1) The document discusses mouth breathing, defining it as respiration through the mouth instead of the nose. It notes nasal breathing is important for proper lung function and development of facial structures. 2) Causes of mouth breathing include nasal obstructions from infections, allergies, or structural issues. Clinical features include effects on facial structure, dental alignment, and gingiva. 3) Treatment involves eliminating causes of nasal obstruction, managing gingiva, exercises to encourage nasal breathing, and appliances or orthodontics to correct dental issues.

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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