Do tonsils have any effect on tooth integrity?

Enlarged tonsils can negatively affect dental integrity by disrupting nasal breathing, altering tongue posture, and contributing to malocclusion and poor oral hygiene.

These effects are powerful, especially during the critical growth years of craniofacial development. Treatment such as tonsillectomy or myofunctional therapy is often considered when these changes begin to affect dental or airway health.

The connection between tonsils and dental integrity is a fascinating example of how oral structures interact with one another. Enlarged tonsils can have significant downstream effects on dental and craniofacial development, ultimately influencing tooth position, occlusion, and oral health.

Here’s a scientifically grounded explanation of this relationship:

1. Mouth Breathing Due to Airway Obstruction

Hypertrophic tonsils and adenoids can obstruct the upper airway, especially in children, leading to chronic mouth breathing.

• Consequences of mouth breathing:
  • Altered tongue posture (low and forward instead of resting on the palate)
  • Decreased lip seal and open-mouth resting posture
  • Changes in swallowing mechanics
• These factors influence dental and skeletal development.

Scientific evidence:
Souki et al., 2009 (Angle Orthod) found that children with obstructive hypertrophic adenoids and tonsils had higher rates of Class II malocclusion and open bites.

Subtelny, 1954 (Am J Orthod) documented correlations between mouth breathing and narrowed maxillary arches and retrognathic jaws.

2. Impact on Tongue Posture and Orofacial Muscle Function

Obstructed nasal breathing due to enlarged tonsils leads to a lowered tongue posture, which reduces the natural expansive pressure of the tongue on the maxilla.

• Resulting issues:
  • Narrowing of the palatal arch
  • Increased likelihood of posterior crossbite, crowding, and malocclusion

Scientific evidence:
Harari et al., 2010 (Am J Orthod Dentofacial Orthop) showed that children with enlarged tonsils/adenoids often present with narrow upper jaws and malocclusions due to altered oral posture.

Brooks et al., 1998 (Pediatrics) indicated improvements in dentofacial development after adenotonsillectomy in children with sleep-disordered breathing.

3. Influence on Craniofacial Growth

4. Indirect Effects on Oral Hygiene and Caries Risk

• Mouth breathing from tonsillar hypertrophy reduces salivary flow and dries the oral cavity, which:
  • Increases plaque accumulation
  • Raises risk for dental caries and gingivitis

Scientific evidence:
Faria et al., 2014 (Arch Oral Biol) found a higher incidence of caries and poor oral hygiene in mouth-breathing children.

Güngör et al., 2013 (J Clin Pediatr Dent) noted that enlarged tonsils may indirectly lead to increased bacterial colonization due to reduced self-cleansing from saliva.

In summary, enlarged tonsils can significantly impact dental integrity and craniofacial development, especially during childhood. They often lead to chronic mouth breathing by obstructing the airway, which disrupts normal tongue posture, lip seal, and swallowing patterns. These changes contribute to malocclusion, narrowed palates, and altered jaw growth, such as increased lower facial height and retrognathic mandibles.

Scientific studies have linked enlarged tonsils to dental issues like open bites, Class II malocclusions, and crossbites. Additionally, mouth breathing caused by tonsillar hypertrophy can reduce salivary flow, increasing the risk of plaque buildup, dental caries, and gingivitis.

Treatments such as tonsillectomy and myofunctional therapy may help restore proper orofacial function and support healthier dental and airway development.