Teeth do not develop in isolation—they grow within a face shaped by function, muscle balance, and breathing
Well!! Most of us, as pediatric dentists, would agree with this statement, as we see the holistic development of our growing patients, not just their teeth. Teeth are just one part of the equation. Pediatric dentistry in the growing child extends far beyond managing cavities and alignment. It encompasses the observation and assessment of how a child breathes, swallows, chews, and positions the tongue and lips. If not, the growing child may silently suffer from “Orofacial dysfunctions” and their consequences. They are common in growing children and range in severity. They are often overlooked because they can appear more like “habits” than functional issues.
Growing child: Why functions matter in the craniofacial complex?
‘Orofacial dysfunctions are altered muscle patterns involving the mouth and face that can quietly guide growth in an unfavorable direction if left unaddressed’. So what??
Well... the dysfunctions manifested as mouth-breathing patterns, lower tongue postures, atypical swallowing patterns, lip incompetence, and chewing inefficiencies are damaging to the growing jaws and, thereby, the child's face. If not addressed these dysfunctions can contribute to consequences in the local growing environment.
There are two key orofacial functions of importance here that ultimately contribute to the consequences: oral breathing and tongue posture. These two functions when deranged effect each other. That is, when due to any abnormal function in the Stomatognathic System, tongue is not able to sit high into the roof of the palate at rest and during swallowing, it leads to more of oral breathing and vice versa.
We swallow 2000 in a single day. Ideally, our tongue rests on the roof of our mouth. In this way our upper jaw may develop to its full potential with enough room for our lower jaw and for all teeth.
So, let us see the consequences:
Lower tongue position and its consequences:
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Activation of the facial cheek muscles –especially the buccinator and mentalis. Unopposed by the low-lying tongue these muscles constrict the upper arch, causing crowding or protrusion, or crossbites
- Speech problems due to inappropriate articulation during oral breathing
- When tongue is resting low, this can cause tongue to fall in front of airway, so to take in more air, the child pushes head forward to take more air into the lungs. Over time, this forward thrust of the head causes pain and muscle fatigue
- Compensatory mechanism for the forward head posture: upper part of body bends back and lower part bends forward slightly at knees.
Oral breathing patterns and their consequences :
- A low tongue position and its consequences
- Mouth breathing dries the saliva, creating a breeding ground for the bacteria that cause halitosis, tooth decay and affect gingival health
Underdevelopment of the maxilla and its consequences :
- Underdeveloped mid face, nares
- Skeletal class III malocclusions
- Dental malocclusions like crossbites, increased palatal height
Orofacial dysfunctions and general health
The orofacial dysfunctions can also have systemic effects:
- Oral breathing creates a muscle imbalance, leading to decreased diaphragm activation and increased activation of the upper chest muscles, the scalenes. Hence diaphragm becomes less active and loses strength
- Breathing via the upper chest muscles is tiring. If the diaphragm is not working these muscles work harder, leading to neck pain and cervical movement range problems
- Breathing mainly from the diaphragm uses just 2% oxygen, while breathing mainly from the upper chest muscles uses up to 25% oxygen
- Mouth breathers have a respiratory rate of more than 12 breaths per minute, because oral breathing offers less resistance than nasal pathways.
- Oral breathing offers less resistance to incoming air than nasal breathing. Hence, oxygen uptake is less than nasal breathing. This also causes greater carbon dioxide to be released. This disturbed gas exchange accounts for fatigue
- Disturbed gas exchange sends fight/flight mode signals to the brain, signaling muscle spasms, causing TMJ pain, migraine, and tension headaches
- When mouthbreathing, the nose is bypassed, and nasal Nitrous oxide is not harnessed, missing out on its advantages
- Effects on body posture, head posture, and asymmetries
- Effects on sleep quality and its consequences
What can a pediatric dentist do?
Identify red flags: such as underdeveloped mid-faces, underdeveloped nares, increased show of sclera under lower eyelid, narrow dental arch shape and narrower dimensions, forward head posture, buccinator bulges, and any other sign/symptom of consequences on general health of the child as mentioned above.
Refer if required: Orofacial dysfunctions may require a collaborative management approach amongst Pediatric dentists, ENT specialists, airway health specialists, speech therapists, orthodontists
Intercept and treat within the team, through: Orofacial myofunctional therapy, orthodontic interventions, airway and ENT management, speech and swallowing therapy, associated habit elimination and behavioral guidance, monitoring jaw growth.
Why a team approach?
Orofacial dysfunctions affect muscle function, skeletal growth, dental alignment, and airway health simultaneously. Treating only one component—such as teeth—without addressing function or airway limitations may lead to incomplete or unstable outcomes
When should you ask parents to consult you?
Encourage parents to seek an assessment if their child: breathes through the mouth or snores at night, sleeps with an open mouth, has difficulty chewing or swallowing, shows persistent speech distortions, or has experienced orthodontic relapse.
Take home message
Early functional assessment allows clinicians to guide growth in children and adolescents rather than correct its consequences.