As a dentist dedicated to the holistic health of my young patients, I often notice things that parents might overlook. When a child walks into my office, I don’t just look at their teeth; I look at how they hold their jaw, where their tongue rests, and most importantly, how they breathe. You might be surprised to learn that something as simple as mouth breathing can have profound effects on a child’s facial development, sleep quality, and overall health. Today, I want to share my expertise on a non-invasive, effective solution that I am truly passionate about: Myofunctional Therapy.

If you have noticed your child sleeping with their mouth open, snoring, or struggling to focus during the day, you are in the right place. We are going to explore how we can correct these habits and help your child thrive.

The Silent Epidemic: Understanding Mouth Breathing

Breathing is the most natural thing we do. We do it roughly 20,000 to 25,000 times a day without even thinking about it. However, how we breathe matters just as much as if we breathe. Humans are designed to be nasal breathers. The nose is not just a passageway for air; it is a complex filtration system.

When I see a child who habitually engages in mouth breathing, I see a respiratory system that is bypassing its primary defense mechanism. The nose warms, humidifies, and filters the air before it reaches the lungs. More importantly, nasal breathing triggers the release of nitric oxide, a molecule that helps widen blood vessels and improves oxygen circulation throughout the body.

When a child breathes through their mouth, they miss out on these benefits. Instead, they inhale cold, dry, unfiltered air. But the problem goes deeper than just air quality. Chronic mouth breathing alters the posture of the mouth and tongue, which can lead to significant developmental changes in the face and jaws.

Why Does Mouth Breathing Happen?

Before we can fix the problem, we have to understand the cause. In my practice, I see several common culprits that force children to open their mouths to breathe:

• Allergic Rhinitis: Chronic allergies can cause nasal congestion, making it physically difficult to breathe through the nose.
• Enlarged Tonsils and Adenoids: When these lymph tissues swell, they block the airway, forcing the child to switch to mouth breathing to get enough oxygen.
• Tongue Ties (Ankyloglossia): If the strip of skin under the tongue is too tight, the tongue cannot rest on the roof of the mouth, which leads to the jaw dropping open.
• Habit: Sometimes, even after the physical obstruction (like enlarged adenoids) is removed, the brain still defaults to the old habit of breathing through the mouth.

It is fascinating, and somewhat alarming, to look at the statistics. According to a study published in the Jornal de Pediatria, the prevalence of mouth breathing in children can be as high as 55% in certain populations. This tells me that over half of the children we see might be struggling with suboptimal breathing habits that could affect their growth.

The Consequence of an Open Mouth: More Than Just Dry Lips

Parents often ask me, “Dr. Vafa, is it really that bad if my child breathes through their mouth?” My answer is always a compassionate but firm “Yes.” The body is an interconnected machine. When one gear is out of alignment, the whole machine runs less efficiently.

Facial Growth and Development

One of the most visible impacts of chronic mouth breathing is on the face itself. We call this “adenoid face” or “long face syndrome.” When a child breathes through the nose, the tongue rests against the roof of the mouth (the palate). The pressure of the tongue shapes the palate into a nice, wide U-shape. This creates plenty of room for adult teeth to come in straight.

However, when a child is a mouth breather, the tongue drops to the floor of the mouth to allow air to pass. Without the support of the tongue, the cheek muscles push inward, causing the palate to become narrow and high (V-shaped). This often leads to:

• Crowded or crooked teeth.
• A recessed chin (weak jawline).
• A gummy smile.
• Dark circles under the eyes (venous pooling).

Sleep and Behavior

Oxygenation is critical for a developing brain. Mouth breathing is strongly linked to sleep-disordered breathing and sleep apnea. If a child isn’t getting deep, restorative sleep, they won’t wake up refreshed. Interestingly, sleep deprivation in children doesn’t always look like lethargy. Often, it looks like hyperactivity.

Many children diagnosed with ADHD are actually suffering from poor sleep caused by airway issues. By correcting the breathing, we often see a dramatic improvement in behavior, focus, and academic performance. It is incredibly rewarding to see a child’s personality blossom once they are finally getting the rest they need.

Enter Myofunctional Therapy: Physical Therapy for the Mouth

So, how do we fix this? If the issue is purely structural, like massive tonsils, I might refer you to an ENT specialist. But for many children, the issue is muscular and habitual. This is where Myofunctional Therapy comes in. I like to describe it to my younger patients as “gym class for your tongue and face.”

Orofacial Myofunctional Therapy (OMT) is a program of exercises that target the muscles of the mouth and face. Just like you would go to a physical therapist to rehabilitate a knee injury, you undergo myofunctional therapy to retrain the oral muscles to function correctly.

The goals of myofunctional therapy are simple but powerful. We aim to achieve the “Four Goals of Myofunctional Therapy”:

1. Nasal Breathing: Restoring breathing through the nose, day and night.
2. Lip Seal: Keeping the lips closed comfortably when at rest.
3. Tongue Posture: Ensuring the tongue rests fully on the roof of the mouth (not pressing against the teeth).
4. Correct Swallowing Pattern: Replacing the “tongue thrust” swallow with a proper swallow mechanism.

For more in-depth information on how breathing affects sleep quality, I often recommend parents read resources from the Sleep Foundation. They provide excellent articles validating why we focus so heavily on nasal breathing.

How the Therapy Works in My Practice

When you bring your child to see me for an evaluation, we start by looking at the soft tissues. I check the tongue for mobility and assess their swallowing pattern. If we decide that myofunctional therapy is the right path, we begin a structured program.

The therapy involves a series of exercises that the child practices at home. These aren’t strenuous, but they require consistency. We might spend 5 to 10 minutes, twice a day, working on these drills.

Examples of Exercises

While I customize the plan for every patient, here are a few concepts we work on to correct mouth breathing:

• The Spot: We teach the child to identify “The Spot”—a small ridge of tissue right behind the upper front teeth. This is the parking spot for the tip of the tongue.
• Tongue Clicks: Making a loud clicking sound requires the tongue to suction up against the palate. This strengthens the back of the tongue, which is crucial for keeping the airway open during sleep.
• Button Pull: We might place a button on a string behind the lips (in front of the teeth) and have the child hold it there while pulling gently on the string. This strengthens the lip muscles (orbicularis oris) to ensure a strong lip seal.
• Card Hold: To encourage nasal breathing while watching TV or doing homework, I might have a child hold a piece of paper or a credit card between their lips. If they open their mouth to breathe, the card drops, giving them immediate feedback.

These exercises might sound funny, but they are neurologically re-patterning the brain. We are building new neural pathways so that nasal breathing becomes the default mode, not the exception.

The Science: Does It Really Work?

I am a man of science, and I believe in evidence-based dentistry. The data supporting myofunctional therapy is compelling. It is not just about looking better; it is about medical health.

A systematic review involving studies on pediatric sleep apnea found that myofunctional therapy could reduce the Apnea-Hypopnea Index (AHI) by approximately 50% in children and adults. The AHI measures the number of times breathing stops or slows during sleep. A 50% reduction is a massive improvement in health outcomes without surgery or medication.

This data reinforces what I see clinically every day. When we strengthen the airway muscles, they don’t collapse at night. The child breathes better, sleeps better, and grows better.

The Orthodontic Connection

As a dentist, I also look at how this therapy interacts with braces or Invisalign. Many parents bring their kids in for crooked teeth, not realizing that the crooked teeth are a symptom of the mouth breathing.

If we straighten the teeth but don’t correct the tongue posture and breathing habit, we face a high risk of “relapse.” This means the teeth will eventually shift back to their crooked positions because the tongue is still pushing against them or the mouth is still hanging open. By combining orthodontics with myofunctional therapy, we are not just fixing the smile esthetically; we are ensuring the results last a lifetime. We are treating the root cause, not just the symptom.

What to Expect from the Journey

Correcting mouth breathing is a journey, not a sprint. In my experience, the active phase of myofunctional therapy usually lasts anywhere from 6 to 12 months, depending on the severity of the habit and the dedication of the patient (and the parents!).

The process usually looks like this:

• Initial Consultation: We assess the airway, tongue tie, and facial structure.
• Intensive Phase: We meet regularly (often every two weeks) to learn new exercises and check progress.
• Generalization Phase: Once the muscles are strong, we focus on making the new habits subconscious. This is where we ensure the child breathes through their nose while sleeping or distracted.
• Maintenance: Periodic check-ins to ensure the habits stick.

I find that children are incredibly adaptable. Once they understand why they are doing the exercises—to run faster in soccer, to sleep better, or to have a nicer smile—they often become very motivated partners in their own health.

A Message of Hope for Parents

It can be overwhelming to hear that your child’s breathing habits might be affecting their development. I want to reassure you that the human body is resilient. Especially in children, whose bones are still growing and malleable, we have a tremendous window of opportunity to intervene.

By catching mouth breathing early and implementing myofunctional therapy, we can actually reverse some of the facial changes and restore proper airway health. I have seen children transform from tired, mouth-breathing patients with dark circles under their eyes to energetic, nasal-breathing kids with bright eyes and wide, healthy smiles.

My goal as Dr. Bruce Vafa is to look beyond the teeth. I want to help you raise a healthy, happy child who can breathe freely and sleep soundly. If you suspect your child is a mouth breather, do not wait. The earlier we address these habits, the easier they are to correct. Let’s work together to give your child the foundation for a lifetime of health.