AMANDA VANDERSTELT, DMD, MSD
Most people don’t realize that healthy breathing should be quiet, effortless, and almost entirely through the nose. We are meant to breathe nasally nearly all the time — while sitting, sleeping, talking, and even during light activity. When a child or adult breathes through the mouth while resting or sleeping, this is rarely just a habit. It is usually the body compensating for an airway that is too small.
This is where orthodontics enters a conversation most parents don’t expect it to be part of.
When people hear sleep apnea, they often think of older adults and CPAP machines — not children and orthodontics. Yet in many non-obese adults, sleep apnea is the result of jaws that developed too small, starting early in life. Breathing disorders rarely begin suddenly in adulthood; they are usually the result of growth patterns that began in childhood and progressed quietly over time.
Why Jaw Growth Matters
Traditional orthodontics focused mainly on straightening teeth. If there wasn’t enough room, teeth were removed to make them fit. Today, we understand that teeth are passengers on the jaws. When jaws are narrow or underdeveloped, teeth never had a fair chance to erupt straight in the first place.
Modern orthodontics focuses on developing the jaws first — especially in growing children — so teeth have enough room to come in naturally. When jaws are widened early, crowding is reduced, smiles are broader, the nasal and throat airway are bigger, and long-term stability improves. This approach can also reduce the risk of gum recession and other issues later in life.
About 90% of jaw growth is completed by around age 12. After that, we can still move teeth, but meaningful jaw change becomes much harder. This is why early evaluation — often between ages 5 and 9 — can be so impactful when growth guidance is needed.
The Link Between Jaws and the Airway
The upper jaw forms the floor of the nose. When the palate is narrow and high, the nasal passageway is smaller and airflow is restricted. A narrow upper jaw also leaves less room for the tongue. When the tongue cannot rest comfortably in the roof of the mouth, it may fall backward toward the airway (restricting oxygen) or thrust forward, affecting breathing, speech, swallowing, and tooth position.
Over time, this pattern can lead to chronic mouth breathing, crowded teeth, and a smaller airway that persists into adolescence and adulthood.
Signs Your Child May Have Airway or Growth Issues
Many children show signs years before orthodontics is ever considered. These may include:
• Snoring or loud breathing during sleep
• Mouth breathing, especially at rest
• Chronic congestion or frequent colds
• Dark circles under the eyes
• Frequent ear or sinus infections
• Bedwetting or night terrors
• Teeth grinding
• Restless sleep or waking tired
• Difficulty focusing or hyperactivity
• Narrow smiles or early crowding
• Crossbites, deep bites, or open bites
In infants and toddlers this poor airflow may already present itself, signs may include poor feeding, mouth open at rest, head tilted back during sleep, or chronic nasal congestion.
The Role of Tonsils, Adenoids, and Inflammation
Tonsils and adenoids play an important role in breathing. When chronically inflamed, they can block airflow through the nose and throat, pushing children toward mouth breathing. Again, mouth breathing is not as healthy as nasal breathing, and it alters how the face and jaws grow.
Chronic mouth breathing guides the face to grow longer and narrower, with jaws developing downward and backward instead of forward. This reduces space for teeth, the tongue, and the airway, increasing the risk of crowding and future breathing problems.
This facial pattern is commonly seen in adults who later develop sleep apnea — even when they are otherwise healthy.
Why Timing Matters
Waiting until all adult teeth are in for a child with small jaws is like waiting for problems instead of preventing them. By that time, growth potential is limited and airway improvement is harder to achieve.
Early orthodontic intervention allows us to:
• Widen the jaws while growth is still adaptable
• Improve nasal airflow
• Make space for the tongue
• Reduce future crowding
• Support healthier facial development
When done thoughtfully, early treatment is often simpler and more stable than waiting, in children who would benefit.
A Team-Based Approach
When airway concerns are present, orthodontics works best as part of a team. Orthodontic treatment guides jaw growth and creates space. Medical providers such as pediatricians, ENTs, or allergists may help address inflamed or obstructive tissues like tonsils, adenoids, or nasal allergies.
Once the jaws are developed and the tongue has enough room, myofunctional therapy can retrain breathing and oral habits. This helps children transition from mouth breathing to stable, natural nasal breathing — which is critical for long-term success.
More Than Straight Teeth
Early orthodontics is not about doing more treatment — it is about doing the right treatment at the right time. It recognizes that jaws come before teeth, and breathing comes before both.
By guiding growth early, we are not just creating straighter smiles. We are supporting healthier breathing, better sleep, and more balanced development that can benefit children well into adulthood.
Dr. Vanderstelt is a Board Certified Orthodontist and the owner of Aligned. Orthodontics, the only comprehensive airway-focused orthodontic practice in the Denver area catering to both children and adults. The practice emphasizes a holistic, root-cause approach, exploring how the alignment of the jaws and bite affects overall health, rather than merely focusing on straightening teeth. Aligned. Orthodontics offers a multidisciplinary strategy aimed at promoting long-term health for smiles, bites, airways, and facial structures.