{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:03:15Z","timestamp":1792803795973,"version":"4.5.0"},"reference-count":53,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T00:00:00Z","timestamp":1736294400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy","id":[{"id":"https:\/\/ror.org\/051h0cw83","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Oral breathing is a common condition, particularly in children, and it is associated with significant changes in craniofacial development, dentomaxillary anomalies, and overall health. Despite extensive research, the role of oral breathing in the development of malocclusion remains controversial, with debates on whether it is a causative factor or a secondary adaptation to existing craniofacial issues. Methods: This narrative review synthesizes studies published in the last 15 years, focusing on the impact of oral breathing on dentofacial development and mandibular posture. A comprehensive search was conducted on four electronic databases (Embase, Medline, ProQUEST, Scopus) using keywords related to oral breathing, malocclusion, mandibular posture, and craniofacial development. Studies were included if they focused on the effects of oral breathing on craniofacial morphology, malocclusion, and postural changes in children and adolescents aged 6\u201318 years. Results: Results indicate a strong link between oral breathing and dentofacial changes such as adenoid facies, Class II malocclusion, posterior crossbite, and anterior open bite. It causes cranial posture changes, particularly increased craniocervical extension, as a compensatory mechanism to maintain airway patency. Conclusions: Oral breathing is a risk factor for malocclusion prognosis, especially in growing children. Dentofacial changes in oral breathers include adenoid facies, convex facial profile, and increased lower facial height. Oral breathing also leads to significant changes in cranial posture, often accompanied by mandibular, lingual, and palatal alterations.<\/jats:p>","DOI":"10.3390\/children12010072","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T09:30:45Z","timestamp":1736328645000},"page":"72","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Oral Breathing Effects on Malocclusions and Mandibular Posture: Complex Consequences on Dentofacial Development in Pediatric Orthodontics"],"prefix":"10.3390","volume":"12","author":[{"given":"Dana","family":"Fe\u0219til\u0103","sequence":"first","affiliation":[{"name":"Department of Orthodontics, Faculty of Dentistry, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3495-4915","authenticated-orcid":false,"given":"Cristina Dora","family":"Ciobotaru","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Faculty of Dentistry, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8819-289X","authenticated-orcid":false,"given":"Tudor","family":"Suciu","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Faculty of Dentistry, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian Doru","family":"Olteanu","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Faculty of Dentistry, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mircea","family":"Ghergie","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Faculty of Dentistry, \u201cIuliu Ha\u021bieganu\u201d University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"495","DOI":"10.18203\/2394-6040.ijcmph20205742","article-title":"Mouth Breathing Habit: A Review","volume":"8","author":"Wasnik","year":"2021","journal-title":"Int. J. Community Med. Public Health"},{"key":"ref_2","first-page":"129","article-title":"Mouth Breathing in Children and Its Impact in Dental Malocclusion: A Systematic Review of Observational Studies","volume":"67","author":"Fraga","year":"2018","journal-title":"Minerva Stomatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/0165-5876(91)90032-7","article-title":"The Influence of Tonsillar Obstruction and Tonsillectomy on Facial Growth and Dental Arch Morphology","volume":"22","author":"Hultcrantz","year":"1991","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/0002-9416(84)90373-7","article-title":"Airway Adequacy, Head Posture, and Craniofacial Morphology","volume":"86","author":"Solow","year":"1984","journal-title":"Am. J. Orthod."},{"key":"ref_5","first-page":"683","article-title":"Postural Alterations and Pulmonary Function of Mouth-Breathing Children","volume":"76","year":"2010","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_6","first-page":"394","article-title":"Prevalence and Factors Related to Mouth Breathing in School Children at the Santo Amaro Project-Recife, 2005","volume":"72","author":"Leal","year":"2015","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"436","DOI":"10.14639\/0392-100X-N1225","article-title":"Association between Upper Airway Obstruction and Malocclusion in Mouth-Breathing Children","volume":"41","author":"Festa","year":"2021","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_8","first-page":"269","article-title":"Influence of Respiratory Pattern on Craniofacial Growth","volume":"51","author":"McNamara","year":"1981","journal-title":"Angle Orthod."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"386","DOI":"10.14639\/0392-100X-770","article-title":"Association between Oral Habits, Mouth Breathing and Malocclusion","volume":"36","author":"Grippaudo","year":"2016","journal-title":"Acta Otorhinolaryngol. Ital."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Masutomi, Y., Goto, T., and Ichikawa, T. (2024). Mouth Breathing Reduces Oral Function in Adolescence. Sci. Rep., 14.","DOI":"10.1038\/s41598-024-54328-x"},{"key":"ref_11","first-page":"18","article-title":"Upper Airway Compromise (UAC) and the Long Face Syndrome","volume":"2","author":"Champagne","year":"1991","journal-title":"J. Gen. Orthod."},{"key":"ref_12","first-page":"167","article-title":"The Long Face Syndrome and Impairment of the Nasopharyngeal Airway","volume":"60","author":"Tourne","year":"1990","journal-title":"Angle Orthod."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.ajodo.2011.06.017","article-title":"Craniofacial Growth Variations in Nasal-Breathing, Oral-Breathing, and Tracheotomized Children","volume":"140","author":"Bakor","year":"2011","journal-title":"Am. J. Orthod. Dentofacial Orthop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/S0165-5876(03)00095-8","article-title":"Muscular, Functional and Orthodontic Changes in Pre School Children with Enlarged Adenoids and Tonsils","volume":"67","author":"Valera","year":"2003","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Lin, L., Zhao, T., Qin, D., Hua, F., and He, H. (2022). The Impact of Mouth Breathing on Dentofacial Development: A Concise Review. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.929165"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"77","DOI":"10.2319\/011507-18.1","article-title":"Oral Breathing and Head Posture","volume":"78","author":"Cuccia","year":"2008","journal-title":"Angle Orthod."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1590\/2317-1782\/20162015002","article-title":"Posture and Body Balance of Schoolchildren Aged 8 to 12 Years with and without Oral Breathing","volume":"28","author":"Roggia","year":"2016","journal-title":"CoDAS"},{"key":"ref_18","first-page":"13","article-title":"Radiological Evaluation of Facial Types in Mouth Breathing Children: A Retrospective Study","volume":"19","author":"Izuka","year":"2008","journal-title":"Int. J. Orthod. Milwaukee Wis"},{"key":"ref_19","first-page":"18","article-title":"Mouth Breathing: Adverse Effects on Facial Growth, Health, Academics, and Behavior","volume":"58","author":"Jefferson","year":"2010","journal-title":"Gen. Dent."},{"key":"ref_20","first-page":"5","article-title":"Interceptive Orthodontics: Awareness and Prevention Is the First Cure","volume":"24","author":"Paglia","year":"2023","journal-title":"Eur. J. Paediatr. Dent."},{"key":"ref_21","first-page":"e030108","article-title":"Oral Breathing: New Early Treatment Protocol","volume":"3","author":"Denotti","year":"2014","journal-title":"J. Pediatr. Neonatal Individ. Med. JPNIM"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"79","DOI":"10.4103\/2231-6027.135977","article-title":"Dental Consequences of Mouth Breathing in the Pediatric Age Group","volume":"3","author":"Malhotra","year":"2013","journal-title":"Int. J. Oral Health Sci."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Cardarelli, F., Drago, S., Rizzi, L., Bazzani, M., Pesce, P., Menini, M., and Migliorati, M. (2024). Effects of Removable Functional Appliances on the Dentoalveolar Unit in Growing Patients. Med. Kaunas Lith., 60.","DOI":"10.3390\/medicina60050746"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Ronsivalle, V., Nucci, L., Bua, N., Palazzo, G., and La Rosa, S. (2023). Elastodontic Appliances for the Interception of Malocclusion in Children: A Systematic Narrative Hybrid Review. Children, 10.","DOI":"10.3390\/children10111821"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Habumugisha, J., Cheng, B., Ma, S.-Y., Zhao, M.-Y., Bu, W.-Q., Wang, G.-L., Liu, Q., Zou, R., and Wang, F. (2022). A Non-Randomized Concurrent Controlled Trial of Myofunctional Treatment in the Mixed Dentition Children with Functional Mouth Breathing Assessed by Cephalometric Radiographs and Study Models. BMC Pediatr., 22.","DOI":"10.1186\/s12887-022-03559-w"},{"key":"ref_26","first-page":"617","article-title":"Rapid Maxillary Expansion and Upper Airway Volume: Systematic Review and Meta-Analysis on the Role of Rapid Maxillary Expansion in Mouth Breathing","volume":"15","author":"Balasubramanian","year":"2022","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_27","first-page":"e59228","article-title":"3D Printer-Assisted Layered Fabrication of a Novel Appliance for Oral Myofunctional Therapy and Functional Evaluation of Its Effects on Orofacial Muscles During Wear","volume":"16","author":"Kujirai","year":"2024","journal-title":"Cureus"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Yang, X., Lai, G., and Wang, J. (2022). Effect of Orofacial Myofunctional Therapy along with Preformed Appliances on Patients with Mixed Dentition and Lip Incompetence. BMC Oral Health, 22.","DOI":"10.1186\/s12903-022-02645-w"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"134","DOI":"10.4274\/TurkJOrthod.2022.2021.0074","article-title":"The Use of 3D Printers in Orthodontics\u2014A Narrative Review","volume":"36","year":"2023","journal-title":"Turk. J. Orthod."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"149","DOI":"10.18231\/j.ijodr.2024.029","article-title":"3D Printing: Changing the Landscape of Orthodontics","volume":"10","author":"Konda","year":"2024","journal-title":"IP Indian J. Orthod. Dentofac. Res."},{"key":"ref_31","unstructured":"(2023, December 23). JabRef Bibliography Management. Available online: https:\/\/docs.jabref.org\/."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.jped.2017.05.007","article-title":"Breathing Mode Influence on Craniofacial Development and Head Posture","volume":"94","year":"2018","journal-title":"J. Pediatr. (Rio J.)"},{"key":"ref_33","first-page":"315","article-title":"Facial Type and Head Posture of Nasal and Mouth-Breathing Children","volume":"23","author":"Souza","year":"2011","journal-title":"J. Soc. Bras. Fonoaudiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"101854","DOI":"10.1016\/j.jormas.2024.101854","article-title":"3D Evaluation of Cranial and Dentofacial Morphological Differences between Individuals with Mouth Breathing and Nasal Breathing","volume":"125","author":"Topsakal","year":"2024","journal-title":"J. Stomatol. Oral Maxillofac. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"\u0130n\u00f6n\u00fc-Sakall\u0131, N., Sakall\u0131, C., Tosun, \u00d6., and Ak\u015fit-B\u0131\u00e7ak, D. (2021). Comparative Evaluation of the Effects of Adenotonsillar Hypertrophy on Oral Health in Children. BioMed Res. Int., 2021.","DOI":"10.1155\/2021\/5550267"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s40510-015-0092-y","article-title":"Dentofacial Characteristics of Oral Breathers in Different Ages: A Retrospective Case\u2013Control Study","volume":"16","author":"Rossi","year":"2015","journal-title":"Prog. Orthod."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1002\/lary.20991","article-title":"The Effect of Mouth Breathing versus Nasal Breathing on Dentofacial and Craniofacial Development in Orthodontic Patients","volume":"120","author":"Harari","year":"2010","journal-title":"Laryngoscope"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1167","DOI":"10.1016\/j.ijporl.2014.04.046","article-title":"Comparison of Cephalometric Patterns in Mouth Breathing and Nose Breathing Children","volume":"78","year":"2014","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1016\/j.ortho.2019.03.016","article-title":"Comparison of Dental Arch Measurements According to the Grade and the Obstructive Character of Adenoids","volume":"17","author":"Diouf","year":"2019","journal-title":"Int. Orthod."},{"key":"ref_40","first-page":"8","article-title":"Impact of Adenoid Hypertrophy on the Open Bite in Children","volume":"73","year":"2019","journal-title":"Otolaryngol. Pol."},{"key":"ref_41","first-page":"664","article-title":"A Study Correlating Breathing Pattern With Different Malocclusions Among Patients Reporting At Department Of Orthodontics Ayub Medical College, Abbottabad, Pakistan","volume":"33","author":"Noor","year":"2021","journal-title":"J. Ayub Med. Coll. Abbottabad-Pak. JAMC"},{"key":"ref_42","first-page":"e20170071","article-title":"Variables Associated with Mouth Breathing Diagnosis in Children Based on a Multidisciplinary Assessment","volume":"30","author":"Berwig","year":"2018","journal-title":"CoDAS"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1016\/j.ijporl.2009.02.006","article-title":"Prevalence of Malocclusion among Mouth Breathing Children: Do Expectations Meet Reality?","volume":"73","author":"Souki","year":"2009","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_44","first-page":"50","article-title":"Influence of Mouth Breathing on the Dentofacial Growth of Children: A Cephalometric Study","volume":"6","author":"Basheer","year":"2014","journal-title":"J. Int. Oral Health JIOH"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1002\/cre2.719","article-title":"Malocclusions and Oral Dysfunctions: A Comprehensive Epidemiological Study on 359 Schoolchildren in France","volume":"9","author":"Borsa","year":"2023","journal-title":"Clin. Exp. Dent. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"316","DOI":"10.20344\/amp.5556","article-title":"Cephalometric Evaluation of Children with Allergic Rhinitis and Mouth Breathing","volume":"28","author":"Agostinho","year":"2015","journal-title":"Acta Med. Port."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"4","DOI":"10.52010\/ijom.1982.8.2.2","article-title":"The Effect of Airway Interference on the Growth and Development of the Face, Jaws, and Dentition","volume":"8","author":"Joseph","year":"1982","journal-title":"Int. J. Orofac. Myol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"03000605211021037","DOI":"10.1177\/03000605211021037","article-title":"Skeletal Class II Malocclusion Caused by Mouth Breathing in a Pediatric Patient Undergoing Treatment by Interceptive Guidance of Occlusion","volume":"49","author":"Lyu","year":"2021","journal-title":"J. Int. Med. Res."},{"key":"ref_49","first-page":"225","article-title":"Maldevelopment of the Cranio-Facial-Respiratory Complex: A Darwinian Perspective","volume":"22","author":"Boyd","year":"2021","journal-title":"Eur. J. Paediatr. Dent."},{"key":"ref_50","first-page":"84","article-title":"Mouth Breathing within a Multidisciplinary Approach: Perception of Orthodontists in the City of Recife, Brazil","volume":"16","author":"Cavalcanti","year":"2011","journal-title":"Dent. Press J. Orthod."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1002\/cre2.161","article-title":"Orthodontic Screening and Treatment Timing in Preschoolers","volume":"5","author":"Grippaudo","year":"2019","journal-title":"Clin. Exp. Dent. Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.bjpt.2017.06.011","article-title":"Postural Disorders in Mouth Breathing Children: A Systematic Review","volume":"22","author":"Neiva","year":"2018","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Zhao, Z., Zheng, L., Huang, X., Li, C., Liu, J., and Hu, Y. (2021). Effects of Mouth Breathing on Facial Skeletal Development in Children: A Systematic Review and Meta-Analysis. BMC Oral Health, 21.","DOI":"10.1186\/s12903-021-01458-7"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/1\/72\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:24:57Z","timestamp":1759919097000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/1\/72"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,8]]},"references-count":53,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["children12010072"],"URL":"https:\/\/doi.org\/10.3390\/children12010072","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,8]]}}}