ArticlePDF Available

The Mouth Breathing Syndrome: prevalence, causes, consequences and treatments. A Literature Review

Authors:

Abstract

Resumo The Mouth Breathing Syndrome (MBS) is characterized by pattern of mouth breathing (MB) or mixed breathing chronic caused by nasal obstruction or inflammatory factors, which may be present in half of the school children. The permanence of the framework affects the individual globally, and especially their stomatognathic functions, posture and quality of life, requiring multidisciplinary care. This paper aims to provide an overview of recent scientific production on the prevalence, etiologies, sequelae and treatments in MBS. The method used was a literature review through a research in the databases of LILACS, Medline and SciELO, obeying defined inclusion criteria. The 45 articles chosen were distributed and analyzed in groups: prevalence (1), causes (9), consequences (28) and treatments (7). This review highlighted the lack of studies on the prevalence of MB, specially in adults, besides the preponderance of studies on the consequences rather than on the analysis of its causes and treatments. It also showed the need to sensitize health professionals to the recognition of MBS, as long as a global and early intervention with these patients.
J Surg Cl Res Vol. 5 (1) 2014:47-55 47
The mouth breathing syndrome: prevalence, causes, consequences and
treatment
Síndrome da respiração oral: prevalência, causas, consequências e tratamento
Diana Lopes Lacerda Martins, Luciana Fontes Silva Cunha Lima, Vanessa Favero
Demeda, Ana Luiza Oliveira da Silva, Angela Rosanne Santos de Oliveira, Flávia Melo
de Oliveira, Sarah Beatriz Freire Lima, Valéria Soraya de Farias Sales
Research performed at Department of Surgery, Federal University of Rio Grande do Norte (UFRN), Brazil.
Financial support: none.
Conflict of interest: none
Correspondence address: Diana Lopes Lacerda, Department of Surgery, Federal University of Rio Grande
do Norte, at Av. Nilo Peçanha 620, Natal, RN, Brazil.
Submitted: 29 Jul 2014. Accepted, after review: 15 Aug 2014.
ABSTRACT
The Mouth Breathing Syndrome (MBS) is characterized by pattern of mouth breathing
(MB) or mixed breathing chronic caused by nasal obstruction or inflammatory factors,
which may be present in half of the school children. The permanence of the framework
affects the individual globally, and especially their stomatognathic functions, posture
and quality of life, requiring multidisciplinary care. This paper aims to provide an
overview of recent scientific production on the prevalence, etiologies, sequelae and
treatments in MBS. The method used was a literature review through a research in the
databases of LILACS, Medline and SciELO, using defined inclusion criteria. The 45
articles chosen were distributed and analyzed in groups: prevalence (1), causes (9),
consequences (28) and treatments (7). This review highlighted the lack of studies on
the prevalence of MB, specially in adults, besides the preponderance of studies on the
consequences rather than on the analysis of its causes and treatments. It also showed
the need to sensitize health professionals to the recognition of MBS, as long as a
global and early intervention with these patients.
Keywords: Mouth Breathing Syndrome; Mouth breathing; Prevalence, Causes,
Sequelae; Treatment.
RESUMO
A Síndrome de Respiração Bucal, (SRB) é caracterizada por um padrão de respiração
bucal (RB) ou respiração crônica mista causada por obstrução nasal ou fatores
inflamatórios, que podem estar presentes em metade das crianças em idade escolar.
A permanência do quadro afeta o indivíduo como um todo, especialmente as suas
funções estomatognáticas, a postura e a qualidade de vida, necessitando de
atendimento multidisciplinar. Este trabalho tem como objetivo fornecer uma visão geral
da produção científica recente sobre a prevalência, etiologia, sequelas e tratamentos
em SRB. O método utilizado foi uma revisão da literatura através de uma pesquisa nas
bases de dados Lilacs, Medline e SciELO, utilizando critérios de inclusão definidos. Os
The mouth breathing syndrome: prevalence, causes, consequences and treatment
Martins DLL, et al
J Surg Cl Res Vol. 5 (1) 2014:47-55 48
45 artigos selecionados foram distribuídos e analisados em grupos: prevalência (1),
etiologia (9), conseqüências (28) e tratamentos (7). Esta avaliação destacou a falta de
estudos sobre a prevalência da RB, especialmente em adultos, além da
predominância de estudos sobre as consequências e não na análise de suas causas e
tratamentos. A revisão também mostrou a necessidade de sensibilizar os profissionais
de saúde para o reconhecimento da SRB, para uma intervenção global e precoce com
esses pacientes.
Descritores: Síndrome de respiração bucal. Respiração oral. Prevalência. Etiologia.
Sequelas. Tratamento.
INTRODUCTION
The mouth breathing syndrome (MBS) is characterized by the replacement of
standard nasal breathing exclusively for a standard oral or mixed substitutive with
lasting longer than 6 months. Commitments in functional, structural, postural and
biomechanical aspects are involved in this syndrome1.
Mouth breathing (MB) in children is a frequent complaint in the pediatrician's,
the allergist and otolaryngologist offices2. Studies in Brazilian cities with students, found
a prevalence of this syndrome ranging from 26% to 56% of the children3,4 . In addition
to these medical specialties, it is very important the contribution of audiologists,
dentists and physiotherapists.
There are several factors that can lead to mouth breathing, and allergic rhinitis
is possibly the most common, affecting 15-20% of the population. The hypertrophy of
palatine tonsils and adenoids is the second cause of this breathing pattern2. The
permanence of this framework, besides endangering the balance of stomatognathic
functions, such as chewing, swallowing, breathing and phonation, conditions that
influence development of individual, will change the balance of muscular and postural
strength, that causes losses in sleep and learning. Therefore, the model of nasal
breathing when replaced by supplementary, oral or mixed pattern, can, according to
their duration, intensity and time of installation, cause severe morphological and quality
of life changes5.
Due to the relevance of the topic, this article aims to survey the scientific
literature in recent years regarding prevalence, etiology, consequences and treatments
for mouth breathing in order to update healthcare professionals involved in the
recognition of this syndrome and sensitize them looking for an early and
comprehensive intervention.
METHODS
For the preparation of this paper, we used a literature review from articles
published in scientific indexed journals identified from the databases LILACS,
MEDLINE and SciELO using key words "mouth breathing". In the study, inclusion
criteria were papers that addressed prevalences, etiology, consequences and
treatments for mouth breathing, published in the last five years, the scientific article
type, made based on studies of the case-control, cohort, clinical trials or literature
The mouth breathing syndrome: prevalence, causes, consequences and treatment
Martins DLL, et al
J Surg Cl Res Vol. 5 (1) 2014:47-55 49
reviews, conducted with samples of all age groups and both sexes. We found 47
articles and 2 were excluded. These articles were excluded for addressing similar
results (postural consequences) to several other selected. Based on 45 studies, were
presented the results of scientific production related to prevalence of MB, their causal
relationships, impact and therapeutic approaches.
RESULTS
Prevalence
A Brazilian study analysed 419 school children, aged 6 to11 years, and showed
that the prevalence of this syndrome was 56.8% from the sample investigated4.
Causes
Regarding the causes of the MBS, two studies found that the emergence of MB
coincides with the decrease in labial sealing and breastfeeding and also with the
increased use of bottle and pacifier sucking6,7. In two articles, allergic rhinitis was
identified as the major etiological factor8,9, and in one of them about 36% of 439
children with MB had atopic cause8. This finding was consistent with a study on the
impact of allergic rhinitis on the breath, revealing that 100% of adults, 96.7% of
adolescents and 83.3% of children had MB10. There were also reports related with
cystic fibrosis11, moderate persistent asthma12, present in 44% and 45% of patients,
respectively. With regard to international literature, a study in Chile, with 100 oral
breathing children aged 3 - 5 years showed that 27% had no obstruction of the upper
airway. The main cause of the obstruction was adenoid hypertrophy (48, 8%), followed
by turbinate hypertrophy (29.0%). The minor causes corresponded to choanal and
maxillary atresia with 12.0% and 7.0%, respectively13. A Brazilian study with 308 mouth
breathers 3-12 years found palatine tonsillar hypertrophy in 47%, adenoid hypertrophy
in 46% and atopy in 36% of evaluated patients2.
Consequences
Postural changes
The postural adaptations in MB are documented in five studies conducted with
children containing samples variables of 34-430 people1,3,14-16. Two of which showed
that the main postural change occurs in the cephalic segment, more anterior in the
mouth breathers14,15 . A study on changes in the thoracic spine showed abnormalities
like retraction of chest, trunk inclination and thoracic kyphosis on the mouth breathers3.
Four researches revealed that the MB and its postural changes negatively
affected respiratory biomechanics 1,16-18, three of them showing a reduction in exercise
capacity by decreased respiratory muscle strength in comparison with nose
breathers1,16,18.
Orofacial and stomatognathic changes
Addressing changes in facial morphology, a survey found that the main clinical
changes of breathers are: long face, narrow nostrils, inappropriate lip seal and
The mouth breathing syndrome: prevalence, causes, consequences and treatment
Martins DLL, et al
J Surg Cl Res Vol. 5 (1) 2014:47-55 50
malocclusion5. In controversy, other research of the sample revealed that the presence
of adenotonsillar hypertrophy or rhinitis was not associated with these facial stigmas19.
In the case of cephalometric evaluation, it was found a total of seven jobs
conducted with children using samples ranging from 40 to 144 subjects20-26. One article
found predominance of short face in nasal and long face in mouth breathers20.
However, two other studies found no differences in anthropometric measurements and
orofacial proportions21,22. Two studies demonstrated that cephalometry in children with
mouth breathing is similar to the cephalometric pattern in patients with obstructive
sleep apnea syndrome (OSAS) described in the literature23,24.
Two studies analyzed measurements of the hard palate, and one of them
demonstrated that the MB was associated, with great frequency, to increase the depth
of the hard palate and, less frequently, to decrease its width25. In the other study, there
was no difference in the measures of the palate in relation to respiratory pattern26.
The research that compared the swallowing mouth and nose breathers found
that the mouth breathers showed swallowing disorders with the presence of lip, chin
and tongue thrust action, while nasal breathers showed no such changes27. Studies on
chewing found no statistical difference on masticatory performance of the oral and
nasal breathers28,29. Another study showed that the RO interfered negatively to
masticatory muscle activity30. One of the studies showed decreased tone of the tongue
and lower lip in oral breathers31 and another highlighted phonation changed in 30% of
the oral breathers analyzed8.
A study related MB with the modification in the overall diet and nutritional status,
associated with the involvement of structures such as the dental arch, to changes in
the masticatory process, difficulties in smelling, taste disorders and orofacial
miofunctional disorders32.
Hearing changes
Research related to the leading causes of MBS with auditory consequences
showed two results. In one of them, the mouth breathers by functional etiology had
100% of normal hearing and in the others etiologies, a mild conductive hearing loss
was prevalent, especially in cases of adenoid hypertrophy33. In the other study, children
with MB showed lower performance on auditory processing skills than children with
normal breathing pattern34.
Sleep changes
We found two articles in the literature that directly address sleep disorders.
OSAS was present in 42% of individuals in a sample of 248 patients, being higher in
males, and correlated with the finding of hypertrophy adenotonsillar, primary snoring in
58% and the peak occurrence of these disorders was within the age range from 4 to 7
years35. In another article, it was performed population-based survey that evaluated
quality of life, especially the MB group reported having problems sleeping, with snoring
achieving 87%36.
The mouth breathing syndrome: prevalence, causes, consequences and treatment
Martins DLL, et al
J Surg Cl Res Vol. 5 (1) 2014:47-55 51
Learling changes
With regard to learning, three articles tested the occurrence of learning deficit in
children affected by MBS, two of which pointed out that damage37,38 and the other
showed no significant differences in this regard36.
Treatments
In the literature, it was found the following approaches to physiotherapy for
MBS: miofuncional therapy, study of 6 children39, reeducation of the respiratory
muscles in 10 school40 and postural correction exercises performed in 12 children with
MB41, which respectively promoted improvement in the standard of labial sealing,
increased inspiratory capacity and improved craniocervical alignment with restoration
of physiological lordosis.
Regarding to the area of speech-therapy, two studies were conducted; one with
24 children and adolescents with asthma and allergic rhinitis, which was based on the
awareness and proprioception mode and respiratory tract, isometric exercises for
strengthening the lips, tongue and cheeks, appropriateness of placement of sealing
lips, adequacy of habitual tongue position and breathing exercises to stimulate nasal
breathing being effective in spacing and reduce allergic crises and exacerbations42.
The second was an intervention made with 40 children, based miofunctional exercises,
workout of the respiratory and miofuncional mode, which resulted in a significant gain
in nasal breathing function, improvement of strength and praxis43.
As for surgical approaches, research has demonstrated the benefits of
adenotonsillectomy for 18 children with adenotonsillar hypertrophy in order to allow the
return of nasal breathing, benefit to the dental occlusion, favoring the adequate
morphofunctional development of the face44. Another article analyzed the effect of rapid
maxillary expansion surgery in 29 children and it was found that this procedure, by
itself, is not justified to induce a nasal breathing pattern in oral breathers45.
DISCUSSION
Mouth breathing leads to several deleterious consequences, such as changes
in body posture, development of the stomatognathic system, changes in nutritional
status, sleep disorders and school problems3. Thus, it is imperative a global
intervention, avoiding pathological compensatory mechanisms1.
In addition to the consequences, it is critical to detect the cause of MB to not
indicate inappropriate or insufficient treatments, and also the overall analysis of the
patient, including aspects that compromise the quality of life.
MB inhibits the neural mechanisms that regulate airway function since its
components are located in the nose32. Nasal block also results in higher airway
resistance with inadequate alveolar ventilation. It has also been shown that breathing
pattern imposed by the MBS involves adaptive postural requirements. To facilitate
airflow through the pharynx, the patient projects the head and extends the neck1,16.
These neuromuscular adaptations may compromise the body balance14 since, facing
the change of one unit biomechanics, refinements and compensation of the postural
control systems occur.
The mouth breathing syndrome: prevalence, causes, consequences and treatment
Martins DLL, et al
J Surg Cl Res Vol. 5 (1) 2014:47-55 52
When opening the mouth to breathe, it also occurs imbalance in orofacial
functions32, may cause dental abnormalities, of the phonoarticulatory organs,
disturbances in chewing and swallowing3. When the genesis of the problem is adenoid
hypertrophy, eustachian tube can be blocked contributing to the development of ear
infections and hearing loss33.
Some children who breathe through the mouth may have nocturnal obstructive
apnea due to the reduction in nasopharyngeal airway23. The change in the sleep
process, often caused by poor cerebral oxygenation, also leads to constant state of
adynamia, headaches, daytime sleepiness, nocturnal enuresis and even learning
deficit32. Sleep disorders are very frequent and pointed out as causes of reduced
quality of life by interfering both in social and scholar performances.
Studies on the prevalence and causes of SRO found results in line with the
literature with emphasis on allergic rhinitis, which is configured as the most prevalent
cause. This reinforces the importance of the allergist in the management of oral
breathing. Exception should be made for the lack of studies about other causes also
common MBS, especially in adults, such as nasal septal deviation and turbinate
hypertrophy, as well as prevalence studies of MBS in adults.
In the analysis of the consequences, is notorious the increase number of works
focusing on this, as well as the range of observed changes. Studies on postural
adaptations confirm what is already known in the literature about these sequels,
especially the cervical anteriorization, recognized as the main compensatory postural
change. Changes in facial measurements and the stomatognathic function were
reported in several analyzed papers, but a minority of them did not find, in the samples
tested, the presence of these deformities in their patients. Less studied sequelae, such
as the effects on hearing health, sleep and neuropsychiatric were also explained,
demonstrating that the MBS affects a wide range of issues involved in health.
The management towards a patient with mouth breathing consists of several
treatment options depending on the cause and the sequel for each patient can be
medication, surgery, rehabilitation speech therapy, physical therapy or orthodontics.
Also in this case it was found that the studies, beyond limited number, are structured
often based on small samples of patients without combat the cause of MB, which
decreases the confidence in the results. Little has been investigated as treatments
targeted on causes of the MB, and the majority of the work is focused only on reducing
sequelae.
CONCLUSION
The mouth breather is a patient with multiple conditions and therefore requires
comprehensive and multidisciplinary clinical look to early detect this syndrome,
minimizing its deleterious effects.
This review showed the lack of studies of the prevalence of MB in adults, and
the preponderance of studies about the consequences of MB rather than analyzing its
causes and treatments. This review concludes that much progress is needed in a
multidisciplinary look regarding these patients, for all health professionals better
understand the syndrome and prevent its sequelae.
The mouth breathing syndrome: prevalence, causes, consequences and treatment
Martins DLL, et al
J Surg Cl Res Vol. 5 (1) 2014:47-55 53
REFERENCES
1. Okuro RT, Morcillo AM, Ribeiro MÂ, Sakano E, Conti PB, Ribeiro JD. Mouth
breathing and forward head posture: effects on respiratory biomechanics and
exercise capacity in children. J Bras Pneumol. 2011; 37: 471-9.
2. Costa Junior EC, Cantareira SHA, Sponchiado MC, Azevedo CB, Menezes UP,
Pereira VFC et al . Atopia e hipertrofia adenoamigdaliana em pacientes
respiradores bucais em um centro de referência. Braz J
Otorhinolaryngol. 2013;79:663-7.
3. Conti PBM, Sakano E, Ribeiro MAGO, Schivinski CIS, Ribeiro JD. Avaliação da
postura corporal em crianças e adolescentes respiradores orais. J Pediatr.
2011;87: 357-63.
4. Felcar JM, Bueno IR, Massan AC, Torezan RP, Cardoso JR. Prevalence of mouth
breathing in children from an elementary school. Cien Saude Colet. 2010;15:437-
44.
5. Menezes VA, Tavares RLO, Granville-Garcia AF. Síndrome da respiração oral:
alterações clínicas e comportamentais. Arq Odontol. 2009; 45:160-5.
6. Pacheco AB, da Silva AMT, Mezzomo CL, Berwig LC, Neu AP. Relation between
oral breathing and nonnutritive sucking habits and stomatognathic system
alterations. Rev CEFAC. 2012;4:281-9.
7. Theodoro E, Oliveira AE, Barbosa RW. The influence of sucking habits on
occlusion development in the first 36 months. Dental Press J Orthod. 2012;17:96
104.
8. Hitos SF, Arakaki R, Solé D, Weckx Luc L M. Respiração oral e alteração de fala
em crianças. J] Pediatr. 2013;89:361-5.
9. Bezerra LA, Silva HJ, de Melo ACC, de Moraes KJR, da Cunha RA, da Cunha DA
et al . Masticatory Changes in Oral Breath Secondary to Allergic Rhinitis:
Integrative Review. Int Arch Otorhinolaryngol. 2014;18:128-31.
10. De Lemos CM, Wilhelmsen NSW, Mion OG, de Mello Júnior JF. Alterações
funcionais do sistema estomatognático em pacientes com rinite alérgica: estudo
caso-controle. Rev Bras Otorrinolaringol. 2009;75:268-74.
11. Franco L P, Moreira PA. Avaliação endoscópica nasal de crianças e adolescentes
com fibrose cística. Braz J Otorhinolaryngol. 2009;75:80613.
12. Menezes VA, Barbosa AMF, Leal RB, Santos JA, Barros LF, Azevedo MFA.
Padrão de respiração em crianças asmáticas. Odonto. 2010;18:24-9.
13. Pérez Quiñónez JA, Martínez JL, Moure Ibarra M, Pérez Padrón A. Respiración
bucal en niños de 3-5 años. Parroquia Catia la Mar Vargas. Rev Med
Electrón. 2010; 32(5):1-7.
14. Roggia B, Correa B, Pranke GI, Facco R, Rossi AG. Postural control of mouth
breathing school aged children regarding gender. Pro Fono. 2010;22:433-8.
15. Motta LJ, Martins MD, Fernandes KPS, Mesquita-Ferrari RA, Biasotto-Gonzalez
DA, Bussadori SK. Relação da postura cervical e oclusão dentária em crianças
respiradoras orais. Rev CEFAC. 2013;11:298-304.
16. Okuro RT, Morcillo AM, Sakano E, Schivinski CIS, Ribeiro MAGO, Ribeiro JD.
Exercise capacity, respiratory mechanics and posture in mouth breathers. Braz J
Otorhinolaryngol. 201;77:656-62.
The mouth breathing syndrome: prevalence, causes, consequences and treatment
Martins DLL, et al
J Surg Cl Res Vol. 5 (1) 2014:47-55 54
17. Da Silveira W, Mello FCQ, Guimarães FS, de Menezes SLS. Alterações posturais
e função pulmonar de crianças respiradoras bucais. Braz J Otorhinolaryngol.
2010;76:683-6.
18. Boas APDV, Marson FAL, Ribeiro MAGO, Sakano E, Conti PBM, Toro ADC et al.
Teste de caminhada e rendimento escolar em crianças respiradoras bucais. Braz
J Otorhinolaryngol. 2013;79:212-8.
19. Souki BQ, Pimenta GB, Souki MQ, Franco LP, Becker HM, Pinto JA. Prevalence
of malocclusion among mouth breathing children: do expectations meet reality? Int
J Pediatr Otorhinolaryngol. 2009;73:767-3.
20. Bolzan GP, Souza JA, Boton LM, da Silva AMT, Corrêa ECR. Tipo facial e postura
de cabeça de crianças respiradoras nasais e orais. J Soc Bras
Fonoaudiol. 2011;23:315-20.
21. Bolzan GP, da Silva AMT, Boton LM, Corrêa ECR. Estudo das medidas
antropométricas e das proporções orofaciais em crianças respiradoras nasais e
orais de diferentes etiologias. Rev Soc Bras Fonoaudiol. 2011;16:85-91.
22. Retamoso LB, Knop LAH, Guariza Filho O, Tanaka OM. Facial and dental
alterations according to the breathing pattern. J Appl Oral Sci 2011;19:175-81.
23. Juliano ML, Machado MAC, de Carvalho LBC, do Prado LBF, do Prado GF. Mouth
breathing children have cephalometric patterns similar to those of adults patients
with obstructive sleep apnea syndrome. Arq Neuro-Psiquiatr. 2009;67(3B): 860-5.
24. Juliano ML, Machado MAC, de Carvalho LBC, dos Santos GMS, Zancanella E, do
Prado LBF et al. Obstructive sleep apnea prevents the expected difference in
craniofacial growth of boys and girls. Arq Neuro-Psiquiatr 2013;71:18-24.
25. Berwig LC, da Silva AMT. Análise quantitativa do palato duro de respiradores
orais: revisão de literatura. Rev Soc Bras Fonoaudiol. 2011;16:483-7.
26. Berwig LC, da Silva AMT, Côrrea ECR, de Moraes AB, Montenegro MM, Ritzel
RA. Análise quantitativa do palato duro em diferentes tipologias faciais de
respiradores nasais e orais. Rev CEFAC. 2012;14:616-25.
27. Hennig TR, da Silva AMT, Busanelo AR, de Almeida FL, Berwig LC, Boton LM.
Deglutição de respiradores orais e nasais: avaliação clínica fonoaudiológica e
eletromiográfica. Rev CEFAC. 2009;11:618-23.
28. De Oliveira RLB, Noronha WP, Bonjardim LR. Avaliação da performance
mastigatória em indivíduos respiradores nasais e orais. Rev CEFAC. 2012;14:114-
21.
29. Pulido VY, Piloto MM, Gounelas AS, Rezk DA, Duque AY. Cambios cefalométricos
en pacientes respiradores bucales con obstrucción de vías aéreas superiores
entre 8-12 años. Rev Cien Méd. 2012;16:90-103.
30. Ikenaga N, Yamaguchi K, Daimon S. Effect of mouth breathing on masticatory
muscle activity during chewing food. J Oral Rehabil. 2013;40:429-35.
31. De Andrada e Silva MA, Marchesan IQ, Ferreira LP, Schmidt R, Ramires RR.
Postura, tônus e mobilidade de lábios e língua de crianças respiradoras orais.
Rev. CEFAC. 2012;14:853-60.
32. Da Cunha DA, da Silva GAP, da Silva HJ. Repercussões da respiração oral no
estado nutricional: por que acontece? Arq Int Otorrinolaringol. 2011;15:223-30.
33. Bianchini AP, Guedes ZCF, Hitos S. Respiração oral: causa x audição. Rev
CEFAC. 2009;11:10-5.
34. Correa BM, Rossi AG, Roggia B, da Silva AMT. Análise das habilidades auditivas
de crianças com respiração oral. Rev CEFAC. 2011;13:668-75.
The mouth breathing syndrome: prevalence, causes, consequences and treatment
Martins DLL, et al
J Surg Cl Res Vol. 5 (1) 2014:47-55 55
35. Izu SC, Itamoto CH, Pradella-Hallinan M, Pizarro GU, Tufik S, Pignatari S, Fujita
RR. Obstructive sleep apnea syndrome (OSAS) in mouth breathing children. Braz
J Otorhinolaryngol. 2010;76:5526.
36. Popoaski C, Marcelino TDF, Sakae TM, Schmitz LM, Henrique L, Correa L.
Avaliação da qualidade de vida em pacientes respiradores orais. Arq Int
Otorrinolaringol. 2012;16:7481.
37. De Menezes VA, Luiz R, Tavares DO, Granville-garcia AF. Síndrome da
respiração oral : alterações clínicas e comportamentais. Arq Odontol.
2009;45:160-5.
38. Fensterseifer GS, Carpes O, Weckx LL, Martha VF. Mouth breathing in children
with learning disorders. Braz J Otorhinolaryngol. 2013;79:620-4.
39. Gallo J, Campiotto AR. Terapia miofuncional orofacial em crianças respiradoras
orais. Rev CEFAC. 2009;11:305-10.
40. Ferreira FS, Weber P, Corrêa ECR, Milanesi JM, Borin GS, Dias MF. Efeito da
fisioterapia sobre os parâmetros ventilatórios e a dinâmica tóraco-abdominal de
crianças respiradoras bucais. Fisioter Pesqui. 2012;19:8-13.
41. Weber P, Corrêa ECR, Ferreira FS, Milanesi JM, Trevisan ME. Análise da postura
craniocervical de crianças respiradoras bucais após tratamento postural em bola
suíça. Fisioter Pesqui. 2012;19:109-14.
42. Campanha SMA, Fontes MJF, Camargos PAM, Freire LMS. O impacto do
tratamento fonoaudiológico no controle da asma e da rinite alérgica em crianças e
adolescentes respiradores orais. J Pediatr. 2010;86:202-8.
43. Marson A, Tessitore A, Sakano E, Nemr K. Efetividade da fonoterapia e proposta
de intervenção breve em respiradores orais. Rev CEFAC. 2012;14:1153-66.
44. Pereira SRA, Bakor SF, Weckx LLM. Adenotonsillectomy in facial growing
patients: spontaneous dental effects. Braz J Otorhinolaryngol. 2011;77:600-4.
45. Itikawa CE, Valera FCP, Matsumoto MAN, Lima WTA. Effect of rapid maxillary
expansion on the dimension of the nasal cavity and on facial morphology assessed
by acoustic rhinometry and rhinomanometry. Dental Press J Orthod. 2012;17:129-
33.
... This leads to altered position and morphology of the jawbone [5]. Specifically, it has been shown that ankyloglossia contributes to maxillary hypoplasia (underdevelopment of the upper jaw bones), which then can predispose toward speech difficulty, nasal obstruction [6], mouth breathing [7], and obstructive sleep apnea [8]. ...
... Tongue position and mobility play significant roles in facial skeletal development. Patients with aberrant development of Fig. 2 Distribution of mouth opening, tongue measurements, tongue range of motion deficit, and tongue range of motion ratio by age cohort and overall population the upper or lower jaws are at increased risk of malocclusion [19], temporomandibular disorders [20], nasal obstruction [7], and obstructive sleep apnea [21]. Most recently, there have been concerted research efforts to explore the role of ankyloglossia and restricted tongue mobility as correctable risk factors of nasal obstruction and sleep-disordered breathing [17,21,22]. ...
Article
Full-text available
Purpose: Alterations of the lingual frenulum may contribute to oromyofacial dysfunction, speech and swallowing impediments, underdevelopment of the maxillofacial skeleton, and even predispose to sleep breathing disorder. This study aims to assess the utility of existing instruments for evaluation of restricted tongue mobility, describe normal and abnormal ranges of tongue mobility, and provide evidence in support of a reliable and efficient measure of tongue mobility. Methods: A prospective cohort study of 1052 consecutive patients was evaluated during a 3-month period. Age, gender, ethnicity, height, weight, BMI, maximal interincisal mouth opening (MIO), mouth opening with tongue tip to maxillary incisive papillae at roof of mouth (MOTTIP), Kotlow's free-tongue measurement, and presence of severe tongue-tie were recorded. Secondary outcome measures include tongue range of motion deficit (TRMD, difference between MIO and MOTTIP) and tongue range of motion ratio (TRMR, ratio of MOTTIP to MIO). Results: Results indicate that MIO is dependent on age and height; MOTTIP and TRMD are dependent on MIO; Kotlow's free-tongue measurement is an independent measure of free-tongue length and tongue mobility. TRMR is the only independent measurement of tongue mobility that is directly associated with restrictions in tongue function. Conclusions: We propose the use of tongue range of motion ratio as an initial screening tool to assess for restrictions in tongue mobility. "Functional" ankyloglossia can thus be defined and treatment effects followed objectively by using the proposed grading scale: grade 1: tongue range of motion ratio is >80%, grade 2 50-80%, grade 3 < 50%, grade 4 < 25%.
Article
Airflow is the reference signal to assess sleep respiratory disorders, such as sleep apnea. Previous studies estimated airflow using tracheal sounds in short segments with specific airflow rates, while requiring calibration or a few breaths for tuning the relationship between sound energy and airflow. Airflow-sound relationship can change by posture, sleep stage and airflow rate or tidal volume. We investigated the possibility of estimating surrogates of tidal volume without calibration in the adult sleep apnea population using tracheal sounds and movements. Two surrogates of tidal volume: thoracoabdominal range of sum movement and airflow level were estimated. Linear regression was used to estimate thoracoabdominal range of sum movement from sound energy and the range of movements. The sound energy lower envelope was found to correlate with airflow level. The agreement between reference and estimated signals was assessed by repeated-measure correlation analysis. The estimated tidal volumes were used to estimate the airflow signal. Sixty-one participants (30 females, age: 51 ± 16 years, body mass index: 29.5 ± 6.4 kg m-2 , and apnoea-hypopnea index: 20.2 ± 21.2) were included. Reference and estimated thoracoabdominal range of sum movement of whole night data were significantly correlated with the reference signal extracted from polysomnography (r = 0.5 ± 0.06). Similarly, significant correlations (r = 0.3 ± 0.05) were found for airflow level. Significant differences in estimated surrogates of tidal volume were found between normal breathing and apnea/hypopnea. Surrogate of airflow can be extracted from tracheal sounds and movements, which can be used for assessing the severity of sleep apnea and even phenotyping sleep apnea patients based on the estimated airflow shape.
Article
One of the most important signals to assess respiratory function, especially in patients with sleep apnea, is airflow. A convenient method to estimate airflow is based on analyzing tracheal sounds and movements. However, this method requires accurate identification of respiratory phases. Our goal is to develop an automatic algorithm to analyze tracheal sounds and movements to identify respiratory phases during sleep. Data from adults with suspected sleep apnea who were referred for in-laboratory sleep studies were included. Simultaneously with polysomnography, tracheal sounds and movements were recorded with a small wearable device attached to the suprasternal notch. First, an adaptive detection algorithm was developed to localize the respiratory phases in tracheal sounds. Then, for each phase, a set of morphological features from sound energy and tracheal movement were extracted to classify the localized phases into inspirations or expirations. The average error and time delay of detecting respiratory phases were 7.62% and 181 ms during normal breathing, 8.95% and 194 ms during snoring, and 13.19% and 220 ms during respiratory events, respectively. The average classification accuracy was 83.7% for inspirations and 75.0% for expirations. Respiratory phases were accurately identified from tracheal sounds and movements during sleep.
Article
Full-text available
Introduction The III Brazilian Consensus on Rhinitis (2012) defines allergic rhinitis as a nasal mucosa inflammation, mediated by immunoglobulin E, after exposure to allergens. The classic signs and symptoms of allergic rhinitis are nasal obstruction, watery rhinorrhea, sneezing, and nasal itching, often reversible either spontaneously or with treatment, and mouth breathing (breathing predominantly through the mouth, regardless of the cause, due to a nasal breathing impairment) in some cases. Objective To evaluate the literature on masticatory changes in children with mouth breathing due to allergic rhinitis. Methods We conducted a search of the past 10 years, at Bireme and MEDLINE databases, for articles that covered masticatory changes in children with mouth breathing secondary to allergic rhinitis. Results We found 1,986 articles, including 15 repeated in databases, but only two articles met the inclusion criteria fully. Discussion We found few studies to answer the question raised in this review, and those studies have some methodological limitations. Most articles claimed no have statistically significant differences in masticatory changes in this population. Conclusion A better controlled study (isolating diseases, exposure time), with a larger sample (sample calculation appropriate), would be necessary to examine such changes.
Article
Full-text available
Introduction: mouth-breathing patients presenting upper airway obstruction create conditions which favour the alteration of the dentomaxillofacial structures. Objective: to assess cephalometric changes in mouth-breathing patients from 8-12 years old presenting upper airway obstruction. Material and Method: observational and case-control study was conducted from July 2009 to April 2010. The target group comprised 11804 patients, 62 of them were included in the study, both sexes and 8 to 12 years old: 31 mouth-breathers presenting air-way impedance, diagnosed in Otolaryngology services (“cases”) and 31 non-mouth-breathers with normal occlusion (“controls”). A lateral teleradiography of the skull was taken to all patients. Percentage, mean value, standard deviation, ratio and inferential statistical tests were used: t-Student, Pearson’s chi square and Fisher’s exact probability to find association between two independent variables with a significant level of α=0.05. Results: in “cases” was found that maxillomandibular angle increased 90,9% in male patients (t=5,9) and 100% in female (t=7,4); Frankfort’s mandibular angle increased in 72,7% in male patients (t=4,4) and 70% in female (t=4,8); anteroinferior height increased 72,7% in male sex (t=2,2) and 85% in female (t=3,8); nasal-spinal distance posterior to the closer adenoid tissue, measured along the posterior basion-nasal-spine line decreased 100% in male sex and in female (t=6,4 and 9,2 respectively) with the distance of the nasal spine posterior to adenoid tissue along with perpendicular to sella turcica-basion decreased in 100% in male and female (t=5,7 and 9,5 respectively). Conclusion: cephalometric changes were present in mouth-breathing patients with upper airway obstruction.
Article
Full-text available
OBJECTIVE: The objective of this study was to identify the influence of sucking habits on the occlusal characteristics of the deciduous dentition. METHODS: The initial sample consisted of 86 infants, aged 0 to 3 months. Seven home visits were performed, when and information on breastfeeding practice, nutritive and non-nutritive sucking habits, mouth breathing and dentition development was collected. From the first sample, impressions of the dental arches were obtained from 58 children at the age of 36 months (+2.51SD). Dental casts were obtained and two examiners, trained and calibrated by the Kappa and Pearson Correlation tests, measured several parameters of dental occlusion, such as arch length, depth, and width. RESULTS: The results showed that bottle feeding before 6 months was associated to an increased mandibular intermolar width (p=0.01). Pacifier use before 6 months was statistically associated to a reduction of the maxillary intercanine (p=0.03) and intermolar (p=0.03) width. In addition to these findings, the increased molar depth of the maxillary arch was associated to loss of lip closure before the age of 12 months (p= 0.03). CONCLUSION: According to these results, it could be concluded that sucking habits interfere with the determination of some deciduous occlusal characteristics: pacifier sucking limits lateral-lateral maxillary growth, bottle feeding favors lateral-lateral mandibular growth and open bite development, and the lack of lip closure favors the anteroposterior maxillary growth.
Article
Full-text available
OBJECTIVE: To assess the effects of rapid maxillary expansion on facial morphology and on nasal cavity dimensions of mouth breathing children by acoustic rhinometry and computed rhinomanometry. METHODS: Cohort; 29 mouth breathing children with posterior crossbite were evaluated. Orthodontic and otorhinolaryngologic documentation were performed at three different times, i.e., before expansion, immediately after and 90 days following expansion. RESULTS: The expansion was accompanied by an increase of the maxillary and nasal bone transversal width. However, there were no significant differences in relation to mucosal area of the nose. Acoustic rhinometry showed no difference in the minimal cross-sectional area at the level of the valve and inferior turbinate between the periods analyzed, although rhinomanometry showed a statistically significant reduction in nasal resistance right after expansion, but were similar to pre-treatment values 90 days after expansion. CONCLUSION: The maxillary expansion increased the maxilla and nasal bony area, but was inefficient to increase the nasal mucosal area, and may lessen the nasal resistance, although there was no difference in nasal geometry. Significance: Nasal bony expansion is followed by a mucosal compensation.
Article
Full-text available
PURPOSE: to investigate the relationship between oral breathing of different etiologies and persisting non-nutritive sucking habits in establishing structural alterations in the stomatognathic system. METHOD: the sample comprised 78 children between 7 and 11 year old, 36 boys and 42 girls, divided in two groups based on non-nutritive sucking habits and breathing mode. All children underwent otolaryngological, speech-language and dentistry evaluations. Data analysis was performed using Chi-square test considering significance level of 5%. RESULTS: there was significant association between breathing mode and lips posture; between breathing mode and hard palate; between nonnutritive sucking habits and cheek posture. In the analysis of the association between breathing mode and nonnutritive sucking habits with the habitual lips posture and hard palate, we also forund a statistical significance. CONCLUSION: it was found that the altered lips posture and hard palate was more frequent in the vicious and obstructive mouth breathers groups. The asymmetrical cheeks posture was more frequent among children with habits. The altered lips posture and hard palate alterations were also more frequent in oral breathers regardless of the presence or absence of any habits.
Article
Full-text available
Given the importance of studying the causes of learning disorders, we designed this case-control study to assess the nasal cavity volume, pharyngeal and palatine tonsils in children with and without learning disabilities. A total of forty-eight children were enrolled in the study: twenty-four coming from the Center for Evaluation and Early Stimulation (CADEP), in which the criterion is the school failure of at least two consecutive years; and twenty-four students with normal learning - which made up the control group. The children were submitted to ENT examination (history, physical examination) and specific tests (acoustic rhinometry, cavum radiography). The results showed that students with learning disabilities have a higher prevalence of pharyngeal tonsil hypertrophy: p < 0.001, and palatine tonsil hypertrophy: p < 0.001. The average volume of the nasal cavities showed no statistically significant association with learning difficulties (p = 0.75). Based on this study, we concluded that children with adenotonsillar hypertrophy have more learning difficulties when compared to children without such hypertrophy.
Article
Full-text available
OBJETIVO: avaliar e comparar a postura de cabeça e pescoço e a relação com a classe oclusal, entre crianças respiradoras orais e respiradoras nasais. MÉTODOS: realizou-se um estudo observacional, de corte transversal em que participaram 110 crianças divididas em Grupo I: respiradoras nasais e Grupo II: respiradoras orais. Para avaliação da respiração utilizou-se o teste do vapor no espelho e água na boca, e exame clínico intra-oral para classificação oclusal de Angle. A análise da postura foi realizada por meio de fotogrametria e o software Alcimage® para mensuração do ângulo pré-definido pelos pontos Processo Espinhoso da sétima vértebra cervical, Manúbrio do Esterno e Ápice do Mento. Os dados obtidos foram tabulados e submetidos à análise estatística, utilizando o programa SPSS 12.0, num intervalo de confiança de 95%. RESULTADOS: foi possível observar valores significativamente maiores do ângulo cervical para o Grupo II (96,59º±8,79) quando comparado ao Grupo I (86,60º±8,53) (p<0,001). As crianças respiradoras orais apresentaram oclusão classe II de Angle (p<0,05). Os participantes classe II apresentaram maior ângulo cervical, diferindo estatisticamente dos pacientes classe I (p<0,05). CONCLUSÃO: existe relação entre respiração oral, alteração na postura da cabeça e pescoço e oclusão classe II de Angle nas crianças estudadas, sendo a anteriorização da cabeça a alteração mais evidente em crianças respiradoras orais.
Article
Normal breathing involves the adequate usage of the nasal and nasopharyngeal tract. The volume increase of the structures inside these spaces makes impossible air passing through these ducts, resulting in children breathing through the mouth, bringing about serious alterations of the stomatognathic apparatus, affecting the child in aesthetical, functional, and psychical way. We developed a transversal, descriptive study, with the objective of characterizing, in a clinical and epidemiological way, mouth breathing in children aged 3-5 years in the parrish Catia la Mar, from January to June 2008. The universe was formed by 350 children and the sample by 100 children having the habit of mouth breathing. The mouth breathing habit was observed in younger children, more frequently male. Pathological mouth breathing prevailed over mouth breathing per habit in male children. Bronchial asthma and asthmatic bronchitis were predominant in ages between 3 and 5 years, the most affected genre was the male one, while among females acute rhinitis prevailed at the age of 5. The patients with obstructions in the respiratory ways were mouth breathers and there was a predominance of adenoidal and/or tonsillar hypertrophy, and turbinal hypertrophy for girls and septum deviation for boys.