North Texas Dentistry Volume 10 Issue 1 2020 ISSUE 1 DE | Page 18

sleep and wellness
A CASCADE OF PROBLEMS
The impact of improper breathing and tongue function
by Mark Musso, DDS
We are designed to breathe through our nose. When we nasal
breathe, the air is filtered, humidified, warmed and sterilized.
We use our diaphragm properly and maximize our lungs’ full
capacity. The lungs receive a full amount of clean air. We receive
nitric oxide through our nasal breathing which dilates the blood
vessels and helps get the clean oxygen to our brain. Nasal
breathing is difficult when we are sick for the short term, but it
can be chronically compromised for several reasons. Chronic
allergies (or sensitivities) cause turbinate inflammation. There
could be a deviated septum or spurs or infections. These all lead
to mouth breathing. Mouth breathing brings toxins straight into
our system with no filter system and none of the benefits men-
tioned above.
If we can't or won't nasal breathe, then we are forced to mouth
breathe. Mouth breathing causes our jaws to grow differently.
We don’t get full growth and development, so our genetic po-
tential is unrealized. Chronic mouth breathing can cause im-
proper tongue function but also improper tongue function can
cause mouth breathing. Let me explain. Chronic mouth breath-
ing doesn't force the tongue to the roof of the mouth. Our
tongue is our natural palatal expander. Without proper expan-
sion, we see a host of issues develop. Mouth breathing isn't the
only factor here. Tongue tie or improper tongue position and
function are also contributing factors. We often see tongue
thrusts that have an impact on teeth alignment as well. One of
our tongue's main role is to form the maxilla to full genetic po-
tential so all the teeth have room to align properly. This then
frees the mandible to grow and develop to its full potential. The
tongue's role in dentistry is often overlooked and underappre-
ciated. There are many factors that cause tongue dysfunctions,
some of which go back to when we were born – lack of nursing
and use of bottle feeding just to mention a few. The other mus-
cles of the mouth play vital roles as well. Our lips and cheeks
act as retention. If they don't have proper tone or don't function
well, then we see poor development.
Once proper nasal breathing and tongue function are estab-
lished, we see better sleep. We often see bedwetting resolved
and the child starts waking up refreshed and attentive for
school. Our bodies need rest. We are designed to rest, and rest
properly. Our body and mind need to “shut down" for several
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hours if we are to maintain good health. In deep sleep, our body
heals itself and our cells regenerate. We dream! We rid the tox-
ins in our brain. Sleep recharges us for the next day so we can
become the best version of ourselves. This is my goal for my
patients now.
When I examine a child patient, I look at teeth and gums after
my sleep exam. This is the opposite of what I have done for
years and what I was taught in school. I realized that I am treat-
ing a person, not just a mouth. I start from the outside in. I look
to see what is “off”, starting with their posture and shoulders.
I look at asymmetries in the head and face. I want to know if
there are any craniofacial abnormalities. Do they have dark cir-
cles under their eyes? Are there lips chapped? I look for irrita-
tion in their eyes and look to see if the lower sclera of their eyes
are showing. I look at the size and shape of their nose and look
to determine if there is nasal blockage. I look at their jaw line.
I look for a chin that is pushed back and deficient maxilla. I look
at their mouth posture and look to see if they are mouth
breathers. I listen to their nasal breathing. I look to see if they
have hypotonic or hypertonic facial muscles. I watch their swal-
low and listen to their speech. I go over an at-home assessment
that I have the parents bring in, which records their observa-
tions over the past two weeks because I won’t see everything
that child does during my one-hour exam. I ask the parents or
the child’s siblings if the patient snores or grinds their teeth.
No child should snore or grind their teeth!
Then I start my intra-oral exam. I look at their smile. Is there a
gummy smile, overbite, underbite, crossbite, vaulted palate,
tongue tie (anterior or posterior), check Mallampati and tonsils,
uvula, crowding, missing teeth, then cavities and gums.
When any of these things are not normal, I know there is an air-
way issue and/or a tongue function problem usually. Although
our bodies are a genetic representation of our parents, most
malocclusion is epigenetic. Epigenetics is defined as changes in
gene expression that do not involve changes to the underlying
DNA. In other words, things that our environment can change.
Bad habits or improper breathing or improper tongue and lip
function can change the genetic expression by creating crowded
teeth and craniofacial abnormalities. For example, the identical
twins seen here: