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  1. 1. Department of Paediatric DentistryMOUTH BREATHING HABIT IN CHILDREN
  2. 2. WHAT IS HABIT?Habit can be defined as - Fixed or constant practice established by frequent repetition -DORLAND (1957) Frequent or constant practice or acquired tendency, which has been fixed by frequent repetition –BUTTERWORTH (1961) Oral habits are learned patterns of muscular contractions-MATHEWSON(1982)
  3. 3. Pedodontist Parents Orthodontist ORAL HABITSpeechPathologist Pediatrician Psychologist
  5. 5. DEFINITION Defined as a prolonged or continued exposure of the tissues of anterior areas of mouth to the drying effects of inspired air .(CHACKER,1961) Defined as habitual respiration through the mouth instead of the nose. (SASSOUNI, 1971)
  6. 6. CLASSIFICATIONObstructive Anatomic Habitual
  7. 7. ETIOLOGY1.Nasal Obstruction due to – -Enlarged turbinates -Deviated nasal septum. -Allergic rhinitis -Nasal polyps -Enlarged adenoids -Chronic inflammation of nasal mucosa
  8. 8. 2.Abnormally short upper lip preventing proper lip seal3.Obstruction in the bronchial tree or larynx4.Obstructive sleep apnoea syndrome5. Genetically predisposed individuals -Ectomorphic children having a genetic type of tapering face & nasopharynx are prone for nasal obstruction6. Thumb sucking or other oral habits can be the instigating agent
  9. 9. CLINICAL FEATURESGeneral effects- -Pigeon chest -Low grade esophagitis -Blood gas constituentsEffects on dentofacial structures- Facial form –- A large face height- Increased mandibular plane angle- Retrognathic mandible & maxilla
  10. 10. Adenoid facies –Characterized By-Long narrow face-Narrow nose & nasal passage-Flaccid lips with upper lip being short-Dolicocephalic skeletal pattern-Nose is tipped superiorly in front-Expressionless face-V shaped maxillary arch & high palatal vault.
  11. 11.  Dental defects : • Upper & lower incisors are retroclined. • Posterior cross bite • Anterior open bite • Narrow palatal & cranial width. • Flaring of incisors • Decrease in vertical overlap of anterior teeth.
  12. 12.  Speech defects: - Nasal tone in voice Lips: - Short thick incompetent upper lip. - Voluminous curled over lower lip. - Gummy smile External Nares: - Slit like external nares with a narrow nose due to atrophy of lateral cartilage.
  13. 13.  Gingiva:- • Inflammed & irritated gingival tissue in the anterior maxillary arch. • Classic rolled marginal gingiva and enlarged interdental papilla. • Inter proximal bone loss and presence of deep pockets.Other Effects:- • Otitis Media • Dull sense of smell and loss of taste
  14. 14. DIAGNOSIS1. History2. Clinical Examination Look for lip competency Size and shape of external nares.3. Clinical Tests- Mirror test- Butterfly test- Water test
  15. 15. n Rhinomanometry (inductive Plethysmography)n Cephalometrics
  16. 16. MANAGEMENT Elimination of the cause Symptomatic treatment Interception of the habit :- If the habit continues even after removal of obstruction, then it should be corrected. Correction can be done by: • Physical exercise • Lip exercises • Maxillothorax myotherapy • Oral screen
  17. 17.  Oral Screen:- • Most effective way to reestablish nasal breathing is to prevent air from entering the oral cavity. • Oral screen should be constructed with a material compatible with the oral tissues. • Reduction in the anterior open bite is obtained after treatment for 3-6 months.
  18. 18. PRE ORTHODONTIC TRAINER It is used in mouth breathers, tongue thruster & thumb suckers.
  19. 19. • Construction of the membrane • Construction of the cast Correction of the malocclusion • Mechanical appliances a. Children with class I occlusion and anterior spacing – oral shield appliance. b. Class II div. I dentition without crowding- Monobloc Activator can be used. c. Class III malocclusion – chin cap can be used.
  20. 20. REFERENCESTextbook of Orthodontics : Gurkeerat SinghTextbook of Pedodontics : Shobha TandonOrthodontics : The Art & Science - S.I. Bhalajhi