Many people ask me “Why?” when they see me with brackets and wires in my mouth. The question is usually followed by the statement, “I thought your teeth were pretty straight before” or the question “Why, did your previous orthodontics not work?” To answer some of these questions and clarify some of these observations, I will give you my backstory.
My teeth were straight by orthodontic standards when my braces came off at age 14. We were attempting to treat my “gummy smile” and the narrow roof of my mouth. I learned later while in dental school that cases like mine are very difficult to treat (long face) because of my growth trajectory of my jaws. My orthodontist did his very best with the tools/knowledge he had to help try to prevent/correct my problems. We tried several appliances, braces more than once and even double jaw surgery. The trouble is that we didn’t understand WHY I was cursed with a long face, so even after orthodontics to line up my teeth and surgery, the teeth weren’t necessarily in the best position in my face and for my jaw joint.
I have had several eye-opening moments over the last few years that lead to a better understanding of the WHY. I contest that there were likely several factors that influenced why my growth went off track (long face), but the greatest of these is mouth breathing. Mouth breathing? Yes, mouth breathing.
I, Dr. Bethany Jensen, am a recovering chronic mouth breather. I say recovering because it is a habit now that is very difficult to change but I am working on it as it has continued to affect my anatomy negatively.
Mouth breathing happens for a variety of reasons but usually starts in children. Allergies and chronic illness/colds that create stuffy noses can lead to mouth breathing. Pet dander, dust, mold, dairy, gluten, etc can all be culprits. Pacifier use or finger/thumb sucking can also lead to open mouth at rest.
Our nose is designed specifically for breathing air. The shape, filtering mechanisms, and warming capabilities are optimal for air exchange and keeping the “yuck” out of our lungs. Our mouths are great for eating and speech, but are TERRIBLE at doing the nose’s job. When the mouth does the nose’s job, sadly the tonsils try to act as an air filter, often causing swelling/enlargement (airway gets smaller) and letting lots of “yuck” into our lungs (sometimes leading to/contributing to asthma). Bottom line is that when the mouth does the work for the nose, there are really BAD consequences for our airway.
When we are breathing through our nose, our lips should be closed and the tongue should be on the roof of the mouth. If the tongue is NOT on the roof of the mouth, the jaws do not grow the way they should. Our tongue is the pillar that helps guide growth of our jaws forward and out. If you search “aglossia” on the internet, you can see photos of jaws that do not develop well in absence of the tongue (super narrow and crowded).
Back to my story, I likely had some allergies that were undiagnosed as a child and as a consequence I developed a mouth breathing habit. I did not keep my lips together because eventually I couldn’t keep my lips together as I was breathing through an open mouth and I was doing it at night as well as during the day. I struggled as a child with nightmares and restless sleep. Because this issue was never addressed, my body continued to remodel my face to keep air flowing as fast as possible and my jaws over the last 20 years continued to remodel keeping a narrow, deep/high arch.
Humans are highly adaptable, though how we adapt isn’t always sustainable. In my case, my airway issues as a child were subacute but have compounded into a worsening situation. My airway has adapted and those adaptions are predisposing me for sleep apnea. Sleep apnea? This post suddenly took a very serious tone as you probably thought I was talking about straight teeth and braces right?
The reality is that straight teeth are awesome, but my goal in treating myself now isn’t just straight teeth. My goal is straight teeth lined up with enough room for my tongue with the largest airway my face can accommodate. I am striving daily to increase the strength of muscle tone in my lips/cheeks/tongue to better position and support my jaws/teeth/face. Most importantly, I am striving to return to nasal breathing and ditch the mouth breathing habit. This is not a small undertaking and has required commitment to be the best me I can be.
Great. Mouth breathing is bad, airway is as important as straight teeth. So what do we do now?
1. Help children be nasal breathers.
Address allergies/runny noses with physician, ENT or allergist.
Ditch unhealthy habits: pacifiers, finger/thumb sucking, etc (condemn the habit not child)
2. Look at sleep symptoms in kids closely (bedwetting, mouth breathing, snoring, night terrors)
Ask Dr. Jensen about habit corrector appliances like HealthyStart to help put kids back on the right track for growth (can be used in kids as young as 2 or 3 if needed)
3. All grown up and a mouth breather? Its not too late. Great books are available to learn more:
Sleep, Interrupted by Dr. Steven Parks MD
Close Your Mouth by Patrick McKeown
Jaws: The Hidden Epidemic by Sandra Kahn and Paul Ehrlich
4. Only given “jaw surgery” as option for you?
Talk to Dr. Jensen about whether this type of orthodontics may be appropriate for you.