The link between the tongue and nasal breathing to development and the snowball effect.
Before we begin discussing the nuances of this very big topic, I want you as the reader to take note of how you’re breathing and the position of your lips and tongue as you’re reading this sentence.
– Are your lips sealed or is your mouth open and dry?
– Is your tongue resting on the floor of your mouth or the roof?
– Do you feel like your face is drooping downwards?
If your answer pertains to the similar lines of mouth open, dry lips and tongue resting on the floor then most likely along the system of nasal breathing (as discussed in the prior blog post) there is a disruption within the flow.
Mouth breathing tends to go unnoticed as many people have not been queried of it in the past, are not aware of its effects or that this has become a norm for them.
The causes of mouth breathing is multifactorial and tends to have a chain reaction starting from one origin of a dysfunction or discrepancy in the anatomy and slowly becomes a snowball effect turning into mouth breathing.
In this blog we will explore the different factors that may contribute to mouth breathing at different stages in life. Now despite dissecting the different age groups, it does not mean that an individual who suffers from mouth breathing has each and every one of these factors. It could just be that there is just one or a few that have offset the cascade into becoming chronic mouth breathers.
Now, this post is by no means comprehensive but it does engage in the common factors in which you are able to start looking out for or perhaps initiate a conversation next time you see one of our dentists, oral health therapists or even your local GP/medic.
Infant
Before we delve into the intricacy of infancy, let’s start off with the fetus, particularly when little bubba is around 28-31 weeks, ultrasounds typically reveal finger/umbilical cord sucking and at the 35th week, suck/swallow sequence becomes developed. Yes! Some of you might be alarmed at the “finger/thumb sucking” , now at this stage and even little bubbas at the age of 1, it is all okay! Particularly as a fetus, the finger sucking is part of natural development to allow for the baby to “practise” this very motion needed for obtaining nutrients through breastfeeding. Therefore, it is not uncommon that infants that are premature born (that is prior to 35 weeks) that do not completely develop their suck/swallow sequence have difficulties with feeding. Let’s leave it at this for now and we will come back to why this is significant in the development and breathing.
On to infants, the main factors in which the tongue has its attention are looking for tongue ties (little stretchy muscles underneath the tongue). As many of you know, tongue ties can be detrimental to an infant’s and young child’s ability to speak and feed. However, not all tongue ties are tongue ties! In infants, it is common for a slight frenectomy (snip) of the tongue tie to facilitate proper feeding. The issue with this sometimes is that parents are not notified of post-operative care of the tongue tie and thus, at times parents find a relapse of this “tongue tie”. In fact, it is scar tissue that has formed because the tongue was not exercised enough after the surgery. In infants, this simply could just be gentle tickles around the floor of the mouth to elevate it and allow the tongue to move in all sorts of directions as it needs to. If not, then this will lead to tongue restriction and dysfunction.
Putting these two puzzles together, principally we are looking at the function of the tongue – that is, the tonicity (how strong it is) and its ability to do what it needs to do, so is it able to lift up, go side to side without any unnecessary jaw movement, suction to the roof of the mouth, depress and protrude and retrude.
Now as an infant, if an individual has not developed the appropriate sucking/swallowing action, then you can imagine the swallowing pattern as they grow into their childhood will not be correctly developed. As an infant, the correct swallow pattern when breastfeeding particularly follows as a wave-like motion of the back part of the tongue to create vacuum when drinking/sucking then slightly protrudes over the lower gum area during front tongue movement but not out of the mouth. Then as a child and into adulthood, it would be chewing on both sides of the jaw, tongue onto the palate creating a suction then a wave-like motion to move the food down the oesophagus. If the initial tongue swallow is not appropriately established due to the discrepancy in embryo development or a tongue restriction/tie (because the tongue is restricted from lifting), the tongue tends to form a FORWARD, THRUSTING motion of swallowing rather than a suction wave-like motion. Why is this significant? Because of the development of the jaw and thus how crowded the teeth are largely influenced by the degree of quality of suction to the roof and swallow pattern.
The tongue is the second strongest muscle in the head and neck , just short before our masseters(two muscles on either sides of the jaw that help us eat) and if you can imagine, as an infant and child the bones are very malleable and the tongue being of the biggest influences in the growth of the upper jaw. And what is attached with the jaw, the rest of the skull!!
Therefore , if there is this lack of motion and more of a forward tongue posture, the upper jaw would become more narrow, high and hourglass-like rather than broad, flat and wide!
With such tongue restrictions and tongue thrusting swallow pattern, there tends to be a downward , forward resting posture of the tongue rather than a slight suction to the roof of the mouth which is its natural position. With this compromised form, comes with compromised tonicity and strength of the tongue. Think about your biceps, if you do not go to the gym to lift weights regularly and hit your protein intake, the tonicity of the biceps will be lacking much like the tongue. As such, the tongue becomes “slouchy”. The tongue can be analogously similar to a sling slot, the tongue becomes weak and “slouchy” and the two poles that the sling is attached to are pulled down. These two poles in the head is your jaw and thus, the jaw tends to droop and thus, mouth breathing commences!!!
These categories of dysfunction go under the umbrella term of “myofunctional disorders’ as it involves the compromised function of the musculature of the head and neck.
Child
In children, there are a number of factors that contribute or even maintain the mouth breathing that we see. These could include: oral habits and tongue restrictions.
In the context of oral habits, the big one is thumb sucking and bottle feeding.
Now in this blog post, we will won’t discuss the fine details of thumb sucking as this is opening another can of worms, but to simply put, the constant pressure of the thumb onto the roof of the mouth becomes the pressure influence to the developmental process of the upper jaw and thus eventually forms the narrow high palate and an anterior open bite. Furthermore, because the thumb is in the way of the tongue, the tongue loses tonicity and thus, its usual function becomes compromised and the normal flow for correct swallowing pattern and resting tongue posture is thus unideal.
Tongue restrictions/dysfunction
Tongue restrictions refer to the limitation for the tongue to exercise its full potential range of motion. The previous aspects have been discussed prior but additional causes could be unaddressed tongue ties and narrow jaws. With unaddressed tongue ties, they may have been unaddressed for a reason as it may not be causing any issues for the child’s daily life such as with feeding and speech development and thus, not every tongue tie is a TONGUE TIE! Therefore, we look at the tongue function which we have prior listed. Sometimes if there’s a dysfunction, prescribed myofunctional exercises may help in increasing the function and may avoid the need for a frenectomy.
Narrow upper jaw:
If a child has a narrow jaw, it is given that there is insufficient space for the tongue to rest itself on the roof of the mouth, thus the tongue naturally rests onto the mouth and the cascade of mouth breathing endlessly cycles through.
Compared with nasal breathing, mouth breathing is not the most optimal and efficient way to breathe and, in some ways, compromises the immune system. The nasal passages have little hairlike structures called “cilia ” which help facilitate the filtering of small invasive particles, bacteria and viruses to prevent them from entering into the body. Furthermore, nasal breathing manifests deeper, substantial breaths and humidifies the air which allows for appropriate blood-gas exchange to occur and thus homeostasis (when the body is at balance and working harmoniously) is maintained. With mouth breathing, we do not have these protective factors in place and oftentimes, nasty bacteria and viruses enter in our body and tonsils become swollen, the immune system is not at its strongest and the air we breathe in is shallow. Therefore, mouth breathing along with potential unaddressed allergies and constant nasal congestion (which is already making the immune system work hard) may manifest for the child to likely get more sick.
Adult
When these myofunctional disorders become unaddressed as a child, they may elicit further regression in health. With what we have discussed prior about mouth breathing, this occurring whilst sleep feeds into the severity of the sleep-disordered-breathing. Snoring being one of the most common symptoms of SDB is from the vibration of the uvula. There is evidence to show that the physical vibration of uvula transmits to the carotid artery (one of the major arteries of the heart) and leads to trauma of the vessels leading to increase risk of high blood pressure.
Furthermore, snoring is not always from mouth breathing as there are other factors that can lead to snoring such as an enlarged uvuvla, collapsed tongue or an elongated soft palate. With the enlarged uvula and elongated soft palate, the ENT (ears, nose, throat doctor) manages this with surgical procedures. With a collapsed tongue, myofunctional therapy can be performed regularly to increase tonicity and strengthen neural pathways to reduce tongue collapse on the airway.Overtime when such presentations progress, it will lead to a level of sleep apnoea and potentially the other systemic issues that have been discussed prior.
Dentally, we will superifically see crowded teeth in some cases chipped teeth (due to traumatic occlusions from the narrow jaws and poor bite), TMJ pain, dry mouth, gingivitis and potentially more holes in the mouth. But as we come to the end of this blog and walked through the stages of each milestone, we can appreciate how one thing can lead to the next and so on and so on. Hence why it is so important to address such issues and dive into its root causes at an early age. As an adult there are way around to intervene but most important goal is to stabilize and work towards a healthier state.
Again, all of what has been discussed is only a contributing piece to the puzzle.
If you would like to have a chat more with our Dentists and Oral Health Therapists, call us on (02) 7228 7272, or book online at https://truesmilesdental.com.au/appointments.
