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Mouth breathing

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Mouth breathing

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Mouth breathing

  1. 1. MOUTH BREATHING Dr.M.Ganesh,MDS (Pediatric Dentistry)
  2. 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. 3. Classification • Obstructive mouth breathing • Habitual mouth breathing • Anatomical mouth breathing
  4. 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. 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. 6. 8) Colds Mucous membrane lining Germs get caught and die in the mucous 9) Bad breath Dry mouth Gingivitis
  7. 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. 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. 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. 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
  11. 11. Clinical features of mouth breathing • Focal infections – Tonsils and adenoids • External nares- disuse atrophy » Slit like »Collapse on inspiration
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. Diagnosis of mouth breathing • History: –Lip apart posture – Frequent tonsillitis –Repeated respiratory infections –Allergic rhinitis –Otitis media
  17. 17. 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
  18. 18. Diagnosis of mouth breathing • Clinical tests: – Mirror test – Butterfly test –Massler and Zwemmer – Water holding test – Rhinomanometry – Cephalometrics
  19. 19. Treatment considerations • Age of the child • ENT examination: – Rule out or eliminate nasal obstruction
  20. 20. 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
  21. 21. 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
  22. 22. d) Correction of malocclusion  Oral shield appliance  Monobloc activator  Chin cap e) Surgery  Septoplasty  Tonsillectomy  Removal of adenoids
  23. 23. Management of mouth breathing • Eliminate cause • Treat the gingiva • Interception: – Physical exercises – Lip exercises – Playing a wind instrument
  24. 24. Appliance therapy • Oral screen • Pre orthodontic trainer • Correction of malocclusion
  25. 25. BRUXISM • Static or dynamic contact or occlusion of teeth at times other than for normal function such as mastication or swallowing • Diurnal • Nocturnal
  26. 26. 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
  27. 27. BRUXISM • Clinical features: – Attrition facets –Muscle tenderness, hypertrophy – Injury to periodontal ligament – Pulpal exposure – Limited mouth opening – Altered pattern of occlusion
  28. 28. BRUXISM • Clinical features …… – Loss of vertical dimension – TMJ problems – Loss of alveolar bone - hyper mobility –Hypersensitivity – Gingival recession
  29. 29. BRUXISM • Management: – Occlusal adjustments, splints – Restore vertical dimension – Psychotherapy – Electrical method – Acupuncture – Orthodontic therapy
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