Department of Paediatric DentistryMOUTH BREATHING HABIT IN CHILDREN
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)
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)
CLASSIFICATIONObstructive Anatomic Habitual
ETIOLOGY1.Nasal Obstruction due to – -Enlarged turbinates -Deviated nasal septum. -Allergic rhinitis -Nasal polyps -Enlarged adenoids -Chronic inflammation of nasal mucosa
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
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
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.
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.
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.
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
DIAGNOSIS1. History2. Clinical Examination Look for lip competency Size and shape of external nares.3. Clinical Tests- Mirror test- Butterfly test- Water test
n Rhinomanometry (inductive Plethysmography)n Cephalometrics
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
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.
PRE ORTHODONTIC TRAINER It is used in mouth breathers, tongue thruster & thumb suckers.
• 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.
REFERENCESTextbook of Orthodontics : Gurkeerat SinghTextbook of Pedodontics : Shobha TandonOrthodontics : The Art & Science - S.I. Bhalajhi