pdf of this article

For more information dentistry, contact:


1150 NW Maynard Road, #140
Cary, NC 27613
Telephone: (919) 323-4242

Maintaining Health: Take a Deep Breath (Through Your Nose!)

Dr. Charles Ferzli’s dental practice—The TMJ and Sleep Therapy Centre in Cary—specializes in highly complex cases. But he often finds that restoring someone to health requires going back to the basics. “You can go two weeks without eating, two days without drinking, but you cannot be two minutes without breathing,” he notes. “Breath is the essence of life.

Dr. Ferzli explains that certain jaw configurations are among the things that can constrict the airways and prevent healthy breathing.

“Moreover, I’ve learned that how you breathe is fundamental to protecting and maintaining your health. And the right way to breathe—the way that ensures that you’re getting the oxygen you need—is through your nose.

“Incorrect breathing creates a ripple effect of compensations and negative impacts in the body. Things tighten up because you’re not getting enough oxygen to the cells,” he explains. “So, breathing through the nose is number one.”

The Problem of Mouth Breathing

When asked how many of his sleep and facial pain patients have breathing issues, Dr. Ferzli responds with a smile: “All of them. The issues that underlie their problems are numerous and complex, and improper breathing is both cause and effect. Nasal congestion as the result of an allergy, for example, might be the initial cause of a mouth breathing habit, but the habit itself will produce other problems. Everything is connected.

“We’re designed to breathe through the nose,” notes Dr. Ferzli, “but there are many things that will cause a person to breathe through the mouth, and it can become a habit. Anatomical problems are one example, chronic nasal congestion is another.”

Other causes, he notes, may be less obvious. Diets high in sugar and processed foods create excessive inflammation in the body. And inflammation—whether from diet or illness or other environment factors—leads to nasal congestion, which frequently results in mouth breathing.

Simple Exercises for Better Breathing, Better Sleep

“Given the enormous impact of poor breathing on one’s health,” says Dr. Ferzli, “it’s wonderfully reassuring to learn that there are quite simple methods to overcome even a lifetime habit of poor breathing.

“Two techniques that I share with my patients are extremely effective. The first of these are the exercises developed by Dr. Konstatin Buteyko to train people to breathe in a healthy manner, so as to improve the oxygen usage in our bodies.

“The foundation of the Buteyko system—which uses seven simple exercises—is to breathe only through the nose both during day and sleep,” he explains. “Nasal breathing with tongue resting in the roof of the mouth helps to ensure that the airway is larger. It’s a remarkable system, and often delivers results rapidly.”

The second technique Dr. Ferzli recommends to help his patients with sleep issues is myofunctional therapy. “This is a program of specific exercises,” he explains, “that target the facial muscles used to chew and swallow, toning the airway muscles, and helping to get better quality sleep and less snoring. It may effectively manage symptoms of sleep apnea, poor digestion, headaches, TMJ, and periodontal disease.”

These techniques are remarkably effective, he says. “Further, they’re easy, non-invasive, and without risk. They just require practice!”

Whatever the cause, once the habit of mouth breathing is acquired, explains Dr. Ferzli, it is likely to result in many other problems. “To begin with, it is a systemic issue, since it may result in low oxygen concentration in the blood. This is associated with high blood pressure and heart failure. Studies show mouth breathing may also decrease lung function and worsen asthma.”

Dental issues—such as gum disease or tooth decay—are commonly associated with mouth breathing, notes Dr. Ferzli, “and it’s also a source of jaw issues. That’s because, since the tongue has to fall on the floor of the mouth to mouth breathe, the jaw may become crowded, decreasing air flow. Mouth breathing can also cause people to grind their teeth, a particular problem while they’re sleeping. Clenching and grinding, in turn, produce chronic jaw joint issues, headaches, or ear pain.

“The problem we see most often,” says Dr. Ferzli, “is sleep impairment. Getting less oxygen to the tissues can elevate the heart rate and even cause an adrenaline surge during the night, waking people up. Sleep interruptions in turn reduce the necessary restoration that takes place during healthy sleep.”

And the list goes on. “The digestive system also takes a hit from mouth breathing,” says Dr. Ferzli. “People have acid reflux more when they’re not sleeping well, and they also may chew faster to swallow if they aren’t used to breathing from the nose. Less chewing and more gulping hamper proper digestion and absorption of nutrients.”

Beyond these specific impacts, mouth breathing puts people in a chronic state of “fight or flight,” according to Dr. Ferzli. They don’t feel rested and have elevated cortisol levels.  The cortisol causes people to feel more pain during the day and reinforces the negative cycle by making it more difficult to fall asleep at night. “In short,” he says, “the lack of proper nasal breathing is the generator for all these problems.”

Correcting the Problem

In large part, Dr. Ferzli focuses on helping teach patients how to breathe better. “Learning how to breathe is an active thing!” he emphasizes. It’s also very customized to each individual’s specific needs.

He starts the process by assessing whether anatomical restrictions are preventing nose breathing. If so, he might send patients to an ENT physician or recommend the use of nasal decongestants or other tools as needed.
Once anatomical issues have been ruled out or addressed, Dr. Ferzli can introduce other techniques and exercises to help improve breathing, such as myofunctional therapy or Buteyko breathing (see box).

“The tongue and breathing are connected to jaw position and movement,” he explains, “both of which influence the type and quality of sleep. Unfortunately, no one teaches us where the tongue should be when we develop. But it matters. We’ve got to retrain the brain to breathe from the nose by keeping the tongue on the roof of the mouth,” explains Dr. Ferzli.
Oral devices are often used By Dr. Ferzli to help with TMJ and other jaw issues, many of them caused or exacerbated by mouth breathing. But he cautions that, while these devices can reduce symptoms such as clenching and grinding stemming from poor oxygenation, they can’t address the root cause of those issues, which is mouth breathing.

Dr. Ferzli also encourages people to make other healthy choices to support nasal breathing, whether by improving diet, addressing allergies or anatomical issues, or using good air filters to improve the quality of indoor air.

“All of these techniques help to calm down the nervous system, getting it out of ‘fight or flight’ mode,” he explains. “And doing that helps the whole body to function better.”

Persistence, Dr. Ferzli emphasizes, is the key to “unlearning” the habit of mouth breathing in order to break its chain of seemingly endless ill-effects. “The techniques themselves aren’t difficult; it just takes commitment.”