robbie Keane. Note the forward position of the jaws, high cheekbones, airway size and width of the face. The jaw is strong and positioned well forward so that the chin is nearly as far forward as the tip of the nose. When cartoonists draw illustrations of a dominant male, his strength is often conveyed by a rugged and exaggerated jaw. Socially, a strong jaw line is considered healthier and more attractive than a recessed chin.

Now take a look at the above image. Because the jaws are set back, the airways are smaller, resulting in diminished athletic performance. Had the jaws been in a more forward position, the nose would be straighter and smaller. The eyes look tired and there is poor definition of the cheekbones as the face sinks downwards. Chronic and habitual mouth breathing is also associated with postural changes which result in decreased muscle strength, reduced chest expansion and impaired breathing. (Okuro RT, et al, Sep 2011 / Okuro RT, et al, Jul 2011 / Conti PB, et al, 2011) Interestingly, researchers have found that mouth breathers are more likely to be male.

While the above image is exaggerated somewhat, these features are identifiable in thousands of children and adults who have fallen between the cracks of our healthcare system and were not encouraged to breathe through their nose. These same individuals often suffer from poor health, low energy and reduced concentration.

In the words of dentist Dr. Josh Jefferson: “These children do not sleep well at night due to obstructed airways; this lack of sleep can adversely affect their growth and academic performance. Many of these children are misdiagnosed with attention deficit disorder (ADD) and hyperactivity.” (Jefferson Y, 2010)

TREATING PATIENTS: EFFECTS OF MOUTH BREATHING ON FACE

Over the past few decades, an assistant has taken a photograph of the face of every child that Dr. Mew has treated and as the years pass, the effects of mouth breathing on face are clear to see.

Figure 1 shows a 10-year-old boy who was a nose breather and who had a good-looking, broad face with everything in proportion. On the boy’s 14th birthday, he was given a gerbil as a present. Soon after, his nose began to block, causing him to breathe through his mouth. Within three years, his face had changed its shape considerably (Figures 2a and 2b).

Because he breathed through his mouth between the ages of 14 and 17, his face grew downwards instead of in width. His face became narrow and long. His jaws are set back from their natural position. He now has a double chin and his jaws come back on his airways, resulting in smaller airways. This creates health problems such as sleep apnea. His nose looks far bigger because his jaws do not come forward enough, and his cheeks are sunken as his face drags everything downwards.

This face is typical of the thousands of children who breathe through their mouths.

Kelly (Figure 3) was seven years old and Samantha (Figure 4) was eight-and-a-half years old. Both sisters displayed habitual mouth breathing and were developing associated facial growth patterns. They attended Dr. Mew, who taught them to breathe through their noses and to swallow correctly. Kelly took on all that Dr. Mew told her, but her older sister Samantha was more complacent. She did not keep her mouth closed while breathing. Both girls returned a few years later. Again, Dr. Mew’s assistant took follow-up photographs.

Kelly is shown in Figure 5 and Samantha in Figure 6. Observe the development of their faces. In your view, who has the more defined face? Look at the tension on Samantha’s mouth, as she closes it to pose for the photograph.

HOW TO FIX MOUTH BREATHER FACE

Every child has the potential to grow an attractive face. Toddlers and young children generally have well-defined, broad and good-looking faces. However, a different story emerges with many teenagers. A visit to a secondary school will uncover many long, narrow and flat faces with sunken cheek bones, receded chins, narrow jaws and prominent noses. So what happens in the interim? Why do children develop crooked teeth and narrow faces? Many young children have beautifully straight teeth at the age of five or six, but the teeth and face can change quickly, if the mouth is left open (see Figure 7).

Consensus from thousands of oral facial myologists, hygienists, dentists, orthodontists and published papers worldwide is that for the face and, consequently, teeth to develop correctly, a number of factors must be employed by the growing child.

Such factors include:

1. Mouth closed with lips gently together.
2. Three-quarters of the tongue resting in the roof of the mouth, with the tip of the tongue placed before the front teeth.
3. Breathing through the nose.
4. Correct swallowing.

According to Meredith (1953), 60% of the growth of the face takes place during the first four years of life and 90% takes place by the age of 12. Development of the lower jaw continues until around age 18. Based on these observations, for correct craniofacial growth to take place, early intervention with nasal breathing and tongue posture is essential.

I recently collaborated in a study at the University of Limerick, Ireland to investigate the Buteyko Breathing Method as a treatment for rhinitis (irritation and inflammation of the nose) in asthma. The results were an 70% reduction of symptoms such as nasal stuffiness, poor sense of smell, snoring, trouble breathing through the nose, trouble sleeping, and having to breathe through the mouth. (Adelola OA et al, 2013)

Below is one of the exercises which I taught to participants of the study. It is a good introductory nasal breathing exercise for beginners:

Nose Unblocking Exercise:

• Take a small, silent breath in and out through your nose.
• Pinch your nose with your fingers to hold your breath.
• Walk as many paces as possible with your breath held. Try to build up a large air shortage, without overdoing it.
• When you resume breathing, only do so through your nose. Try to calm your breathing immediately.
• After resuming your breathing, your first breath will probably be bigger than normal. Make sure that you calm your breathing as soon as possible by suppressing your second and third breaths.
• You should be able to recover normal breathing within 2-3 breaths. If your breathing is erratic or heavier than usual, you have held your breath for too long.
• Wait for a minute or two before repeating the breath hold.
• Repeat this exercise five or six times until the nose is decongested.

Generally, this exercise will unblock the nose, even if you have a head cold. However, as soon as the effects of the breath hold wear off, the nose will likely feel blocked again. By gradually increasing the number of steps you can take with your breath held, you will find the results continue to improve. When you are able to walk a total of 80 paces with the breath held, your nose will be free permanently. A goal of eighty paces is actually very achievable, and you can expect to progress by an additional ten paces per week.

I have often taught this exercise to groups of five to ten-year-old children, many of whom have pretty serious breathing difficulties. Within 2-3 weeks, most children are able to walk 60 paces with their breath held, with some children quickly achieving up to 80 paces. Try it yourself, and see how you do.

More on Buteyko Breathing Exercises

CAN MOUTH BREATHING FACE BE REVERSED IN ADULTS?

Finally, according to American research, 95% of head circumference growth for the average North American child takes place by the age of nine. Development of the lower jaw, however, continues until approximately age 18. (Meridith HV, 1953)

Based on these observations, for correct craniofacial growth to take place, early intervention with nasal breathing and tongue posture is essential. The negative effects of mouth breathing on the structure of the jaws and face will have the most impact when they occur before puberty, so there is only a brief window of opportunity to avoid significant changes in a child’s facial structure. (Schreiner C, 1996)

• Reversible at an Early Age

Learning correct breathing and swallowing before the age of eight often corrects facial development without the need for any orthodontic treatment. As the lower jaws are still developing until the age of 18, teenagers can also derive considerable benefit.

Furthermore, the success of any orthodontic treatment depends on the application of correct breathing and swallowing. Estimates in the field are that up to 90% of orthodontic work relapses unless poor oral habits such as mouth breathing are addressed (Flutter J, 2007).

During the 1970s and 1980s, Linder-Aronsen consistently noted the relationship between nasal obstruction and craniofacial changes, including longer faces, open bite and cross bite. More importantly, significant craniofacial changes toward normal were observed to take place after patients returned to nasal breathing. In another study of 26 children, Kerr et al (1989) showed how development of the lower jaws began to normalize after they switched from mouth to nasal breathing.

We believe every child has the ability to develop an attractive face and reduce, if not eliminate, mouth breather face, along with associated physical and dental health problems by being taught to breathe in the right way. Encouraging children to breathe through the nose, thus allowing the tongue to rest in the ideal position, will do away with the negative impact of upper airway obstruction on normal facial growth and physiologic health.

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