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Mouth breathing and tongue position: a risk factor for health


Author: Erik Peper, PhD, BCB and Ron Swatzyna, PhD, LCSW, BCB, BCN





Breathing usually occurs without awareness unless there are problems such as asthma, emphysema, allergies, or viral infections. Infant and child development may affect how we breathe as adults. This blog discusses the benefits of nasal breathing, factors that contribute to mouth breathing, how babies’ breastfeeding and chewing decreases the risk of mouth breathing, recommendations that parents may implement to support healthy development of a wider palate, and the embedded video presentation, How the Tongue Informs Healthy (or Unhealthy) Neurocognitive Development, by Karindy Ong, MA, CCC-SLP, CFT, .


Benefits of nasal breathing

Breathing through the nose filters, humidifies, warms, or cools the inhaled air as well as reduces the air turbulence in the upper airways. In addition, the epithelial cells of the nasal cavities produce nitric oxide that are carried into the lungs when inhaling during nasal breathing (Lundberg & Weitzberg, 1999). The nitric oxide contributes to healthy respiratory function by promoting vasodilation, aiding in airway clearance, exerting antimicrobial effects, and regulating inflammation. Breathing through the nose is associated with deeper and slower breathing rate than mouth breathing. This slower breathing also facilitates sympathetic parasympathetic balance and reduces airway irritation.


Mouth breathing

Some people breathe predominantly through their mouth although nose breathing is preferred and health promoting. Mouth breathing negatively impacts the ability to perform during the day as well as affect our cognitions and mood (Nestor, 2020). It contributes to disturbed sleep, snoring, sleep apnea, dry mouth upon waking, fatigue, allergies, ear infections, attention deficit disorders, crowded mis-aligned teeth, and poorer quality of life (Kahn & Ehrlich, 2018). Even the risk of ear infections in children is 2.4 time higher for mouth breathers than nasal breathers (van Bon et al, 1989) and nine and ten year old children who mouth breath have significantly poorer quality of life and have higher use of medications (Leal et al, 2016).

One recommendation to reduce mouth breathing is to tape the mouths closed with mouth tape (McKeown, 2021). Using mouth tape while sleeping bolsters nose breathing and may help people improve sleep, reduce snoring, and improves alertness when awake (Lee et al, 2022).


Experience how mouth breathing affects the throat and upper airway

Inhale quickly, like a gasp, as much air as possible through your open mouth. Exhale letting the air flow out through your mouth. Repeat once more.

Inhale quickly as much air through the nose, then exhale by allow the airflow out through the nose. Repeat once more.


What did you observe? Many people report that rapidly inhaling through the mouth causes the back of the throat and even upper airways to feel drier and irritated. This does not occur when inhaling through the nose. This simple experiment illustrates how habitual mouth breathing may irritate the airways.


Developmental behavior that contributes to mouth breathing

The development of mouth breathing may begin right at birth when the mouth, tongue, jaw and nasal area are still developing. The arch of the upper palate forms the roof of the oral cavity that separates the oral and nasal cavities. When the palate and jaw narrows, the arch of the palate increases and pushes upwards into the nasal area. This reduces space in the nasal cavity for the air to flow and obstructs nasal breathing. The highly vaulted palate is not only genetically predetermined but also by how we use our tongue and jaw from birth. The highly arched palate is only a recent anatomical phenomena since the physical structure of the upper palate and jaw from the pre- industrial era was wider (less arched upper palate) than many of our current skulls (Kahn & Ehrlich, 2018).



The role of the tongue in palate development

After babies are born, they breastfeed by sucking with the appropriate tongue movements that help widen the upper palate and jaw. On the other hand, when babies are bottle fed, the tongue tends to move differently which causes the cheek to pull in and the upper palate to arch which may create a high narrow upper palate and making the jaw narrower. There are many other possible factors that could cause mouth breathing such as tongue-tie (ankyloglossia), septal deviation, congenital malformation, enlarged adenoids and tonsils (Aden tonsillar hyperplasia), inflammatory diseases such as allergic rhinitis (Trabalon et al, 2012). Whatever the reasons, the result of the impoverished tongue movement and jaw increases the risk for having a higher arched upper palate that impedes nasal breathing and contributes to habitual mouth breathing.


The forces that operate on the mouth, jaw and palate during bottle feeding may be similar to when you suck on straw and the cheeks coming in with the face narrowing. The way the infants are fed will change the development of the physical structure that may result in lifelong problems and may contribute to developing a highly arched palate with a narrow jaw and facial abnormalities such as long face syndrome (Tourne, 1990).


To widen the upper palate and jaw, the infant needs to chew, chew and tear the food with their gums and teeth. Before the industrialization of foods, children had to tear food with their teeth, chew fibrous foods or gnaw at the meat on bones. The chewing forces allows the jaw to widen and develop so that when the permanent teeth are erupting, they would more likely be aligned since there would be enough space–eliminating the need for orthodontics. On the other hand, when young children eat puréed and highly processed soft foods (e.g., cereals soaked in milk, soft breads), the chewing forces are not powerful enough to encourage the widening of the palate and jaw.


Although the solution in adults can be the use of mouth tape to keep the mouth closed at night to retrain the breathing pattern, we should not wait until we have symptoms. The focus needs to be on prevention. The first step is an assessment whether the children’s tongue can do its job effectively or limited by tongue-tie and the arch of the palate. These structures are not totally fixed and can change depending on our oral habits. The field of orthodontics is based upon the premise that the physical structure of the jaw and palate can be changed, and teeth can be realigned by applying constant forces with braces.


Support healthy development of the palate and jaw

Breastfeed babies (if possible) for the first year of life and do NOT use bottle feeding. When weaning, provide chewable foods (fruits, vegetable, roots, berries, meats on bone) that was traditionally part of our pre-industrial diet. These foods support in infants’ healthy tongue and jaw development, which helps to support the normal widening of the palate to provide space for nasal breathing.


Provide fresh organic foods that children must tear and chew. Avoid any processed foods which are soft and do not demand chewing. This will have many other beneficial health effects since processed foods are high in simple carbohydrates and usually contain color additives as well as traces of pesticides and herbicides. The highly processed foods increase the risk of developing depression, type 2 diabetes, inflammatory disease, and colon cancer (Srour et al., 2019).


Sadly, the USA allows much higher residues of pesticide and herbicides that act as neurotoxins than are allowed in by the European Union. For example, the acceptable level of the herbicide glyphosate (Round-Up) is 0.7 parts per million in the USA while in the acceptable level is 0.01 parts per million in European countries (Tano, 2016; EPA, 2023; European Commission, 2023). The USA allows this higher exposure even though about half of the human gut microbiota are vulnerable to glyphosate exposure (Puigbò et al., 2022).


The negative effects of herbicides and pesticides are harmful for growing infants. Even fetal exposure from the mother (gestational exposure) is associated with an increase in behaviors related to attention-deficit/hyperactivity disorders and executive function in the child when they are 7 to 12 years old (Sagiv et al., 2021) and organophosphate exposure is correlated with ADHD prevalence in children (Bouchard et al., 2010).


To implement these basic recommendations are very challenging. It means the mother has to breastfeed her infant during the first year of life. This is often not possible because of socioeconomic inequalities; work demands and medical complications. It also goes against the recent cultural norm that fathers should participate in caring for the baby by giving the baby a bottle of stored breast milk or formula.


From our perspective, women who give birth must have a year paid maternity leave to provide their infants with the best opportunity for health (e.g., breast-feeding, emotional bonding, and reduced financial stress). As a society, we have the option to pay the upfront cost now by providing a year- long maternity leave to mothers or later pay much more costs for treating chronic conditions that may have developed because we did not support the natural developmental process of babies.


Relevance to the field of neurofeedback and biofeedback

Clinicians often see clients, especially children with diagnostic labels such as ADHD who have failed to respond to numerous psychotherapies and pharmacotherapies. In the recent umbrella review and meta-analytic evaluation of recent meta-analyses, Leichsenring et al. (2022) found only small benefits overall for both types of intervention. They suggest that a paradigm shift in research seems to be required to achieve further progress in resolving mental health issues. As the past director of National Institute of Health, Dr. Thomas Insel pointed out that the Diagnostic and Statistical Manual of Mental Disorders (DSM) is not a valid instrument and should be a big wake up call for all of us to think outside the box (Insel, 2009). One factor that starts right at birth is the oral cavity development by dysfunctional tongue movements.


We want to make all of you aware of a serious issue in children that you may come across. For those of us who work with children, we need to ask their parents about the following: tongue-tie, mouth breathing, bedwetting, high-vaulted palate, thumb sucking, abnormal eating issues, apraxia, dysarthria, and hypotonia. Research suggests that the palates of these children are so arched that the tongue cannot do its job effectively, causing multiple issues which may be related.


Please view the webinar from May 17, 2023. Presented by Karindy Ong, MA, CCC-SLP, CFT, How the Tongue Informs Healthy (or Unhealthy) Neurocognitive Development. The presentation explains the developmental process of the role the tongue plays and how it contributes to nasal breathing. Please pass it on to others who may have interest.




References

Bouchard, M.F., Bellinger, D.C., Wright, R.O., & Weisskopf, M.G. (2010). Attention-deficit/hyperactivity disorder and urinary metabolites of organophosphate pesticides. Pediatrics, 125(6), e1270-7. https://doi.org/10.1542/peds.2009-3058



EPA. (2023). Glyphosate. United States Environmental Protection Agency. Accessed April 1, 2023. https://www.epa.gov/ingredients-used-pesticide-products/glyphosate





Insel, T.R. (2009). Translating scientific opportunity into public health impact: a strategic plan for research on mental illness. Arch Gen Psychiatry, 66(2), 128-133. https://doi.org/10.1001/archgenpsychiatry.2008.540





Leal, R.B., Gomes, M.C., Granville-Garcia, A.F., Goes, P.S.A., & de Menezes, V.A. (2016). Impact of Breathing Patterns on the Quality of Life of 9- to 10-year-old Schoolchildren. American Journal of Rhinology & Allergy, 30(5):e147-e152. https://doi.org/10.2500/ajra.2016.30.4363



Lee, Y.C., Lu, C.T., Cheng, W.N., & Li, H.Y. (2022).The Impact of Mouth-Taping in Mouth-Breathers with Mild Obstructive Sleep Apnea: A Preliminary Study. Healthcare (Basel), 10(9), 1755. https://doi.org/10.3390/healthcare10091755



Leichsenring, F., Steinert, C., Rabung, S. and Ioannidis, J.P.A. (2022), The efficacy of psychotherapies and pharmacotherapies for mental disorders in adults: an umbrella review and meta-analytic evaluation of recent meta-analyses. World Psychiatry, 21: 133-145. https://doi.org/10.1002/wps.20941



Lundberg, J.O. & Weitzberg, E. (1999). Nasal nitric oxide in man. Thorax. (10):947-52. https://doi.org/10.1136/thx.54.10.947



McKeown, P. (2021). The Breathing Cure: Develop New Habits for a Healthier, Happier, and Longer Life. Boca Raton, Fl “Humanix Books. https://www.amazon.com/BREATHING-CURE-Develop-Healthier-Happier/dp/1630061972/



Nestor, J. (2020). Breath: The New Science of a Lost Art. New York: Riverhead Books. https://www.amazon.com/Breath/dp/0593191358/ref=tmm_pap_swatch_0?_encoding=UTF8&qid=1686191995&sr=8-1



Puigbò, P., Leino, L. I., Rainio, M. J., Saikkonen, K., Saloniemi, I., & Helander, M. (2022). Does Glyphosate Affect the Human Microbiota?. Life, 12(5), 707. https://doi.org/10.3390/life12050707



Sagiv, S.K., Kogut, K., Harley, K., Bradman, A., Morga, N., & Eskenazi, B. (2021). Gestational Exposure to Organophosphate Pesticides and Longitudinally Assessed Behaviors Related to Attention-Deficit/Hyperactivity Disorder and Executive Function, American Journal of Epidemiology, 190(11), 2420–2431. https://doi.org/10.1093/aje/kwab173



Srour, B. et al. (2019). Ultra-processed food intake and risk of cardiovascular disease: prospective cohort study (NutriNet-Santé).BMJ, 365. https://doi.org/10.1136/bmj.l1451

Tano, B. (2016). The Layman’s Guide to Integrative Immunity. Integrative Medical Press. https://www.amazon.com/Laymans-Guide-Integrative-Immunity-Discover/dp/0983419299/_



Tourne, L.P. (1990). The long face syndrome and impairment of the nasopharyngeal airway. Angle Orthod, 60(3):167-76. https://doi.org/10.1043/0003



Trabalon, M. & Schaal, B. (2012). It takes a mouth to eat and a nose to breathe: abnormal oral respiration affects neonates’ oral competence and systemic adaptation. Int J Pediatr, 207605. https://doi.org/10.1155/2012/207605



van Bon, M.J., Zielhuis, G.A., Rach, G.H., & van den Broek, P. (1989). Otitis media with effusion and habitual mouth breathing in Dutch preschool children. Int J Pediatr Otorhinolaryngol, (2), 119-25. https://doi.org/10.1016/0165-5876(89)90087-6

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