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The Art Of Breathing

Written by:  Dr. Hamid Nassery


The simple act of taking air in and pushing it out. Seems elementary. All of us do it since birth so we all think we know it. But do we really?

Many of our new patients are curious and somewhat surprised as to why a dentist talks so much about breathing.

Well, allow me to elaborate. Having dedicated the last 20 years of my professional life to the treatments of cranio-mandibular diseases, I have had a front row seat to the progression of this terrible and sometimes debilitating disease.

In my humble experience, the great majority of these cases represent major and minor malocclusion (poorly or incorrectly matching upper and lower dentition). Now, I am acutely aware that there are systemic and physiologic factors and conditions that would make some patients more prone to symptomatic responses vs. another. These conditions should rightly be addressed by the proper medical professionals.

However, going back to malocclusion, be it slight or extensive, to me represents skeletal discrepancy. After all these teeth are inside the bone and if they are not in the proper place and position, then it really means that the bone they sit in, is not in the right position. Hence we have to agree there was a developmental or growth issue.

As with other parts of our skeletal system, growth and proper development of facial bones and structure  depends on proper and balanced muscular function. The law of transformation of bone, as described by Julius Wolf in 1892, basically explains that function forms bone. The oral cavity is no exception to this rule and proper development of dental arches depend on the correct position and function of tongue, lips, cheek, and nasal breathing(1).

In dentistry we call it the big three factors: tongue in the palate, lip seal and breathing through the nose. This means the position of the tongue during rest is just as important as during function. The swallow pattern is affected by this little known fact.

In our practice, on a daily basis, we examine patients with all different types of malocclusion and without exception we can always find one or more of these factors missing or aberrant. Nasal breathing has long been established as the ultimate goal for proper facial development(2).

The facial changes are only the tip of the iceberg. Some of the other issues associated with improper breathing are as follows; Sugar metabolism, Thyroid problems, Gut microbiome, Ear disease, Heart palpitations.

If the previous issues are not enough to get your attention for yourself, the following should spark attention, at least as it pertains to your children. There is a growing body of research as it relates to children with breathing issues and especially difficulties during sleep.

I will come back to this and recount the research. The biggest hurdle to me in this area is that most parents, themselves, don’t know what proper breathing is. Most often, they are poor breathers and most have sleep disordered breathing and disregard it as a nuisance at best. This is why breathing education and exercises are a main focus in our practice. 

Going back to nasal breathing and growth and development, the effects of an enlarged adenoid to this arena can be devastating. Changing facial format to a narrower and longer form hence making the airway smaller(3). Unfortunately I still have difficulty when referring some of these patients to some ENT’s or even pediatricians. The most common response I get is “they are going to grow out of it”. That is exactly the opposite to the truth, they will not grow to their fullest potential.

Dysfunctional breathing is one of the most overlooked causes of Postural and neck problems. This particular factor is one close to my heart, as much of my practice for the past 20 years has been dedicated to the treatment of these patients. Very difficult to overcome in adults, but if we start early in children we have a chance.

We know now that even children with common allergic rhinitis are affected and the sooner this issue is resolved the less harm they suffer(4).

The effects on facial growth is more than just aesthetic, longer facial growth patterns are also associated with TMJ issues and cervical postural issues(5). This facial growth pattern is almost always associated with a nasal septum deviation and smaller airway, and larger craniocervical curvature(6).

This is a lengthy and important subject that can be elaborated on in books. This is just a small window into the vast area of breathing and sleep breathing issues that is meant to introduce our readers to the importance of this very basic function that is breathing. What should be obvious is that to have the best chances in life, it is important to breathe properly.

1.Acta Otorhinolaryngol Ital
. 2021 Oct;41(5):436-442. doi: 10.14639/0392-100X-N1225.
Association between upper airway obstruction and malocclusion in mouth-breathing children
Paola Festa 1 2, Nicola Mansi 1, Alfonso Maria Varricchio 1, Fabio Savoia 3, Camilla Calì 3, Carmela Marraudino 4, Giovanni Carlo De Vincentiis 5, Angela Galeotti 2

2. Establishment of Nasal Breathing Should Be the Ultimate Goal to Secure Adequate Craniofacial and Airway Development in Children.
Torre C, Guilleminault C.
J Pediatr (Rio J). 2018 Mar-Apr;94(2):101-103. doi: 10.1016/j.jped.2017.08.002. Epub 2017 Aug 30.

3.Transl Pediat
. 2021 Oct;10(10):2563-2572. doi: 10.21037/tp-21-437.
Effect of adenoid hypertrophy on the upper airway and craniomaxillofacial region
Hongwei Wang 1, Xiaotong Qiao 2, Suqing Qi 3, Xiaolan Zhang 4, Song Li 1

4.Acta Otolaryngol
. 2021 Mar;141(3):286-292. doi: 10.1080/00016489.2020.1846782. Epub 2020 Dec 14.
Long-term outcome of concurrent coblator turbinoplasty with adenotonsillectomy in children with allergic rhinitis
In Kwon Mun 1, Shin Hyuk Yoo 1, Ji-Hun Mo 1

5.J World Fed Orthod
. 2021 Mar;10(1):20-28. doi: 10.1016/j.ejwf.2021.01.001. Epub 2021 Feb 22.
Association between degenerative temporomandibular joint disorders, vertical facial growth, and airway dimension