Mouth Breathing in Children: What Every Parent Should Know

Mouth breathing is often dismissed as a harmless habit in children — but in reality, it can be an early sign of deeper concerns affecting your child’s growth, health, and development.

At Orthodontics Victoria, we regularly see young patients who present with crowded teeth, narrow jaws, or underbites — and in many cases, mouth breathing is at the root of these issues.

Understanding Mouth Breathing and Its Impact

Let’s take the example of Lucas (name changed for privacy), an energetic 8-year-old who came to us with dental crowding and an underbite. What stood out during his assessment wasn’t just his bite — it was his breathing.

What We Observed:

• Chronic mouth breathing due to an enlarged nasal turbinate

• A narrow upper jaw and anterior crossbite

• A tongue thrust swallowing pattern with lower lip overactivity

These weren’t just cosmetic findings. They were linked to how Lucas was breathing, sleeping, and using the muscles of his face — all of which influence long-term development.

The Hidden Consequences of Mouth Breathing

Mouth breathing in children is often associated with:

• 🦷 Abnormal jaw and facial growthChronic open-mouth posture can alter tongue position and lead to a narrow palate, long-face appearance, and crowded teeth.

• 😴 A marker of sleep-disordered breathing (SDB)Mouth breathing, snoring, and nasal obstruction are key clinical signs of SDB in children, a condition that disrupts sleep quality, oxygen levels, and healthy growth.

• 🧠 Behavioral and cognitive effectsPoor sleep from SDB can lead to difficulty concentrating, hyperactivity, and reduced academic performance.

• 😬 Oral health issuesMouth breathing contributes to dry mouth, plaque buildup, increased risk of cavities, and gum inflammation.

• 🫁 Systemic health impactsIf untreated, chronic mouth breathing and SDB may increase long-term risk for metabolic, cardiovascular, and immune challenges.

How We Approach Treatment

For children like Lucas, we take a multidisciplinary, airway-focused approach to care:

1. Medical coordination – We work with your child’s physician to assess airway concerns and determine if ENT referral is needed.

2. Orthodontic intervention – We use gentle appliances like palatal expanders to widen the upper jaw, improve nasal airflow, and correct crossbites.

3. Myofunctional therapy – We help your child develop proper tongue posture, lip seal, swallow patterns, and nasal breathing.

4. Growth monitoring – We track changes every 6 months to ensure healthy development and timely adjustments.

Why Early Intervention Matters

The earlier we identify and treat the effects of mouth breathing, the more we can influence healthy growth. By improving breathing, posture, and function early, we reduce the need for more invasive interventions later.

Is Your Child a Mouth Breather?

If your child snores, breathes through their mouth, has crowded teeth, or shows signs of poor sleep, we encourage you to book an early orthodontic evaluation. It’s not just about straight teeth — it’s about helping your child breathe, grow, and thrive.

Why Black Triangles Appear During or After Orthodontic Treatment

A beautifully aligned smile is the goal of orthodontic treatment, but for some patients, the final result includes a surprise: small, dark spaces near the gumline between the teeth. These are known as black triangles, or open gingival embrasures. While they do not pose a direct health risk, they can be a cosmetic concern and affect how your smile looks and feels.

🦷 What Are Black Triangles?

Black triangles are visible triangular gaps between the teeth and gums when the gum tissue (known as the interdental papilla) doesn’t completely fill the space under the contact point between two adjacent teeth. These spaces often become noticeable during or after orthodontic treatment.

🔍 Why Do They Appear After Orthodontics?

As teeth are properly aligned with braces or clear aligners, pre-existing gaps or anatomical deficiencies that were previously hidden by crowding or rotation can become more visible. In many cases, these black triangles were already present, just not detectable until after the teeth were moved into their correct positions.

🧠 What Causes These Gaps?

Several factors contribute to the formation of black triangles:

• Tooth Shape: Teeth with a triangular shape (wider at the top and narrower toward the gumline) often have smaller contact points and leave more space for gaps to form.

• Gingival Recession: Gum tissue can recede due to periodontal inflammation, overzealous brushing, or natural aging. When the gum pulls back, the space between teeth becomes exposed.

• Loss of Interdental Bone: The intercrestal (interdental) alveolar bone supports the gum tissue between teeth. If this bone diminishes—due to gum disease, aging, or biting stress—the gum tissue collapses downward, revealing a black triangle.

• Thin Gingival Biotype: Individuals with thinner or more delicate gum tissue have less volume to fill the space between teeth, increasing the likelihood of black triangle formation.

• Pre-Existing Gingival Gaps: Even before orthodontic treatment, some patients have small deficiencies in papillary fill that are revealed once teeth are aligned.

🛠️ Treatment Options

Managing black triangles depends on the underlying cause, severity, and patient preference. Treatment may include:

1. Hyaluronic Acid (HA) Injections

A minimally invasive approach using biocompatible fillers to plump the gum tissue between the teeth. This is a non-surgical option, typically requiring retreatment every 6–12 months.Reference: Alsharif & Aljahdali, 2024

2. Interproximal Reduction (IPR)

A conservative method where small amounts of enamel are polished between teeth to improve their contact and support soft tissue closure.

3. Composite Bonding (e.g., Bioclear Technique)

Tooth-colored material is added to reshape the sides of the teeth and close the triangle. This technique is highly esthetic and minimally invasive.Reference: BMC Oral Health, 2023

4. Porcelain Veneers

Custom ceramic restorations are used to reshape the tooth and close the gap permanently, particularly in cases involving tooth morphology issues.

5. Gum Grafting

In cases with significant tissue or bone loss, periodontal surgery can restore the papilla through connective tissue grafts or regenerative techniques.Reference: Nayyar et al., 2020

🧾 Key Considerations

Each treatment has specific indications, advantages, and limitations. If you're unsure about proceeding with interproximal reduction (IPR), we recommend consulting with your general dentist or periodontist to explore alternatives based on your clinical presentation and esthetic goals.

📞 We're Here to Help

If you've noticed black triangles during or after orthodontic treatment, we invite you to schedule a consultation. At Orthodontics Victoria, we’ll guide you through a personalized treatment plan that prioritizes both function and esthetics—so you can love your smile with confidence.

Orthodontic Therapies for Breathing Disorders

Introduction

Sleep-Disordered Breathing (SDB) is a condition that impairs airflow during sleep. These can lead to fragmented sleep, behavioral changes, cardiovascular strain, and developmental concerns in children.

For severe obstructive sleep apnea (OSA), the gold standard treatment is CPAP (Continuous Positive Airway Pressure). However, individuals with severe OSA who cannot tolerate CPAP, and those with mild to moderate OSA, may benefit from orthodontic therapies. It’s important to note that orthodontists do not diagnose or treat OSA. Instead, they provide supportive airway devices in collaboration with sleep physicians to improve outcomes.

Common Symptoms:

Snoring

Mouth breathing

Grinding (bruxism)

Daytime fatigue or sleepiness

Restless sleep

Difficulty concentrating

Hyperactivity

Morning headaches

Dental Signs:

Narrow, high-arched palate

Crowded or misaligned teeth

Retrognathic (retruded) mandible

Large overjet or open bite

Tongue thrust or low tongue posture

Dental Causes:

Maxillary constriction

Mandibular retrusion

Enlarged adenoids or tonsils

Nasal obstruction

Orthodontic Therapies

1. Rapid Palatal Expansion (RPE)

Purpose: Widen the upper jaw to increase nasal cavity volume and improve nasal airflow.

Evidence: Increases nasal and nasopharyngeal volume in children. Benefits are most notable in the short term (Niu et al., 2020).

2. Mandibular Advancement Devices (MADs)

Purpose: Reposition the lower jaw forward during sleep to prevent airway collapse. Primarily for adults with mild to moderate OSA or those with severe OSA intolerant to CPAP.

Evidence: Effective as a CPAP alternative in improving AHI and sleep quality (Sharples et al., 2016).

3. Functional Orthopedic Appliances (e.g., Bionator, Twin Block, Herbst). Purpose: Advance the mandible in growing children, correcting skeletal discrepancies and enlarging airway volume.

Evidence: Randomized trials show improvements in oropharyngeal dimensions and breathing in Class II children (Radwan et al., 2024).

Conclusion

Orthodontic interventions such as Rapid Palatal Expansion (RPE), Mandibular Advancement Devices (MADs), and functional orthopedic appliances offer promising avenues for managing SDB. These treatments not only address dental and skeletal discrepancies but also play a crucial role in enhancing airway dimensions and improving respiratory function. Early consultation with an orthodontist and coordination with a sleep physician ensures the best outcomes for patients with compromised airway.

References

Niu X., Di Carlo G., Cornelis M.A., Cattaneo P.M. (2020). Three-dimensional analyses of short- and long-term effects of rapid maxillary expansion on nasal cavity and upper airway: A systematic review and meta-analysis. Orthod Craniofac Res; 23(3):250–276. https://doi.org/10.1111/ocr.12378

Sharples L.D. et al. (2016). Meta-analysis of randomized controlled trials of oral mandibular advancement devices and CPAP for OSA-hypopnea. Sleep Med Rev; 27:108–124. https://doi.org/10.1016/j.smrv.2015.05.003

Radwan E.S., Maher A., Montasser M.A. (2024). Effect of functional appliances on sleep-disordered breathing in Class II division 1 malocclusion children: A randomized controlled trial. Orthod Craniofac Res; 27(1):126–138. https://doi.org/10.1111/ocr.12696

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