Narrow Jaws, Mouth Breathing & Broken Sleep in Children: What We Look For
Parents often bring their child to us about crowded teeth and end up talking about sleep. The two are more closely connected than most families expect, and childhood is the window in which the connection can be acted upon.
Signs worth mentioning to us
Snoring most nights, or noisy, effortful breathing during sleep.
Habitually sleeping with the mouth open, or dry lips and mouth on waking.
Restless sleep, unusual sleeping positions, or bedwetting beyond the expected age.
Daytime tiredness, irritability, or difficulty concentrating at school.
A high, narrow palate, crowded teeth, or a crossbite.
Why the shape of the palate matters
The roof of the mouth is also the floor of the nose. A narrow upper jaw means a narrower nasal airway, which can make nasal breathing harder work and push a child towards breathing through the mouth.
This is treatable during growth. In children with a narrow or high-arched palate and diagnosed sleep apnoea, expansion of the upper jaw has been shown to reduce the apnoea–hypopnoea index substantially in the years following treatment. Pooled evidence also links habitual mouth breathing to a backward and downward growth pattern of the jaws and a narrower pharyngeal airway, although those studies are observational and cannot prove cause.
What happens at an assessment
We examine the palate, arch width, bite and soft tissues, and we ask about sleep, breathing and nasal congestion. Where enlarged tonsils or adenoids, allergy or persistent nasal obstruction are suspected, we refer for medical or ENT assessment, because these are addressed by colleagues rather than by orthodontics alone.
Where a child needs a sleep study, that is arranged through the appropriate medical pathway. Interceptive treatment is considered alongside that, not instead of it.
Contact the practice to arrange a children's growth and airway assessment.
References
Camacho, M., Chang, E. T., Song, S. A., Abdullatif, J., Zaghi, S., Pirelli, P., Certal, V., & Guilleminault, C. (2017). Rapid maxillary expansion for pediatric obstructive sleep apnea: A systematic review and meta-analysis. The Laryngoscope, 127(7), 1712–1719. https://doi.org/10.1002/lary.26352
Liu, Y., Zhou, J.-R., Xie, S.-Q., Yang, X., & Chen, J.-L. (2023). The effects of orofacial myofunctional therapy on children with OSAHS's craniomaxillofacial growth: A systematic review. Children, 10(4), Article 670. https://doi.org/10.3390/children10040670
Zhao, Z., Zheng, L., Huang, X., Li, C., Liu, J., & Hu, Y. (2021). Effects of mouth breathing on facial skeletal development in children: A systematic review and meta-analysis. BMC Oral Health, 21, Article 108. https://doi.org/10.1186/s12903-021-01458-7
