--- title: "Allergic Rhinitis and Orthodontics UK | Breathing and Bite" url: https://virtualconsultant.online/guides/allergic-rhinitis-orthodontics-uk description: "Hay fever and perennial rhinitis cause mouth breathing that changes jaw development in children. UK 2026 guide covers adenoid face, palate expansion." updated: 2026-08-17T00:00:00Z publisher: Virtual Consultant Online --- Allergic Rhinitis Mouth Breathing Facial Development # Allergic Rhinitis and Orthodontic Treatment Allergic rhinitis affects one in five people in the UK and is the most common chronic condition in children. When nasal congestion forces habitual mouth breathing during childhood, it can alter jaw development and increase orthodontic complexity. This guide covers the key clinical links, palate expansion as a dual intervention, antihistamine effects on oral health and the ENT referral pathway. [Start Photo Assessment](https://virtualconsultant.online/evaluations/quote) [Compare Costs](https://virtualconsultant.online/costs) ## How allergic rhinitis causes mouth breathing Allergic rhinitis causes inflammation and oedema of the nasal mucosa, leading to varying degrees of nasal obstruction. When nasal breathing is obstructed, whether continuously or during sleep and exercise, the body switches to mouth breathing as an alternative airway. While occasional mouth breathing during an acute allergic episode is harmless, habitual mouth breathing — particularly during the years of active jaw and facial development in childhood — alters the pattern of muscular forces acting on the developing jaws and teeth. The tongue, which normally rests against the palate during nasal breathing and acts as an internal scaffolding for palatal width, drops to a lower resting position during mouth breathing, reducing its stimulatory effect on palatal development. ## Effects on jaw and facial development: the adenoid face pattern Chronic mouth breathing during childhood and adolescence is associated with a recognised pattern of dentofacial changes often described as the adenoid face or long face syndrome. Characteristic features include a high, narrow palate (high arched palate), increased anterior face height (long lower third of the face), anterior open bite (front teeth not meeting), retrognathia (recessed lower jaw), and an increased overjet. The upper dental arch becomes narrow and crowded. These changes occur because nasal breathing, with the lips sealed and the tongue resting on the palate, provides an internal widening force on the developing maxilla; without it, the palate develops more narrowly. Mouth breathing also alters the position and function of the circumoral muscles, affecting the labial pressure on upper incisors. ## Palate expansion and nasal airflow Rapid palatal expansion (RPE) or slow palatal expansion using a palatal expander appliance widens the maxillary arch by opening the midpalatal suture. Because the nasal floor forms the roof of the mouth, maxillary expansion simultaneously widens the nasal floor and increases nasal cross-sectional area. Studies using acoustic rhinometry and peak nasal inspiratory flow have shown objectively measurable improvements in nasal airway volume following palatal expansion in children. For patients with allergic rhinitis and a high narrow palate, palatal expansion can therefore address both the dental problem — narrow arch, crowding, crossbite — and contribute to improved nasal breathing. This makes early palatal expansion, before the midpalatal suture fuses in mid to late adolescence, a particularly valuable intervention in children with allergic rhinitis. ## The orthodontic-ENT referral pathway for children Children with suspected mouth breathing, adenoid face features, or habitual open mouth posture should ideally be assessed by both an orthodontist and an ear, nose, and throat (ENT) surgeon. ENT assessment can identify enlarged adenoids or tonsils contributing to nasal obstruction, as well as intrinsic nasal problems such as septal deviation or turbinate hypertrophy. Adenotonsillectomy — surgical removal of enlarged adenoids and tonsils — can significantly improve nasal airway patency and, when performed before extensive facial growth changes have occurred, may reduce the severity of resulting orthodontic problems. The orthodontist and ENT surgeon should communicate about timing: orthodontic expansion is more effective when the nasal airway obstruction has been addressed simultaneously or beforehand. NHS referral to ENT via the GP is the standard pathway; orthodontic referral is available under NHS for eligible children. ## Antihistamines and steroid nasal sprays: oral health effects Antihistamines — both first-generation (e.g. chlorphenamine) and second-generation (e.g. cetirizine, loratadine) — reduce allergic symptoms but have significant xerostomic (dry mouth) effects, particularly first-generation antihistamines due to their anticholinergic activity. Dry mouth reduces the protective, buffering, and antimicrobial benefits of saliva, increasing the risk of dental caries, erosion, and gingival problems — all of which are heightened around orthodontic appliances. Intranasal corticosteroid sprays (e.g. fluticasone, mometasone) are the most effective treatment for perennial allergic rhinitis and have minimal systemic absorption; their direct effect on oral tissues is negligible. However, patients using steroid sprays should be instructed in correct technique to avoid spraying directly onto oral tissues. Saline nasal irrigation can be a useful adjunct that does not cause dry mouth. ## Managing allergic rhinitis during orthodontic treatment Before commencing orthodontic treatment, patients with allergic rhinitis should optimise their nasal symptom control. Second-generation antihistamines are preferred over first-generation to minimise dry mouth. Regular intranasal steroid spray use throughout the allergy season or year-round for perennial rhinitis reduces mucosal swelling and nasal obstruction. Staying hydrated and using sugar-free chewing gum to stimulate saliva flow can partially counteract antihistamine-induced dry mouth. Orthodontic appointments during high pollen periods may need to be timed sensitively; some patients find their nasal congestion makes lying back in the dental chair uncomfortable during periods of peak symptoms. Informing the orthodontic team of the diagnosis allows adjustments to appointment management. ## Useful related pages [Mouth Breathing and Orthodontics](https://virtualconsultant.online/guides/mouth-breathing-orthodontics-uk) [Palatal Expander UK](https://virtualconsultant.online/guides/palatal-expander-uk) [High Arch Palate Orthodontics](https://virtualconsultant.online/guides/high-arch-palate-orthodontics-uk) [Orthodontics and Sinuses](https://virtualconsultant.online/guides/orthodontics-palate-expansion-sinuses-uk) This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist. ### Compare next steps [Orthodontist Near Me](https://virtualconsultant.online/locations/orthodontic-treatment-near-me) [Clear Aligners Near Me](https://virtualconsultant.online/treatments/clear-aligners-near-me) [Invisalign Near Me](https://virtualconsultant.online/locations/invisalign-provider-near-me) [Browse Locations](https://virtualconsultant.online/locations) ### Ready for a clearer starting point? Upload guided photos and receive an indication of likely treatment options and pricing before booking appointments. [Get an Online Quote](https://virtualconsultant.online/evaluations/quote) ### Frequently Asked Questions Can allergic rhinitis affect my child's jaw development? Yes. Chronic nasal obstruction from allergic rhinitis encourages habitual mouth breathing, which alters the muscle forces acting on the developing jaws during growth. The tongue drops from its normal palatal resting position, reducing internal stimulation of the upper arch, while altered lip posture changes external pressure on the front teeth. This can contribute to a high, narrow palate, anterior open bite, increased overjet, and a longer facial profile. Early assessment by an orthodontist is recommended if your child habitually breathes through the mouth. Will a palatal expander help with hay fever? Palatal expansion widens the nasal floor as well as the dental arch, and studies show measurable increases in nasal cross-sectional area following expansion in children. For children with both allergic rhinitis and a narrow high palate, palatal expansion can contribute to improved nasal airflow alongside medical treatment of the allergy. It is not a treatment for the allergy itself but addresses one of the structural consequences of chronic nasal obstruction. Do antihistamines affect my braces or orthodontic treatment? Antihistamines — particularly older first-generation types — can cause significant dry mouth, which reduces salivary protection of the teeth and gums. During orthodontic treatment, when plaque retention is already increased around brackets and wires, dry mouth raises the risk of white spot lesions, decay, and gingival inflammation. Choosing second-generation antihistamines, staying well hydrated, and attending regular hygiene appointments during orthodontic treatment helps mitigate this risk. Should my child see an ENT surgeon before starting orthodontics? If nasal obstruction from enlarged adenoids or tonsils is contributing to your child's mouth breathing, ENT assessment and potentially adenotonsillectomy should happen before or alongside orthodontic treatment. Addressing the airway obstruction makes subsequent orthodontic treatment more effective and reduces the risk of relapse. The GP can refer to NHS ENT, and the orthodontist can refer independently via the specialist pathway. Can orthodontic treatment help with breathing problems caused by rhinitis? Orthodontic treatment, particularly palatal expansion in children, can address some of the structural consequences of mouth breathing by widening the narrow palate and potentially improving nasal airway dimensions. However, orthodontic treatment does not treat allergic rhinitis itself, which requires appropriate medical management with antihistamines, nasal sprays, and, where appropriate, immunotherapy. The two aspects of management should proceed in a coordinated way. What is adenoid face and how does orthodontics treat it? Adenoid face is a term for the facial and dental pattern associated with chronic mouth breathing: long lower face, high narrow palate, anterior open bite, increased overjet, and retrognathia. Orthodontic treatment aims to correct the dental features — narrow arch, open bite, overjet — using palatal expanders, fixed braces or aligners, and functional appliances in growing patients. In severe cases, combined orthodontic and orthognathic surgical treatment is needed after growth is complete. Early intervention during the growth period generally produces better outcomes than waiting until adulthood. Are intranasal steroid sprays safe to use with braces? Yes. Intranasal steroid sprays used correctly — directed away from the nasal septum, using one spray per nostril — have minimal systemic absorption and no significant effect on orthodontic treatment. They are the most effective pharmacological treatment for perennial allergic rhinitis and are safe for long-term daily use. Good inhaler technique avoids any direct spray contact with oral tissues. If in doubt about technique, the pharmacist or GP can demonstrate correct use. Explore your options Quick links Not sure where to start? Use these quick links to explore orthodontic treatments, typical costs, and helpful guides that explain what different options involve. 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Upload guided photos and get a tailored recommendation for your teeth and bite. [Start Photo Assessment](https://virtualconsultant.online/evaluations/quote) [Find an Orthodontist](https://virtualconsultant.online/locations) Citation details Title Allergic Rhinitis and Orthodontics UK | Breathing and Bite Publisher Virtual Consultant Online Published 2024-06-01 Updated 2026-08-17 URL [https://staging.virtualconsultant.online/guides/allergic-rhinitis-orthodontics-uk](https://staging.virtualconsultant.online/guides/allergic-rhinitis-orthodontics-uk)