This document discusses mouth breathing habits. It defines mouth breathing and classifies it as anatomic, obstructive, or habitual. Common causes of mouth breathing include developmental anomalies, infections, tumors, and enlarged adenoids. Clinical features include increased facial height and retrognathic jaws. Diagnosis involves tests like mirror tests and asking patients to hold water in their mouth. Treatment focuses on eliminating causes, intercepting habits, exercises, and using oral screens during sleep.

1. MOUTH BREATHING
HABITS.
-NOOHA AYSHA KAMAL
3rd year BDS
20D067

2. SPECIFIC LEARNING OBJECTIVE:
• INTRODUCTION
• CLASSIFICATION OF MOUTH BREATHING
• ETIOLOGY OF MOUTH BREATHING
• CLINICAL FEATURES OF MOUTH BREATHING
• DIAGNOSIS OF MOUTH BREATHING
• TREATMENT OF MOUTH BREATHING

4. INTRODUCTION:
For normal breathing to occur , there should be normal
dentofacial growth . Increased resistance to the flow of air
through the nasal passages may be considered as primary
cause of mouth breathing
DEFINITION:
SASSOUNI(1971): Defined as habitual respiration through the mouth instead of
nose.
MERLE(1980):he used the term ‘’Oro-nasal breathing’’ instead of mouth breathing
.

5. CLASSIFICATION:
• ANATOMIC :The anatomic mouth breather is the one whose short upper lip does
not permit complete closure without undue effort.
• OBSTRUCTIVE : Children who have complete obstruction of normal flow of air
through normal passages .The child is forced by sheer necessity to breathe through
mouth .
• HABITUAL : Habitual mouth breather is a child who continuously breathes through
his mouth by force of habit ,although abnormal obstruction has been removed .

8. ETIOLOGY:
• Developmental and morphological anomalies like abnormal development of nasal
cavity , shorter upper lip , nasal turbinate .
• Traumatic injuries to the nasal cavity
• Infection and inflammation of nasal mucosa , chronic allergic stomatitis ,enlarged
adenoids and tonsils , nasal polyps .
• Partial obstruction due to deviated nasal septum , localized benign tumors .

9. STOMATITIS

10. CLINICAL FEATURES :
1.Increased facial height .
2.Increased mandibular plane angle .
3.Retrognathic mandible and maxilla .
4.V shaped dental arch .
‘ADENOID FACIES’ particular type of facial configuration or ‘LONG FACIES SYNDROME
’frequently associated with mouth accompanying narrow nose and nasal passages , with upper
lip being short .
-Nose is tipped superiorly
-Long narrow face
-Face expression is lost

11. FEATURES OF ADENOID FACES OR LONG FACE
SYNDROME:
1. Increased overjet.
2. Increased facial height.
3. Narrow maxillary arch.
4. Supra eruption of posterior teeth.
5. Posterior cross bite
6. Gingival and periodontal disease.
7. Open bite.
8. Mandible rotates downwards and backwards.

13. DIAGNOSIS:
HISTORY :
The parents are questioned whether the child adopts frequently the lip
apart posture , frequency of tonsilitis and an allergic rhinitis , Otitis media
etc.
CLINICAL :
MIRRORTEST : A double sided mirror ,patient is asked to hold between
the nose and the mouth . Fogging on the nasal side of the mirror
indicates nasal breathing while fogging towards the oral side indicates
mouth breathing .
TEST :Three tests are carried out

15. .
• BUTTERFLYTEST : Hold a cotton over each nostril . If the cotton fibers fly away , this
indicates nasal breathing . If the cotton fibers does not move , indicates mouth
breathing.
• WATER HOLDINGTEST :The patient is asked to fill his mouth with water and retain for
sometime .While nasal breather will have this work easily done , mouth breathers find
this task difficult .
• RASHDEEP METHOD : An innovative method suggested by Deepesh and Rashmi (2013)
to confirm whether patient can breathe through the nose .This method can also be
used to diagnose any unilateral nasal blockade .

16. TECHNIQUE:
• The glove at clinicians left thumb is trimmed .
• Patient is made to sit straight in the dental chair.
• Clinicians –in 10’o clock position and left hand is placed over patient’s lip , with the exposed
area of thumb just below nostrils .
• The fingers of the left hand are approximating both the lips and covering the mouth in
patient with incompetent lips .
• Patient will not be aware that test for mouth breathing is being conducted to them .
• When the patient breathes the expired air from the nostrils , it can be easily felt on the
thumb of clinician .
• To test each nostrils air obstruction one of nostrils can be blocked with the index finger of
right hand and patient is asked to exhale from other nostril. If air passage is clear the air
can be felt on thumb.

17. TREATMENT CONSIDERATION:
• AGE OFTHE CHILD : As with any habits , corrections of mouth breathing could be
expected to be decreased as the child matures .This can lead to increase in nasal
passage as the child grows ,Thereby relieving the obstruction caused due to
enlarged adenoids
• ENT EXAMINATION :This examination may be advised to determine whether
conditions requiring treatment are present with tonsils , nasal septum or adenoids
.

18. CORRECTIONS :
• ELIMINATION OFTHE CAUSE : If the nasal or pharyngeal obstruction has been diagnosed
, attempts should be made at treating first the etiology . Removing these obstructions
through survey or local indication should be decided . If respiratory allergy is present , this
should be brought under control.
• INTERCEPTION OFTHE HABIT: If the habits continues even after the removal of the
obstruction , then it should be corrected .
• SOME EXERCISE CAN BE FOLLOWED : like physical exercises ,lip exercises .

19. .
• PHYSICAL EXERCISE :This is done in the morning and night .Deep breathing exercises are
done with deep inhalation through the nose with arms raised sideways . After a short
period , the arms are dropped to the sides and the air is exhaled through the mouth .
• LIP EXERCISE :The child is instructed to extend the upper lip as far as possible to cover the
vermillion border under and behind the maxillary incisors .This exercise should be done 15-
30mins a day for a period of 4-5months when the child has a short upper lip .
If the maxillary incisors are protruded, the lower lip can be used to extend the upper lip
exercise .The upper lip is first extended into the previously described position .The vermillion
border of the lower lip is then placed against the outside of the extended upper lip and
pressed as hard as possible against the upper lip .

21. ORAL SCREEN :
• The most effective way to re-establish nasal breathing patient is to prevent air from
entering the oral cavity.To do this either the lips or the oral cavity must be closed , for this
purpose an oral screen can be used .Oral screen should be constructed with the material
compatible to the oral tissues .Reduction in the anterior open bite is obtained after
treatment for 3-6months .
• This is an effective device during sleeping hours , it is a thin rubber membrane either cut or
cast to fit over the labial and buccal surfaces of the teeth and gums reduced in the vestibule
of the mouth .During the initial phase, holes are placed on the oral screen so as not to
completely block the airway passage .

23. EXAMINATION OF A CHILD FOR MOUTH
BREATHING ACTIVITY:
1.Observe the patient unknowingly at rest,
- In a nasal breather :The lips touch lightly .
- In a mouth breather :The lips are kept apart.
2.Patient is asked to take a deep breathe ,
-Nasal breather : keeps the lips tightly closed .
-Mouth breather : takes a deep breath , keeping mouth open .
3.Ask the patient to close the lips and take a deep breath through the nose,
-Nasal breather : It demonstrates good control of alar muscles which the size and shape of external
nostrils change.
-Mouth breather : Do not change the size and shape of the external nostrils .

24. .
4.BUTTERFLYTEST :Take a piece of cotton and shape it into a butterfly .place it on the
philtrum and check for the movement of cotton fibers. If the are moving in a direction
towards the nose , If they are moving in a direction towards the nose , then the patient is
a mouth breather.
5.TWO SURFACE MIRRORTEST : A double sided mouth mirror is taken . It is kept on the
philtrum . If the fog is formed on the mirror facing the mouth , then the patient is a mouth
breather .
6.WATERTEST :The patient is asked to hold a mouthful of water for few minutes without
swallowing .If the patient Is a mouth breather he/she will not be able to hold the water in
the mouth for a long period.

25. REFERENCE:
• Textbook of Pediatric Dentistry by SHOBATANDON.
• Textbook of Pediatric Dentistry by NIKHIL MARWAH.
• Textbook of Pediatric Dentistry by S.G DAMLE.