What You Need to Know About the “Mouth Breather Face” Phenomenon
Mouth breathing is often dismissed as a minor habit — something people do when they have a cold or during heavy exercise. But when it becomes chronic, especially in children and teens, the effects go far beyond just dry lips or bad breath. Over time, habitual mouth breathing can actually reshape the structure of the face, alter jaw development, and affect long-term health. This condition, sometimes referred to as “mouth breathing face” or “mouth breather face,” is gaining attention not only from parents and orthodontists, but also from professionals in sleep medicine, ENT (ear, nose, and throat), and craniofacial research.
In this guide, we’ll explore what a mouth breathing face is, how it develops, the health risks associated with it, and what you can do to prevent or reverse it. We’ll also cover the science behind facial growth, provide actionable advice for parents and adults, and answer some of the most common questions people have about this under-discussed but important topic.
Why Does This Matter?
According to a study published in the Journal of Otolaryngology – Head & Neck Surgery, up to 50% of children show signs of habitual mouth breathing, and many parents aren’t even aware of it. If left untreated, this seemingly harmless habit can affect not only facial development, but also oral health, breathing efficiency, posture, and cognitive function.
“Mouth breathing is not just an aesthetic problem — it’s a health problem. The face grows differently when the mouth is habitually open. That changes everything.”
— Dr. John Mew, Orthotropic Specialist
We’ll break down this concept section-by-section, starting with the basics of what mouth breathing is and how it differs from the natural and optimal method of nasal breathing.
What Is Mouth Breathing?
Mouth breathing refers to the act of inhaling and exhaling through the mouth instead of the nose. While it’s normal to breathe through the mouth occasionally — such as during intense exercise or when the nose is blocked — chronic mouth breathing becomes problematic when it becomes a person’s default breathing mode, even during rest or sleep.
Definition and Explanation
Mouth breathing is defined as persistent breathing through the mouth during waking hours and/or sleep, particularly when it is not due to temporary congestion or illness. It often starts in childhood but can persist into adulthood if not addressed.
How It Differs From Nasal Breathing
Feature | Nasal Breathing | Mouth Breathing |
---|---|---|
Filtration | Filters allergens, dust, and pathogens | No filtration |
Moisturization | Humidifies and warms the air | Dries out mouth and throat |
Oxygen Efficiency | Nitric oxide boosts oxygen absorption | Less efficient oxygen uptake |
Facial Development | Supports proper jaw and palate growth | Can lead to long face, recessed jaw, etc. |
Common Causes of Mouth Breathing
Many people don’t realize they’re breathing through their mouths until symptoms or facial changes become apparent. The causes of mouth breathing can be structural, habitual, or medical.
Here are the most common causes:
- Nasal Blockages
- Chronic allergies
- Nasal polyps
- Deviated septum
- Enlarged Tonsils or Adenoids
- Often seen in children
- Blocks airflow through the nose, forcing mouth breathing
- Poor Oral Posture or Habitual Behavior
- Slouching posture, slack jaw, or poor tongue position
- Breathing through the mouth becomes a learned habit
- Obstructive Sleep Apnea
- Interrupts nasal breathing during sleep
- May cause mouth to open involuntarily to maintain airflow
- Facial or Craniofacial Abnormalities
- Narrow palate or small nasal passages
- Genetic or developmental conditions that make nasal breathing difficult
Why Is This Important to Catch Early?
In children, especially during crucial developmental years (ages 2–12), breathing method directly influences facial growth, jaw alignment, and even the shape of the dental arch. If mouth breathing is not identified early, these changes can become permanent, leading to the phenomenon known as a “mouth breathing face.”
Fact: The tongue is nature’s orthodontic retainer. When it rests on the roof of the mouth (as it should during nasal breathing), it helps widen the palate and shape the midface properly.
FAQs for Answer Engine Optimization (AEO)
What is mouth breathing?
Mouth breathing refers to the act of breathing through the mouth instead of the nose. While temporary mouth breathing can occur during illness, chronic mouth breathing can lead to health and facial structure issues.
Is mouth breathing bad for you?
Yes, habitual mouth breathing can lead to poor sleep, dry mouth, dental issues, and changes in facial structure over time.
Can you fix mouth breathing?
Yes, through nasal breathing training, myofunctional therapy, and in some cases, surgery or orthodontic intervention, mouth breathing can be corrected.
Great — let’s move on to the next section:
What Is a “Mouth Breathing Face”?
The term “mouth breathing face” refers to the distinct facial characteristics that may develop over time due to chronic mouth breathing, especially when it begins in childhood. This is not just a slang term — it is rooted in clinical observations by orthodontists, ENT specialists, and researchers who study craniofacial development.
Understanding the Term “Mouth Breather Face”
While the term has sometimes been used pejoratively in pop culture, medically, it describes a set of structural changes in the face caused by abnormal breathing patterns. These changes happen subtly and gradually as the bones of the face and skull develop in response to improper tongue posture, airway resistance, and jaw positioning.
According to the American Journal of Orthodontics and Dentofacial Orthopedics, nasal breathing promotes proper craniofacial development, whereas mouth breathing can lead to noticeable physical alterations. When the mouth is open for prolonged periods, it changes the resting position of the tongue and jaw, which in turn reshapes the face.
“Chronic mouth breathing alters the balance of orofacial muscles and tongue posture, contributing to facial skeletal changes such as a long face and narrow jaw.”
— Journal of Clinical Pediatrics Dentistry (source)
Facial Features Commonly Linked to Mouth Breathing
Here are the common physical traits and structural changes that define a mouth breathing face:
1. Long, Narrow Face
Mouth breathers often develop a vertically elongated face due to the downward pull of gravity on the jaw and tongue when the mouth is open. This condition is sometimes referred to as “long face syndrome.”
2. Recessed Chin and Weak Jawline
A lack of proper tongue pressure on the palate can cause the mandible (lower jaw) to grow downward and backward rather than forward, leading to a weak chin and poor jaw definition.
3. Narrow Palate and Crowded Teeth
Mouth breathing can cause the tongue to rest on the bottom of the mouth instead of the roof, which prevents the upper palate from expanding properly. This leads to dental crowding, overbites, and crooked teeth — common reasons for braces or palate expanders in children.
4. Dark Circles and Droopy Eyes
Chronic oxygen deprivation and poor sleep quality associated with mouth breathing can result in under-eye shadows and a tired appearance. Swollen nasal tissues may also contribute to eye puffiness.
5. Gummy Smile or Low Resting Lip Posture
Mouth breathers may develop an altered smile where more of the gum is visible, or the upper lip appears shorter due to muscular adaptation.
Visual Summary: Mouth Breather Face Features
Facial Feature | How Mouth Breathing Affects It |
---|---|
Jawline | Weakens, recesses backward |
Chin | Appears smaller, less defined |
Face length | Grows longer vertically |
Eyes | Tired, droopy look; dark under-eye circles |
Lips | Dry, parted at rest; upper lip may thin over time |
Palate | Becomes narrow, causing dental crowding |
Before and After Cases of Mouth Breathing Face
In clinical settings, orthodontists and myofunctional therapists have documented dramatic improvements in facial structure when mouth breathing is corrected early — particularly in children.
- A case study published in Sleep and Breathing documented a 12-year-old boy with obstructive breathing and mouth breathing habits. After 12 months of myofunctional therapy and nasal expansion, significant improvements in nasal airflow, facial width, and jaw posture were observed. (source)
Is “Mouth Breather Face” Recognized by Doctors?
Yes, though doctors may use clinical terms like “long face syndrome,” “adenoid facies,” or “craniofacial dysmorphology,” many in the medical and dental fields recognize the link between mouth breathing and altered facial growth.
The American Association of Orthodontists states:
“Breathing problems can impact facial development, particularly when chronic mouth breathing is present during early growth periods.”
— AAO (source)
FAQs for Answer Engine Optimization (AEO)
What are the signs of a mouth breathing face?
Typical signs include a long, narrow face, recessed chin, narrow jaw, dark under-eye circles, and open mouth posture.
Can you tell if someone is a mouth breather by looking at them?
In some cases, yes. Facial features such as a weak chin, narrow dental arch, and constantly open lips may suggest habitual mouth breathing.
Does mouth breathing change your face permanently?
Yes, especially in children whose bones are still growing. If uncorrected, changes can become permanent. However, some improvements can be made with therapy or orthodontic intervention.
How Does Mouth Breathing Affect Facial Structure?
Facial structure is not solely determined by genetics — it’s also shaped by how we use our facial muscles and oral posture during development. One of the most significant functional factors is how we breathe. Chronic mouth breathing, especially during childhood and adolescence, can significantly alter the growth and alignment of facial bones, contributing to what’s commonly called a mouth breathing face.
Studies in orthodontics and craniofacial development have shown that the position of the tongue, lips, and jaw — all influenced by breathing patterns — play a major role in the way the face forms during growth.
Effects in Children and Teens
The most critical period for facial development occurs before puberty, roughly between ages 2 and 12. During this time, the bones of the skull and face are highly malleable. If a child habitually breathes through the mouth during this phase, it can change the structure of their face, jaws, and airway.
How Mouth Breathing Affects a Developing Face
- Low Tongue Posture:
When breathing through the nose, the tongue naturally rests against the roof of the mouth, exerting light upward pressure that helps widen the palate and stimulate forward facial growth.
With mouth breathing, the tongue rests low in the mouth, leading to a narrow upper jaw (maxilla) and a longer, flatter midface. - Open Mouth Posture:
Children who breathe with an open mouth tend to develop a longer lower face, drooping cheeks, and poor lip seal. Over time, this posture pulls the lower jaw downward and backward. - Underdeveloped Jaw and Chin:
Nasal breathers tend to have a more forward-growing mandible, while mouth breathers often develop a recessed or “weak” chin. - Narrow Dental Arches:
Without the tongue’s support on the palate, the dental arches become narrower, often leading to crowded teeth, crossbites, and overbites. - Impaired Airway Development:
Long-term mouth breathing can also narrow the nasal cavity and reduce airflow capacity, which may lead to snoring, sleep apnea, and poor oxygenation.
Clinical Evidence:
A landmark study in the American Journal of Orthodontics showed that children who mouth breathed over long periods developed significantly longer faces, steeper mandibular planes, and narrower palates than nasal breathers. (source)
Changes in Adult Facial Appearance
In adults, the bones of the face have largely finished growing. However, habitual mouth breathing can still affect facial appearance, especially in ways related to muscle tone, posture, and sleep quality.
Common Adult Facial Changes Linked to Mouth Breathing:
- Sagging or hollow cheeks
- Forward head posture, which changes the profile and neck alignment
- Narrower jaw and nasal passages
- Increased likelihood of bruxism (teeth grinding) and TMJ issues
- Dry, wrinkled lips and a perpetually tired appearance
Although the structural changes are less dramatic than in children, adults may still develop what resembles a “mouth breathing face,” especially if the behavior persists over many years.
Research Insight:
A study published in Sleep Medicine Reviews found that adult mouth breathers were more likely to report poor sleep quality, facial muscle fatigue, and signs of premature aging, due in part to compromised nasal airflow and low oxygenation. (source)
Can Facial Changes Be Prevented or Reversed?
Yes — partially, and the earlier the intervention, the better.
- In children, early detection and treatment can often reverse or prevent most of the craniofacial changes associated with mouth breathing.
- In adults, improvements in posture, breathing patterns, and oral function can enhance appearance and health, though some structural issues may require orthodontic or surgical correction.
Dr. Derek Mahony, an internationally recognized orthodontist, notes:
“When mouth breathing is addressed early — ideally by age 7 — we can redirect facial growth with interventions like myofunctional therapy and palate expansion.”
(source)
Comparative Overview: Nasal vs Mouth Breathing Impact on Facial Development
Breathing Pattern | Facial Outcome |
---|---|
Nasal Breathing | Balanced midface, wider jaw, strong chin, good oral posture, healthy airway |
Mouth Breathing | Long face, narrow palate, recessed chin, poor lip seal, high risk of dental issues |
FAQs for Answer Engine Optimization (AEO)
Can mouth breathing cause facial deformities?
Yes. Chronic mouth breathing can change the shape of the face, especially in children. This includes a long face, narrow jaw, and recessed chin.
Is it too late to fix mouth breathing in adults?
While bone growth is complete in adults, improvements can still be made through breathing therapy, dental correction, and in some cases, surgery.
Why does mouth breathing make your face longer?
The open-mouth posture allows gravity and muscle tension to pull the jaw downward. Over time, this leads to a longer, vertically grown face.
Health Effects of Chronic Mouth Breathing
Chronic mouth breathing isn’t just a cosmetic or facial development issue — it has significant health consequences that can impact breathing quality, oral health, sleep, and even cognitive function. Understanding these health risks is essential for recognizing the importance of addressing mouth breathing early.
1. Poor Oral Health
Mouth breathing leads to a dry mouth because saliva evaporates faster when breathing through the mouth. Saliva is crucial for:
- Neutralizing acids
- Washing away bacteria
- Preventing tooth decay and gum disease
Without sufficient saliva, mouth breathers are at higher risk for:
- Tooth decay
- Gingivitis and periodontal disease
- Bad breath (halitosis)
- Mouth sores and irritation
A 2018 study in the Journal of Clinical Pediatric Dentistry found a significant correlation between mouth breathing and increased risk of dental caries and gum inflammation. (source)
2. Sleep-Related Breathing Disorders
Chronic mouth breathing is often linked to obstructive sleep apnea (OSA) and other sleep-disordered breathing issues. Mouth breathers tend to have narrower airways, increasing the risk of airway collapse during sleep.
Common consequences include:
- Snoring
- Interrupted sleep cycles
- Daytime fatigue and sleepiness
- Poor concentration and memory
According to the American Sleep Apnea Association, untreated sleep apnea due to mouth breathing can increase risks for high blood pressure, heart disease, stroke, and diabetes. (source)
3. Impaired Oxygenation and Cognitive Function
Nasal breathing produces nitric oxide, a molecule that helps increase oxygen absorption in the lungs and supports cardiovascular health. Mouth breathing bypasses this mechanism, leading to less efficient oxygen delivery to the brain and tissues.
Studies suggest that chronic mouth breathers may experience:
- Lower cognitive performance
- Reduced attention span
- Increased anxiety and irritability
A 2017 clinical review in the International Journal of Pediatric Otorhinolaryngology links mouth breathing with poor academic performance and behavioral issues in children. (source)
4. Altered Facial and Postural Development
As covered earlier, mouth breathing impacts facial development, but it also affects posture. Mouth breathers often develop forward head posture and neck strain, which can lead to chronic pain and muscle tension.
5. Increased Risk of Respiratory Infections
The nose acts as a natural filter, trapping dust, allergens, and pathogens before they reach the lungs. Mouth breathing bypasses this filter, increasing vulnerability to:
- Common colds
- Sinus infections
- Bronchitis and respiratory illnesses
The European Respiratory Journal highlights that nasal breathing is crucial for respiratory defense mechanisms. (source)
Summary Table: Health Effects of Chronic Mouth Breathing
Health Issue | Impact of Mouth Breathing | Reference |
---|---|---|
Oral Health | Dry mouth, cavities, gum disease | J Clin Pediatr Dent, 2018 |
Sleep Quality | Snoring, obstructive sleep apnea, daytime fatigue | American Sleep Apnea Association |
Oxygenation & Cognitive | Reduced oxygen absorption, impaired focus | Int J Pediatr Otorhinolaryngol, 2017 |
Posture & Musculoskeletal | Forward head posture, neck and muscle pain | Clinical observations |
Respiratory Health | Increased infections, reduced airway defense | Eur Respir J, 2008 |
FAQs for Answer Engine Optimization (AEO)
Can mouth breathing cause sleep problems?
Yes, it is strongly linked to obstructive sleep apnea, snoring, and poor sleep quality.
Why does mouth breathing cause bad breath?
Because it dries out saliva, which normally cleanses the mouth and controls bacteria.
Does mouth breathing affect mental focus?
Chronic mouth breathing may reduce oxygen efficiency, negatively affecting concentration and cognitive function.
How to Prevent and Correct Mouth Breathing Face
Addressing mouth breathing early is crucial to preventing the long-term facial and health consequences associated with a mouth breathing face. Fortunately, a combination of medical, dental, and therapeutic interventions can help correct breathing patterns and improve facial structure over time.
1. Early Diagnosis and Treatment
The first step is early recognition of mouth breathing, especially in children. Pediatricians, dentists, and orthodontists play a vital role in screening for signs of mouth breathing during routine visits.
Key signs to watch for:
- Chronic open mouth posture
- Snoring or noisy breathing during sleep
- Frequent colds or nasal congestion
- Dental crowding or malocclusion
Early diagnosis allows for prompt intervention, which is more effective during the critical growth periods of childhood.
Reference: The American Academy of Pediatrics recommends screening for breathing disorders in children to prevent developmental issues. (AAP Policy Statement)
2. Medical Management of Nasal Obstruction
Many mouth breathers suffer from nasal obstructions such as:
- Enlarged adenoids or tonsils
- Chronic allergies
- Deviated septum
- Nasal polyps
Treating these conditions medically or surgically can restore nasal airflow and encourage nasal breathing.
Common treatments include:
- Allergy management (antihistamines, nasal steroids)
- Adenoidectomy or tonsillectomy
- Septoplasty for structural correction
According to the American Academy of Otolaryngology–Head and Neck Surgery, resolving nasal obstructions significantly improves breathing patterns in children and adults. (AAO-HNS Guidelines)
3. Myofunctional Therapy
Orofacial myofunctional therapy (OMT) involves exercises designed to retrain the muscles of the mouth, tongue, and face to promote nasal breathing and correct oral posture.
OMT can help:
- Strengthen lip seal
- Correct tongue resting position
- Improve swallowing patterns
- Enhance nasal airflow
A 2019 meta-analysis in the Journal of Oral Rehabilitation confirmed that myofunctional therapy improves nasal breathing and reduces mouth breathing in both children and adults. (source)
4. Orthodontic and Dental Interventions
Dental appliances and orthodontics can play a crucial role in correcting the anatomical changes caused by mouth breathing:
- Palatal expanders widen a narrow upper jaw to improve airflow and create room for teeth.
- Braces or aligners correct malocclusion caused by improper oral posture.
- Mandibular advancement devices can improve jaw positioning and airway space.
The American Association of Orthodontists notes that these treatments, combined with breathing correction, can lead to substantial improvements in facial structure and function. (AAO Patient Info)
5. Breathing Retraining and Lifestyle Changes
Encouraging nasal breathing through conscious effort and lifestyle adjustments helps maintain the improvements from other treatments.
Tips include:
- Practicing nasal breathing exercises daily
- Keeping lips closed at rest
- Using humidifiers to prevent nasal dryness
- Managing allergies and avoiding irritants
Some breathing retraining methods like the Buteyko method have been shown to reduce mouth breathing and improve respiratory health. (Buteyko Institute)
Summary Table: Prevention and Correction Strategies
Strategy | Purpose | Effectiveness | Reference |
---|---|---|---|
Early screening and diagnosis | Identify mouth breathing early | High in children | AAP |
Medical treatment | Clear nasal obstructions | High | AAO-HNS |
Myofunctional therapy | Retrain orofacial muscles | Moderate to high | J Oral Rehab |
Orthodontic treatment | Correct dental/facial structure | High when combined with therapy | AAO |
Breathing retraining | Promote nasal breathing habit | Moderate | Buteyko Institute |
FAQs for Answer Engine Optimization (AEO)
How can I stop mouth breathing naturally?
Focus on nasal breathing exercises, keeping lips closed, and managing nasal congestion. Consulting a healthcare provider is important if symptoms persist.
Is myofunctional therapy effective for mouth breathing?
Yes, it helps retrain oral muscles to promote nasal breathing and improve facial posture.
Can braces fix a mouth breathing face?
Braces can help correct dental issues caused by mouth breathing but are most effective when combined with therapies addressing the underlying breathing pattern.
Long-Term Outlook and When to See a Specialist for Mouth Breathing Face
Understanding the long-term implications of a mouth breathing face is essential for both prevention and treatment. If left unaddressed, chronic mouth breathing can lead to permanent structural changes and health complications. Early intervention is ideal, but specialized care can help at any stage.
Long-Term Consequences of Untreated Mouth Breathing
If mouth breathing persists without correction, the following issues may become permanent or worsen:
- Structural facial changes: Long, narrow face; recessed chin; high-arched palate
- Dental problems: Crowded teeth, malocclusion, and increased risk of periodontal disease
- Sleep disorders: Chronic snoring, obstructive sleep apnea (OSA), and daytime fatigue
- Cognitive and behavioral effects: Poor concentration, learning difficulties, and mood disorders
- Chronic respiratory issues: Frequent infections and compromised lung function
A study in the European Respiratory Journal underscores that untreated mouth breathing can contribute to lifelong respiratory and sleep-related health problems. (source)
When to See a Specialist
It’s crucial to seek professional help if you or your child exhibit any of the following signs related to mouth breathing:
- Persistent open mouth posture
- Frequent nasal congestion or difficulty breathing through the nose
- Snoring, gasping, or pauses in breathing during sleep
- Dental crowding or noticeable changes in facial shape
- Daytime sleepiness, difficulty concentrating, or behavioral issues
Types of Specialists to Consult
- Pediatrician or Primary Care Physician
For initial evaluation and referral, especially in children. - Otolaryngologist (ENT Specialist)
To assess and treat nasal obstructions, enlarged tonsils/adenoids, and sinus issues. - Orthodontist or Dentist
To diagnose and manage dental and jaw alignment problems related to mouth breathing. - Sleep Specialist
For evaluation and treatment of sleep-related breathing disorders like obstructive sleep apnea. - Myofunctional Therapist or Speech-Language Pathologist
For muscle retraining and correction of oral posture.
According to the Mayo Clinic, multidisciplinary care often yields the best outcomes for chronic mouth breathing and its effects. (source)
Prognosis and Expectations
- Early treatment in childhood often results in complete or near-complete reversal of facial and functional issues.
- Adult treatment can still improve symptoms and quality of life but structural changes may require orthodontic or surgical correction.
- Ongoing monitoring is recommended to prevent relapse or progression.
Case Study: Successful Intervention
A 10-year longitudinal study published in The Angle Orthodontist demonstrated that early intervention combining adenotonsillectomy, orthodontics, and myofunctional therapy led to significant improvements in facial structure and airway function in children with chronic mouth breathing. (source)
FAQs for Answer Engine Optimization (AEO)
How do I know if mouth breathing is affecting my child’s face?
Look for signs like an open mouth posture, narrow upper jaw, dental crowding, and frequent nasal congestion.
Can adults reverse mouth breathing face?
While some structural changes may be permanent, many symptoms can be improved with therapy, orthodontics, or surgery.
Which doctor should I see first for mouth breathing issues?
Start with your primary care physician or pediatrician for initial assessment and referral.
Conclusion: Understanding and Addressing Mouth Breathing Face
Mouth breathing face is more than a cosmetic concern—it is a sign of underlying breathing and health issues that can have lasting effects on facial development, oral health, sleep quality, and overall wellbeing. Recognizing the signs early and seeking professional care is essential to prevent long-term complications.
By combining medical treatments to address nasal obstructions, orthodontic interventions to correct dental structure, myofunctional therapy to retrain oral muscles, and lifestyle changes promoting nasal breathing, individuals can significantly improve both their facial appearance and health outcomes.
If you or your child exhibit symptoms of mouth breathing, consult healthcare providers promptly. Early intervention offers the best chance for positive, lasting results.
Frequently Asked Questions (FAQs) about Mouth Breathing Face
1. What is a mouth breathing face?
A mouth breathing face describes the characteristic facial features that develop over time due to chronic mouth breathing, including a long narrow face, recessed chin, and dental malformations.
2. Why does mouth breathing affect facial development?
Mouth breathing changes the natural resting posture of the tongue and lips, disrupting normal muscle function and bone growth, which alters facial structure, especially in children.
3. Can mouth breathing cause health problems besides facial changes?
Yes, chronic mouth breathing is linked to poor oral health, sleep apnea, cognitive issues, and increased respiratory infections.
4. How can I tell if I’m a mouth breather?
Signs include frequently breathing through the mouth, dry mouth, snoring, nasal congestion, and noticing an open mouth posture at rest.
5. Is mouth breathing reversible?
Early intervention can reverse many effects of mouth breathing, especially in children. Adults can improve symptoms, though some structural changes may require orthodontics or surgery.
6. What treatments are available for mouth breathing face?
Treatments include medical management of nasal obstructions, myofunctional therapy, orthodontics, breathing retraining exercises, and sometimes surgery.
7. When should I see a specialist for mouth breathing?
If you notice persistent open mouth posture, snoring, difficulty breathing through the nose, or dental and facial changes, seek evaluation from a pediatrician, ENT, or orthodontist.
8. Can my child’s school performance be affected by mouth breathing?
Yes, mouth breathing can lead to sleep disturbances and reduced oxygenation, which may negatively impact concentration and academic performance.