Enlarged tonsils and adenoids frequently cause serious health problems for children, but simply removing the tonsils and adenoids doesn’t always correct the source of the problems. When narrow palates and restricted airways are also involved, specialized dentistry can help with palate and airway expansion, and establishment of nasal breathing. In this interview, Dr. Gio Iuculano, DDS discusses the role of dentistry in resolving these issues.

What kinds of health issues do enlarged tonsils and adenoids cause, and how do these issues relate to dentistry?

Enlarged tonsils and adenoids are frequently associated with snoring and sore throats. They can be a causative factor in ADD/ADHD in children. Children with enlarged tonsils and adenoids frequently develop sleep breathing disorders because they receive insufficient oxygen to their brains and organs while they sleep. In adults these breathing disorders cause daytime sleepiness and fatigue; in children they cause hyperactivity. In an adult, the brain doesn’t rest at night so it tries to sleep during the day, whereas an unrested brain and body in children revs them up to keep them going all day. When children have their enlarged tonsils and adenoids removed, we frequently see enormous changes in their well-being within a few months. They may develop better appetites and better focus in school, and experience growth spurts. However, enlarged tonsils and adenoids are not always the actual source of these problems, but a symptom. For children to experience long-lasting health benefits, it’s important to address the problems at their source.

Why do tonsils and adenoids become enlarged?

The nose filters air that it takes in, but the mouth does not. When children breathe through their mouths as they sleep, their tonsils and adenoids attempt to filter the air that goes down the throat. This constant stream of unfiltered air causes the tonsils and adenoids to become enlarged. So in many cases, mouth breathing is the real culprit.

Additionally, the latest research shows a link between gut bacteria and the tonsils and adenoids. Improving gut bacteria allows the bacteria in the sinus areas and throat areas to improve as well. By making recommendations for some patients to adjust their diets and eliminate substances that aggravate their gut flora, we will often see the tonsils and adenoids shrink in size and return to normal. When this is the situation, I always encourage patients to try this before considering surgery.

Are these issues more common in children, adults, or both?

Typically, we see tonsil and adenoid issues more in children because with them, we’re seeing the beginning of the process. After 20 or more years of mouth breathing, one’s body adapts to the mouth breathing and compensates a different way. In an adult, this increases the likelihood of chronic diseases. A book we recommend on this topic is The Oxygen Advantage by Patrick McKeown.

Do dental issues cause problems with tonsils and adenoids, or is it the other way around?

In some cases, issues with tonsils and adenoids cause a child to mouth-breathe, which increases the likelihood of narrowing jaws, which in turn results in crowded teeth and increases the likelihood of the child needing orthodontics. When a child is regularly nasal breathing from a very early age, there is less likelihood that he or she will need orthodontics. But if a patient continues mouth breathing after the removal of his or her tonsils and adenoids, it may be because of a narrow palate and a restricted airway.

Many specialists would recommend that patients with enlarged tonsils and adenoids have them removed surgically. Can specialized dental treatment help these patients avoid this?

Many times when we treat these patients with functional orthodontics and expand their palates, advance their jaws forward, and reestablish their nasal breathing, within six to twelve months we can see an improvement in the size of their tonsils and adenoids. At this point, there may no longer be a need for surgery.

Do you begin dental treatment right away in cases of tonsil and adenoid issues?

If a child’s airway is severely restricted, it restricts his or her growth and development. In extreme cases, we begin by recommending that these patients visit and otolaryngologist (ENT specialist) for an evaluation. Depending on what the ENT specialist tells us, we may then continue with dental treatment. If the problem is not so severe, we may try functional orthodontics for six months and then reevaluate to see if we need to consult an ENT. We always keep in mind that we want help children maximize their oxygen intake. Airways are critical to children during their formative years, during which so much cognitive development occurs. We want to help our youngest patients reach their fullest potential.

Once a patient has completed dental treatment for tonsil and adenoid issues, what is the chance that the issues will recur? What can patients do to help avoid recurrence?

What we sometimes find is that children who snore have their tonsils and adenoids removed, but six months later they are snoring again because the source of the problem was never addressed. We always try to correct the source of the enlargement, whether it is bad gut bacteria or mouth breathing. Correcting the problem at its source greatly diminishes the possibility of recurrence. And of course, we recommend that patients diligently maintain any new regimen we help them to establish.