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 levelsCreation of back pressureMore time for lungs to extract OxygenBalanced blood pH.

2) Afferent stimuli from the nerves that regulate breathing are in the nasal passagesReflex nerves that control breathingMouth breathing bypasses this.Leads to obstructive sleep apnoea syndrome and

other heart problems

3) When mouth breathing, brain thinks carbon dioxide is lost too quicklyBrain senses thisStimulation of goblet cells

Nasal breathing leads to limited intake of air.

4) Nostrils and sinuses filter and warm air going into the lungsSinus 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) ColdsMucous membrane liningGerms get caught and die in the mucous

9) Bad breathDry mouthGingivitis

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

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 featuresof 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 featuresof 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 featuresof mouth breathing

• Focal infections– Tonsils and adenoids

• External nares- disuse atrophy

» Slit like

» Collapse on inspiration

Clinical featuresof 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 featuresof 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 featuresof 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 featuresof 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 patient’s 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 modalitiesa) 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 exercisesExtending upper lipLower lip exercisePlaying a wind instrumentCelluloid strip or metal disk

Maxillothoracic myotherapyBy Macaray in 1960Macaray 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