Pacific Coast Society of Orthodontists Bulletin Spring 2021 - 44

Presentation Summary

Doctors

How Breathing Habits Influence
Skeletal Growth and Development
Dr. Anthony Brungo
Scottsdale, AZ
PCSO Bulletin Contributor

Dr. Rebecca Bockow
Inspired Orthodontics

Presented by Dr. Rebecca Bockow at the PCSO/
RMSO/MSO/SWSO Annual Session, Oct 2, 2020
Dr. Rebecca Bockow is a dual-trained orthodontist
and periodontist with board certification in both
disciplines. She is the only dual-trained provider
in Seattle, where her clinical practice is located.
Dr. Bockow completed her combined residency at
the University of Pennsylvania while simultaneously receiving a master's degree in oral biology.
She lectures both nationally and internationally
on periodontics, orthodontics, interdisciplinary
orthodontics, airway issues, and skeletal growth
and development. She also contributes to numerous professional journals as both an author and
editor, and is resident faculty at Spear Education.
The Importance of Tongue Position
Dr. Bockow began her lecture by discussing how
both tongue position (synonymous with tongue
posture) and breathing dysfunction directly contribute to the most common malocclusions seen
every day in clinical orthodontics. The tongue,
when in its ideal position, pushes into the upper
arch during the formative years, which helps to
develop both the palate and the maxillary arch.
Redundant tissue in adulthood is an indicator of
a deficiency in this form of development, possibly
indicating improper tongue position.
Airway and Sleep Development
Clinical observation and documentation of a
patient's airway and sleep habits should be a
part of every orthodontic diagnosis. The airway is
directly dependent on jaw position which occurs
in three planes of space: sagittal, vertical, and
transverse. As a side note, ectopic canines are
typically caused by a lack of space, especially in
the maxillary arch. Maxillary canines are usually
the last teeth to erupt, so when they are blocked
out and do not have enough space to come into
the arch, this is an indicator of maxillary transverse deficiency. Closed lips and nasal breathing
are the goal for all babies and children during development. When looking at babies and children,
lips, posture, breathing, tongue, cheeks, food

44	

choices, and speech all affect the way the arches
grow and develop. Breastfeeding, rather than
bottle-feeding, helps start to form and shape
the palate along with much of the oral musculature. This behavior also encourages mandibular
development along with mid-facial development.
In an ideal situation, breastfeeding will lead to a
state of equilibrium by achieving equal pressure
from all orofacial musculature in terms of the lips,
tongue, and cheeks, among others. As another
side note, bruxism and clenching are also signs of
an airway issue.
Tongue Position and Skeletal Growth and
Development
Tongue position directly influences skeletal
growth and development. As previously mentioned, tongue position affects the maxilla in the
transverse direction. More specifically, the tongue
coming up and forward is responsible for proper
skeletal growth and development in this plane.
Tongue position also develops the nasal passages.
When taking into consideration that the maxilla
is the floor of the nasal cavity and not just the
roof of the mouth, the effects of tongue position
on the development of the nasal cavity become
more apparent. This is why mouth breathing is
associated with a narrow transverse maxilla and
nasal breathing is associated with a maxilla of
normal transverse width.
Open mouth posture will change the way in
which we grow. Skeletal growth is influenced by
proper airway and airway obstruction as much as
it is influenced by tongue position. Nasal respiratory obstruction is typically associated with Class
II skeletal growth, although there are exceptions.
The presence of large tonsils encourages mouth
breathing in the vast majority of cases. The resulting Class II skeletal development in the presence
of a nasal obstruction is directly correlated with
narrow upper and lower arch forms. This also
results in low positioning of the hyoid bone and
downward tongue pressure, which are correlated
with Class II skeletal growth. In a Class III skeletal
growth pattern, large tonsils force down and

PCSO Bulletin    Spring 2021



Pacific Coast Society of Orthodontists Bulletin Spring 2021

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2021

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