Routine pediatric dental visits are typically thought of as cavity checkups or lessons in brushing and flossing. Increasingly, however, dental professionals are raising awareness about a deeper issue: compromised airway development that begins in infancy and can affect breathing, sleep and overall health for life.

Early Red Flags

David A. Schwartz, DDS, founder of David A. Schwartz, DDS, PC, a family dental practice in Berks County, says dentists are often the first to identify red flags in a child’s oral and facial development that could signal airway dysfunction—problems that, if caught early, can be corrected before they cause long-term damage.

“You only go through growth and development once; there are no do-overs,” says Schwartz. “Like most issues, the earlier they are detected and corrected, the better.”

According to Schwartz, issues like tongue-tie, improper oral posture and habitual mouth breathing in children can restrict normal airway development. If left untreated, these can lead to a cascade of health issues, including poor sleep quality, speech problems, behavioral challenges and even facial deformities.

Schwartz finds that not every healthcare provider has the same level of training or understanding. “This can lead to conflicting opinions,” Schwartz says, emphasizing that not all pediatricians or general dentists may screen for airway or tongue-related issues with the same level of scrutiny.

Understanding Tongue-Tie

One commonly overlooked factor is ankyloglossia, more commonly known as tongue-tie. The condition restricts the tongue’s range of motion and can interfere with everything from breastfeeding to breathing and speech development.

Tongue-ties are classified by severity, and treatment options depend on how the restriction affects the patient. Some cases can be managed with oro-myofunctional therapy (OMT), a type of physical therapy for the muscles of the face and mouth that retrains how the tongue rests and functions. Others may require surgical intervention, often using laser technology.

“There are OMT therapists as well as dentists, like myself, who are trained,” Schwartz explains. “Some [patients] need surgical revision. While it is infinitely best to treat a tie while a person is still an infant, for some, there can be the need for further revision later on due to a multitude of factors.”

The Importance of Nasal Breathing

Beyond infant tongue-tie, which can be diagnosed with a skilled lactation evaluation, Schwartz employs a straightforward diagnostic tool in his practice to assess nasal breathing capability—something he believes should be a part of pediatric assessments when indicated.  

“I give what is called a three-minute nasal breathing test to anyone I suspect has an upper airway breathing issue to know if an ENT referral is required or just some OMT to retrain habits,” says Schwartz. “The person sits for three minutes with their lips gently closed and gently breathes through their nose. If they need to take a deeper inhale or open their mouth to inhale prior to the three minutes, or at the conclusion of the test, they cannot get enough air through their nose to live [and they fail the test]. The only way to pass the test is to be able to continue gently breathing through their nose past the three minutes.”

Nasal breathing, as opposed to mouth breathing, is critical to optimal health. It filters and humidifies air, facilitates proper jaw development and supports restful sleep. Chronic mouth breathing, especially during formative years, can lead to underdeveloped jaws, crowded teeth and obstructed airways—all of which can contribute to obstructive sleep apnea and other serious health conditions later in life.

What Parents Should Know

Schwartz offers that not all pacifiers are created equal. “Some designs can be very damaging because they encourage poor tongue posture, increase cheek pressure against the bones that hold the teeth and contribute to many oral developmental issues.” He adds, “The NUK pacifier has the best design,” emphasizing that “all pacifier use should be discontinued by age 2. Around this age, sucking strength increases dramatically, and even with the NUK design, there can be damaging effects on the jawbones.” Schwartz states that finger sucking, although less common, is just as damaging as thumb sucking or prolonged pacifier use.

When evaluating children, Schwartz also recommends observing the area under their eyes. Dark circles—sometimes called allergic shiners—often indicate nasal breathing difficulties. Says Schwartz, “If present, an ENT consult is definitely required. That being said, as with all healthcare providers, there are differences in ENTs’ training, too. Some will give an opinion without testing, scoping or imaging. In other words, just guessing and saying give it a few years [to] see what happens. Others will take the issue[s] more seriously and try to find out why they are present and offer solutions.”

For parents, this evolving understanding means that choosing the right dental provider—one trained to evaluate airway health—can be a critical decision in a child’s developmental journey. Schwartz advises parents to look for providers that understand oro-myofunctional therapy, airway anatomy and growth patterns, rather than relying solely on visual cavity checks or orthodontic alignment.

Many of these issues are not just dental problems; they’re whole-body health problems. Airway health, Schwartz says, should be part of every child’s routine exam from the beginning.

As more dentists like Schwartz adopt a holistic, airway-focused approach to pediatric care, the hope is that fewer children will grow into adults with lifelong breathing issues that could have been prevented.

David A. Schwartz, DDS, PC, is located at 701 Jefferson Blvd., in West Lawn. For more information or to make an appointment, call 610-670-6910 or visit SchwartzFamilyDental.com.