Did you know tongue scalloping or tooth indents on the side of the tongue, are a strong clinical indicator of obstructive breathing during sleep?

Tongue scalloping is a result of low tongue tone and posture.  It often reflects poor palate development and constricted tongue space.

Research suggests in a pool of people with tongue scalloping:

• 89% have severe collapses of the airway lasting ten seconds or more.
• 89% have reductions in oxygenation during the night.

More details can be found here: “The Association of Tongue Scalloping With Obstructive Sleep Apnea and Related Sleep Pathology.”

The researchers conclude tongue-scalloping should prompt physicians to enquire about snoring history.


What is the significance of not recognising this red flag of breathing problems?

Obstructive breathing is linked to chronic stress, inflammation, and sleep disruption. It is linked to increased risk of virtually every chronic health disease and reduced quality of life.

Many patients with these hidden airway problems are medicated for its symptoms.

This patient has spent her life revolving in and out of the GP’s office.  She was on at least six medications, each with their own side effects, including immune suppression and dry mouth. This compounds the reduced quality of life.

Sleep is terrible.  She has been prescribed a pill to aid sleep, but underlying breathing disturbances have not been investigated thoroughly.

There has been chronic use of medication for reflux, anxiety, and depression.


What is the better path moving forward?

Healthcare must move from medication to placing more emphasis on healthy breathing and sleep as key pillars for good health and prevention of disease.

Our best opportunity to establish airway health is in childhood. This means promoting nasal breathing, and healthy mouth function and structural development early.

In this case, there is a tongue-tie, and the palate is underdeveloped resulting in constricted tongue-space.

There were so many warning signs that oral function and structural development were off track in early in life, starting with a history of breastfeeding difficulties. We just need to promote greater awareness of what to look for.

Teeth grinding related dental wear is a strong predictor a child has disturbed breathing during sleep. If a child is grinding their teeth during sleep, a screening for sleep and airway problems is worthwhile.

The other type of dental wear commonly seen in children is erosion, or acid wear – magnified in the image.

This is typically seen in children who have ground and wore away their tooth enamel, exposing the yellow and softer dentine underneath.

Tooth enamel is harder than bone and the acid wears away the exposed dentine at a faster rate, giving it a scooped-out appearance.

Unless a child is sucking excessively on lemons, or having excessive coke or energy drinks, the most likely source of acid is reflux disease.

In airway reflux, a child who is breathing in more effortfully when they have airway restriction is going to have increased vacuum pressures in their thorax (region below the neck and above the stomach). Think of how a straw gets pinched if we suck too hard. This can allow stomach acids to be aerolised back into the throat and mouth. This can contribute to inflammation and swelling of the adenoids and tonsils.

Children with airway reflux (also called laryngopharyngeal reflux) may present with:

• Throat clearing
• Chronic cough
• Mild hoarseness
• Postnasal drip
• Reports of “Spew burps”
• Bad taste in the mouth or bad breath

Children may be misdiagnosed with asthma.

The constant acid exposure in the mouth can accelerate teeth-grinding related tooth wear and contribute to very obvious loss of tooth structure.

It can increase a child’s risk of dental decay. As much as we look at diet, and dental hygiene, mouth breathing and airway-reflux should not be overlooked as a risk factor. It is my observation that children who have had a lot of decay and fillings in the past often have a lot of these erosional wear facets.

It’s another example of the need for us to pay more attention to obstructive breathing as a root cause of common childhood problems.

Share This

Select your desired option below to share a direct link to this page.
Your friends or family will thank you later.