Mouth Breathing – Definition, Classification, Diagnosis and Treatment

Mouth Breathing is a Habit which is not normal, as a Habit is defined as a methodical way in which mind and body act as a result of frequent repetition of a certain definite sets of nervous impulses. Mouth Breathing has been defined by Sassouni ad Merle.

  • Chacker FM (1961): It is a prolonged or continued exposure of the tissues of anterior areas of mouth to the drying effects of inspired air.
  • Sassouni (1971): It is the habitual respiration through the mouth instead of Nose.
  • Merle (1980): Introduced the term Oro-nasal breathing instead of mouth Breathing.

Classification of Mouth Breathing:

1 – Obstructive mouth breathing: Nasal Obstruction leading to mouth breathing which can be due to Hypertrophy of nasal turbinates, hypertrophy of pharyngeal lymphoid tissue-tonsils and adenoids.

2 – Habitual mouth breathing: It is due to no underlying condition but mouth breathing

3 – Anatomical mouth breathing:  It is caused due to Anatomical malformations seen in the Oral and Nasal anatomy which leads to Mouth breathing – Deviated Nasal Septum.

Etiology of Mouth Breathing:

The primary Etiology is Nasal Obstruction which can be caused due to any reason. In case of Obstruction of the nasal passage it is our body’s innate response to start breathing through our mouth.

1 – Allergic Rhinitis

2 – Shape of Maxilla – V shaped maxilla is seen in Mouth Breathers

3 – Nasal Polyps

4 – Sleep Apnea – Obstructive Sleep apnea syndrome

5 – Facial Type – Ectomorphs

6 – Intranasal Defects – Deviated Nasal Septum

7 – Genetic Predisposition

8 – Due to other Habits – Thumb Sucking

9 – Short Upper lip or Flaccid upper lip – which does not close completely while in rest leading to breathing through the oral cavity.

Clinical Features of Mouth Breathing:

The most obvious feature of Mouth Breathers is the Shape of the Face – Adenoid Face. It is the appearance of Open mouth face with features such as short upper lip, prominent upper teeth, crowded teeth, high arched palate, hypoplastic maxilla, underdeveloped thin nostrils.

(Adenoid Facies – Long narrow face (Dolicofacial), Expression less face, Flaccid lips, short upper lip, Nares anteriorly placed, Narrow maxilla)

  1. Snoring
  2. Dry Mouth
  3. Bad Breath
  4. Redness of Gum in the upper and lower anterior teeth – Mouth Breathing Gingivitis
  5. Colds – frequent colds are seen in mouth breathers
  6. Oesophagitis – Low Grade
  7. Tired and Irritable of waking up in the morning
  8. Hoarseness in voice
  9. Tonsils Infection and Adenoid infection
  10. Decreased sense of smell
  11. Altered Speech – What we call as Nasal Tone
  12. Brain fog
  13. Chronic Fatigue
  14. Pigeon chest deformity
  15. Poorly developed Sinuses

Oral or Dento-facial clinical features of Mouth Breathing:

  1. Long Face – increased Anterior facial height
  2. Increase in Mandibular Plane angle
  3. Open and Everted Lips
  4. Lips which cannot be closed completely
  5. Reduction in the Vertical Overlap of Upper and lower Anteriors – “Open Bite”
  6. Leading to Gummy Smile
  7. Constriction of the Maxillary Arch and Crossbite in the posterior teeth
  8. Increased Viscosity of Saliva

Diagnosis of Mouth Breathing:

Diagnosis of Mouth breathing can be done by observing the most common features associated with it and coming to a conclusion based on the Clinical features and findings.

Some of the most commonly found or associated clinical features which help in diagnosing mouth breathing are –

  1. Not able close Lips together
  2. Recurring Tonsilitis / Oseophagitis
  3. Recurring Respiratory infections
  4. Allergic Rhinitis
  5. Otitis Media – Ear Infection which is related to cold, sore throat or any respiratory infection
  6. Hoarseness of Voice
  7. Malocclusion

Apart from Observing the clinical features we can also conduct some Clinical tests to confirm Mouth Breathing –

Note: Atleast two tests should be taken into consideration before coming to a conclusion.

Mirror Test for Mouth Breathing – In a Dental Clinic setting – Place the mirror ends of two Mouth Mirrors opposing each other – one facing the mouth and the other facing the Nostrils . Ask the patient to breathe – here we can see fogging of the mirror facing the Mouth side.

Water Holding Test: The patient is asked to hold water in their mouth (15 ml approximately) and is asked to hold it for 3 minutes minimum. To make sure there are no leaks, it is best to seal both the lips shit with a Tape. If the patient is able to hold without gasping for breath we can rule out mouth breathing, but if he/she is finding it difficult to hold for long we can confirm mouth breathing.

Massler and Zwemmer Butterfly Test: A cotton piece is taken and shaped like a butterfly, it is placed over the upper lip just below the nostrils – Ask the patient to breathe, if the Cotton moves downwards while exhaling it is Nasal breather, if the cotton moves upwards while Exhaling it is a Mouth Breather.



Treatment of Mouth Breathing:

Treatment of Mouth Breathing can be called as Management as Mouth breathing is caused due to multiple factors, it has to be addressed at an early age to prevent any permanent damage.

First thing is to rule out – Nasal Obstructions which are the most common cause of Mouth Breathing, so if any Nasal Obstruction is observed treating it will directly treat Mouth breathing.

Some factors which are to be considered or kept in mind during the treatment of Mouth Breathing are – Age of the Child, ENT Examination and elimination of any Causes such as – Removal of Inflamed Tonsils, Removal of Adnoids, Septoplasty.

The best age for correction of Mouth breathing is Mixed Dentition Period with either Surgery, Rapid Maxillary Expansion or Local Medication depending on the cause.

During the Treatment process it is important to make sure that Symptomatic Treatment is given – Inflamed Anterior Gingiva is moistened during the night using a petroleum jelly. Lip Exercises are performed – Extension of Upper Lip, Patient is asked to play a Wind Instrument, lower lip exercise to help close the lips together.

We can use a Macaray Activator which is used under Maxillothorasic myotherapy. Physical exercises or Breathing exercises are advised – Deep breathes in the morning and night. Use of an Oral Screen is also advised. Use o Orthodontic treatment like Oral Shield appliance, Monoblock Activator and Chin Cap are advised depending on the case.

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