Habitual Mouth Breathing Research Articles

Gender as risk factor for mouth breathing and other harmful oral habits in preschoolers

Aim: To analyze associations between the mouth-breathing pattern and other harmful oral habits among preschoolers. Methods: An observational, cross-sectional study was carried out involving 198 children from 3 to five 5 of age. A questionnaire, clinical evaluation and specific tests (mirror and water tests) were used for confirmation of the mouth-breathing pattern. Results: Mean age of the participants was 4.13 ± 0.8 years and 57.1% were male. A total of 87.4% exhibited one or more harmful oral habits. Harmful habits were more common in the male gender (61.8%); this association was statistically significant (p<0.001). Mouth breathing was the most prevalent habit (49%), followed by biting/sucking on objects (33.3%). Regarding gender, statistically significant associations were found for bottle feeding (p=0.02) and nail biting (p=0.02). Mouth breathing was associated with biting on object (p=0.00), pacifier use (p=0.02) and thumb sucking (p=0.00). Conclusions: The results of the present study suggest that mouth breathing is significantly associated with biting/sucking on objects, pacifier use and thumb sucking in preschoolers and that the occurrence of harmful oral habits is more prevalent among the male gender. Early diagnosis and intervention should be established in order to avoid future consequences involving the orofacial region.

Coordination of tongue activity during swallowing in mouth-breathing children.

Habitual mouth breathing is often accompanied by habitual anterior tongue thrust, instead of a lip closure, in order to create the anterior seal necessary for the initiation of physiological deglutition. We tested the null hypothesis of no significant influence of oral maneuver and the use of oral screens on tongue coordination and position during deglutition in 29 subjects (age = 6–16; mean = 9.69 years; 13/16 female/male) with habitual open-mouth posture using intraoral polysensography. The target parameters for swallowing were swallowing-associated nasal airflow interruption (NAI) and coordination of tongue–palate contact during NAI. Conventional myofunctional maneuvers could be facilitated and made more efficient, in terms of increasing the numbers of favorable early tongue–palate contacts typical of somatic swallowing, if accompanied by the application of an oral screen. Habitual open-mouth breathing does not necessarily coincide with distinctively pronounced proportions of late tongue–palate contact.

Tipo facial e postura de cabeça de crianças respiradoras nasais e orais

To verify the facial type and the head posture of nasal and mouth-breathing children from habitual and obstructive etiologies, as well as to correlate the morphological facial index to the head angulation position in the sagittal plane. Participants were 59 children with ages between 8 years and 11 years and 10 months. All subjects were undergone to speech-language pathology screening, otorhinolaryngologic evaluation, and nasopharyngoscopy, allowing the constitution of three groups: nasal breathers--15 children; mouth breathers from obstructive etiology--22 children; and habitual mouth breathers--22 children. In order to determine facial type and morphological facial index, the height and the width of the face were measured using a digital caliper. The head posture was assessed through physical examination and computerized photogrammetry. It was verified the predominance of short face in nasal breathers, and long face in mouth breathers. There was an association among facial type and breathing mode/mouth breathing etiology: the brachyfacial type was more frequent among nasal breathers, and less frequent in subjects with obstructive nasal breathing. Head posture was similar in all three groups. No correlation was found between morphological facial index and head posture. The brachyfacial type favors the nasal-breathing mode and the head posture is not influenced by breathing mode and by the etiology of mouth breathing, as well as it is not related to facial type.

Dimensões do palato duro de respiradores nasais e orais por diferentes etiologias

To compare the hard palate dimensions of nasal-breathing children, mouth breathers from obstructive etiology, and habitual mouth breathers. The sample comprised 76 children, 37 boys and 39 girls, with mean age of 9.32±1.16 years, distributed according to the diagnosis of breathing mode and to the etiology of mouth breathing. Plaster cast models of the subjects' superior dental arch were obtained in order to measure the hard palate with a digital caliper. Measurements of transverse, vertical and anteroposterior palatal length were taken. The hard palate measures were compared among the groups through statistical analysis. The comparison of hard palate dimensions observed in nasal and mouth breathers showed differences regarding the distance and depth of second premolars, and the distance of first molars. Differences were also found between the groups of mouth breathers regarding the hard palate depth at the level of canines. Mouth breathers showed narrower hard palate at the level of second premolars and first molars, and deeper palate in the level of second premolars, when compared to nasal breathers. It is evidenced that habitual mouth breathers presented deeper hard palate at the level of canines, when compared to mouth breathers from obstructive etiology.

Associations between sleep-disordered breathing symptoms and facial and dental morphometry, assessed with screening examinations

Chronic snoring is considered abnormal in a pediatric population. This disorder is often attributed to enlarged tonsils and adenoids, but multiple anatomic obstructions should also be considered. Facial and dental morphometry associations with various sleep-disordered breathing symptoms were investigated at an orthodontic clinic. Parents or guardians were asked to complete a 4-part questionnaire on behalf of their children (n = 604; <18 years of age), including medical and dental history, bruxism and temporomandibular disorder habits, sleep and daytime behavior, and sleep duration and quality. All subjects underwent a clinical screening assessment by the same orthodontist to identify standard dental, skeletal, functional, and esthetic factors. In contrast to sleep-disordered breathing or sleep apnea in adults, which is predominantly associated with obesity, sleep-disordered breathing symptoms in this pediatric cohort were primarily associated with adenotonsillar hypertrophy, morphologic features related to a long and narrow face (dolichofacial, high mandibular plane angle, narrow palate, and severe crowding in the maxilla and the mandible), allergies, frequent colds, and habitual mouth breathing. Because of the recognized impact of pediatric snoring on children's health, the determination of these good predictors can help in preventing and managing sleep-disordered breathing. If a health professional notices signs and symptoms of sleep-disordered breathing, the young patient should be referred to a sleep medicine specialist in conjunction with an orthodontist if there are dentoskeletal abnormalities.

Prevalence and Persistence of Sleep Disordered Breathing Symptoms in Young Children: A 6-Year Population-Based Cohort Study

To describe the prevalence, persistence, and characteristics associated with sleep disordered breathing (SDB) symptoms in a population-based cohort followed from 6 months to 6.75 years. Avon Longitudinal Study of Parents and Children (ALSPAC). England, 1991-1999. 12,447 children in ALSPAC with parental report of apnea, snoring, or mouth-breathing frequency on any one of 7 questionnaires. Symptom prevalence rates-assessed as "Always" and "Habitually"-are reported at 0.5, 1.5, 2.5, 3.5, 4.75, 5.75, and 6.75 years of age. The proportion of children in whom symptoms develop, persist or abate between observation points is reported. Exploratory multivariate analyses identified SDB risk factors at 1.5, 4.75, and 6.75 years. The prevalence of apnea ("Always") is 1%-2% at all ages assessed. In contrast, snoring "Always" ranges from 3.6% to 7.7%, and snoring "Habitually" ranges from 9.6% to 21.2%, with a notable increase from 1.5- 2.5 years. At 6 years old, 25% are habitual mouth-breathers. The "Always" and "Habitual" incidence of each symptom between time points is 1%-5% and 5%-10%, respectively. In multivariate analyses of combined symptoms, socioeconomic factors have stronger, more persistent effects upon increased SDB risk than gestational age, gender, or race (aside from 1.5 years); adenoidectomy decreases risk by 40%-50%. This is the first natural history study of the primary symptoms of SDB across a key 6-year period in the development of SDB symptoms. Snoring rates are higher and spike earlier than previously reported. Symptoms are dynamic, suggesting the need for early and continued vigilance in early childhood.

Estudo das medidas antropométricas e das proporções orofaciais em crianças respiradoras nasais e orais de diferentes etiologias

OBJETIVO: Verificar e comparar as medidas e proporções orofaciais de crianças respiradoras nasais, orais obstrutivas e orais viciosas, com dentição mista. MÉTODOS: Participaram do estudo 57 crianças, 32 meninas e 25 meninos, leucodermas, com idades entre sete anos e cinco meses e 11 anos e dez meses. Os participantes realizaram triagem fonoaudiológica e avaliação otorrinolaringológica para diagnóstico do modo respiratório e etiologia da respiração oral. As avaliações possibilitaram a classificação das crianças em três grupos: 15 respiradores nasais; 22 respiradores orais obstrutivos; e 20 respiradores orais viciosos. Foi realizada avaliação antropométrica orofacial, com paquímetro digital. As medidas e proporções orofaciais de cada grupo estudado foram descritas. Medidas antropométricas e proporções orofaciais dos grupos foram comparadas, num nível de significância de 5%. RESULTADOS: Não foram verificadas diferenças nas medidas antropométricas e proporções orofaciais de respiradores nasais e respiradores orais obstrutivos e viciosos. CONCLUSÃO: Os resultados obtidos sugerem que o modo respiratório e as diferentes etiologias da respiração oral não determinam diferenças nas medidas e proporções orofaciais em crianças no período de dentição mista.

Some comments on surgery of nasal septum and turbinates in children

Every day orthodontists observe the consequences habitual mouth breathing has in their patients’ oral cavities and the limitations this dysfunction places on their orthopedic and orthodontic treatments. Orthodontists can enlist the assistance of their ENT colleagues for the elimination of hypertrophied adenoidal and tonsillar tissue, but when asked to perform surgical correction of malformed nasal septa and turbinates for young children most otolaryngologists usually advise strongly against such procedures. Even surgery for labio-maxillo-palatal clefts is still entangled in the same web of dogmatic disapproval. For these unilateral or bilateral cleft patients, 75 % of whom breathe primarily through their mouths, the potential for growth is considered to be limited and unpredictable. This belief, we feel, is related to the tendency of workers in our field to pay insufficient attention to nasal breathing. But in our practice, for the past thirty years we have been re-establishing it for patients at about the age of 6 and now we are doing it for children between the ages of 4 and 5. For the last 13 years we have helped affected children to breathe nasally at the age of 6 months by means of an ambitious but rigorous surgical procedure on all patients with total clefts. The current results on the nasal and maxillary growth of these children are good enough to encourage us to continue along the same lines, with the expectation of very soon being able to confirm our results as they reach the end of their growth periods.

Orthodontic treatment after adenoidectomy patients: effect on jaw relations in saggital plane

Adenoid hypertrophy is a normal phenomenon seen in young children. Adenoids may however be of large size or may not reduce in size in adulthood. Large adenoids may cause mouth breathing, overcrowding of teeth or otological symptoms. When adenoids are large and producing these effects, adenoidectomy is necessary. Adenoidectomy immensely benefits such patients but they may still continue to be habitual mouth breathers. This can lead to formation of long narrow face, labially protruded maxillary incisors and class 2 malocclusion. Immediate orthodontic treatment of such patients will improve facial profile and lead to class 1 (Angle) occlusion. We present here a study of 20 patients who were given early orthodontic treatment in postadenoidectomy period as compared to those patients who were not treated by orthodontist.

Treatment of mutilated malocclusion – A case report

A case report of 19-year old man who had an skeletal Class III mutilated malocclusion characterized by bilateral posterior cross bite & open blte, crowding, nail-biting, mouth breathing habit etc. A non-surgical approach was used to obtain significant improvement in occlusion & facial esthetics.

Influência do biofeedback respiratório associado ao padão quiet breathing sobre a função pulmonar e hábitos de respiradores bucais funcionais

OBJECTIVE: To evaluate the effects of using respiratory biofeedback associated with a quiet breathing pattern, on chest circumference, pulmonary function, respiratory muscle strength and the following functional mouth-breathing habits: watching things with mouth open, sleeping with mouth open, dribbling on the pillow, difficulty in waking up, snoring and restlessness during sleep. METHOD: Twenty functional mouth-breathing children were evaluated. They underwent 15 sessions of respiratory biofeedback by means of the biofeedback pletsmovent (MICROHARD® V1.0), which provided biofeedback on thoracoabdominal movements. Chest circumference, spirometry and maximum static respiratory pressures were determined before and after the therapy. The adults responsible for these children were asked questions about the children's mouth-breathing habits. Student's t test for paired data and non-parametric tests were used to analyze the data. RESULTS: The use of respiratory biofeedback in association with a quiet breathing pattern did not produce significant alterations in chest circumference or in forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), Tiffeneau index (TI) or maximal expiratory pressure (MEP). However, there was a significant difference in maximal inspiratory pressure (MIP) (-53.6 ± 2.9 cmH2O vs. -65.0 ± 6.0 cmH2O; p< 0.05) and there were significant changes in the evaluated habits. CONCLUSION: The results allow the conclusion that respiratory biofeedback associated with a quiet breathing pattern improves the inspiratory muscle strength and habits of functional mouth-breathers. It can therefore be used as a therapeutic method for such individuals.

Prevalence of oral malodor and the relationship with habitual mouth breathing in children.

The prevalence of oral malodor and association of habitual mouth breathing with oral malodor were investigated in children residing in rural areas. One hundred and nineteen children participated in this study. A sulfide monitor and organoleptic method were used to evaluate oral malodor. About 8% of children had a sulfide level in mouth air above the socially acceptable limit (75 ppb). Habitual mouth breathing was a factor contributing to oral malodor. Oral malodor was not significantly correlated with plaque index, history of caries or frequency of toothbrushing.

Otitis media with effusion and habitual mouth breathing in Dutch preschool children

Habitual mouth breathing (HMB) is defined as the habit of in- and exhaling (part of) the air through the mouth, when an individual is at rest and the nose is sufficiently free. It is postulated that HMB is a risk factor for otitis media with effusion (OME) in preschool children. The results are presented of a prospective cohort study on 253 3-year-old children, free from OME, with a follow-up period of 3 months, to determine the role of HMB in the etiology of OME. The risk ratio for OME of habitual mouth breathers, compared to nose breathers, was found to be 2.4 (95% confidence interval (C.I.): 0.99–5.70). Moreover, there is a clear and significant linear trend in the proportion of OME in 3 breathing categories: nose breathing, intermediate and mouth breathing. This relation remains after correction for confounding. It is concluded that HMB is a risk factor for OME. It is estimated that about 20% of the incidence of OME is caused by HMB. The high incidence of OME means that HMB carries a great deal of impact. Suggestions are made for the prevention and treatment of HMB.

The relationship between nasal airway size and nasal-oral breathing

Most clinicians agree that impaired nasal breathing results in obligatory mouth breathing. Some believe that mouth breathing influences dentofacial growth; others disagree. The term mouth breathing is confusing because total mouth breathing rarely occurs. A combination of nasal and oral breathing is more usual. The purpose of the present study involving 116 adult subjects was to (1) assess the relationship between nasal impairment and nasal-oral breathing, (2) determine the switching range from nasal to nasal-oral breathing, and (3) quantify the term mouth breathing. The pressure-flow technique was used to estimate nasal airway size; inductive plethysmography was used to assess nasal-oral breathing in normal and impaired breathers. Analysis of the date showed a Pearson rank correlation of 0.545 ( P < 0.001) between nasal area and nasal-oral respiration. Ninety-seven percent of subjects with a nasal size <0.4 cm 2 were mouth breathers to some extent. About 12% of subjects with an adequate airway were assumed to be habitual mouth breathers. The findings indicate that the switching range from nasal to nasal-oral breathing is very narrow (0.45–0.45 cm 2). These results also confirm our contention that in adults an airway <0.4 cm 2 is impaired.

Influence of Breathing Mode and Activity Level on the Regional Deposition of Inhaled Particles and Implications for Regulatory Standards

Particulate-size-selective sampling is an important consideration in determining ambient air-quality standards and threshold limit values for workplace exposures. Hazard evaluations, as well as risk analyses, can benefit from an improved understanding of factors affecting regional respiratory tract deposition of particles in man. Here, thoracic deposition and its component parts are examined, as a function of particulate size, for ventilation rates ranging from normal respiration to heavy exercise in individuals who are habitual mouth breathers and in those who normally employ oronasal breathing when minute ventilations exceed approximately 35 Lmin-1. Nonlinear regression techniques were used to fit logistic models of the form Y = (1+e alpha+beta log X)-1 to data from tests measuring extrathoracic (ET) and tracheobronchial (TB) deposition.

12 口呼吸における口腔内気流の可視化実験(1)

Nasal cavity is well fitted for respiratory function. Habitual mouth breathing, however, is not only un-physiological, but also quite hazardous to maintain oral health condition. Clinically, severe gum-disease, multiple tooth decay and bad mouth odor may be associated with mouth breasing, but their cause has not been clarified yet sufficiently. To estimate the flow pattern associated with mouth breathing, equipotential points in and out oral cavity were measured on a jaw model. Following to this experiment, Uranin and aluminum powder introduced in water flow to visualize flow patterns of inspiration and expiration. As the results of these experiments, the followings were observed:(i) Main inhalation flow goes into the oral cavity along the lower lip as. well as in front of the mouth;(ii) Direction and speed of flow were mainly affected by angulations and opening widths of upper and lower teeth ;(iii) After entering into the mouth, main flow clashed against the palatal gum margin and then ran into the throat alongside hard palate.

The stability of maxillary expansion

The assessment and treatment by rapid maxillary expansion of 516 cases referred by medical practitioners for the treatment of poor nasal airway is reported. The technique is simple and most suitable for the correction of crossbite and Class III malocclusion and for establishing a nasal airway in habitual mouth breathers with a history of ENT problems.

Orofacial muscle imbalance: Some considerations in referral

Orofacial muscle imbalance, with its ancillary disorders of tongue thrust swallow, poor tongue posture habit, mouth breathing, thumb sucking, and other orolingual habits or activities, presents some problems related to the time when a referral should be made. These referrals may originate from the dentist, orthodontist, allergist, otorhinolaryngologist, neurologist, speech pathologist, or the myofunctional clinician, to mention a few. This paper was written to discuss some of the conditions which should be considered in determining if a referral should be made, and if so, to whom? Along with the more typical referral reasons, the referring clinician may wish to consider growth factors, tongue size, patency of the nasal airway and related problems of lisping and tongue thrust, resting postures, diet, masticatory muscle tonus, and signs of neuromuscular dysfunction. [article excerpts]

口呼吸の歯周組織におよぼす影響に関する研究

Mouth breathing is an important etiological factor of chronic gingivitis and chronic marginal periodontitis as well as dental plaque and calculus. However, mechanism of mouth breathing for the initiation of gingival inflammation has not been clearly demonstrated.The purpose of this study is to observe the effect of oral screen and lip seal tape for mouth breathers, during sleeping.Ten patients suffering from chronic marginal periodontitis with habitual mouth breathing were used for this study and experimental periods were 30 days. Before, during and after experimental periods, oral findings were examined and biopsy specimens of the gingiva were taken.Consequently we obtained the findings of clinical changes, pocket depth, thickness of the gums and histopathologic changes of the gingiva.Results were as follows:1. Halitosis and unconfortable feeling in mouth were decreased clearly.2. Depth of periodontal pocket and labio-lingual width of the gingiva were improved. They were mainly seen at labial side of maxilla.3. The histopathologic examination showed that vacuolar degeneration of epithelial cells were reduced, but inflammations of connective tissue were not improved clearly.

On the Formation of Salivary Calculus over the Inferior Incisors, caused by Habitual Mouth-Breathing

On the Formation of Salivary Calculus over the Inferior Incisors, caused by Habitual Mouth-Breathing