The development of a child’s face and jaw to genetic potential determines facial beauty and profile, lifetime TMJ health and a proper airway development as well as position and alignment of teeth. Normal growth promotes a broad smile with well-aligned teeth and little need for orthodontic treatment. We invite you to contact our office at (509) 965-7909 to schedule with our dentist in Yakima, Washington, and learn more about pediatric facial development and growth and what you can do to be certain that your child’s face is growing normally.

Bolton Analysis and Cosmetic Line

Ask about our complimentary Cosmetic Line Screening for pediatric patients or Bolton Analysis for adult and pediatric patients. Both of these tools screen for abnormal facial and jaw growth and development. The Cosmetic Line is a linear measurement from the edge of the front tooth to the tip of the nose.  An increase of 5 mm or more over the standard for a particular age indicates undesirable facial development.  The Bolton Analysis is a computer overlay that identifies changes in a patient’s profile that indicate facial aesthetic issues, small airway or potential TMJ problems due to the downward and back trajectory of face and jaw growth.


The “Big Three” influences on facial development:

  • Nasal breathing
  • Lip seal
  • Proper tongue position

When these three factors are not present during growth and development of the jaws, disharmonies and imbalances of the craniofacial structure can result in conditions known as midface deficiency and long-face syndrome because the jaws don’t develop to their true genetic potential.


The REAL causes of orthodontic problems (malocclusion and incorrect facial development):

  • Mouth breathing due to soft tissue dysfunction (enlarged tonsils, adenoids, allergies)
  • Incorrect tongue position
  • Poor oral positions (lips apart, tongue not resting on palate)
  • Adverse swallowing patterns
  • Thumb- and finger-sucking
  • Genetics — only 10 percent


Effects of Incorrect tongue position due to mouth breathing or poor oral position


The Damaging Effects of Mouth Breathing, Poor Oral Posture and Myofunctional Habits in Your Baby and Developing Child

It is critical to your child’s proper facial growth, airway development and jaw joint health that the child consistently and exclusively breathes through the nose and maintains proper oral posture (lips together at rest) and that all damaging myofunctional (oral and tongue) habits are eliminated.

Tongue position is largely responsible for the normal growth and development of the face and jaws. The tongue is a powerful muscle and should rest against the upper palate (roof of mouth) and cause the upper jaw to broaden and grow forward in a healthy and aesthetically appealing manner. When this does not happen, because of mouth breathing, open-mouth posture or tongue tie, the midface does not grow properly, and the lower face narrows and elongates. At Yakima Smiles, we screen for this abnormal facial growth by measuring the child’s “cosmetic line” and by analyzing the child’s sagittal photograph with the computerized Bolton Analysis.

Mouth breathing doesn’t look good, but more importantly, it leads to:

  • Facial feature defects including long-face syndrome and mid-face deficiency
  • Sleep disordered breathing
  • Attention Deficit Disorder
  • Reduction in oxygen absorption


Facial feature defects that are noted in the mouth-breathing child include:

  • High narrow palate/narrow maxillary arch
  • Mid-face deficiency
  • Flattened face
  • Elongated lower face
  • Narrow face
  • Recessed chin/jaw
  • Sunken cheeks
  • Small jaws without room for all the permanent teeth


Not only does mouth breathing and poor oral rest cause changes in facial growth, they also impact the child’s long-term health because the jaws, palate and airways develop abnormally and lead to:

  • Future TMJ issues
  • Current or future Obstructive Sleep Apnea
  • Headaches/shoulder & neck pain/poor posture
  • Dental crowding and malocclusion

The causes of mouth breathing include:

  • Enlarged tonsils and adenoids
  • Allergies
  • Frequents viral infections
  • Chronic open mouth posture
  • Myofunctional (tongue) habits
  • Ankyloglossia (tongue tie)
  • Pacifier use
  • Thumb-sucking


Signs that your child may be a mouth-breather:

  • Lips not together at rest
  • Snoring and restless sleep
  • Mouth open when sleeping
  • Grinding teeth
  • Constant stuffy nose
  • Large tonsils
  • Allergic shiners under eyes
  • Fatigue, attention deficit

It is so important for the child’s current and future health as well as for the aesthetic development of the child’s face that nasal patency and consistent nasal breathing are established and maintained. Yakima Smiles will provide complimentary screening with Bolton Analysis to evaluate the child’s facial growth and can refer the child to an ENT and/or allergist if indicated. The two main food allergens are dairy and gluten. Dr. encourages parents to be very proactive in monitoring this aspect of their child’s health and appearance and to insist on treatment and intervention when necessary to ensure proper face and jaw development and a lifetime free from jaw joint pain and obstructive sleep apnea. Dr. Pete Nathe of Yakima Smiles will do a free facial growth analysis if you would like.

If mouth breathing has already resulted in some detrimental growth patterns, these can be addressed by talking to Dr. about a growth appliance that redirects the growth of the jaws in the proper direction. Contact our office today at (509) 965-7909 for more information.

Tongue Position Is Key

The tongue is the major shaper of the palate and jaw and can perform its function when it is in the proper position. It is NEVER in the proper position when a child is mouth breathing or exhibiting open mouth posture during the day or while asleep.

Fact: The tongue can exert up to 500g (17.5oz) of force, making it one of the strongest muscles in the human body. And to move a single tooth, it only takes 1.7g (0.05oz) of force.

When you are not eating or speaking, there is an ideal spot in your mouth where your tongue should natural rest. This is because the tongue position determines the shape and size of the upper jaw. If your child habitually has a low tongue position (as in mouth breathing or tongue tie), the upper teeth will not have enough space, and the lower jaw will be forced back and down, affecting the way the face grows.

A normal top jaw grows properly because the tongue rests in the correct position (known as the Correct Tongue Resting Position), which is in the roof of your mouth. If your tongue does not rest in the roof of your mouth, the top jaw will become too narrow, and teeth won’t have enough room to grow straight.
For more information about correct tongue positioning and to schedule an appointment with Dr. Pete Nathe at Yakima Smiles, please contact our office at (509) 965-7909. We will be happy to provide you with additional information and help you schedule a consultation with our caring dentist to receive treatment.

Normal Growth

Abnormal Growth

The Myobrace®

Dr. Pete Nathe may recommend the Myobrace® habit trainer as a valuable tool to help develop proper tongue and lip position. With Myobrace, we can help you child grow and develop properly so that they avoid malocclusion and incorrect facial development. This may also help them avoid the need for extensive orthodontic care in the future. Call Yakima Smiles at (509) 965-7909 to make your appointment with our caring dentist and learn more about the Myobrace in Yakima, Washington.

Recent studies show that 75 percent of growing children have malocclusion and incorrect facial development. Soft tissue disfunction is the major cause. By age 3 to 5, crooked teeth and abnormal face and jaw development can already be noted. These changes are often blamed on genetics, but mouth breathing, incorrect tongue position and reverse swallow are the real causes of poor cranio-facial growth.

If a child breathes through his/her mouth at night, the tongue drops to the mouth and no longer holds and spreads the upper jaw into a healthy and aesthetically pleasing position. The restricted development limits the space for erupting teeth and prevents them from emerging into their ideal natural position.

The Myobrace habit trainer is a newly developed myofunctional orthodontic appliance that teaches children to breathe through their nose, put their tongue on the roof of their mouth in the resting position, keep their lips together and swallow correctly for optimal facial and jaw development AND early alignment of erupting teeth.

The Myobrace habit trainer is worn 1 to 2 hours per day and at night and is an excellent myofunctional trainer and also serves to identify children with an obstruction or other issue needing medical intervention to establish nasal breathing.


  • Myobrace and special exercises can be used to train a child to breathe through his or her nose and maintain proper tongue and lip position.
  • Myobrace may confirm an obstruction and a child’s INABILITY to nasal breathe and indicate the need for medical intervention to establish nasal patency.


For more information and to schedule a consultation, please contact our office today!

Interceptive and Corrective Orthodontics: Removable Anterior Growth Guidance Appliance

The Removable Anterior Growth Guidance Appliance “RAGGA” is an exciting new orthopedic technology that actually stimulates the production of new bone and models and shapes existing bone. It corrects the devastating effects of mouth breathing on the development of a child’s face, airway and jaw joints. Dr. Pete Nathe at Yakima Smiles may recommend an Anterior Growth Guidance Appliance to correct damaging effects and help your child’s face and jaws develop correctly. We invite you to contact our office at (509) 965-7909 to learn more about the growth appliance in Yakima, Washington, and schedule an appointment with our dentist.

In developing children, RAGGA will develop faces to their genetic potential by:

  • Widening the upper palate
  • Stimulating the upper jaw to grow forward
  • Creating space and allowing teeth to move to proper position
  • Decreasing the need for future orthodontics if facial development problems are caught early and interceptive treatment is initiated

Mouth breathing, open mouth posture and tongue positioning habits are known to have a very destructive influence on a child’s developing face. Without the scaffolding effect of the tongue resting on the palate, the maxilla deforms in three dimensions and changes the shape of the maxilla and lower half of the face, causing:

  • mid-face deficiency
  • elongated face
  • narrow face
  • larger appearing nose
  • thin lips
  • retracted lower jaw and chin
  • increased chance of Temporal Mandibular Disorder (TMD or TMJ)
  • increased chance of clenching or grinding teeth
  • increased chance of headaches
  • increased chance of shoulder and neck pain
  • increased chance of back problems
  • increased chance of Obstructive Sleep Apnea (OSA)

Achieving proper tongue posture and function by proactively addressing mouth breathing requires addressing nasal and pharyngeal patency first. Once, nasal breathing and proper oral posture have been re-established, it is possible to reverse the facial defects that have begun to develop in the small child with the help of the newly developed growth appliance. A dentist or other specialist can evaluate a child’s facial growth with a Cosmetic Line Score or with a Bolton Analysis. Yakima Smiles offers complimentary screening. If deficient growth tendency is discovered, growth guidance orthopedics can be used to correct the trajectory of growth, and this can have dramatic effects on the face, jaw and airway.

A comfortable custom oral appliance is fabricated for the child that stimulates the palate to produce more bone and growth in each dimension. The entire mid-face and upper jaw broaden and grow forward, allowing for a beautiful broad smile, a healthy airway, painless jaw joints and plenty of space for the teeth to evenly erupt. In some instances, a growth appliance can eliminate the need for future retraction orthodontics. A broad arch is critical for facial beauty, a healthy airway and the child’s overall well-being.

This 7-year-old patient is wearing a removable growth guidance appliance, and you can see the robust changes to the growing lower jaw (mandible) in just one month!  The jaw is being stimulated to grow and remodel to create coupling of the teeth. In just one month, you can see all the back teeth are now touching the appliance and anterior teeth are quickly moving into proper position as the temporal mandibular joint decompresses. This is remarkable physical evidence that we can sculpt and stimulate the entire lower jaw to change its shape, size and position. We are correcting the trajectory of growth from an unwanted vertical down and back path and converting it to a forward and up trajectory, which is in the direction for the best airway, posture and aesthetics of the face. This remarkable, simple and elegant appliance has multiple profound orthopedic effects on both jaws as well as a myofunctional effect that amplifies the desirable orthopedic change.


Breathing Disorders In Children

Have you noticed that your child has difficulty breathing while asleep? In children, facial shape development may be adversely affected by mouth breathing at night. Sleep breathing disorders can also impact your child’s overall health and is linked to hyperactivity. A recently published article states that children with snoring, apnea or mouth breathing are 40 to 100 percent more likely to suffer from Attention Deficit Hyperactivity Disorder (ADHD). Dr. Pete Nathe of Yakima Smiles can help! Contact our office at (509) 965-7909 to learn more about pediatric sleep disordered breathing in Yakima, Washington, and make your child’s appointment with our dentist.

Poor growth due to mouth breathing

If a child is a mouth-breather, his or her tongue won’t rest on the roof of the mouth, which often results in an underdeveloped upper jaw and restricted forward growth of the lower jaw. Along with the concern of crowding, incorrect development of the upper jaw can affect a child’s breathing by restricting the airway. Obstructive sleep apnea (OSA) in children is associated with narrow faces and small jaws. There is simply not enough room for the tongue, and during sleep, it obstructs the airway. It’s like parking a semi-truck in a garage built for a compact car.

Early evaluation for the signs of poor jaw development is increasingly becoming a treatment option more dentists, orthodontists and medical practitioners are implementing. As well as affecting jaw and facial development, the medical profession now recognizes that mouth breathing is abnormal and is also one of the main contributors of Sleep Disordered Breathing (SDB) problems.

Symptoms commonly associated with Sleep Disordered Breathing (SDB) can include:


  • Snoring, gasping, open-mouth posture at night
  • Morning tiredness and daytime fatigue
  • Developmental and behavioral problems
  • Interrupted sleep
  • Hyperactivity
  • Withdrawal
  • Executive dysfunction
  • Depression
  • Learning difficulties
  • Social issues
  • Bed wetting

Yakima Smiles is proactive in addressing these pediatric health issues that may impact your child for years to come. Ask us how we can help!


Way to Go Dr. Nathe!

Congratulations to Dr. Pete Nathe on his successful and informative presentation to the students and medical faculty at Pacific Northwest University School of Medicine! Dr. Nathe addressed the adverse effects of mouth-breathing on facial development in children and the long-term health effects including TMD and sleep apnea problems. He also explained newer technology to correct adverse facial growth, including the anterior growth guidance appliance and facial development orthodontics, and presented several case studies. We are grateful to have such an experienced and knowledgeable doctor helping out patients!