Enlarged Tonsils, Adenoids and Allergies
How breathing can affect a child’s bite, facial appearance and/or behavior

If you see adults with a face that appears somewhat longer than normal, there is a strong possibility they had difficulty breathing through their mouth as a child.  Obstructions due to chronically congested nasal passages or enlarged tonsils can affect the growth of the face.  “Long face syndrome” is a term describing the longer, narrow face of children who suffer from uncontrolled allergies or, an obstruction of the upper airway which creates an inability to breathe through the nose.  Narrow nostrils, shadows beneath the eyes and constantly open lips are often associated with blockage of the upper airway or allergies.

If a child is unable to breathe through the nose, mouth-breathing results, which may affect the child's overall health since important nasal functions are bypassed.  As air passes through the nose, it is warmed, humidified and cleansed of foreign particles, pollen and bacteria.  In addition, dry air carries less oxygen than moist air to the lungs, causing these children to fatigue more rapidly,

The child’s bite may change too.  Mouth-breathing often causes unbalanced muscle forces which compress the upper jaw.  As the palate constricts and creates a smaller space, the tongue may complicate matters by protruding through the front teeth, forcing them outward.  As the upper jaw constricts, it creates a very high vault in the palate (roof of the mouth) and increases the overall length of the lower face, thus the term “long face syndrome”.  If the constriction of the upper jaw repositions the molars, your dentist may recommend expansion of the upper jaw with an orthodontic appliance, which also often improves breathing.  It is important to catch the problem early as this is the easiest time to correct any concern there may be.  As the teeth shift, a change in the bite can occur.  In some instances, if the child develops a “crossbite” where the forces on the teeth aren’t even, asymmetry in the development of the jaws can also occur.

In some children, a severe upper airway blockage can cause breathing to stop during sleep or sleep apnea.  These children may not grow normally because of the energy they expend trying to breathe during the night.  Also, these children may be hyperactive and experience poor concentration, headaches, nightmares and bedwetting.

Parents may use an audio or video to tape documentation of the child’s sleep disturbances.  A physician may recommend removal of the adenoids if sleep apnea is due to obstruction of the upper airway.

If allergies are the source of the problem, the causes need to be determined and removed.  Buy hypoallergenic pillows and cover mattresses and pillows with dust mite barrier covers.  The child’s doctor may recommend drugs or allergy shots to reduce allergic responses.

Use the BEARS acronym to determine if sleep apnea is a possibility:

• Bedtime problems, such as snoring, sleep apnea or nightmares
• Excessive daytime sleepiness
• Awakenings at night
• Regularity and duration of sleep
• Snoring

It may not seem like a big deal, but as you can see, breathing difficulties in children can have life long effects.  If you have any concerns feel free to ask your dentist to evaluate the health of your child’s mouth.