Mouth Breathing & Facial Development

Dr Mew

Dr Mew

Dr John Mew is an orthodontist living and working in London. He graduated in dentistry from the University College London, and then trained in Orthognathic surgery at the Royal Victoria Hospital, East Grinstead where he developed an interest in the science of facial growth. In 1965, he returned to University College to specialise in orthodontics. Since then, he has been developing non-surgical methods of correcting unattractive vertical growth in childrens faces.

Dr Mews family has an excellent tradition of dentistry, as his father was a dentist and his son, Dr Mike Mew, is an orthodontist.

A good-looking face is determined by a strong, sturdy chin, developed jaws, high cheekbones, good lips, correct nose size and straight teeth. When a face develops correctly, it follows that the teeth will be straight. Straight teeth do not create a good-looking face, but a good-looking face will create straight teeth.

Each year, parents spend thousands of pounds and dollars in an effort to straighten their childs teeth, while ignoring other factors. Dr Mews work is to ensure the normal development of a childs face and teeth by correcting habits and by applying non-invasive techniques.

Dr Mews patients

patient

Over the past few decades, Dr Mews assistant has taken a photograph of the face of every child that Dr Mew has treated.

This ten-year-old boy is a nose breather and has a good-looking, broad face with everything in proportion. In other words, everything is in its right place. The boy exhibits well-defined eyes, cheekbones, lips and chin.

patient

On the boys fourteenth birthday, he was given a gerbil as a present. Soon after, his nose began to block, causing him to breathe through his mouth. Within three years, his face had changed its shape considerably.

The above photograph is of the boy at age seventeen. Because he kept his mouth open from the ages of 14 until 17, his face grew downwards instead of in width. His face became narrow and long. His jaws are set back from their perfect and natural position. He now has a double chin and his jaws come back on his airways, resulting in smaller airways. This creates health problems such as sleep apnoea. His nose looks far bigger because his jaws do not come forward enough, and his cheeks are sunken as his face drags everything downwards. This face is typical of the thousands of children who breathe through their mouths.

In many ways, the boys face reminds me of my own face. I was a mouth breather until the age of 25, and know too well the health consequences. Making a change to nasal breathing changed my life in every way. The benefits that I experienced included better sleep, no more snoring, more energy, better concentration, no more asthma attacks, no need for asthma medication, and a far calmer disposition. In addition, I am now embarking on orthotropic treatment to expand my jaws to make room for my existing teeth, something that my tongue would have done had I been encouraged to breathe through my nose as a child.

patient

Two sisters

Kelly was seven years old and Samantha was eight-and-a-half years old. Both sisters displayed habitual mouth breathing and were developing associated facial growth patterns. They attended Dr Mew, who taught them to breathe through their noses and to swallow correctly.

Kelly took on all that Dr Mew told her, but her older sister Samantha was more complacent. She did not keep her mouth closed while breathing.

Both girls returned a few years later. Again, Dr Mews assistant took follow-up photographs, which are shown below. Kelly is to the left and Samantha is to the right. Observe the development of their faces. In your view, who has the more attractively defined face? Look at the tension on Samanthas mouth as she closes her mouth for the photograph.

patient

The human lineage can be traced without break from Homo Erectus who existed on Earth approximately 600,000 years ago. Throughout this time, humans have exhibited straight teeth.

If one visits a natural history museum and examine the skulls of prehistoric man, wide facial structures and straight teeth would be evident.

Crooked teeth are a modern day phenomena. Even as late as the 1600s, crooked teeth while present amongst the wealthier class affected only a small portion of the population. Research has shown that this degeneration has become more marked within the past 400 years, and in European countries again appears to be linked with social progress and possibly a change of diet.1

Over seventy years ago, dentist Dr Weston Price visited many primitive and isolated groups such as aborigines, Gaelic people, Swiss people, Eskimos, North American Indians and Maoris. His interest was in determining the effect of a change from their traditional to a more modernised European diet. His findings are published in a highly informative book entitled Nutrition and Physical Degeneration.2

Dr Price noted that when the Gaelic people, living on the Hebrides off the coast of Scotland, changed from their traditional diet of small seafoods and oatmeal to a modernised diet of "angel food cake, white bread and many white flour commodities, marmalade, canned vegetables, sweetened fruit juices, jams, and confections," first-generation children became mouth breathers and their immunity from the diseases of civilisation reduced dramatically.2

One of his observations is as follows: The change in the two generations was illustrated by a little girl and her grandfather on the Isle of Skye. He was the product of the old regime, and about eighty years of age. He was typical of the stalwart product raised on the native foods.

His granddaughter had pinched nostrils and narrowed face. Her dental arches were deformed and her teeth crowded. She was a mouth breather. She had the typical expression of the result of modernisation after the parents had adopted the modern foods of commerce, and abandoned the oatcake, oatmeal porridge and sea foods.2

Recognizing the fact that children become mouth breathers is significant and illustrates the link between the modern diet and chronic mouth breathing. As a child experiences a greater demand to breathe heavier, he or she opens his or her mouth to breathe, thus causing craniofacial changes and negatively impacting his or her health. Increased breathing volume in turn affects immunity responses, often resulting in a blocked nose and thus completing the cycle.

donkey

Of all the species on earth, humans are most affected by crooked teeth. The traditional explanation is that the child inherited smaller jaws from his or her mother and larger teeth from his or her father. Could this be true?

In the aptly entitled book, Why Raise Ugly Kids? Dr Hal A. Huggins questions the genetic argument and cites his observation of working on the family farm. One comment is as follows: Horse and donkey – cross them and you get a fine work animal. Used them a lot on the farm and know what? I never saw a mule with horses teeth and a donkeys jaw.3

Dogs, with the exception of those who have been crossbred, are another good example, as the pups of a labrador father and poodle mother will have straight teeth. Domestic dogs dont develop malocclusions (crooked teeth) unless they are selectively crossbred for the purpose as with bulldogs.1

According to Australian orthodontist Dr John Flutter; every childs face has the growth potential to match its own set of teeth.5 Bearing this in mind, Dr Mike Mew advocates that there is no evidence that we should not accommodate 32 well aligned teeth today or that there has been any genetic change.4

Mouth breathing causes children to develop crooked teeth. Correct with Buteyko.

During the 1960s, dentist Egil P Harvold recognised that oral respiration associated with obstruction of the nasal airway is a common finding among patients seeking orthodontic treatment.6 To determine the relationship between mouth breathing and crooked teeth, he conducted a number of experiments by blocking the noses of young monkeys with silicon nose plugs. The experiments showed that the monkeys adapted to nasal obstruction in different ways. In general, the experimental animals maintained an open mouth. All experimental animals gradually acquired a facial appearance and dental occlusion different from those of the control animals.6 The mouth-breathing monkeys developed crooked teeth and other facial deformities, including a lowering of the chin, a steeper mandibular plane angle, and an increase in the gonial angle as compared with the eight control animals.7 Harvold claimed to be able to reproduce the equivalent of most human dental irregularities; Any common type of dental irregularity can be produced experimentally in monkeys with normal dentition.1

In support of Harvolds findings, Dr Mew states that it is hard to escape the conclusion that in monkeys, a change in the action and posture of the tongue can produce severe malocclusions. 1

Every child has the potential to grow an attractive face. Children who are taught the Buteyko Method learn how to avoid cranio facial abnormalities as discussed.

Toddlers generally have well-defined, broad and good-looking faces. However, a different story emerges with many teenagers. A visit to a high school will uncover many long, narrow and flat faces with sunken cheek bones, receded chins, narrow jaws and prominent noses. So what happens in the interim? Why do children develop crooked teeth and narrow faces? Consensus from thousands of oral facial mycologists, hygienists, dentists, orthodontists and published papers worldwide is that for the face and, consequently, teeth to develop correctly, a number of factors must be employed by the growing child. The Buteyko Method has special exercises for children to learn these factors which include:

1) Mouth closed with lips gently together;
2) Three quarters of the tongue resting in the roof of the mouth, with the tip of the tongue placed before the front teeth;
3) Breathing through the nose;
4) Correct swallowing; (correct swallowing is not taught as part of the Buteyko Method for children. It is however included in the book entitled Buteykokids meet Dr Mew")

According to Meredith, 60% of the growth of the face takes place during the first four years of life and 90% takes place by the age of 12. Development of the lower jaw continues until around age 18.8

Based on these observations, for correct craniofacial growth to take place, early intervention with nasal breathing and tongue posture is essential. In the words of Dr Carl Schreiner, The deleterious effects of nasal obstruction are virtually complete by puberty so the window of opportunity is relatively brief. Delay in intervention may result in unsuccessful orthodontic treatment which may require orhthagnathic surgery at an older age.9

All mouth-breathing children develop crooked teeth

The normal growth direction of the jaws is forward. This occurs as a result of the forces exerted by the lips and tongue. It works based on this same principal used by orthodontics: light forces move teeth.

growing

The lips exert an estimated pressure against the teeth of between 100 gm and 300 gm.10 While swallowing, the pressure exerted against the anterior teeth by the tongue is estimated to be 500 gms,11 while the force required to move a tooth is as small as 1.7gm.5

We swallow an estimated 2,000 times per day, and each time we swallow, the tongue pushes upwards and flattens in the roof of the mouth, exerting a considerable force that shapes the jaws.5 The correct position of the tongue is resting in the roof of the mouth. As the child grows, the top jaw forms around the tongue. In other words, the shape of the top jaw is the shape of the tongue. As the tongue is U-shaped, it results in a broad facial structure with sufficient room to house all teeth. Nature dictates that the shape of the lower jaw will follow that of the top jaw.5

When the mouth is open, the tongue cannot rest in the roof of the mouth, resulting in a poorer developed, narrow, V-shaped top jaw. A smaller top jaw leads to a narrow facial structure and overcrowding of the teeth. “Low tongue posture seen with oral respiration (mouth breathing) impedes the lateral expansion and anterior development of the maxilla (top jaw).”12

In the words of dentist Dr Raymond Silkman, The most important orthodontic appliance that you all have and carry with you twenty-four hours a day is your tongue. People who breathe through their nose normally have a tongue that postures up into the maxilla (the top jaw). When the tongue sits right up behind the front teeth, it is maintaining the shape of the maxilla (top jaw) every time you swallow. Every time the proper tongue swallow motion takes place, it spreads up against maxilla (top jaw), activating it and contributing to that little cranial motion. Individuals who breathe through their mouths have a lower tongue posture and the maxilla does not receive the stimulation from the tongue that it should.13

This is supported by Dr John Flutters statement: There is no doubt that the tongue has an enormous influence on dentition,”14 and by Dr Mews statement: “Lack of tongue pressure hinders the growth of the maxilla (top jaw). Put conversely, the maxilla may not be able to achieve its inherited potential without assistance from tongue posture.”1

In addition, “the main characteristics of the respiratory obstruction syndrome (blocked nose is addressed using the Buteyko method) are presence of hypertrophied tonsils or adenoids, mouth breathing, open bite, cross bite, excessive anterior face height, incompetent lip posture, excessive appearance of maxillary anterior teeth, narrow external nares, V-shaped maxillary arch (top jaw).15

To avoid facial changes, crooked teeth and associated health problems- the Buteyko Method for children is necessary. 15

topjaw

During an interview on the Australian TV programme “Sixty Seconds,” Australian orthodontist Dr Derek Mahony talks of one of his patients: “If you look at Zoe, whats caused all this crowding is really not genetics, its more related to the way she breathes and, if you open really wide there, Zoe, you can see that narrow, top jaw V-shape arch.”16

He goes on to say, “the key is to diagnosing the problem is starting treatment at an early age. And the problem often starts here in the roof of the mouth. When children suck their thumbs or breathe through their mouths, it can be pushed in and this narrowing can have a knock-on effect. The lower jaw is forced back and down, producing what most of us would call buck teeth.”

Craniofacial growth associated with mouth breathing. Avoid these changes when children learn the Buteyko Method.

It is well documented that mouth-breathing children grow longer faces. A paper by Tourne entitled, The long face syndrome and impairment of the nasopharyngeal airway, recognised that “the switch from a nasal to an oronasal (mouth and nose combined) breathing pattern induces functional adaptations that include an increase in total anterior face height and vertical development of the lower anterior face”.17

In another paper, Dr Carl Schreiner comments that “Long-standing nasal obstruction appears to affect craniofacial morphology during periods of rapid facial growth in genetically susceptible children with narrow facial pattern”.18

In a paper entitled, Care of nasal airway to prevent orthodontic problems in children, “a mouth breather lowers the tongue position to facilitate the flow of air in to the expanding lungs. The resultant effect is maldevelopment of the jaw in particular and deformity of the face in general. Setting of the teeth on the jaw is also affected. All these make the face look negative. So, to prevent orthodontic problem in children, it is necessary to detect the nasopharyngeal obstruction and treat the same accordingly.”19

In a study of 47 children between the ages of 6 to 15 years that was done to determine the correlation between breathing mode and craniofacial morphology, “findings demonstrated a significant predominance of mouth breathing compared to nasal breathing in the vertical growth patterns studied.” The paper concluded that, “results show a correlation between obstructed nasal breathing, large adenoids and vertical growth pattern.”20

Another study involving 73 children between the ages of 3 to 6 years that was done to determine the influence of mouth breathing on dentofacial growth and development concluded that “mouth breathing can influence craniofacial and occlusal development early in childhood.” 21

When the tongue is not resting in the roof of the mouth, the jaws are impeded from growing forward and are instead set back from their ideal position. This contracts the airways, contributing to breathing difficulties and sleep apnea. In addition, the nose will seem larger, similar to that of a roman nose. The “nose is more pronounced in an ideal occlusion (straight teeth) but in the various malocclusions (crooked teeth) where the maxilla (top jaw) is underdeveloped it appears larger, although in fact it is smaller.”1

According to Dr Mew, “Lack of growth affects the whole face and is associated with flat cheeks, unattractive lips, large noses, tired eyes, double chin, receding chins and sloping forehead, features that will be readily recognised when there is a pronounced crowding of teeth.”22

Given the extent of information available, it is surprising that few dentists seem to be aware of the craniofacial effects from mouth breathing. The journal General Dentist noted that “the vast majority of health care professionals are unaware of the negative impact of upper airway obstruction (mouth breathing) on normal facial growth and physiologic health. Children whose mouth breathing is untreated may develop long, narrow faces, narrow mouths, high palatal vaults, dental malocclusion (crooked teeth), gummy smiles and many other unattractive facial features. These children do not sleep well at night due to obstructed airways; this lack of sleep can adversely affect their growth and academic performance. Many of these children are misdiagnosed with attention deficit disorder (ADD) and hyperactivity”. The paper further states that “if mouth breathing is treated early, its negative effect on facial and dental development and the medical and social problems associated with it can be reduced or averted.”23

The good news is that these issues are reversible when caught at an early age provided that children are taught exercises or similar pertaining to the Buteyko Method.

Learning correct breathing and swallowing before the age of eight years often corrects facial development without the need for any orthodontic treatment. As the lower jaws are still developing until the age of eighteen, teenagers can also derive considerable benefit.

Furthermore, the success of any orthodontic treatment depends on the application of correct breathing and swallowing. Estimates in the field are that up to 90% of orthodontic work relapses unless poor oral habits such as mouth breathing are addressed.Again this can be reversed when children are taught the basic principals of the Buteyko Breathing Method. 5

In a paper entitled, Nasal obstruction in children and secondary dental deformities, “Effective orthodontic therapy may require the elimination of the nasal obstruction to allow for normalization of the facial musculature surrounding the dentition.”9 This can be added to by stating that for orthodontic treatment to be effective, patients must be taught how to unblock their noses, breathe through their noses and swallow correctly.

During the 70s and 80s, Linder-Aronsen consistently noted the relationship between nasal obstruction and craniofacial changes, including longer faces, open bite and cross bite. More importantly, significant craniofacial changes toward normal were observed to take place after patients returned to nasal breathing.24,25,26,27

In another study of 26 children, Kerr showed how development of the lower jaws began to normalise after they switched from mouth to nasal breathing.28 Finally, “Evidence of reversibility is also strongly supported by studies of monozygotic twins in which one developed nasal obstruction due to trauma. The obstructed twin developed characteristics of the long face syndrome which partially normalized following correction of the (nasal) obstruction”.9

Teenagers embarking on orthodontic treatment

For parents embarking upon orthodontic treatment to advance the health and facial appearance of their children, there is much concern among the worlds scientific community over the lack of science in current clinical practise.29,30,31,32

Conventional orthodontic treatment is unable to replicate the straight teeth that develop naturally when the mouth is closed and the tongue is resting in the roof of the mouth. According to orthodontist Dr John Flutter, “the best aligned teeth I see are people who never had orthodontic treatment”.5

Traditional orthodontics recognises the cause of crooked teeth as a result of teeth being too large for the jaws. The approach is to wait until the child is twelve years of age or older before treatment begins. Normally, two to four teeth are extracted to make room for existing teeth, which are then aligned with braces.

UK based Channel Four dispatches a programme that aired during December 1999, which queried whether the standard orthodontic treatment of extractions to make room for teeth actually damages a childs face.33 The programme showed that parents who bring their children with crooked teeth to an orthodontist are not told that the treatment could cause serious damage.

During the programme, 700 UK families were interviewed. More than half of the children undergoing treatment had teeth extracted. A comparison was made with treatment in California, where extractions take place in only 15% of cases.33 There, many orthodontists apply expandable braces to gently widen the jaws to make room for the teeth. In addition, children are taught exercises, including correct swallowing and nasal breathing, as part of their treatment.

In an interview with the British newspaper The Independent, Dr Mew is quoted as follows: “I frequently see examples of faces which have been really badly spoiled. In my personal opinion, probably about 20 per cent of orthodontic patients are noticeably damaged and maybe another 30 per cent are slightly damaged.”34

Dr Mew further adds that extraction of teeth can result in “long-term damage to the skull, jaw pain and headaches as a result of orthodontic dentistry. In the worst cases, they suffer ringing in the ears, postural problems leading to muscle pain in the neck, shoulders and back, and extreme headaches”.34

ben

One case that Dr Mew puts forward to support his claims is the case history of twin brothers Quentin and Ben Creed. Quentin, the more serious case, was treated by Dr Mew using orthotropics. Dr Mew reshaped his jaw with appliances to make room for the overcrowded teeth. His twin brother Ben opted for traditional orthodontics, resulting in the extraction of four teeth and fixed braces.

A number of years later, Ben is quoted as saying "Because of the extractions, the width of my mouth is smaller. In hindsight, I would have preferred to have gone with Dr Mews method as it got much better results.”34

Ever since the 1960s, Dr Mews treatment is based on “aiming to encourage horizontal growth of the facial bones by means of good muscle tone and a tongue-to-palate resting posture with the mouth closed, in the belief that, in these circumstances, the teeth will align themselves. This is in contrast to the mechanical approach of most orthodontists, which innumerable papers have shown tends to increase vertical growth”.35

In a paper by Dr Mew published in the World Journal of Orthodontics, a study compared the effect of traditional fixed appliances and orthotropic (growth guidance) treatment without fixed appliances on a series of identical twins ten years after treatment. A panel of 12 lay judges assessed the facial changes. “The results showed that most of the traditionally treated twins were judged to look less attractive after treatment, while most treated by Orthotropics were judged to have improved. There was little difference in the dental results, but the traditionally treated cases seemed to relapse more frequently.”36

Sixty Minutes TV interview16

Australian TV programme Sixty Minutes interviewed a number of orthodontists on this subject. The interviewer was Peter Overton. Dr Geoff Wexler was spokesman for the Australian Society of Orthodontists. The following is part of the transcript.

PETER OVERTON: Well, how about this example. Nineteen-year-old Michael Buggy went to six Sydney orthodontists for his condition, some minor crowding. All insisted he lose four teeth. But his mother Valerie wasnt so sure.

VALERIE BUGGY: And I was horrified, because I didnt think that he had such a big problem and I begged them not to take them out. I said, "Isnt there, in all the knowledge that you have and all the studying that youve done, isnt there another way?" But they were quite steadfast that no, the teeth have got to come out or the problem would come back.

PETER OVERTON: Finally Valerie gave in and took Michael to the dentist for the extractions.

VALERIE BUGGY: He was just at the point of having them out, she had all the tools in her hand and she said, "You dont want this to happen, do you?" And I said, "No, I dont, but what else can I do?" And as luck would have it she gave me this dentists card and said, "Give him a ring."

PETER OVERTON: That card belonged to Derek Mahony and he straightened Michaels teeth without extractions.

VALERIE BUGGY: I would like to actually show these orthodontists that said to me, "Youll be back, youll be sorry." Id like to show them his smile now and I just wish that orthodontists would get together and give any mother like me the opportunity not to have the teeth taken out.

PETER OVERTON: Can I show you this patient here? Do you think he needs extractions?

DR GEOFF WEXLER: Well, I wouldnt.

PETER OVERTON: You wouldnt?

DR GEOFF WEXLER: No.

PETER OVERTON: Six eminent orthodontists recommended to this patients mother that he needed to have the classic four on the floor.

DR GEOFF WEXLER: What youve presented me here is part of the information. Based on what youve shown me I wouldnt, but there might be other factors that you havent shown me in this patients diagnosis.

PETER OVERTON: Hes had very successful treatment with Derek Mahony without extractions. Does that surprise you?

DR GEOFF WEXLER: No.

PETER OVERTON: Are faces being damaged by traditional extraction-type orthodontics?
DR GEOFF WEXLER: I havent seen any evidence at all to say that faces are being damaged in general.
PETER OVERTON: Try telling that to dentist Dr Mike Fennel. He pulled out four of his sons teeth on the advice of an orthodontist. The result? Davids face ended up looking like this.
DR MIKE FENNEL: It ruined the look of his mouth. So from the nose upwards he looks great, but from the nose downwards he just looks terrible, but how do you tell that to your son? In fact, he looked like an old man. At the age of 18, he looked like an old man with no teeth.
PETER OVERTON: Is “damaged” the right word?
DR MIKE FENNEL: Yes, it is really.
PETER OVERTON: Traditional orthodontics did that to his face?
DR MIKE FENNEL: They did, yes. Yes.



References

1) Biobloc therapy John Mew p19
2) Price W. Nutrition and physical degeneration Redlands California Buteyko
3) Why raise ugly kids? Dr Hal A. Huggins
4) A Black Swan by Mike Mew British Dental Journal 206, 393 (2009) Published online: 25 April 2009 | doi:10.1038/sj.bdj.2009.325
5) Dr John Flutter speaking at BIBH conference 2007
6) Primate experiments on oral respiration. Egil P Harvold. American Journal of orthodontics. Volume 79, issue 4, April 1981, pages 359- 372)
7) Primate experiments on mandibular growth direction. Tomer, Harvold Ep. Am J Orthod 1982 Aug: 82 (2): 114-9
8) Meridith HV: Growth in head width during the first twelve years of life. Pediatrics 12:411-429, 1953
9) Nasal Airway Obstruction In Children and Secondary Dental Deformities SOURCE: UTMB, Dept. of Otolaryngology, Grand Rounds Presentation RESIDENT PHYSICIAN: Carl Schreiner, MD, December 18, 1996
10) Sakuda M Ishizua M. Study of the lip bumper. J dentist Res. 1970: 49:667
11) Profit. W.R lingual pressure pattern in the transition from tongue thrust to adult swallowing. Arch Oral Biol. 1972:17:555:63
12) Upper airway obstruction and craniofacial morphology. Otolaryngol head neck surgery: 1991 Jun; 104 (6): 881-90)
13) Mental or dental: Dr Raymond Silkman
14) Dr John Flutter: instruction video
15) Malocclusion and upper airway obstruction. Publishes in medicina (Kaunas) 2002; 38 (3): 277- 83)
16) Sixty Seconds interview with Dr Mahony. Straight talk. Sunday, August 3, 2003
17) Tourne. The long face syndrome and impairment of the nasopharyngeal airway. Angle Orthod 1990 Fall 60(3) 167- 76
18) Nasal Airway Obstruction In Children and Secondary Dental Deformities. RESIDENT PHYSICIAN: Carl Schreiner, MD. December 18, 1996
19) Care of nasal airway to prevent orthodontic problems in children” J Indian Med association 2007 Nov; 105 (11):640,642)
20) Effect of breathing mode and nose ventilation on growth of the facial bones. HNO 1996 May; 4(5):229-34)buteyko
21) Skeletal and occlusal characteristics in mouth breathing pre school children. By Mattar SE, Anselmo- Lima WT, Valera FC, Matsumoto MA. Published in J Clin Pediatr Dent 2004 Summer; 28(4): 315-8 )
22) Dr Mew. Orthotropics brochure
23) General dentist: Mouth breathing: adverse effects on facial growth, health, academics and behaviour. Jefferson Y, 2010 Jan- Feb; 58 (1): 18-25 buteyko
24) : Linder-Aronson S. Adenoids: their effect of the mode of breathing and nasal airflow, and their relationship to characteristics of the facial skeleton and the dentition. Acta Otolaryngology 1970:265 supp.
25) Linder-Aronson S. Adenoid obstruction of the nasopharynx. In: Nasorespiratory function and craniofacial growth. Monograph 9. craniofacial growth series. Ann Arbor: University of Mich. 1979:121-47
26) Linder-Aronson S. Cephalometric radiographs as a means of evaluating the capacity of the nasal and nasopharyngeal airway. Am J Orthod Dentofacial Orthop 1979;76:479-90
27) Linder-Aronson S. mandibular growth following adenoidectomy. Am J Orthod 1986;89:273-84
28) Kerr WJ, McWilliams JS, et al. Mandibular forma and position related to changes mode of breathing - a five year longitudinal study. Angle Orthod 1987;59:91-96
29) Johnston LE Fear and loathing in orthodontics: Notes on the death of theory. Carlson D S. (Ed). The University of Michigan Ann Arbor: Craniofacial Growth Series 23, Center for Human Growth and Development, 1990.
30) Johnston LE. Growing Jaws for Fun and Profit. What doesnt and why. McNamara J A. (Ed). The University of Michigan. Ann Arbor: Craniofacial Growth Series 35, Center for Human Growth and Development, 1999.
31) Mew JRC. Are random controlled trials appropriate for orthodontics? Evid Based Dent 2002; 3: 36. Buteyko
32) Angle EH. Treatment of malocclusion of the teeth. 7th ed. Philadelphia: S S White Dental Manufacturing Company, 1907.
33) Dispatches, Channel 4, 1999.
34) Independent newspaper.co.uk, Childrens dentists at odds in battle of the braces buteyko. Sunday, 21 November 1999
35) British Dental Journal 199, 495 - 497 (2005)
Published online: 22 October 2005 | doi:10.1038/sj.bdj.4812851)
36) (ref: Facial changes in Identical twins treated by different orthodontic techniques. Mew J. World J Orthod. 2007 Summer; 8(2):174-88