MOUTH BREATHING.pptx

mouth breathing

1. MOUTH BREATHING HABITS. -NOOHA AYSHA KAMAL 3 rd 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

3. 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 .

4. 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 .

5. 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 .

6. STOMATITIS

7. 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

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

9. 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 : MIRROR TEST : 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

10. . BUTTERFLY TEST : 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 HOLDING TEST : 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 .

11. 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.

12. TREATMENT CONSIDERATION: AGE OF THE 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 .

13. CORRECTIONS : ELIMINATION OF THE 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 OF THE 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 .

14. . 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 .

15. 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 .

16. 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 .

17. . 4.BUTTERFLY TEST : 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 MIRROR TEST : 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.WATER TEST :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.

18. REFERENCE: Textbook of Pediatric Dentistry by SHOBA TANDON. Textbook of Pediatric Dentistry by NIKHIL MARWAH. Textbook of Pediatric Dentistry by S.G DAMLE.