When oral development tells a child’s bigger story

National Children’s Dental Health Month (NCDHM) is our opportunity to broaden how we see pediatric oral health. When you’re assessing hygiene in pediatric patients, you’re also collecting valuable information about how their oral structures are developing.

Those oral structures can impact teeth and oral hygiene, but it can also play a role in breathing, sleep quality, and overall quality of life. That is when the “why” behind what we see starts to matter more. For example, are you seeing early childhood caries? If so, why? Is a restrictive lip-tie trapping food and making it difficult for a toothbrush to reach certain areas? Is that same restriction preventing proper lip-closure and contributing to mouth breathing? We know mouth breathing affects oral health, but it can also impact jaw development and the airway. When the mouth stays open, the tongue can rest low in the mouth, limiting its natural support of palatal development. Over time, this can contribute to a narrow, high-arched palate, a pattern often seen in children with airway restriction.¹

Additional reading: Tough but necessary: Preventive care for young patients

The American Dental Hygienists’ Association (ADHA) “supports the role of dental hygienists in screening patients of all ages for airway health as an integral part of comprehensive patient care, recognizing its importance in oral health and function, craniofacial growth and development, disease prevention, early detection of upper airway resistance syndrome, obstructive sleep apnea, and mouth breathing.”² As children grow and develop, airway screening should evolve with them, and while this is not a comprehensive list, these age-based observations can offer a practical framework to begin.

Infants and toddlers

During these early years, dental hygienists can screen for:

• Lip-tie and tongue-tie that may affect feeding, tongue mobility, and oral posture
• Open mouth posture or mouth breathing
• Prolonged nonnutritive sucking habits such as pacifier, thumb sucking, or finger sucking, which may affect palatal development

Oral function, tongue posture, and feeding patterns can influence palatal development and airway space, reinforcing the value of early screening and referral when concerns are identified. Caregiver education during these years can include guidance on discontinuing nonnutritive sucking habits. The American Academy of Pediatric Dentistry (AAPD) recommends discontinuing nonnutritive sucking habits by 36 months of age. Pacifier use beyond 18 months can impact developing orofacial complexes.³ This is also an ideal time to encourage textures and food that support chewing and oral-motor development.

Young children

When children transition into preschool and early school-age years, hygienists can screen for:

• Palatal width and arch form: a high or narrow palate can indicate underdevelopment
• Crowding or developing malocclusion, such as crossbites
• Persistent mouth breathing or open mouth posture
• Bruxism or abnormal wear patterns
• Enlarged tonsils
• Scalloped tongue

This is a time when oral development and sleep habits can show up in more noticeable ways. Chronic breathing and altered tongue posture can limit natural palatal expansion and contribute to airway resistance during sleep.¹ Caregiver education should include sleep-related symptoms such as loud or habitual snoring, restless sleep, behavioral concerns, such as hyperactivity or difficulty focusing or continual bedwetting after an appropriate potty training age.⁴ These observations combined with clinical findings can help catch concerns early and determine the appropriate referrals.

Additional reading: 3 effortless behavior guidance strategies for pediatric dental patients

Older children and adolescents

In older children and adolescents, hygienists can look for:

• Reported poor sleep quality
• Daytime fatigue, headaches, or difficulty concentrating
• Facial growth patterns that can impact airway restriction
• Failed dental work, wear facets, or erosion

By this age, children may be compensating for inadequate sleep, so in addition to what we observe in their mouths, signs can also show up behaviorally or academically. Observing patterns such as fatigue, trouble focusing, or mood changes alongside oral and facial findings gives hygienists insight into how oral development and airway function may be affecting overall sleep and daily functioning.¹

What hygienists can do at any age

Start by implementing sleep and breathing questions to identify patients at risk. Here are some questions the AAPD suggests to include⁴:

• Does your child snore loudly when sleeping?
• Does your child have trouble breathing while sleeping?
• Does your child stop breathing during sleep?
• Does your child occasionally wet the bed at night?
• Is it hard for your child to wake up in the morning?
• Does your child complain of headaches in the morning?
• Does your child tend to breathe through his/her mouth during the day?
• Have you or the teacher commented that your child appears sleepy during the day?
• Does your child fall asleep quickly?

Continue to observe and document oral and facial findings and take time to educate families on how oral development, airway health, and sleep are connected. While the signs and symptoms listed here are not all-inclusive, they still highlight the important role we play in prevention. NCDHM reminds us that caring for a child’s mouth goes beyond teeth, and it’s about supporting healthy growth, breathing, sleep, and daily functioning.⁵

References

1. Heit T, Tablizo BJ, Salud M, et al. Craniofacial sleep medicine: the important role of dental providers in detecting and treating sleep disordered breathing in children. Children (Basel). 2022;9(7):1057. doi:10.3390/children9071057
2. ADHA board approves interim policies on scaling procedures and airway health screening. American Dental Hygienists’ Association. News release. October 18, 2024. Accessed January 9, 2026. https://www.adha.org/newsroom/interim-policies-approved-october2024/
3. Policy on pacifiers. American Academy of Pediatric Dentistry. 2025:86-89. https://www.aapd.org/globalassets/media/policies_guidelines/p_pacifiers.pdf
4. Policy on obstructive sleep apnea (OSA). American Academy of Pediatric Dentistry. 2025:145-148. https://www.aapd.org/globalassets/media/policies_guidelines/p_sleepapnea.pdf
5. Patel AK, Reddy V, Shumway KR, Araujo JF. Physiology, Sleep Stages. In: StatPearls [Internet]. StatPearls Publishing; 2025. https://www.ncbi.nlm.nih.gov/books/NBK526132/