Mouth breathing

1. MOUTH BREATHING
Dr.M.Ganesh,MDS (Pediatric Dentistry)

2. DEFINITION OF MOUTH
BREATHING
• Sassouni (1971): It is the habitual respiration
through the mouth instead of the nose.
• Merle (1980); Suggested the term oro-nasal
breathing instead of mouth breathing

3. Classification
• Obstructive mouth breathing
• Habitual mouth breathing
• Anatomical mouth breathing

4. WHY IS NASAL BREATHING
IMPORTANT
1) Lungs are primary control of our energy levels
Creation of back pressure
More time for lungs to extract Oxygen
Balanced blood pH.
2) Afferent stimuli from the nerves that regulate
breathing are in the nasal passages
Reflex nerves that control breathing
Mouth breathing bypasses this.
Leads to obstructive sleep apnoea syndrome and
other heart problems

5. 3) When mouth breathing, brain thinks carbon dioxide
is lost too quickly
Brain senses this
Stimulation of goblet cells
Nasal breathing leads to limited intake of air.
4) Nostrils and sinuses filter and warm air going into
the lungs
Sinus produces nitric oxide
Acceleration of water loss leading to dehydration
5) Each nostril is innervated by 5 cranial nerves from a
different side of the brain
6) Maintaining a keen sense of smell
7) Upper airway resistance syndrome
 Also known as Snoring
 Social problems and other medical problems

6. 8) Colds
Mucous membrane lining
Germs get caught and die in the mucous
9) Bad breath
Dry mouth
Gingivitis

7. Etiology of mouth breathing
• Nasal obstruction
– Hypertrophy of nasal turbinates due to
• Allergies
• Chronic respiratory infections
• Pollution
• Hot and dry climatic conditions
– Hypertrophy of pharyngeal lymphoid tissue-tonsils
and adenoids

8. Etiology of mouth breathing
• Intranasal defects- deviated nasal septum
• Allergic rhinitis, nasal polyps
• Facial type – ectomorphs
• Genetic predisposition
• Short hypotonic or flaccid upper lip
• Obstructive sleep apnoea syndrome
• Other habits

9. Clinical features
of mouth breathing
• Normal respiration
– Cleansing, humidification and moisturisation of
inspired air
– Nasal resistance for proper functioning of the
diaphragm and intercostal muscles
– Lubricates oesophagus

10. Clinical features
of mouth breathing
• General effects-
– Pigeon chest deformity
– Low grade oesophagitis
– Altered blood gas levels
• Nose and associated structures
– Reduced ciliary activity
– Decreased sense of smell
– Poorly developed sinuses

12. Clinical features
of mouth breathing
• Focal infections
– Tonsils and adenoids
• External nares- disuse atrophy
» Slit like
»Collapse on inspiration

13. Clinical features
of mouth breathing
• Dento facial structures:
• Facial form –long face
• Increase anterior face height
• Increased mandibular plane angle
• Lips
• Slack lips ,open, everted lower lip
• Lip apart posture

18. Clinical features
of mouth breathing
• Dental effects
– Proclination and spacing of anterior teeth
– Constricted maxillary arch, posterior crossbites
– Decreased vertical overlap of anteriors
• Gingiva
– Inflammed gingival tissue in upper anterior region

19. Clinical features
of mouth breathing
• Mouth breathing gingivitis
– Constant drying and wetting
– Increased viscosity of saliva
– loss of cleansing action and resultant bacterial
plaque deposits
• Gummy smile
• Speech-nasal tone

21. Clinical features
of mouth breathing
• Adenoid facies
– Frequently associated with mouth breathing
– Long narrow face-dolicofacial
– Expressionless face
– Flaccid lips, short upper lip
– Nares anteriorly placed
– narrow maxilla

22. Diagnosis of mouth breathing
• History:
–Lip apart posture
– Frequent tonsillitis
–Repeated respiratory infections
–Allergic rhinitis
–Otitis media

23. Diagnosis of mouth breathing
• Examination:
– Observe patient’s breathing - Lips apart
– Deep breathing-alae contract/ no change/
mouth breathing
– Hoarseness of voice
– Malocclusion
– Other associated habits

24. Diagnosis of mouth breathing
• Clinical tests:
– Mirror test
– Butterfly test –Massler and Zwemmer
– Water holding test
– Rhinomanometry
– Cephalometrics

26. Treatment considerations
• Age of the child
• ENT examination:
– Rule out or eliminate nasal obstruction

27. MANAGEMENT
1) Treatment is required at an early age
2) Treatment considerations
 Age of the child
 ENT examination
3) Timing for treatment
 Mixed dentition period
4) Treatment modalities
a) Elimination of the cause
 Surgery
 Local medication
 Rapid maxillary expansion

28. b) Symptomatic treatment for gingiva
 Petroleum jelly
 Nocturnal moisture appliance
c) Interception of habit
 Physical exercises
Deep breathes in the morning and at night
 Lip exercises
Extending upper lip
Lower lip exercise
Playing a wind instrument
Celluloid strip or metal disk
 Maxillothoracic myotherapy
By Macaray in 1960
Macaray activator
 Oral screen

29. d) Correction of malocclusion
 Oral shield appliance
 Monobloc activator
 Chin cap
e) Surgery
 Septoplasty
 Tonsillectomy
 Removal of adenoids

30. Management of mouth breathing
• Eliminate cause
• Treat the gingiva
• Interception:
– Physical exercises
– Lip exercises
– Playing a wind instrument

31. Appliance therapy
• Oral screen
• Pre orthodontic trainer
• Correction of malocclusion

32. BRUXISM
• Static or dynamic contact or occlusion of
teeth at times other than for normal
function such as mastication or
swallowing
• Diurnal
• Nocturnal

33. BRUXISM
• Etiology:
– Psychological – stress, anger, aggression
– Local causes – premature contacts
– Faulty restorations
– Deep bite
– Systemic causes– GI disturbances, nutritional,
allergic , endocrine disorders
– CNS disorders – cerebral palsy, mental retardation
– Occupational factors

34. BRUXISM
• Clinical features:
– Attrition facets
–Muscle tenderness, hypertrophy
– Injury to periodontal ligament
– Pulpal exposure
– Limited mouth opening
– Altered pattern of occlusion

35. BRUXISM
• Clinical features ……
– Loss of vertical dimension
– TMJ problems
– Loss of alveolar bone - hyper mobility
–Hypersensitivity
– Gingival recession

38. BRUXISM
• Management:
– Occlusal adjustments, splints
– Restore vertical dimension
– Psychotherapy
– Electrical method
– Acupuncture
– Orthodontic therapy

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