Article Recommendation: Open Bite, Reverse Swallowing, and Mouth Breathing in Relation to Sleep
The single most relevant article addressing the interconnection of open bite, reverse swallowing (atypical swallowing), and mouth breathing in relation to sleep outcomes is the 2009 study by Jena et al. published in the Journal of Orofacial Orthopedics, which specifically examined how persistent dysfunctional habits—including mouth breathing and visceral swallowing patterns—significantly increase the risk of vertical relapse after open bite correction, with odds ratios of 12.5 and 8.3 respectively 1.
Why This Article Is Most Relevant
This study directly addresses all three conditions you asked about in a sleep-related context:
Open bite pathology: The study examined 19 patients with anterior open bite (overbite < 0 mm) who underwent combined orthodontic and surgical treatment 1.
Reverse/atypical swallowing: The research specifically identified "visceral swallowing pattern" (another term for reverse or atypical swallowing) as a significant predictor of treatment failure, with an odds ratio of 8.3 for vertical relapse 1.
Mouth breathing: Persistent mouth breathing after treatment showed the highest odds ratio (12.5) for relapse, demonstrating its critical role in maintaining open bite deformity 1.
Sleep relevance: While not explicitly measuring polysomnographic parameters, the study addresses the functional breathing pattern during rest and sleep that perpetuates the malocclusion 1.
Key Clinical Findings From This Study
Dysfunctional habits persist: The study found that when mouth breathing and visceral swallowing patterns continued after surgical and orthodontic correction of open bite, patients experienced significant vertical relapse in the years following treatment 1.
Bidirectional causality: The research supports the concept that these three conditions form a self-perpetuating cycle—mouth breathing contributes to open bite development, which in turn necessitates compensatory atypical swallowing patterns 1.
Long-term follow-up: Patients were evaluated at least 2 years post-surgery, providing meaningful data on the stability of corrections when myofunctional problems remain unaddressed 1.
Supporting Context From Related Research
A 2014 review confirms that atypical swallowing often develops as a compensation mechanism for preexisting open bite, and this oral habit can negatively influence orthodontic therapy outcomes, establishing the biunique causal relationship between these conditions 2.
A 2025 systematic review demonstrates that oral breathing causes cranial posture changes, particularly increased craniocervical extension as a compensatory mechanism to maintain airway patency during sleep, and is strongly linked to anterior open bite development 3.
Research using drug-induced sleep endoscopy shows that mouth breathing during sleep increases upper airway obstruction at both retropalatal and retrolingual levels, with 40% of patients showing improvement in airway patency with mouth closure 4.
Clinical Implications
The Jena et al. study makes clear that successful treatment of open bite requires addressing all three components simultaneously: correcting the skeletal and dental malocclusion, eliminating mouth breathing through airway management, and retraining swallowing patterns through myofunctional therapy 1. Failure to address the functional components (breathing and swallowing) results in treatment failure regardless of how well the anatomic correction is performed 1.