MOUTH BREATHING

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

Classification
Obstructive mouth breathing Habitual mouth breathing Anatomical mouth breathing

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

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

8) Colds Mucous membrane lining Germs get caught and die in the mucous

9) Bad breath Dry mouth Gingivitis

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 tissuetonsils and adenoids

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

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

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

Clinical features of mouth breathing

Focal infections
Tonsils and adenoids

External nares- disuse atrophy

Slit like Collapse on inspiration

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

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

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

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

Diagnosis of mouth breathing

History:
Lip apart posture Frequent tonsillitis Repeated respiratory infections Allergic rhinitis

Otitis media

Diagnosis of mouth breathing

Examination:
Observe patients breathing - Lips apart Deep breathing-alae contract/ no change/ mouth breathing Hoarseness of voice

Malocclusion
Other associated habits

Diagnosis of mouth breathing

Clinical tests:
Mirror test Butterfly test Massler and Zwemmer Water holding test Rhinomanometry Cephalometrics

Treatment considerations
Age of the child ENT examination: Rule out or eliminate nasal obstruction

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

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

d) Correction of malocclusion
Oral shield appliance Monobloc activator Chin cap

e) Surgery
Septoplasty Tonsillectomy Removal of adenoids

Management of mouth breathing

Eliminate cause
Treat the gingiva Interception:
Physical exercises Lip exercises

Playing a wind instrument

Appliance therapy
Oral screen Pre orthodontic trainer Correction of malocclusion

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

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

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

BRUXISM
Clinical features Loss of vertical dimension TMJ problems Loss of alveolar bone - hyper mobility Hypersensitivity Gingival recession

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