Mouth breathing is a chronic dysfunctional breathing pattern linked to anatomical obstruction, habits, and sleep-related disorders.
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✅ Introduction
Mouth breathing refers to the predominant use of the oral cavity instead of the nose for airflow at rest. While occasional mouth breathing during a cold or intense exercise is normal, persistent oral respiration is clinically significant. Research shows that chronic mouth breathing disrupts nasal filtration, alters muscle activity, modifies dental arch development, and contributes to both malocclusions and sleep-disordered breathing (Zaghi et al., 2022). Early identification is crucial because craniofacial structures in children are still developing and more susceptible to functional changes.
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➤ Anatomical Causes
▪️ Adenoid or tonsillar hypertrophy
▪️ Deviated nasal septum
▪️ Chronic allergic rhinitis
▪️ Nasal polyps
▪️ Inferior turbinate hypertrophy
➤ Functional and Behavioral Causes
▪️ Habitual open-mouth posture
▪️ Thumb sucking or prolonged pacifier use
▪️ Incorrect resting tongue position
▪️ Orofacial muscle hypotonia
➤ Sleep-Related Causes
▪️ Obstructive Sleep Apnea (OSA)
▪️ Primary snoring
▪️ Sleep-disordered breathing secondary to obesity
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➤ Craniofacial Growth Alterations
Chronic mouth breathing can redirect mandibular and maxillary growth patterns, producing the classic long-face syndrome (adenoid facies). Associated findings include:
▪️ Narrow maxilla
▪️ High palatal vault
▪️ Increased lower facial height
▪️ Posterior crossbite
▪️ Class II malocclusion tendencies
➤ Oral Health Impacts
▪️ Increased risk of dental caries due to reduced salivary flow
▪️ Gingival inflammation
▪️ Halitosis
▪️ Lip incompetence and dry mucosa
➤ Systemic and Behavioral Consequences
▪️ Daytime fatigue
▪️ Learning difficulties
▪️ Reduced concentration
▪️ Behavioral issues resembling ADHD
▪️ Poor sleep quality
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➤ Oral and Periodontal Effects
Persistent oral breathing in adults often leads to:
▪️ Chronic xerostomia
▪️ Gingivitis and periodontitis progression
▪️ Higher susceptibility to root caries
➤ Respiratory and Sleep Effects
▪️ Snoring
▪️ Sleep-disordered breathing
▪️ Reduced oxygen saturation during sleep
▪️ Morning headaches
➤ Musculoskeletal and Postural Changes
▪️ Forward head posture
▪️ Neck and shoulder tension
▪️ Temporomandibular joint (TMJ) discomfort
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➤ Clinical Evaluation
A comprehensive assessment includes:
▪️ Nasal patency examination
▪️ Lip competence observation
▪️ Tongue posture evaluation
▪️ Adenoid/tonsillar inspection
▪️ Cervicofacial posture assessment
➤ Complementary Exams
▪️ Lateral cephalometric radiograph
▪️ Nasal endoscopy (ENT evaluation)
▪️ Sleep study if OSA is suspected
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➤ Treatment in Children
Management depends on etiology and severity:
▪️ Adenotonsillectomy for obstructive hypertrophy
▪️ Allergy control (intranasal corticosteroids or antihistamines under medical guidance)
▪️ Maxillary expansion (RPE, SME) to widen nasal cavity and improve airflow
▪️ Myofunctional therapy to correct oral posture
▪️ Discontinuation of harmful habits
➤ Treatment in Adults
▪️ Nasal obstruction management (surgical or medical depending on case)
▪️ CPAP if associated with OSA
▪️ Orthodontic or orthognathic treatment when skeletal discrepancies persist
▪️ Orofacial myofunctional training
📊 Comparative Table: Nasal Breathing vs. Mouth Breathing
| Aspect | Advantages | Limitations |
|---|---|---|
| Nasal Breathing | Filters, warms and humidifies air; supports optimal craniofacial growth | Limited during obstruction or anatomical deviations |
| Mouth Breathing | Allows airflow when nasal passages are blocked | Leads to malocclusions, dry mouth, poor sleep and systemic effects |
💬 Discussion
Chronic mouth breathing is not a simple habit; it is a multifactorial condition with structural, functional, and behavioral consequences. Evidence shows that early intervention produces better outcomes, especially in the pediatric population where craniofacial growth can still be redirected. Adults, on the other hand, often require combined therapies rather than single-modality treatment. A multidisciplinary approach—pediatric dentistry, ENT, orthodontics, speech therapy, sleep medicine—is essential for long-term success.
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Mouth breathing substantially affects oral health, craniofacial development, systemic physiology, and sleep quality. Early diagnosis and targeted intervention are essential to prevent irreversible complications. Both adults and children benefit from an individualized management plan addressing nasal obstruction, soft-tissue dysfunction, and skeletal discrepancies.
🔎 Recommendations
▪️ Evaluate nasal patency and adenoid/tonsil size in all mouth-breathing children.
▪️ Implement orthodontic expansion when indicated.
▪️ Consider ENT referral early when obstruction is suspected.
▪️ Educate parents about the impact of oral habits on breathing.
▪️ Incorporate myofunctional therapy as part of long-term rehabilitation.
▪️ For adults, screen for sleep-disordered breathing before starting treatment.
📚 References
✔ Villa, M. P., Evangelisti, M., Barreto, M., Cecili, M., & Kaditis, A. G. (2017). Nasal obstruction in children: A clinical review. International Journal of Pediatric Otorhinolaryngology, 99, 81–88. https://doi.org/10.1016/j.ijporl.2017.05.029
✔ Zaghi, S., Patel, P., Barber, R., & Guilleminault, C. (2022). Sleep disordered breathing, mouth breathing, and craniofacial development: The role of myofunctional therapy. Sleep Medicine Reviews, 61, 101572. https://doi.org/10.1016/j.smrv.2021.101572
✔ Camacho, M., Certal, V., Abdullatif, J., et al. (2015). Myofunctional therapy to treat obstructive sleep apnea: A systematic review and meta-analysis. Sleep, 38(5), 669–675. https://doi.org/10.5665/sleep.4652
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