A Staged Guide for Children, Teenagers and Parents

Our aim is to support your child with:

✅ Better nasal breathing

✅ Improved lip seal

✅ Better tongue posture

✅ Healthier chewing and swallowing patterns

✅ Healthy jaw and facial development

✅ Improved bite and dental alignment

✅ Stable long-term orthodontic results

Stage 1: Simple conservative management 🌿

Usually suitable for younger children, especially age 6–10.

Stage 1 is about simple awareness and daily habit-building. It is gentle, safe and easy to start.

This stage is useful when:

• Your child has mild mouth-open posture
• There is no significant snoring or obvious sleep-apnoea symptom
• The nose is usually clear
• The main issue appears to be habit and awareness

Simple daily exercises may include:

• Quiet nasal breathing practice 🌬️ — your child sits upright, closes the lips gently and breathes quietly through the nose for 1 minute. This can be done three times daily and gradually increased if comfortable.
• Lip seal awareness 👄 — your child gently closes the lips without clenching the teeth.
• Tongue resting posture 👅 — the tongue rests gently on the palate, just behind the upper front teeth, without pushing against the teeth.
• Water drinking 💧 — encourage water instead of frequent sugary drinks. A suitable water bottle or straw bottle can help lip seal, suction and controlled swallowing.

🥕 Diet and chewing changes at Stage 1

As part of improving nasal breathing and oral muscle function, we also encourage your child to move gradually towards a more fibrous and slightly firmer diet where appropriate.

This may include:

• Chewing on both sides rather than only one side
• Eating slowly and chewing properly before swallowing
• Including safe, age-appropriate firmer foods such as cheese cubes, apple slices, carrot sticks, crusty bread, salad, cucumber and fibrous vegetables
• Reducing over-reliance on very soft foods where possible
• Encouraging closed-mouth chewing where comfortable and safe

These small changes can help improve chewing strength, oral awareness, lip seal and tongue function over time.

Important: Stage 1 should not involve forcing the mouth closed. If your child cannot breathe comfortably through the nose, they need further assessment.

Stage 2: Myofunctional support and habit training 💪

Usually suitable for children and younger teenagers once nasal breathing is possible.

Stage 2 is more structured. It is useful when your child needs additional support to improve lip seal, tongue posture, swallowing pattern and nasal breathing awareness.

Stage 2 may include:

• Face Former
• MyoMunchee-type appliance in younger children, usually age 6–13
• Nasal vents / nasal dilators
• Water-bottle suction training
• Lip seal exercises and tongue-to-palate exercises
• Daytime mouth tape as a reminder only
• Myofunctional therapy referral where needed

🧠 Neuromuscular training, myofunctional therapy and speech therapy

For all age groups, nasal breathing is not only about closing the lips or opening the nose. It also involves retraining the muscles of the lips, tongue, cheeks and throat so that your child can develop a more stable oral resting posture.

Where appropriate, we may recommend support from a myofunctional therapist or speech and language therapist. This can help with tongue positioning, tongue-to-palate posture, lip seal, swallowing pattern, speech-related tongue function and reducing tongue-thrust habits.

This neuromuscular training is useful across all ages, from younger children to teenagers, especially where there is low tongue posture, mouth-open posture, tongue thrust, poor lip seal, speech concerns, relapse risk or difficulty maintaining nasal breathing habits.

👄 Face Former

Face Former should be regarded as an important myofunctional support tool. It may help with lip seal, tongue posture, swallowing pattern, perioral muscle tone, nasal breathing awareness, habit retraining and stability after orthodontic correction.

Face Former may be useful in suitable younger children, teenagers and even older teenagers, provided it is used correctly and under appropriate guidance. It is not a replacement for orthodontic treatment or ENT assessment where these are required, but it can be a very useful adjunct to improve muscle function and oral posture.

🦷 MyoMunchee-type appliance

MyoMunchee or similar chewing trainers are mainly considered for the younger age group, usually around 6–13 years of age, depending on your child’s maturity, dentition, cooperation and clinical suitability.

For older teenagers, MyoMunchee is not usually the main tool we would rely on. In that age group, we are more likely to consider Face Former, structured myofunctional therapy, orthodontic appliances, aligners, fixed appliances, functional appliances or expansion depending on the diagnosis.

🌬️ Nasal vents / nasal dilators

Nasal vents, also known as internal nasal dilators, can be a very useful conservative support tool for children and teenagers who are trying to move from mouth breathing towards nasal breathing.

They are small, soft devices, usually made from silicone, which sit gently inside the nostrils. Their purpose is to help open the nasal entrance and reduce resistance to airflow. Unlike nasal sprays, they do not contain medication. They work mechanically by helping the nostrils remain more open.

There are different types available:

• Soft silicone nasal vents
• Mesh or open-frame nasal dilators
• Non-mesh or tubular nasal dilators
• External nasal strips

Nasal dilators may help your child feel that nasal airflow is easier. This can be particularly useful during daytime practice when we are trying to encourage lips together, tongue on the palate, quiet nasal breathing, reduced mouth-open posture and better awareness of nasal airflow.

How to use nasal vents safely:

1. Choose the smallest comfortable size. It should feel supportive, not tight.
2. Use during the day first, starting with 5–10 minutes while sitting calmly.
3. Insert gently. The vents should sit just inside the nostrils and should not be forced deeply into the nose.
4. Practise quiet nasal breathing with lips gently closed.
5. Clean after use with warm soapy water, rinse well and allow to dry before storage.
6. Stop using them if there is pain, soreness, nosebleeds, irritation or anxiety.

Nasal vents are a support tool. They do not treat enlarged adenoids, enlarged tonsils, significant nasal obstruction or sleep apnoea. If your child has persistent nasal blockage, regular snoring, pauses in breathing, gasping at night or disturbed sleep, GP or ENT assessment is important.

⚠️ Daytime mouth taping

A small piece of gentle tape may sometimes be used during the day as a reminder to keep the lips together. This should only be used if your child can breathe comfortably through the nose.

It should not be used if there is blocked nose, snoring, gasping at night, pauses in breathing, enlarged tonsils/adenoids, anxiety about the tape, asthma flare-up or suspected sleep-disordered breathing.

Night-time mouth taping in children should be approached with great caution and is not our first-line recommendation. It should not be used to force nasal breathing where the airway has not been assessed.

Stage 3: Orthodontic, myofunctional and tongue-mobility assessment 🦷

Usually age 6–12 or early teens, depending on development.

Stage 3 is considered when there is an orthodontic, skeletal or functional diagnosis contributing to your child’s mouth-breathing pattern or poor oral posture.

Examples include:

• Narrow upper jaw, high palate or posterior crossbite
• Increased overjet
• Class II jaw pattern
• Class II Division 1 malocclusion
• Class II Division 2 malocclusion with deep bite
• Open bite tendency, poor lip competence, crowding, low tongue posture or tongue thrust
• Tongue tie / lower lingual frenum restriction where tongue mobility is genuinely limited

👅 Tongue tie / lower lingual frenum release where required

In some children and teenagers, the lower tongue frenum may be short, tight or restrictive. This is commonly referred to as tongue tie. If the tongue is held down and cannot move well, it may contribute to low tongue posture, difficulty placing the tongue on the palate, altered swallowing, speech concerns, poor oral rest posture or difficulty progressing with myofunctional exercises.

Tongue-tie release is not required in every case. It should only be considered where there is a clear functional restriction and where the diagnosis supports it. Assessment may involve the orthodontist, dentist, speech and language therapist, myofunctional therapist, ENT specialist or oral surgeon.

Where a tongue-tie release is clinically indicated, it is usually most effective when combined with appropriate pre- and post-release exercises, myofunctional therapy and orthodontic planning. The aim is to improve tongue mobility and help the tongue learn a better resting posture on the palate, rather than simply performing the release in isolation.

Expansion options in Stage 3 🦷

• Rapid Maxillary Expansion, or RME: often useful in younger growing patients with narrow upper jaw, posterior crossbite, constricted arch form, high palate or transverse discrepancy.
• Invisalign Palatal Expander: may be considered in selected younger patients where removable digital palatal expansion is suitable. This is different from Invisalign First.
• Aligner-based arch development: in selected cases, Angel, Spark or Invisalign First may be used for dental arch development, mild expansion and alignment.

😊 Clear aligner options in children

In younger children and early teenagers, clear aligners can sometimes be used for early orthodontic treatment. However, not all aligner systems are the same.

In our practice, where function, growth guidance, bite correction, lip seal and mouth-breathing patterns are relevant, we often consider Angel Aligners or Spark Aligners before Invisalign First.

Invisalign First remains useful in selected cases, particularly when the problem is mainly dental rather than functional.

Class II correction and functional appliances 🦷

Some children and teenagers with mouth breathing also have a Class II pattern, where the lower jaw is relatively behind the upper jaw. This may be associated with increased overjet, poor lip seal, lip trap, mouth-open posture, lower jaw retrusion, deep bite, Class II Division 1 or Class II Division 2 pattern.

The appliance choice depends heavily on age, growth, severity, overjet, overbite and diagnosis.

Removable functional appliances

TwinBlock is a removable functional appliance used in growing patients to posture the lower jaw forwards. It can be very effective in the right age group, especially where there is good growth remaining and good compliance.

Dynamax is another removable functional option for selected Class II cases. It can be useful where mandibular advancement and bite correction are needed.

Fixed functional Class II appliances, including AdvanSync

In older children and teenagers, particularly where compliance with removable appliances may be less predictable, a fixed functional Class II appliance may be more suitable.

Options may include AdvanSync, PowerScope-type Class II corrector, Forsus-type Class II corrector, Herbst-type appliance or other fixed Class II appliances.

These are attached to the braces and do not rely as heavily on the patient remembering to wear a removable appliance.

AdvanSync can be particularly useful in the 13–15-year-old age group, where there may still be useful growth remaining and where continuous Class II correction is desirable.

AdvanSync or a similar fixed functional Class II appliance can be helpful in suitable cases with:

• Increased overjet
• Poor lip seal
• Lower jaw retrusion
• Class II Division 1 pattern
• Selected Class II Division 2 cases once the deep bite and upper incisor position have been managed
• Reduced compliance with removable functional appliances

Class II correction with aligners

• Angel A6 mandibular advancement: useful where we want to combine alignment, mandibular advancement, bite opening and functional correction. Angel allows block-style mechanics and staged mandibular advancement within the aligner system in selected cases.
• Spark BiteSync: useful where Class II correction, mandibular advancement, Class II elastics and upper molar distalisation mechanics may be required. The Occlusion Guide and SideBar can be used together or separately depending on the diagnosis.
• Invisalign mandibular advancement: uses precision wings or block-style mandibular advancement features, depending on the case and system available, to guide the lower jaw forwards.

Stage 4: Older teenager and late teen pathway 🚀

Usually age 12–19, depending on growth and skeletal maturity.

In older teenagers, the pattern may be more established. The patient may have less growth remaining, and treatment planning becomes more comprehensive.

Stage 4 may include:

• Myofunctional therapy and speech therapy where appropriate
• Face Former where appropriate
• Tongue-tie release where clearly indicated and appropriately referred/planned
• Fixed braces or clear aligners
• Class II elastics
• Fixed functional Class II appliances, including AdvanSync
• MARPE / MSE / MASPE
• SARPE in selected mature cases
• GP, ENT or sleep referral where required

For this older age group, MyoMunchee-type appliances are not usually our primary recommendation. They are mainly considered for younger children, usually around 6–13 years of age. In older teenagers, we usually place greater emphasis on Face Former, structured myofunctional therapy, orthodontic mechanics, aligners, braces, functional appliances and expansion where indicated.

Expansion in older teenagers

• RME: may still be possible in some younger teenagers, depending on skeletal maturity.
• MARPE / MSE / MASPE: in older teenagers and young adults, mini-screw assisted palatal expansion may be more suitable where skeletal expansion is required.
• SARPE: surgically assisted rapid palatal expansion may be considered in skeletally mature patients where non-surgical expansion is unlikely to be sufficient.

Important safety message: If your child has significant snoring, disturbed sleep or suspected sleep apnoea, we would not recommend simply taping the mouth closed. The airway should be assessed properly.

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This information is intended as general guidance and does not replace an individual clinical assessment. Treatment recommendations depend on diagnosis, growth stage, airway history and clinical findings.