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Does someone you care about chew with their mouth open?

“Does your son chew with his mouth open?” A simple question I asked of a parent who had brought their 10 year old son in for a second opinion regarding orthodontic treatment. I had obviously touched on a very sensitive subject in this family and was totally unprepared for the answer that followed.

The boy’s mother started to vent her frustrations about her son who refused to chew his food with his mouth closed. She said, “He has never chewed his food with his mouth shut since he started to eat solid foods. It is so bad and gross that we cannot stand to eat with him. I have scolded him, threatened him, made him leave the table without eating yet he refuses to chew with his mouth closed. We finally made him leave the table and eat in the other room.”

As his mother was describing his eating behavior, the boy sat slumped down, shoulders rolled forward, staring at the floor feeling obviously ridiculed and worthless. The body language of the 10 year old made it evident that this was not the first time he had suffered his mother’s wrath on this issue. I felt sorry for him but knew I could help him provided his mother wanted to end this battle with him.

When I entered the consultation room where the boy and his mother waited, I observed that the bridge of the boy’s nose was very flat. His nostrils were very small and his mouth was open with his chin pushed forward. It was obvious to me that he was a mouth breather from his facial appearance before I even looked at the cephalometric x-ray his mother had brought along with the plaster models of his teeth. A cephalometric x-ray is a head view from the side allowing the treating doctor to measure the jaw lengths, angulations of the teeth in the bone, other orthodontic landmarks and some soft tissue. The x-ray revealed the largest adenoids I had ever seen on a child which completely blocked the airway from the nose. This poor child could not breathe through is nose no matter what one did to him. For him in his current state, it was structurally impossible. His nose was small and collapsed at the bridge because it was not being used for breathing, thus he had very small nostrils which had not developed from lack of use. I was sure the mother had no idea that her son could not breathe through his nose.

“How important is breathing for the life of your son?” I asked. “I know that he has to breathe to live,” answered his mother. “From the x-ray you brought with you today and from observing the physical characteristics of your son’s face, it is evident to me that your son cannot possibly chew with his mouth closed. He can only breathe through his mouth, his nose is totally blocked and not functional for breathing. It is fixable, but in his current state he can only breathe through his mouth even while he eats so he eats with his mouth open,” I said calmly.

His mother was in disbelief. I showed her the airway on the x-ray and how it was blocked by adenoid tissue. She avoided eye contact and changed the subject. “So, how much would you charge to straighten his teeth?” she asked. I told her I would not even attempt to straighten his teeth until he could breathe more normally. While I could move the teeth into a better position they would not be stable and would relapse if the airway and breathing issue was not resolved first.

“How do you resolve it?” she asked “By surgically removing the adenoids and opening the airway,” I said. The mother gathered up her things in obvious disgust. She then looked me straight in the face and stated firmly, “I only want to have my child’s teeth straightened. There is nothing else wrong with him except he is very obstinate about his terrible eating habit. He certainly does not need surgery.”

She took the boy’s hand and almost dragged him as they left. I never saw them again. I have often wondered what became of the poor, suffering boy. Did he get help for his problem? Did they find someone who would look beyond the breathing issue and straighten the teeth anyway? This was over 20 years ago. I wonder where the boy a 30+ year old man is now? How has life turned out for him? I hope someone was able to help him.

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