Your airway is much more than a passage for air. Every cell in your body needs oxygen to live and function. God designed the nose to filter, warm, and add moisture to the air before it reaches the lungs. Healthy nasal breathing also supports good sleep, brain function, and the body's ability to work properly.
The Way We Eat Can Influence How the Mouth Develops
The mouth is designed to do more than chew soft food. During childhood, the growing jaws and facial bones respond to many influences, including genetics, nutrition, muscle activity, tongue position, breathing patterns, and the amount and type of chewing.
In the early 1900s, Cleveland dentist Dr. Weston A. Price traveled around the world studying traditional populations. He observed that people who continued eating traditional diets often had broad dental arches and straight teeth, while groups that adopted more highly processed Western foods showed more narrow dental arches and crowded teeth. Price believed that the change in diet was an important cause of this difference.¹
Modern research gives us a more careful picture. We cannot say that a soft diet alone causes a narrow palate or crowded teeth. However, research supports the idea that normal chewing and mechanical forces are important influences on jaw and facial development during growth. A diet made largely of soft, highly processed foods requires less chewing than a diet containing naturally firm, fibrous, and whole foods. Less chewing means less mechanical stimulation of the developing jaws. Genetics, nutrition, breathing patterns, muscle function, and other factors also play important roles.²
Your Palate Is Also Part of Your Nasal Airway
Here is a connection that is easy to miss:
The roof of your mouth is also the floor of your nasal cavity.
The hard palate separates the mouth from the nose. Therefore, the shape and width of the developing upper jaw can also influence the space within the nasal cavity.
When the upper jaw is narrow, the palate may become high and narrow. In some people, this can be associated with reduced transverse dimensions of the nasal cavity and increased nasal resistance. Research on maxillary expansion has demonstrated that widening a narrow upper jaw can increase nasal cavity dimensions, although the effect on actual breathing varies from person to person.³
This does not mean that every person with a narrow palate will have difficulty breathing through the nose. Nasal breathing is influenced by many other factors, including allergies, enlarged adenoids or tonsils, nasal congestion, the nasal septum, and the overall anatomy of the airway.
But the relationship is important.
A developing child may experience a chain of influences:
Reduced chewing and altered functional forces
↓
Possible changes in development of the upper jaw and dental arch
↓
A narrower or higher palate in some individuals
↓
Changes in the dimensions of the nasal cavity
↓
Greater nasal resistance in some individuals
↓
Nasal breathing may become more difficult
↓
Mouth breathing may become an easier compensatory pattern
The relationship can also work in the other direction. Chronic nasal obstruction can encourage mouth breathing during childhood. Persistent changes in breathing and oral muscle posture may, in turn, influence craniofacial development during growth. This is why airway development should be viewed as multifactorial and interconnected, rather than as the result of one single cause.
Why Crowded Teeth Matter
Why does all of this matter for oral health? A smaller dental arch may leave less room for the teeth, increasing the chance of crowding and teeth that overlap one another. Crowded teeth can make brushing and cleaning between the teeth more difficult. Areas that are difficult to clean can retain more plaque. More plaque can contribute to gingivitis and periodontal disease. In this way, the way a child eats, breathes, and develops can eventually affect the ability to keep the mouth clean and healthy.
Mouth Breathing and Gum Health
There is another important connection:
Mouth breathing can affect the gums directly. When the lips remain open and air continually passes over the gums, the tissues can become dry and irritated. Saliva normally helps protect and moisten the mouth. When the mouth becomes dry, that protective environment changes. Research in schoolchildren has found that mouth breathing was associated with higher levels of plaque and gingival inflammation, including redness and bleeding.⁴ This is something parents and caregivers should pay attention to.
A child who regularly sleeps or spends the day with an open mouth may experience:
- Dry mouth
- Red or swollen gums
- Gum bleeding
- Increased plaque buildup
- Greater difficulty keeping the gums healthy
Dry, inflamed, bleeding gums are not simply a cosmetic problem.
Gingivitis is inflammation of the gums, and if the conditions that cause inflammation are not corrected, periodontal disease can develop. Periodontal disease affects the tissues and bone that support the teeth. Periodontal disease is also a chronic inflammatory condition. Research has found associations between periodontal inflammation and increased systemic inflammatory markers, including **C-reactive protein (CRP).**⁵ This does not mean that every person with mouth breathing will develop periodontal disease, or that periodontal disease automatically causes systemic disease. The relationship is more complex than that. But it does mean that persistent mouth breathing, dry mouth, bleeding gums, and poor oral hygiene should not be ignored.
From the Mouth to the Whole Body
Now the connections become easier to see.
A child's development can be influenced by:
Nutrition + chewing + breathing + muscle function + genetics
↓
These factors can influence the developing jaws and dental arches.
↓
A narrow dental arch may contribute to crowding.
↓
Crowded teeth can make cleaning between teeth more difficult.
↓
Poor plaque control can contribute to gingival inflammation and periodontal disease.
↓
Periodontal disease produces an inflammatory response that can affect the whole body.
At the same time:
Nasal obstruction or other airway problems
↓
Mouth breathing
↓
Dry oral tissues
↓
Greater irritation and inflammation of the gums
↓
More difficult oral health maintenance
↓
Greater risk of gingival disease when plaque is not adequately controlled.
Airway, Sleep, and Overall Health
The way we breathe also affects our sleep.
Snoring, gasping, pauses in breathing, restless sleep, morning headaches, dry mouth, and excessive daytime tiredness can be warning signs of sleep-disordered breathing, including obstructive sleep apnea.
During obstructive sleep apnea, the airway repeatedly narrows or becomes blocked during sleep. Breathing may stop for short periods, and the brain repeatedly responds by partially waking the person so breathing can resume.
These interruptions may happen many times during one night, even though the person may not remember them the next morning.
Poor-quality sleep can affect:
- Brain function
- Memory
- Concentration
- Mood
- Blood pressure
- Metabolism
- Immune function
- Cardiovascular health
- Daytime energy
This is why airway health is not simply about breathing.
It is about how the entire body functions.
Protecting Your Airway
Protecting your airway begins with simple habits:
- Breathe through your nose when possible.
- Eat nutritious foods that require normal chewing.
- Care for your teeth and gums every day.
- Clean between your teeth.
- Stay physically active.
- Protect your sleep.
- Address chronic nasal congestion and allergies.
- Do not ignore persistent snoring or breathing problems.
If you or your child has ongoing mouth breathing, loud snoring, pauses in breathing during sleep, or other breathing concerns, seek evaluation from a qualified healthcare professional.
Your body is wonderfully designed.
Caring for your airway is one way to honor the gift of life God has given you.
God's Design Is Beautifully Connected
The more we study the human body, the more clearly we see that its systems do not operate independently.
Breathing.
Facial growth.
Chewing.
Tooth alignment.
Oral hygiene.
Gum health.
Inflammation.
Sleep.
Brain health.
Whole-body health.
These are not isolated subjects.
They are connected parts of the same body.
This is another example of God's design working as an interconnected system: breathing, facial growth, chewing, tooth alignment, oral hygiene, gum health, inflammation, and whole-body health are not isolated subjects. They are connected parts of the same body.
Why Airway Matters
Your airway is much more than a passage for air. Your body needs oxygen to live, and every organ and cell depends on a steady supply of oxygen. God designed the nose to do important work before air reaches the lungs. The nasal passages help filter particles from the air, warm and humidify it, and provide an important part of the body's defense system. The nose also produces nitric oxide, a substance involved in blood-vessel regulation, immune function, and respiratory physiology.¹,²
For these reasons, nasal breathing is normally the body's preferred way to breathe. When breathing through the nose becomes difficult, the mouth may become the body's backup airway. That may seem like a small change, but breathing pattern can be connected with the development of the face and jaws, the health of the mouth and gums, the quality of sleep, and, through several pathways, whole-body health.³,⁴
Airway health is therefore not simply a matter of getting enough air into the lungs. It involves the nose, mouth, throat, jaws, tongue, muscles, teeth, sleep, and nervous and circulatory systems. Understanding these connections helps us see why problems such as chronic mouth breathing, persistent nasal obstruction, loud snoring, and sleep-disordered breathing should not simply be ignored.
The Way We Eat Can Influence How the Mouth Develops
The mouth was designed to do more than receive food. When we chew, the jaw muscles work, the teeth apply force, the tongue moves food around the mouth, and the jaw moves repeatedly. During childhood, these activities take place while the facial bones and jaws are still growing. Research indicates that the muscles used for chewing and the forces created during chewing are among the factors that can influence craniofacial growth.⁵,⁶ (PubMed)
This gives us a reason to think about food texture, especially during childhood. A child who eats an apple, a raw or lightly cooked vegetable that is appropriate for the child's age, or another naturally firm food has to chew more than a child eating primarily liquids, purees, and highly processed soft foods. This does not mean that soft foods are unhealthy, nor does it mean that children should be given foods that are unsafe for their age. It means that, when developmentally appropriate, a healthy diet should provide normal opportunities for the child to chew.
The amount of work required to chew a food can change how the jaw muscles work. Researchers studying masticatory function have found that the strength and activity of the chewing muscles are related to changes in the width and shape of the developing facial bones. In a review of experimental and clinical research, Kiliaridis concluded that masticatory muscle function can influence the transverse and vertical dimensions of the face and can affect the development of the bony foundations that support the dental arches.⁵ (PubMed)
This does not mean that chewing is the only thing that determines how a child's face develops. Genetics, nutrition, hormones, breathing pattern, tongue position, muscle function, and many other factors all play a role. The scientifically responsible conclusion is that chewing is one part of a much larger developmental system.
What Did Dr. Weston A. Price Observe?
In the early twentieth century, Cleveland dentist Dr. Weston A. Price traveled extensively to study the teeth, jaws, facial development, and diets of people living in traditional communities. He reported that many people who continued to eat their traditional foods had broad dental arches and well-aligned teeth. He also observed more dental crowding and changes in facial development among people who had adopted modern processed foods. Price believed that changes in diet were an important explanation for these differences.⁷
Price's observations are interesting and historically important, but they need to be presented honestly. His work was observational rather than a modern controlled clinical trial, so it cannot prove that a soft or processed diet by itself causes a narrow palate or crowded teeth. His observations should therefore be treated as an early contribution to a question that later researchers have investigated using experimental and clinical methods.
Modern research provides support for an important part of Price's basic observation: the amount and type of mechanical work performed by the chewing muscles can influence developing craniofacial structures. Experimental research has demonstrated changes in jaw and facial structures when growing animals are given diets that require less chewing, and systematic reviews of this experimental literature have found evidence that dietary consistency can influence several structures involved in craniofacial development.⁵,⁸,⁹
Therefore, the lesson should not be, “Soft food causes crooked teeth.” That statement is too strong. A better conclusion is: “Children need appropriate opportunities to chew, because chewing is one of several factors that helps shape the growing jaws and face.”
Why Chewing Matters
Think about what happens when a child chews a food that requires some work. The jaw muscles contract repeatedly, the lower jaw moves, the teeth apply pressure, and the tongue and other muscles coordinate the food between the teeth. These repeated forces provide mechanical stimulation to the growing structures of the face and jaws. Researchers often refer to these as masticatory forces, meaning the forces created by chewing.
Studies of masticatory muscle function indicate that greater muscle activity can influence bone growth and remodeling in the developing face. Kiliaridis's review of experimental and clinical research concluded that the muscles that close and move the jaw can influence the width and vertical development of the face and the bony foundations supporting the dental arches.⁵ (PubMed)
A systematic review and meta-analysis of experimental studies also examined the effect of dietary consistency on structures such as the jaw joint, jaw cartilage, alveolar bone, and periodontal ligament. The authors found evidence that dietary consistency can influence craniofacial structures, while also emphasizing limitations in the quality and consistency of the available research.⁸ (PubMed)
That is why we should encourage normal, age-appropriate chewing rather than suggesting that a child's diet should consist primarily of foods that require almost no chewing. The goal is not to make food unnecessarily hard. The goal is to allow the mouth to perform the work it was designed to perform.
When There Is Not Enough Room for the Teeth
The upper jaw forms the dental arch that holds the upper teeth. If the available space in the dental arch is too small for the size and number of teeth, the teeth may overlap, rotate, or become crowded. Dental crowding is common, and modern research shows that it has many causes, including tooth size, dental-arch dimensions, skeletal structure, age-related changes, genetics, and environmental influences.¹⁰
A recent systematic review of human studies found that reduced dental-arch dimensions and larger tooth size are consistently associated with dental crowding, although the relative contribution of each factor is not yet completely understood.¹⁰ (Frontiers)
This matters for oral health because crowded teeth can make some areas more difficult to clean. When teeth overlap or sit very close together, toothbrush bristles and interdental cleaning tools may not reach every surface easily. Plaque can remain in these areas, increasing the opportunity for gingival inflammation.
This does not mean that every person with crowded teeth will develop gum disease. Good oral hygiene, professional dental care, individual susceptibility, diet, smoking, systemic health, and many other factors influence periodontal health. Nevertheless, anything that makes effective plaque removal more difficult deserves attention.
Your Palate Is Also Part of Your Nasal Airway
Here is one of the most important connections to understand: the roof of your mouth is also the floor of your nasal cavity. The hard palate separates the mouth from the nasal cavity. Its lower surface forms the roof of the mouth, while its upper surface forms the floor of the nasal cavity.¹¹
This means that the upper jaw is not simply the structure that holds the upper teeth. It is also part of the structure that forms the bottom of the nasal airway.
When the upper jaw is narrow, the palate may become relatively narrow and high. Because the nasal cavity sits directly above the palate, changes in the width of the upper jaw can also affect the dimensions of the nasal cavity. This relationship has been studied extensively in children with maxillary constriction.
One of the clearest ways researchers have studied this relationship is through maxillary expansion, a dental treatment used to widen a constricted upper jaw. A systematic review and meta-analysis of pediatric patients found that palatal expansion decreased nasal resistance and increased nasal airflow in the studies included in the review.¹² (PubMed) Other systematic reviews have also found measurable increases in nasal cavity dimensions following maxillary expansion.¹³,¹⁴
This does not mean that every person with a narrow palate has an obstructed airway. Nasal breathing can be affected by allergies, chronic congestion, enlarged tonsils or adenoids, the nasal septum, swollen nasal tissues, and many other factors. It would therefore be incorrect to say, “A narrow palate causes mouth breathing.”
A more accurate statement is this:
A narrow upper jaw can be associated with reduced nasal airway dimensions and greater nasal resistance in some individuals, and this may make nasal breathing more difficult.
That distinction is important because it allows us to recognize a genuine anatomical relationship without pretending that one factor explains every airway problem.
Chewing, the Palate, and Breathing
We can now see how several parts of development may fit together. During childhood, nutrition, chewing, muscle activity, tongue position, breathing pattern, genetics, and other factors interact as the face and jaws develop. These influences can affect the shape and width of the dental arches and the upper jaw. If the upper jaw is relatively narrow, the palate may also be narrow and high, and because the palate forms the floor of the nasal cavity, the available space within the nasal airway may also be affected.
This is not a guaranteed chain of events. It is better understood as a network of influences. Some children with narrow dental arches breathe normally through their noses, while some children with normal-looking dental arches may have significant nasal obstruction for other reasons.
The relationship can also work in the opposite direction. A child may have difficulty breathing through the nose because of allergies, enlarged adenoids or tonsils, chronic congestion, or another problem. The child may then begin breathing through the mouth. If mouth breathing continues for a long time during growth, changes in tongue, lip, and jaw posture may influence facial development. A systematic review and meta-analysis found measurable differences in facial skeletal development among children who mouth-breathe compared with children who primarily breathe through the nose.¹⁵ (PubMed)
This is why airway development should be viewed as multifactorial and interconnected, rather than as a single cause-and-effect chain.
Why Crowded Teeth Matter
Crowded teeth are not simply a cosmetic issue. When teeth overlap or rotate, some surfaces can become difficult to reach with a toothbrush or floss. These areas may retain plaque more easily, especially when a person does not have access to good oral-hygiene instruction or appropriate interdental cleaning tools.
Plaque is a bacterial biofilm. When it remains around the gumline, the body's immune system responds to the bacteria and their products, producing inflammation. The gums may become red, swollen, tender, and prone to bleeding. This early inflammation is called gingivitis.
Gingivitis is generally reversible when the causes are controlled and effective plaque removal is established. Periodontitis is more serious because the inflammation is associated with destruction of the tissues and bone supporting the teeth. Not everyone with gingivitis develops periodontitis, and the progression depends upon many factors, including the person's immune response, smoking, diabetes and metabolic health, genetics, microbial factors, and oral-hygiene conditions.
Nevertheless, keeping the teeth and gums clean is one of the most important ways to reduce the risk.
Mouth Breathing and Gum Health
There is another important connection between the airway and the mouth: mouth breathing can affect the tissues of the mouth directly.
When a person keeps the mouth open for long periods, air continually passes over the gums and other oral tissues. This can contribute to dryness and irritation. Saliva normally helps lubricate the mouth and provides several protective functions, so a chronically dry mouth can change the environment in which the teeth and gums must remain healthy.
Research has found a relationship between mouth breathing and gingival inflammation. One particularly relevant study was conducted by researchers at the University of Nairobi Dental School. Wagaiyu and Ashley examined 201 schoolchildren aged 11 to 14, recording plaque, redness, and bleeding while also assessing mouth breathing and lip position. They found that mouth breathing was associated with higher levels of plaque and gingival inflammation, and the relationship remained significant after accounting for factors including gender, crowding, and plaque levels.¹⁶ (PubMed)
This study is especially useful for our purposes because it demonstrates that the relationship is not simply theoretical. The researchers actually examined children and measured the condition of their gums. The strongest relationship was found in the upper front region of the mouth, where the tissues may be particularly exposed to drying from mouth breathing.¹⁶
Another study examining children also reported poorer gingival-health measurements among mouth breathers.¹⁷ Taken together, these studies support the idea that persistent mouth breathing can be an additional risk factor for gingival inflammation, although it should never be presented as the only cause.
A child who regularly breathes through the mouth may therefore have a dry mouth, irritated or red gums, gum bleeding, increased plaque accumulation, or greater difficulty maintaining healthy gum tissues. These signs do not prove that the child has a serious airway disorder, but they are reasons to ask why the child is breathing through the mouth.
From Gum Inflammation to Whole-Body Inflammation
The gums are living tissues. They contain blood vessels and immune cells, and inflammation in the gums involves the body's immune response. When periodontal disease becomes established, the inflammatory process can extend beyond the immediate tissues around the teeth.
One of the most studied blood markers in periodontal research is C-reactive protein, or CRP. CRP is produced by the liver in response to inflammatory signals and is commonly used as a marker of systemic inflammation. It does not tell us exactly where inflammation is coming from, but elevated CRP can indicate that inflammatory activity is occurring somewhere in the body.
A systematic review and meta-analysis by Machado and colleagues examined the relationship between periodontitis and CRP. The authors found that people with periodontitis generally had higher CRP and high-sensitivity CRP levels than people without periodontitis.¹⁸ (Frontiers)
Even more importantly, researchers have investigated whether treating periodontal disease can change this marker. A 2023 systematic review and meta-analysis included 26 randomized controlled trials involving 2,579 participants. The researchers found that periodontal treatment reduced CRP by an average of approximately 0.69 mg/L at six months, although the evidence for longer follow-up was limited.¹⁹ (PubMed)
This does not mean that periodontal disease causes every chronic disease in the body. It would be scientifically incorrect to make that claim. What the evidence does support is that periodontal disease is associated with systemic inflammatory activity and can contribute to the body's overall inflammatory burden.
That makes healthy gums relevant to whole-body health.
The Airway, Sleep, and Overall Health
The airway also affects health through sleep. Occasional snoring is common, but loud and frequent snoring can sometimes be a sign that the airway is becoming too narrow during sleep.
In obstructive sleep apnea, the upper airway repeatedly becomes narrowed or blocked during sleep. Breathing may stop for a short period, and the brain responds by partially waking the person so that the airway can reopen. The person may not remember these brief awakenings, but they can happen repeatedly throughout the night.
The result is not simply “poor sleep.” Repeated airway obstruction can produce sleep fragmentation, changes in oxygen levels, and repeated activation of the body's stress-response systems. Over time, untreated obstructive sleep apnea is associated with conditions including hypertension and cardiovascular disease.²⁰
Researchers have also studied inflammation in people with obstructive sleep apnea. A systematic review and meta-analysis found that CRP was higher in people with obstructive sleep apnea than in comparison groups, even after researchers considered factors such as age, sex, smoking, body mass index, and other conditions.²¹ (PubMed) Another systematic review and meta-analysis likewise found higher CRP and high-sensitivity CRP levels among people with obstructive sleep apnea.²²
This gives us another pathway by which airway health can connect with systemic inflammation: repeated airway obstruction during sleep can produce repeated physiological stress, changes in oxygen levels, nervous-system activation, and inflammatory responses. This does not mean that everyone who snores has sleep apnea, nor does it mean that OSA is caused by one particular anatomical feature. It means that persistent airway obstruction during sleep deserves attention because it can affect the entire body.
Sleep and Inflammation
Sleep itself is also important for controlling inflammation. Researchers have found that inadequate sleep can activate inflammatory pathways in the body. In one experimental study, healthy adults who experienced partial sleep deprivation showed increased activation of NF-κB, a molecular pathway involved in inflammation.²³ (PubMed)
Another study by Irwin and colleagues found that sleep deprivation was associated with increased cellular and genomic markers of inflammation.²⁴ (PubMed) These studies do not mean that one night of poor sleep will make someone sick. They demonstrate that sleep loss can produce measurable changes in biological pathways involved in inflammation.
This becomes particularly important when poor sleep is repeated night after night. If airway obstruction repeatedly interrupts sleep, the problem may extend beyond daytime tiredness. Concentration, memory, mood, blood pressure, metabolism, cardiovascular health, and daytime functioning can all be affected by chronic sleep disruption.
This is another reason why airway health and sleep health cannot be completely separated.
From the Mouth and Airway to the Whole Body
When we step back, we can see how these relationships fit together without pretending that one factor causes everything.
A child's nutrition, chewing, muscle activity, tongue position, breathing pattern, genetics, and other developmental influences can affect the way the jaws, palate, dental arches, and airway develop. A relatively narrow dental arch may contribute to crowding, and crowded teeth can make some areas more difficult to clean. Difficult-to-clean areas may retain plaque, and plaque can contribute to gingival inflammation and, in susceptible individuals, periodontal disease.
At the same time, nasal obstruction can encourage mouth breathing.
Persistent mouth breathing can contribute to dryness and irritation of the oral tissues and is associated with greater gingival inflammation in some children. If periodontal disease develops, the resulting inflammation can be associated with increased systemic inflammatory markers such as CRP.¹⁶,¹⁸,¹⁹
During sleep, another pathway may occur. Airway narrowing can interrupt breathing and fragment sleep. Repeated breathing interruptions can produce changes in oxygen levels and nervous-system activity, while poor sleep itself can activate inflammatory pathways.²¹,²²,²³,²⁴
These pathways can overlap. The body is not a collection of separate compartments. The mouth, airway, sleep system, nervous system, immune system, and cardiovascular system communicate with one another.
That is why airway health belongs in a whole-health program.
What Can We Do?
The practical message does not have to be complicated.
Children should have opportunities to eat nutritious foods with appropriate natural texture and to develop normal chewing skills. This does not mean giving young children foods that could cause choking, nor does it mean that every food must be hard. It simply means that a healthy diet should not depend almost entirely on liquids, purees, and highly processed foods when a child is developmentally ready for more varied textures.
Good oral hygiene is equally important. Teeth should be brushed carefully, and the spaces between the teeth should be cleaned. Crowded areas may require additional attention because they can be more difficult to reach.
Persistent mouth breathing should also be investigated rather than simply accepted. If a child cannot comfortably breathe through the nose, there may be an underlying reason such as allergies, chronic nasal congestion, enlarged adenoids or tonsils, or another airway problem. The goal is not to tell someone simply to “breathe through the nose”; the goal is to determine why nasal breathing is difficult.
Snoring should also be taken seriously when it is loud and habitual, particularly when it is accompanied by gasping, witnessed pauses in breathing, restless sleep, morning headaches, difficulty concentrating, or excessive daytime sleepiness. These signs can warrant evaluation for sleep-disordered breathing.
Bleeding gums should not be considered normal. Bleeding is a sign of inflammation and deserves attention, particularly when it occurs repeatedly.
When to Seek Professional Evaluation
A community health educator should not attempt to diagnose airway disease, sleep apnea, or periodontal disease. The educator's role is to recognize possible warning signs and encourage appropriate professional evaluation.
Persistent mouth breathing, chronic nasal obstruction, loud habitual snoring, gasping during sleep, witnessed pauses in breathing, significant daytime sleepiness, repeated morning headaches, persistent dry mouth, frequent gum bleeding, significant dental crowding, or difficulty chewing or swallowing are all reasons to consider evaluation by an appropriately qualified healthcare professional.
Depending upon the problem, that may include a dentist, dental hygienist, physician, pediatrician, orthodontist, ear-nose-and-throat specialist, sleep specialist, or another qualified professional. The important point is that the health educator does not need to determine the diagnosis. The health educator needs to recognize when something may deserve further attention.
God's Design Is Beautifully Connected
The more we study the human body, the more clearly we see that its systems do not work independently. Breathing connects the nose, mouth, tongue, throat, and lungs. Chewing involves the teeth, jaw muscles, tongue, and facial bones. The hard palate is both the roof of the mouth and the floor of the nasal cavity. The gums are living tissues connected with the circulatory and immune systems. Sleep affects the brain, nervous system, hormones, metabolism, and inflammatory processes.
These are not isolated subjects. They are connected parts of the same body.
A child does not have one system for breathing, another completely separate system for eating, another for developing facial bones, and another for sleeping. These systems develop together and influence one another. When we care for one part of the body, we should remember its relationship to the rest.
This is another example of God's design working as an interconnected system: breathing, facial growth, chewing, tooth alignment, nasal development, oral hygiene, gum health, inflammation, sleep, brain function, and whole-body health are not isolated subjects. They are connected parts of the same body.
The more we understand these connections, the more remarkable that design becomes.
Your body is wonderfully designed. Caring for your airway is one way to honor the gift of life God has given you.
FOOTNOTES / RESEARCH REFERENCES
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3. Katyal V, Pamula Y, Martin AJ, Daynes CN, Kennedy JD, Sampson WJ. Craniofacial and upper airway morphology in pediatric sleep-disordered breathing: systematic review and meta-analysis. American Journal of Orthodontics and Dentofacial Orthopedics. 2013;143(1):20–30.e3.
4. Zhao Z, Zheng L, Huang X, Li C, Liu J, Hu Y. Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis. BMC Oral Health. 2021;21:108. doi:10.1186/s12903-021-01458-7.
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15. Zhao Z, Zheng L, Huang X, Li C, Liu J, Hu Y. Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis. BMC Oral Health. 2021;21:108. doi:10.1186/s12903-021-01458-7.
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18. Machado V, Botelho J, Escalda C, Hussain SB, Luthra S, Mascarenhas P, Orlandi M, Mendes JJ, D'Aiuto F. Serum C-reactive protein and periodontitis: a systematic review and meta-analysis. Frontiers in Immunology. 2021;12:706432. doi:10.3389/fimmu.2021.706432. (Frontiers)
19. Luthra S, Orlandi M, Hussain SB, Leira Y, Botelho J, Machado V, Mendes JJ, Marletta D, Harden S, D'Aiuto F. Treatment of periodontitis and C-reactive protein: a systematic review and meta-analysis of randomized clinical trials. Journal of Clinical Periodontology. 2023;50(1):45–60. doi:10.1111/jcpe.13709. (PubMed)
20. Mitra AK, Bhuiyan AR, Jones EA. Association and risk factors for obstructive sleep apnea and cardiovascular diseases: a systematic review. Diseases. 2021;9(4):88.
21. Van der Touw T, Andronicos NM, Smart N. Is C-reactive protein elevated in obstructive sleep apnea? A systematic review and meta-analysis. Biomarkers. 2019;24(5):429–435. doi:10.1080/1354750X.2019.1600025. (PubMed)
22. Peker Y, et al. Evaluation of blood levels of C-reactive protein marker in obstructive sleep apnea: a systematic review, meta-analysis and meta-regression. Life. 2021;11(4):362.
23. Irwin MR, Wang M, Ribeiro D, Cho HJ, Olmstead R, Breen EC, Martinez-Maza O, Cole S. Sleep loss activates cellular inflammatory signaling. Biological Psychiatry. 2008;64(6):538–540. doi:10.1016/j.biopsych.2008.05.004. (PubMed)
24. Irwin MR, Wang M, Campomayor CO, Collado-Hidalgo A, Cole S. Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Archives of Internal Medicine. 2006;166(16):1756–1762. doi:10.1001/archinte.166.16.1756. (PubMed)
For those who want a more scientific and "in-depth" version, with research citations, the rest is for you...
A — AIRWAY
A.N.S.W.E.R.S. TO Health & Longevity®
Your airway is much more than a passage for air. Every cell in your body depends on oxygen to carry out the work of living. The nose is designed to do much more than simply allow air to pass through. The nasal passages filter particles, warm and humidify incoming air, and contain a rich system of blood vessels, mucus, cilia, and immune defenses. The nasal cavity and paranasal sinuses also produce nitric oxide, a signaling molecule involved in blood-vessel regulation, immune defense, and respiratory function.¹,² (PubMed)
Healthy nasal breathing is therefore part of normal respiratory physiology. It also connects with sleep, oral health, facial development, and whole-body health. When nasal breathing becomes difficult, the body may compensate by breathing through the mouth. In a child whose facial structures are still developing, chronic mouth breathing is particularly important because breathing pattern, tongue posture, muscle activity, airway resistance, and craniofacial growth can influence one another over time.³,⁴ (PubMed)
The Way We Eat Can Influence How the Mouth Develops
The mouth is designed to do more than receive food. It is a working, growing part of the respiratory and digestive system. During childhood, the jaws, palate, facial bones, muscles, teeth, and airway are developing together. Their development is influenced by genetics, nutrition, hormones, muscle function, tongue position, breathing patterns, and mechanical forces created when we chew. Research in both humans and experimental models indicates that masticatory function is one of the environmental influences that can affect craniofacial growth.⁵,⁶ (PubMed)
In the early twentieth century, Cleveland dentist Dr. Weston A. Price made an observation that has remained influential in discussions of dental and facial development. In his field studies of traditional and modernized populations, he reported that groups maintaining traditional diets often had broad dental arches and relatively well-aligned teeth, whereas members of the same populations who adopted modern processed foods more often displayed dental crowding and changes in facial form. Price believed that modernization of the diet was an important explanation for these differences. His observations are historically interesting, but they were observational rather than modern controlled clinical trials, so they should be regarded as a hypothesis-generating historical contribution rather than proof that diet alone causes facial development or dental crowding.⁷ (New England Journal of Medicine)
Modern research gives us a more careful picture. We cannot responsibly say that “soft food causes narrow palates.” Craniofacial development is multifactorial. However, there is substantial experimental evidence that changing the mechanical demands placed on the masticatory system can alter muscle function and craniofacial structures during growth. A systematic review and meta-analysis of experimental animal studies found that softer diets were associated with measurable reductions in condylar dimensions, although the authors also emphasized limitations in the quality and reporting of the available studies.⁸ A separate experimental study found that growing animals fed a soft diet developed changes in craniofacial morphology associated with reduced masticatory forces.⁹ (PubMed)
Human research also supports the importance of chewing as part of normal development, although the evidence is not strong enough to reduce facial growth to a single dietary factor. Reviews of childhood mastication report that harder food textures require different patterns of jaw movement and muscle activity, and both human and animal studies suggest that harder textures can provide greater functional stimulation to the developing oral structures.⁶,¹⁰ More recent research continues to examine the relationship between dietary consistency, chewing patterns, maxillary development, and malocclusion, but the evidence remains heterogeneous.¹¹,¹² (PubMed)
This gives us a scientifically responsible principle:
A growing child needs appropriate opportunities to use the muscles and structures of the mouth. A diet made almost entirely of soft, highly processed foods may reduce the amount of mechanical work required for chewing, while appropriately textured whole foods can provide greater masticatory stimulation.
That does not mean that children should be given foods that are unsafe for their age or ability to chew. It means that, when developmentally appropriate, a healthy diet should include foods with natural texture rather than relying primarily on liquids, purees, highly processed foods, and foods requiring little chewing.
From Chewing to Dental Crowding
Why might this matter?
The dental arches must provide enough space to accommodate the developing teeth. Dental crowding occurs when the available space in the dental arch is insufficient relative to tooth size and arrangement. Modern research shows that reduced arch dimensions and larger tooth size are important factors associated with dental crowding, although genetics and many other developmental factors also contribute.¹³ (PubMed)
If the upper dental arch develops with less transverse width, the teeth may have less room to align properly. Teeth can overlap, rotate, or become displaced. This is not merely a cosmetic concern.
Crowded teeth can be harder to clean.
When toothbrush bristles and interdental cleaning devices cannot easily reach between overlapping teeth, plaque can remain in areas that are difficult to access. Persistent plaque can trigger gingival inflammation and, in susceptible individuals, contribute to periodontal disease.
Therefore, the potential pathway is not:
“Soft food causes crooked teeth.”
It is more accurately understood as:
Dietary texture and chewing forces
- genetics
- breathing pattern
- tongue and muscle function
- nutrition
- other developmental influences
↓
craniofacial and dental development
↓
dental arch dimensions
↓
available space for teeth
↓
possible crowding or malocclusion
↓
greater difficulty cleaning certain areas
↓
greater opportunity for plaque retention and gingival inflammation
That is a much stronger statement scientifically because it recognizes that many factors contribute to the final result.
Your Palate Is Also Part of Your Nasal Airway
Here is a connection that is easy to miss:
The roof of your mouth is also the floor of your nasal cavity.
The hard palate separates the oral cavity from the nasal cavity. Its upper surface forms the floor of the nasal cavity, while its lower surface forms the roof of the mouth. The anterior portion of the hard palate is formed primarily by the palatal processes of the maxilla.¹⁴ (PubMed)
This anatomical relationship is extremely important.
The upper jaw is not simply a framework that holds the upper teeth. It is also part of the structure that forms the floor of the nasal airway.
Therefore, the width and shape of the maxilla and palate can influence the dimensions of the nasal cavity.
When the maxilla is constricted, the palate may be narrow and high. Research on children with maxillary constriction has shown that expansion of the upper jaw can increase nasal cavity dimensions and, in many studies, reduce nasal airway resistance. Systematic reviews and an umbrella review have found evidence that maxillary expansion can produce measurable increases in nasal and upper-airway dimensions in growing children and adolescents.¹⁵,¹⁶,¹⁷ (PubMed)
A 2025 systematic review likewise found that rapid maxillary expansion consistently increased transverse dimensions and nasal cavity volume, although improvements in actual nasal resistance varied between individuals. The authors specifically noted that age, the condition of the skeleton before treatment, and adenotonsillar enlargement can influence the results.¹⁸ (PubMed)
This distinction is important.
A narrow palate does not automatically mean that a person will have an obstructed airway. Nasal breathing is affected by many other factors, including allergies, chronic nasal congestion, enlarged adenoids or tonsils, nasal septal anatomy, turbinate size, inflammation, and other structural characteristics.
But the relationship between the upper jaw, palate, nasal cavity, and airway is real.
A Developing Child May Experience a Chain of Influences
A developing child may experience a series of interacting influences:
Reduced chewing and altered functional forces
↓
Changes in masticatory muscle activity and craniofacial development
↓
Possible changes in upper-jaw and dental-arch width
↓
A narrower or higher palate in some individuals
↓
Changes in the dimensions of the nasal cavity
↓
Potential increase in nasal resistance
↓
Nasal breathing may become more difficult
↓
Mouth breathing may become an easier compensatory pattern
Research supports portions of this pathway, but the entire chain should not be presented as a guaranteed sequence. Human facial development is too complex for that. What we can say is that masticatory function, craniofacial structure, nasal airway dimensions, and breathing pattern are biologically related, and research continues to investigate how these factors influence one another.⁵,¹⁶,¹⁹ (PubMed)
The relationship can also work in the other direction.
Chronic nasal obstruction can encourage mouth breathing during childhood. Persistent mouth breathing is associated with changes in craniofacial development, including alterations in maxillary and mandibular position, vertical facial growth, dental relationships, and airway dimensions. A systematic review and meta-analysis found that children who mouth-breathe showed several measurable differences in facial skeletal relationships and airway dimensions compared with nasal breathers.¹⁹ (PubMed)
Again, association does not prove that mouth breathing alone caused every structural change. Children who mouth-breathe often have underlying nasal obstruction or other conditions that may themselves influence development. The best interpretation is that airway obstruction, breathing pattern, muscle posture, and craniofacial development can form a connected cycle during growth.
Why Crowded Teeth Matter
Why does all of this matter for oral health?
A smaller dental arch may leave less room for the teeth, increasing the chance of crowding and teeth that overlap one another. Contemporary research confirms that dental arch dimensions are associated with the occurrence and severity of crowding, while also emphasizing that tooth size, genetics, and other factors contribute.¹³ (PubMed)
Crowded teeth can make brushing and cleaning between the teeth more difficult. Areas that are difficult to reach can retain more plaque, and persistent plaque can contribute to gingivitis. If periodontal inflammation progresses and is not adequately controlled, periodontal tissues and supporting bone can become damaged.
So an airway discussion can legitimately lead us back to the mouth:
Airway structure → breathing pattern → oral environment → plaque control → gum health.
The connections are not imaginary, but they are also not one-way or automatic. The body works as an integrated system.
Mouth Breathing and Gum Health
There is another important connection:
Mouth breathing can affect the gums directly.
When the mouth remains open for long periods, the constant flow of air can dry the oral tissues. Saliva normally helps lubricate the mouth, maintain the oral environment, assist in swallowing and speaking, and protect the teeth and soft tissues. When the mouth becomes chronically dry, those protective functions are reduced.
Research has found a relationship between mouth breathing and gingival inflammation. In a study of 201 schoolchildren aged 11–14 years, Wagaiyu and Ashley assessed plaque, redness, and bleeding on probing and found that mouth breathing was associated with higher levels of plaque and gingival inflammation. The relationship remained statistically significant after adjustment for factors including gender, crowding, and plaque levels, and was particularly evident in the upper anterior region.²⁰ (PubMed)
A separate comparative study of 240 children aged 10–14 years also found higher gingival-index scores among mouth breathers with an incompetent lip seal. Increased lip separation and reduced upper-incisor coverage were associated with higher plaque and gingival-index scores.²¹ (PubMed)
These findings fit what we would expect biologically. A dry, exposed gingival margin is more vulnerable to irritation, while plaque provides the microbial stimulus that drives gingival inflammation. Mouth breathing therefore should not be viewed as an isolated breathing habit; when persistent, it can become an additional oral-health concern.
A child who regularly sleeps or spends the day with an open mouth may therefore be more likely to experience:
Dry mouth
Dry or irritated oral tissues
Red or swollen gums
Gum bleeding
Increased plaque retention
Difficulty maintaining healthy gingival tissues
However, we should not tell parents that mouth breathing automatically means their child has gum disease. Mouth breathing is one contributing factor among several, and good plaque control remains extremely important.
From Gingivitis to Periodontal Disease
Dry, inflamed, bleeding gums are not simply a cosmetic problem.
Gingivitis is inflammation of the gums. When plaque remains undisturbed, the body's immune system responds to the bacterial biofilm, producing an inflammatory reaction. With effective plaque removal and appropriate professional care, gingivitis is generally reversible.
Periodontitis is different. It involves inflammation and destruction of the tissues supporting the teeth, including the periodontal ligament and alveolar bone. The transition from gingivitis to periodontitis is influenced by the individual's immune response, microbial community, smoking, metabolic health, genetics, and other risk factors. Therefore, it is important not to teach that every case of gingivitis will automatically become periodontitis.
But persistent inflammation deserves attention.
And this is where the airway and oral cavity begin connecting with systemic inflammation.
From the Mouth to the Whole Body
Periodontal disease is not confined entirely to the mouth. The tissues surrounding the teeth are vascular and immunologically active, and periodontal inflammation can contribute to the release of inflammatory mediators into the circulation.
Research has repeatedly found an association between periodontitis and elevated blood levels of C-reactive protein (CRP), a marker of systemic inflammatory activity. A systematic review and meta-analysis involving dozens of studies found that people with periodontitis had significantly higher CRP and high-sensitivity CRP levels than controls.²² (PubMed)
More recent evidence goes one step further. A 2023 systematic review and meta-analysis of 26 randomized controlled trials involving 2,579 participants found that periodontal treatment reduced serum CRP levels by approximately 0.69 mg/L at six months, although the authors noted substantial heterogeneity and limited evidence beyond six months.²³ (PubMed)
This does not mean that periodontal disease is the sole cause of cardiovascular disease, diabetes, or other inflammatory diseases. It means that periodontal inflammation can contribute to the body's overall inflammatory burden, and that treating periodontal disease can measurably reduce one marker of systemic inflammation.
That is an important distinction—and exactly the kind of distinction a scientifically critical reader will appreciate.
At the Same Time: The Airway Can Influence Inflammation
The connection does not stop with the gums.
Sleep-disordered breathing, particularly obstructive sleep apnea, involves repeated episodes of upper-airway narrowing or collapse during sleep. These episodes can cause intermittent reductions in blood oxygen, repeated arousals from sleep, activation of the sympathetic nervous system, oxidative stress, and inflammatory signaling.
Research has found increased inflammatory markers in people with obstructive sleep apnea. A systematic review and meta-analysis examining CRP found that even after accounting for important confounding factors such as age, sex, body mass index, smoking, and comorbidities, CRP was higher in people with OSA than in matched controls.²⁴ (PubMed)
A larger systematic review, meta-analysis, and meta-regression including 109 studies also found higher CRP and high-sensitivity CRP levels in both adults and children with obstructive sleep apnea compared with controls.²⁵ (PubMed)
This gives us another important pathway:
Airway obstruction during sleep
↓
Repeated interruptions in breathing
↓
Intermittent oxygen changes + repeated arousals
↓
Sympathetic activation + oxidative stress + inflammatory signaling
↓
Greater systemic inflammatory burden
The airway is therefore connected to inflammation through more than one pathway.
Airway, Sleep, and Overall Health
The way we breathe also affects our sleep.
Snoring, gasping, pauses in breathing, restless sleep, morning headaches, dry mouth, difficulty concentrating, and excessive daytime sleepiness can be warning signs of sleep-disordered breathing, including obstructive sleep apnea.
During obstructive sleep apnea, the upper airway repeatedly narrows or becomes blocked during sleep. The person may stop breathing temporarily, and the brain responds by producing an arousal that helps reopen the airway. The person may not fully awaken or remember these events, but the repeated disruption can fragment normal sleep.
This can happen many times during one night.
Over time, untreated sleep-disordered breathing can affect more than nighttime comfort. Research has linked obstructive sleep apnea with hypertension and cardiovascular disease, including stroke, heart failure, and cardiac arrhythmias.²⁶,²⁷ (PubMed)
Sleep itself also has an important relationship with inflammation. The research cited in the material you provided includes work by Irwin and colleagues demonstrating that experimental sleep loss activates inflammatory signaling, including the NF-κB pathway, and research by Simpson and Dinges reviewing the relationship between sleep and inflammation.²⁸,²⁹ (PubMed)
Another study by Irwin and colleagues found that sleep deprivation increased cellular and genomic markers of inflammation.³⁰ (PubMed)
Therefore, airway health and sleep health cannot be completely separated.
Poor airway function can disturb sleep.
Poor sleep can increase inflammatory signaling.
Inflammation can influence multiple body systems.
And multiple health conditions can, in turn, worsen sleep and airway function.
The relationship is circular, not linear.
From the Mouth and Airway to the Whole Body
Now the connections become easier to see.
A child's development can be influenced by:
Nutrition + chewing + breathing + muscle function + genetics
↓
These factors can influence the developing jaws, palate, dental arches, and airway.
↓
A narrow dental arch may contribute to crowding.
↓
Crowded teeth can make cleaning between teeth more difficult.
↓
Poor plaque control can contribute to gingival inflammation.
↓
Persistent periodontal inflammation can contribute to systemic inflammatory burden.
At the same time:
Nasal obstruction or other airway problems
↓
Mouth breathing
↓
Dry oral tissues
↓
Greater susceptibility to gingival irritation and inflammation
↓
Greater difficulty maintaining oral health
↓
Potential contribution to periodontal disease when plaque is not adequately controlled
And during sleep:
Airway narrowing or obstruction
↓
Repeated breathing interruptions
↓
Sleep fragmentation + intermittent oxygen changes
↓
Sympathetic activation + oxidative stress + inflammatory signaling
↓
Potential effects on blood pressure, cardiovascular health, metabolism, cognition, mood, and daytime function
This is why the airway cannot be considered merely a tube through which air travels.
It is part of a biological network connecting breathing, sleep, oral health, inflammation, cardiovascular function, brain function, and overall health.
Protecting Your Airway
Protecting your airway begins with simple, practical habits.
Breathe through your nose when possible. If nasal breathing is consistently difficult, do not simply force yourself to breathe through your nose; investigate why the nose is obstructed.
Eat nutritious foods with appropriate texture. For children, provide developmentally appropriate whole foods that require normal chewing rather than relying primarily on liquids, purees, and highly processed soft foods.
Care for your teeth and gums every day. Brush effectively and clean between the teeth.
Pay attention to persistent mouth breathing. Especially in children, chronic mouth breathing may be a sign of nasal obstruction, enlarged adenoids or tonsils, allergies, or another airway problem.
Protect your sleep. Loud habitual snoring, gasping, witnessed pauses in breathing, restless sleep, morning headaches, or excessive daytime sleepiness deserve attention.
Address chronic nasal congestion and allergies. Persistent obstruction should be evaluated rather than simply accepted as normal.
Do not ignore bleeding gums. Bleeding is a sign of inflammation and should not be dismissed as something that “just happens” when brushing.
If you or your child has ongoing mouth breathing, loud snoring, pauses in breathing during sleep, persistent nasal obstruction, significant daytime sleepiness, or unexplained problems with sleep, seek evaluation from an appropriately qualified healthcare professional.
The goal is not to diagnose disease from a website or health lesson.
The goal is to recognize warning signs early and encourage appropriate evaluation.
God's Design Is Beautifully Connected
The more we study the human body, the more clearly we see that its systems do not operate independently.
Breathing.
Facial growth.
Chewing.
Tooth alignment.
Nasal development.
Oral hygiene.
Gum health.
Inflammation.
Sleep.
Brain health.
Cardiovascular health.
Whole-body health.
These are not isolated subjects.
They are connected parts of the same body.
The hard palate is both the roof of the mouth and the floor of the nasal cavity. The tongue helps with chewing, swallowing, speech, and airway function. The nose prepares the air we breathe and produces nitric oxide. The gums are living tissues connected to the circulation and immune system. Sleep gives the brain and body time to restore and regulate themselves.
The more we understand these relationships, the more remarkable the design becomes.
This is another example of God's design working as an interconnected system: breathing, facial growth, chewing, tooth alignment, oral hygiene, gum health, inflammation, sleep, brain function, and whole-body health are not isolated subjects. They are connected parts of the same body.
Caring for the airway is therefore not simply about preventing snoring.
It is about respecting the remarkable system God designed to sustain life.
Your body is wonderfully designed.
Caring for your airway is one way to honor the gift of life God has given you.
FOOTNOTES / RESEARCH REFERENCES
1. Proctor DF. The nose: upper airway physiology and the atmospheric environment. American Review of Respiratory Disease. 1977;115(6 Pt 2):97–129.
2. Djupesland PG, Chatkin JM, Qian W, Haight JSJ. Nitric oxide in the nasal airway: a new dimension in otorhinolaryngology. American Journal of Otolaryngology. 2001;22(1):19–32. doi:10.1053/ajot.2001.20700. (PubMed)
3. Kim YH, et al. Mouth breathing and craniofacial development in children: a systematic narrative review and clinical implications. Healthcare. 2026;14(12):1737. doi:10.3390/healthcare14121737. (PubMed)
4. Katyal V, Pamula Y, Martin AJ, Daynes CN, Kennedy JD, Sampson WJ. Craniofacial and upper airway morphology in pediatric sleep-disordered breathing: systematic review and meta-analysis. American Journal of Orthodontics and Dentofacial Orthopedics. 2013;143(1):20–30.e3. doi:10.1016/j.ajodo.2012.08.021. (PubMed)
5. Kiliaridis S. Masticatory muscle influence on craniofacial growth. Acta Odontologica Scandinavica. 1995;53(3):196–202. doi:10.3109/00016359509005972. (PubMed)
6. Le Révérend BJD, Edelson LR, Loret C. Anatomical, functional, physiological and behavioural aspects of the development of mastication in early childhood. Archives of Oral Biology. 2014;59(2):126–134. (PubMed)
7. Price WA. The observations reported by Price concerning dental arch form, facial development, and modernization were published in his 1939 work and reviewed contemporaneously in the New England Journal of Medicine. For the present curriculum, these observations are treated as historical evidence rather than modern causal proof. New England Journal of Medicine. 1940;222:984. doi:10.1056/NEJM194006062222324. (New England Journal of Medicine)
8. Scheidegger R, Koletsi D, Eliades T. The impact of dietary consistency on structural craniofacial components: temporomandibular joint/condyle, condylar cartilage, alveolar bone and periodontal ligament. A systematic review and meta-analysis in experimental in vivo research. Archives of Oral Biology. 2018;94:33–47. doi:10.1016/j.archoralbio.2018.06.016. (PubMed)
9. Kiliaridis S. Masticatory muscle function and craniofacial morphology: an experimental study in the growing rat fed a soft diet. Swedish Dental Journal Supplement. 1986;36:1–55. PMID:3465055. (PubMed)
10. Piancino MG, et al. Paediatric orthodontics Part 3: masticatory function during development. European Journal of Paediatric Dentistry. 2019;20(3). doi:10.23804/ejpd.2019.20.03.15. (PubMed)
11. Tonni I, Cinesi L, Piancino MG, Fossati G, Paganelli C. The influence of food hardness on the physiological parameters of mastication in children: a scoping review. Archives of Oral Biology. 2026. doi:10.1016/j.archoralbio.2026.106691. (PubMed)
12. Ugolini A, et al. Transactional evaluation of the influence of diet consistency on transverse maxillary deficiency, plaque index and dental caries in pediatric patients: a cross-sectional study. Nutrients. 2025;17(6):982. doi:10.3390/nu17060982. (PubMed)
13. Contreras-Madrid AI, Pérez-Jorge D, Melwani-Sadhwani R, et al. Dental arch morphology and factors associated with dental crowding: a systematic review. Frontiers in Oral Health. 2026;7:1784622. doi:10.3389/froh.2026.1784622. (PubMed)
14. Helwany M, Rathee M. Anatomy, Head and Neck, Palate. StatPearls. Updated 2026. PMID:32491749. (PubMed)
15. Calvo-Henriquez C, Capasso R, Chiesa-Estomba C, et al. The role of pediatric maxillary expansion on nasal breathing: a systematic review and meta-analysis. International Journal of Pediatric Otorhinolaryngology. 2020;135:110139. doi:10.1016/j.ijporl.2020.110139. (PubMed)
16. Zambon M, et al. Effects of non-surgical rapid maxillary expansion on nasal structures and breathing: a systematic review. International Journal of Pediatric Otorhinolaryngology. 2019. PMID:30732977. (PubMed)
17. Pozo-Molina G, et al. Rapid maxillary expansion and its consequences on the nasal and oropharyngeal anatomy and breathing function of children and adolescents: an umbrella review. Journal of Clinical Medicine. 2023. PMID:37421834. (PubMed)
18. Inchingolo AD, et al. Rapid palate expansion's impact on nasal breathing: a systematic review. International Journal of Pediatric Otorhinolaryngology. 2025;190:112248. doi:10.1016/j.ijporl.2025.112248. (PubMed)
19. Zhao Z, et al. Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis. BMC Oral Health. 2021;21:108. doi:10.1186/s12903-021-01458-7. (PubMed)
20. Wagaiyu EG, Ashley FP. Mouthbreathing, lip seal and upper lip coverage and their relationship with gingival inflammation in 11–14 year-old schoolchildren. Journal of Clinical Periodontology. 1991;18(9):698–702. PMID:1820769. (PubMed)
21. Gulati MS, Grewal N, Kaur A. A comparative study of effects of mouth breathing and normal breathing on gingival health in children. Journal of Indian Society of Pedodontics and Preventive Dentistry. 1998;16(3):72–83. PMID:10635129. (PubMed)
22. Machado V, Botelho J, Escalda N, et al. Serum C-reactive protein and periodontitis: a systematic review and meta-analysis. Frontiers in Immunology. 2021. PMID:34394107. (PubMed)
23. Luthra S, Orlandi M, Hussain SB, et al. Treatment of periodontitis and C-reactive protein: a systematic review and meta-analysis of randomized clinical trials. Journal of Clinical Periodontology. 2023;50(1):45–60. doi:10.1111/jcpe.13709. (PubMed)
24. Van der Touw T, Andronicos NM, Smart N. Is C-reactive protein elevated in obstructive sleep apnea? A systematic review and meta-analysis. Biomarkers. 2019;24(5):429–435. doi:10.1080/1354750X.2019.1600025. (PubMed)
25. Peker Y, et al. Evaluation of blood levels of C-reactive protein marker in obstructive sleep apnea: a systematic review, meta-analysis and meta-regression. Life. 2021;11(4):362. doi:10.3390/life11040362. (PubMed)
26. Mitra AK, Bhuiyan AR, Jones EA. Association and risk factors for obstructive sleep apnea and cardiovascular diseases: a systematic review. Diseases. 2021;9(4):88. doi:10.3390/diseases9040088. (PubMed)
27. Drager LF, Polotsky VY, Lorenzi-Filho G. Cardiovascular consequences of obstructive sleep apnea. Journal of the American College of Cardiology. 2016. (PubMed)
28. Irwin MR, Wang M, Ribeiro D, et al. Sleep loss activates cellular inflammatory signaling. Biological Psychiatry. 2008;64(6):538–540. doi:10.1016/j.biopsych.2008.05.004. (PubMed)
29. Simpson N, Dinges DF. Sleep and inflammation. Nutrition Reviews. 2007;65(12 Pt 2):S244–S252. doi:10.1111/j.1753-4887.2007.tb00371.x. (PubMed)
30. Irwin MR, Wang M, Campomayor CO, Collado-Hidalgo A, Cole S. Sleep deprivation and activation of morning levels of cellular and genomic markers of inflammation. Archives of Internal Medicine. 2006;166(16):1756–1762. doi:10.1001/archinte.166.16.1756. (PubMed)
Scholarly Note for the Final Publication
The strongest way to defend this chapter is not to make the claims more dramatic. It is to make the distinctions more precise.
The evidence supports:
chewing and masticatory function as influences on craniofacial development,
associations between dietary texture and masticatory function,
associations between maxillary constriction and nasal airway dimensions,
measurable changes in nasal dimensions and resistance following maxillary expansion,
associations between chronic mouth breathing and craniofacial changes,
associations between mouth breathing and gingival inflammation,
associations between periodontitis and systemic CRP,
associations between OSA and inflammatory markers,
and associations between sleep disruption and inflammatory signaling.
The evidence does not justify saying that a soft diet by itself causes narrow palates, that a narrow palate inevitably causes mouth breathing, or that mouth breathing inevitably causes periodontal disease.
That distinction actually makes the A — AIRWAY chapter considerably stronger. It allows the curriculum to teach the remarkable interconnectedness of the body while remaining scientifically defensible under critical review.
