Obstructions due to chronically congested nasal passages or enlarged tonsils may affect the growth of the face. "Long face syndrome" is a term describing the longer, narrow face of children who suffer from uncontrolled allergies or, an obstruction of the upper airway which creates an inability to breathe through the nose, reports an article in the July/August 2004 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal.

"Narrow nostrils, shadows beneath the eyes and constantly open lips may also be associated with blockage of the upper airway or allergies," explains Jane A. Soxman, DDS, lead author of the report.

If the child is unable to breathe through the nose, mouthbreathing results, which may affect overall health since important nasal functions are bypassed. As air passes through the nose, it is warmed, humidified and cleansed of foreign particles, pollen and bacteria. "In addition, dry air carries less oxygen than moist air to the lungs, causing these children to fatigue more rapidly," explains Dr. Soxman.

The child's bite may change too. Unbalanced muscle forces compress the upper jaw and the tongue may protrude through the front teeth, forcing them outward. If the constriction of the upper jaw repositions the molars, a dentist may recommend expansion of the upper jaw with an appliance, which also often improves breathing.

In some children, a severe upper airway blockage can cause breathing to stop during sleep or sleep apnea. According to Dr. Soxman, these children may not grow normally because of the energy they expend trying to breathe during the night. Also, these children may be hyperactive and experience poor concentration, headaches, nightmares and bedwetting. Use the BEARS acronym to determine if sleep apnea is a possibility:

-- Bedtime problems, such as snoring, sleep apnea or nightmares
-- Excessive daytime sleepiness
-- Awakenings at night
-- Regularity and duration of sleep
-- Snoring

Parents may use an audio or video to tape documentation of the child's sleep disturbances. A physician may recommend removal of the adenoids if sleep apnea is due to obstruction of the upper airway.

If allergies are the source of the problem, the causes need to be determined and removed. Dr. Soxman encourages parents to minimize dust. "Use a damp cloth to dust, remove carpet, stuffed animals, down pillows and down comforters. Buy hypoallergenic pillows and cover mattresses and pillows with dust mite barrier covers." The child's doctor may recommend drugs or allergy shots to reduce allergic responses.

"Knowing what a nose knows may help to improve the quality of life," says Dr. Soxman.

The AGD is a non-profit organization of more than 37,000 general dentists dedicated to staying up-to-date in the profession through continuing education. A general dentist is the primary care provider for patients of all ages and is responsible for the diagnosis, treatment, management and overall coordination of services related to patient's oral health needs.

Contact: Jennifer Starkey
Academy of General Dentistry

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