Mouth Breathing and Snoring in Children: Why It Matters

"He sleeps with his mouth wide open, and he snores like his grandfather!" Parents often mention this almost as a joke. But regular mouth breathing and snoring in children are worth paying attention to. They can affect teeth and gums, and sometimes they point to a problem with breathing during sleep that a doctor should check.

Nose breathing is the default

Children are designed to breathe through their nose most of the time. The nose warms, filters and moistens the air. Breathing through the mouth now and then, such as during a cold or after running, is normal. The concern is when a child breathes through the mouth most of the time, day or night.

Common causes

• Enlarged adenoids or tonsils. These are common in young children and can partly block the airway, especially when lying down.
• Allergies and a blocked nose. Allergic rhinitis, dust and seasonal triggers can keep the nose congested for long periods.
• Frequent colds or sinus problems.
• Habit. Some children keep breathing through the mouth even after the original blockage has cleared.

Effects on teeth and gums

Saliva is the mouth's natural protection. It washes away food and helps neutralise acids. When a child breathes through the mouth, especially at night, the mouth dries out and loses much of that protection. Possible effects include:

• Dry mouth and cracked lips.
• More risk of cavities, because teeth are not bathed in saliva.
• Red, puffy gums, often around the upper front teeth.
• Bad breath, particularly in the morning.

Effects on growth and sleep

Long-term mouth breathing may also be linked to how the face and jaws develop. Some children who breathe through the mouth for years develop a narrow upper jaw, a high palate, crowded teeth or a "long face" appearance. Research on this is still evolving, and not every mouth-breathing child will be affected, but it is one reason to look into the cause early.

Disturbed breathing at night can also mean poor-quality sleep. That can show up during the day as:

• Tiredness, or being hard to wake in the morning.
• Irritability, hyperactivity or trouble concentrating at school.
• Morning headaches.
• Bedwetting in a child who was previously dry.

Red flags for sleep apnea

Obstructive sleep apnea is when the airway repeatedly narrows or closes during sleep. Talk to your paediatrician promptly if your child:

• Snores loudly on most nights.
• Has pauses in breathing, gasps or chokes during sleep.
• Sleeps restlessly or in unusual positions, such as with the neck stretched back.
• Is very sleepy or struggling with behaviour or learning during the day.

What your dentist may notice

At routine check-ups, dentists sometimes spot signs that suggest mouth breathing: dry or inflamed gums, a narrow upper jaw, crowding, a crossbite, large tonsils visible at the back of the throat, or tooth wear from grinding. Your dentist can't diagnose a sleep problem, but can tell you when it makes sense to have your child assessed.

Who to see

1. Start with your paediatrician. They can look at the nose, tonsils and allergies and check for signs of sleep apnea.
2. ENT specialist. If needed, your paediatrician may refer your child to an ear, nose and throat doctor to assess the adenoids and tonsils.
3. Dentist or orthodontist. If the jaws or bite are affected, an orthodontic assessment may be suggested.

Tips you can try at home

• Watch your child sleep for a few minutes on several nights, and record a short video of any snoring or pauses to show the doctor.
• Keep the bedroom dust-free and wash bedding regularly if allergies are suspected.
• Encourage water during the day, and keep brushing twice daily with fluoride toothpaste, because a dry mouth needs extra protection.
• Don't add sugary drinks at night to soothe a dry mouth. Water only after the last brush.