Physician Leadership: The Mouth Breathing Effect
Mouth breathing. No one seems to be talking about it, how it starts and the long-term effects it has on your facial structure and overall breathing. Madan Kandula, MD and Ethan Handler, MD sit down to discuss the effects of mouth breathing, why you should be concerned and how to explore your options:
Interviewer: “Hi! Welcome to our round table series. This is where you get an insider scoop right from our medical providers on how an advocate for your healthcare one topic at a time.
Today, I'm here with Dr. Madan Kandula and Dr. Ethan Handler and we're going to be talking about mouth breathing! All right gentlemen, so for those people who maybe think they have it or not. What is mouth breathing and why should somebody care?”
Dr. Madan Kandula: “Mouth breathing is a menace, Right?”
Dr. Ethan Handler: “Mouth breathing is a menace.”
Dr. K: “I guess my take on mouth breathing is, mouth breathing is something that nobody would choose to do. Right? It's not natural; it's not normal. If the only time somebody will do it is that they have to do it. The only time somebody normal would actually have to do it is if they're exerting themselves beyond the capacity to breathe through their nose. Like, if you're running sprints, fine. If you're sitting in your easy chair watching tv, it shouldn't be happening.”
Dr. H: “I would agree. Dr. Kandula and I were recently at a lecture, where I think there was an interesting statement that had been made, that you should breathe through your mouth as much as you eat through your nose. It's a simple statement, but it makes total sense and that's kind of the ethos of what we do here is that we are not designed to breathe through our mouths unless we have to if we're running or something like that.”
Dr. K: “This is the way it is 100% of the time. If a kiddo comes in, mouth hanging open to their pediatrician's office and even Mom or Dad says, ‘Hey, what's up with this mouth breathing?’ I pretty well know the answer is going to be, ‘Ah, it's not a problem. He'll probably grow out of it. No big issue.’”
Dr. H: “Right.”
Dr. K: “Versus, that's a problem. That's going to create a situation. It's going to create a domino effect that is going to ripple through that kid's life, irrevocably. There's not a way once somebody has grown and is done growing, that's how they're built, and the damage is done basically.”
Dr. H: “Right.”
Dr. K: “The first domino to tip is a nose that doesn't work, and a nose that doesn't work causes a mouth to be open to breath, and a mouth that's open to breathe causes somebody's facial structure to not form properly. Meaning, what you do not want, from an airway standpoint, is you don't want your face to be narrow and elongated. That narrowing and elongation means, if you think about it, the airway is now narrow and then now your face is sort of shoved back on it. What you ideally want is somebody's face to be wide and if you think about it, aesthetically pleasing faces are actually wide; wide cheekbones. That's what you want.
If you've got a kid who has a nose that's not working, is mouth breathing, then all the sudden what should be growing ‘this’ way is all the sudden not. What happens then, what we've come to understand, is then all of a sudden somebody's nose that was supposed be wider from a nose standard, is a triangular. The wider the triangle, the more open it is. The narrower the triangle, the narrower it is. If somebody's nose isn't as big as it ought to be, it's not going to be working as well. If somebody's airway is not as big as it ought to be, it just creates- and then once that's set, once you've gone through puberty, once you're done growing then-“
Dr. H: “Right.”
Dr. K: “Now you're an adult who's got sleep apnea that we have to sort of pick the pieces up, and we can certainly help, and that's really important.”
Dr. H: “Yep.”
Dr. K “And, that's really important. There are millions of people out there that need that help, but there's also millions of kids and younger folks who are on that same pathway that we could get off of that pathway.”
Dr. H: “Yeah, I mean, there's catch-up to be done, but if you can treat the cause early, you can prevent the ramifications from that. It’s not a knock on pediatrics or pediatricians, and it's just that this is kind of the niche that we land in and they have such a broad array of things that they have to handle amongst kids that like, yeah, there might be this perception out there. Certainly, ‘Oh, snoring, you'll grow out of it or it's no big deal,’ and again, my wife and I had that same discussion with our kid, ‘Hey, what if a pediatrician sees thousands of kids per year and they only send, you know, 20% for a referral because they're snoring?’ doesn't mean those other ones aren't a problem. It doesn't mean those other ones shouldn't be treated.
I think that with tonsillectomy being as common as it is, and obviously there are certain kids that get tonsillectomy and adenoidectomy for sleep apnea, I think there's definitely strong reasons for why that should be done in cases, but there's a whole group of kids who might have that procedure done and still have problems after. What do you do with those kids? And, was that the right procedure necessarily to start with? Because, maybe they're still mouth breathing and maybe they're still having attention problems at school and not sleeping well. So, the question is ‘well, was the nose ever thought about and addressed?’”
Interviewer: “So, you guys mentioned the ripple effect and in regard to whether it's a parent that has a kid or maybe you're a grown adult and you are identifying with everything that you've talked about. What should a parent be doing? What is that next step or the next few steps that a parent should be doing to make sure that their kid isn't growing up and having these long-term issues?”
Dr. K: “The medical system is not really equipped to answer a lot of these simple questions in reality. Reality is that if the parent is concerned about their child's ability to breathe and especially breathing through their nose and they go in to almost, unfortunately, anybody in the medical community right now, they're going to get turned away. I think that's the challenge. That's wrong, and if you go in to see your doctor, your dentist, whomever, and they dismiss that, understand that that's wrong.
Your right as a parent, your right as an adult if you have these issues to say, and it doesn't mean you have to be disrespectful, but I'd say, acknowledge, I mean this is where and I think there's an untold truth in medicine which is you as a person and as a parent of another person are the steward of your own health. Meaning that if you identify something as a problem and you want to find a solution that sometimes you've got to kind of push through a system to get an answer because the typical answer a lot of time especially for the issues that we're talking about, the typical answer is going to be to dismiss your concerns out of hand. Part of that dismissiveness is lack of understanding. Part of that dismissiveness is lack of any active option to make any difference. Having the comfort and confidence for those people to understand that we're not going to dismiss those issues, that we identify them as real issues, and we have real solutions for those issues. This is the place if somebody has these sorts of concerns that they can go and we'll at the very least have an understanding about what's going on. At the very least you'll have an understanding about what's happening; what your options are. To me, I'd say that's it. Meaning that's that first step; that's what you need to get as a first step. You have to understand what's happening. We don't leave it there. We're going to talk about various solutions and we're going to talk about pros and cons of those various solutions and then you're going to sort of take that information and you can bounce stuff off of us as far as figuring out what's the right solution for you.
If you know what's going on; you know what your solutions are and you choose not to do anything about it, more power to you. That's fine. I don't have any issues with that whatsoever, and even for somebody who's sort of not a proponent or an advocate of being proactive with these issues. If they're giving you a good understanding; you know what's happening; you know what you could do and they sort of steer you in a direction towards, ‘Let's just keep an eye on it.’ That's okay. I mean, I guess here, for us here, it's understand, explain, and how I'm wired, is I want to- if I see a problem, I want to solve it. How we're wired here, we see a problem, we want to solve it. Now, it's your body and it's your decision to make, but that's our attitude. That another under told reality is that doctors are people, too.”
Interviewer: “So, let's say for somebody who maybe thinks they might be a mouth breather when they're up, but maybe, are there signs or ways that they could tell, if, say, they live by themselves then they're not sure, or maybe, they're doing it at night. How can they identify that?”
Dr. K: “I don't know percentages. I'd say a lot of mouth breathers don't know. Some do. Some folks have only ever known breathing, either mainly or mostly, through their mouth and so how would they know any different?
I would say a clue is if somebody is seeing you with your mouth hanging open, then you're a mouth breather. Basically, it's not rocket science that way. I think when somebody is sleeping at night, I guess I'd say, how do you know if you're breathing through your mouth when you're sleeping at night because you're asleep? I'd say, if you wake up in the morning and there's drool on your pillow fairly consistently-“
Dr. H: “Right.”
Dr. K: “Or ever, like pretty much ever, if there's drool on your pillow, you're a mouth breather. If there's drool on your pillow every night, you're a mouth breather.”
Dr. H: “Or your mouth is super dry.”
Dr. K: “Or you have the super dry… You know either of those things. Like, you wake up in the morning, or another clue is, do you have to have a glass of water by the side of your bed. You know, well, maybe you're just like, you need to be hydrated. Maybe you're breathing through your mouth. I'd say if, a subtle clue is do you have to have a glass of water that's sitting there. Do you look at your pillow? Do you kind of wipe the drool off your pillow in the morning? That's a big-time clue, yeah. Are you waking up with your mouth like it's bone dry? Yep, that's a problem.”
Dr. H: “You know, I genuinely believe that parents will advocate the best for their kids and I think that most of us can kind of say that that's true. I do and you have, but most parents out there will do that. So, I think that one of the important things is coming to ADVENT, they can discuss with us the various options that we have.
We may not think like the rest of the medical community does, but I think that there are plenty of parents out there, I mean, we've seen these kids that have kind of thrown their hands up in the air and say, ‘I don't what else I can do,’ and have laid out for us the other things that they've done, and realize that there are different ways of thinking about it. Different ways of doing something.”
Interviewer: “So, gentlemen, our conversation is coming to a close. Any last comments or maybe a tip, closing tip, for anyone if they weren't ready? They know their significant other or a friend is a mouth breather. How do they… what's a gentle way to kind of have that kind of conversation?”
Dr. K: “Yeah, it depends on the relationship honestly. You know, it's tricky. Why do you care that somebody's mouth, like, why do you care that your spouse is mouth breathing? Or your child is mouth breathing? Generally, because you care about them. If you cared about somebody, this goes back to what I was saying before; if you care somebody and you see they've got an issue, then it's, again, from a place of care and concern and love, pointing it out in a gentle manner; pointing out the repercussions of this issue, and you basically… it's just pointing out why it's a problem. Why it's probably more of a problem then you know about. Then, also pointing out that there are some simple options nowadays.”
Interviewer: “Great! Well, thank you so much for your time Dr. Kandula and Dr. Handler.
Thanks for tuning in! Stay tuned for next time.”